Yun Gu

Ziyan Huang, Haoyu Wang, Zhongying Deng et al.

Large-scale models pre-trained on large-scale datasets have profoundly advanced the development of deep learning. However, the state-of-the-art models for medical image segmentation are still small-scale, with their parameters only in the tens of millions. Further scaling them up to higher orders of magnitude is rarely explored. An overarching goal of exploring large-scale models is to train them on large-scale medical segmentation datasets for better transfer capacities. In this work, we design a series of Scalable and Transferable U-Net (STU-Net) models, with parameter sizes ranging from 14 million to 1.4 billion. Notably, the 1.4B STU-Net is the largest medical image segmentation model to date. Our STU-Net is based on nnU-Net framework due to its popularity and impressive performance. We first refine the default convolutional blocks in nnU-Net to make them scalable. Then, we empirically evaluate different scaling combinations of network depth and width, discovering that it is optimal to scale model depth and width together. We train our scalable STU-Net models on a large-scale TotalSegmentator dataset and find that increasing model size brings a stronger performance gain. This observation reveals that a large model is promising in medical image segmentation. Furthermore, we evaluate the transferability of our model on 14 downstream datasets for direct inference and 3 datasets for further fine-tuning, covering various modalities and segmentation targets. We observe good performance of our pre-trained model in both direct inference and fine-tuning. The code and pre-trained models are available at https://github.com/Ziyan-Huang/STU-Net.

Yulei Qin, Xingyu Chen, Chao Chen et al.

Recently, webly supervised learning (WSL) has been studied to leverage numerous and accessible data from the Internet. Most existing methods focus on learning noise-robust models from web images while neglecting the performance drop caused by the differences between web domain and real-world domain. However, only by tackling the performance gap above can we fully exploit the practical value of web datasets. To this end, we propose a Few-shot guided Prototypical (FoPro) representation learning method, which only needs a few labeled examples from reality and can significantly improve the performance in the real-world domain. Specifically, we initialize each class center with few-shot real-world data as the ``realistic" prototype. Then, the intra-class distance between web instances and ``realistic" prototypes is narrowed by contrastive learning. Finally, we measure image-prototype distance with a learnable metric. Prototypes are polished by adjacent high-quality web images and involved in removing distant out-of-distribution samples. In experiments, FoPro is trained on web datasets with a few real-world examples guided and evaluated on real-world datasets. Our method achieves the state-of-the-art performance on three fine-grained datasets and two large-scale datasets. Compared with existing WSL methods under the same few-shot settings, FoPro still excels in real-world generalization. Code is available at https://github.com/yuleiqin/fopro.

Ziyan Huang, Zhongying Deng, Jin Ye et al.

Although deep learning have revolutionized abdominal multi-organ segmentation, models often struggle with generalization due to training on small, specific datasets. With the recent emergence of large-scale datasets, some important questions arise: \textbf{Can models trained on these datasets generalize well on different ones? If yes/no, how to further improve their generalizability?} To address these questions, we introduce A-Eval, a benchmark for the cross-dataset Evaluation ('Eval') of Abdominal ('A') multi-organ segmentation. We employ training sets from four large-scale public datasets: FLARE22, AMOS, WORD, and TotalSegmentator, each providing extensive labels for abdominal multi-organ segmentation. For evaluation, we incorporate the validation sets from these datasets along with the training set from the BTCV dataset, forming a robust benchmark comprising five distinct datasets. We evaluate the generalizability of various models using the A-Eval benchmark, with a focus on diverse data usage scenarios: training on individual datasets independently, utilizing unlabeled data via pseudo-labeling, mixing different modalities, and joint training across all available datasets. Additionally, we explore the impact of model sizes on cross-dataset generalizability. Through these analyses, we underline the importance of effective data usage in enhancing models' generalization capabilities, offering valuable insights for assembling large-scale datasets and improving training strategies. The code and pre-trained models are available at \href{https://github.com/uni-medical/A-Eval}{https://github.com/uni-medical/A-Eval}.

Yuncheng Yang, Meng Wei, Junjun He et al.

Transfer learning is a critical technique in training deep neural networks for the challenging medical image segmentation task that requires enormous resources. With the abundance of medical image data, many research institutions release models trained on various datasets that can form a huge pool of candidate source models to choose from. Hence, it's vital to estimate the source models' transferability (i.e., the ability to generalize across different downstream tasks) for proper and efficient model reuse. To make up for its deficiency when applying transfer learning to medical image segmentation, in this paper, we therefore propose a new Transferability Estimation (TE) method. We first analyze the drawbacks of using the existing TE algorithms for medical image segmentation and then design a source-free TE framework that considers both class consistency and feature variety for better estimation. Extensive experiments show that our method surpasses all current algorithms for transferability estimation in medical image segmentation. Code is available at https://github.com/EndoluminalSurgicalVision-IMR/CCFV

Xin You, Junjun He, Jie Yang et al.

Medical image segmentation is a fundamental task for medical image analysis and surgical planning. In recent years, UNet-based networks have prevailed in the field of medical image segmentation. However, convolution-neural networks (CNNs) suffer from limited receptive fields, which fail to model the long-range dependency of organs or tumors. Besides, these models are heavily dependent on the training of the final segmentation head. And existing methods can not well address these two limitations at the same time. Hence, in our work, we proposed a novel shape prior module (SPM), which can explicitly introduce shape priors to promote the segmentation performance of UNet-based models. The explicit shape priors consist of global and local shape priors. The former with coarse shape representations provides networks with capabilities to model global contexts. The latter with finer shape information serves as additional guidance to boost the segmentation performance, which relieves the heavy dependence on the learnable prototype in the segmentation head. To evaluate the effectiveness of SPM, we conduct experiments on three challenging public datasets. And our proposed model achieves state-of-the-art performance. Furthermore, SPM shows an outstanding generalization ability on classic CNNs and recent Transformer-based backbones, which can serve as a plug-and-play structure for the segmentation task of different datasets. Source codes are available at https://github.com/AlexYouXin/Explicit-Shape-Priors

Minghui Zhang, Yangqian Wu, Hanxiao Zhang et al. · harvard

Open international challenges are becoming the de facto standard for assessing computer vision and image analysis algorithms. In recent years, new methods have extended the reach of pulmonary airway segmentation that is closer to the limit of image resolution. Since EXACT'09 pulmonary airway segmentation, limited effort has been directed to quantitative comparison of newly emerged algorithms driven by the maturity of deep learning based approaches and clinical drive for resolving finer details of distal airways for early intervention of pulmonary diseases. Thus far, public annotated datasets are extremely limited, hindering the development of data-driven methods and detailed performance evaluation of new algorithms. To provide a benchmark for the medical imaging community, we organized the Multi-site, Multi-domain Airway Tree Modeling (ATM'22), which was held as an official challenge event during the MICCAI 2022 conference. ATM'22 provides large-scale CT scans with detailed pulmonary airway annotation, including 500 CT scans (300 for training, 50 for validation, and 150 for testing). The dataset was collected from different sites and it further included a portion of noisy COVID-19 CTs with ground-glass opacity and consolidation. Twenty-three teams participated in the entire phase of the challenge and the algorithms for the top ten teams are reviewed in this paper. Quantitative and qualitative results revealed that deep learning models embedded with the topological continuity enhancement achieved superior performance in general. ATM'22 challenge holds as an open-call design, the training data and the gold standard evaluation are available upon successful registration via its homepage.

Chuyan Zhang, Yuncheng Yang, Hao Zheng et al.

Driven by the latest trend towards self-supervised learning (SSL), the paradigm of "pretraining-then-finetuning" has been extensively explored to enhance the performance of clinical applications with limited annotations. Previous literature on model finetuning has mainly focused on regularization terms and specific policy models, while the misalignment of channels between source and target models has not received sufficient attention. In this work, we revisited the dynamics of batch normalization (BN) layers and observed that the trainable affine parameters of BN serve as sensitive indicators of domain information. Therefore, Affine Collaborative Normalization (AC-Norm) is proposed for finetuning, which dynamically recalibrates the channels in the target model according to the cross-domain channel-wise correlations without adding extra parameters. Based on a single-step backpropagation, AC-Norm can also be utilized to measure the transferability of pretrained models. We evaluated AC-Norm against the vanilla finetuning and state-of-the-art fine-tuning methods on transferring diverse pretrained models to the diabetic retinopathy grade classification, retinal vessel segmentation, CT lung nodule segmentation/classification, CT liver-tumor segmentation and MRI cardiac segmentation tasks. Extensive experiments demonstrate that AC-Norm unanimously outperforms the vanilla finetuning by up to 4% improvement, even under significant domain shifts where the state-of-the-art methods bring no gains. We also prove the capability of AC-Norm in fast transferability estimation. Our code is available at https://github.com/EndoluminalSurgicalVision-IMR/ACNorm.

Yulei Qin, Xingyu Chen, Yunhang Shen et al.

Webly supervised learning has attracted increasing attention for its effectiveness in exploring publicly accessible data at scale without manual annotation. However, most existing methods of learning with web datasets are faced with challenges from label noise, and they have limited assumptions on clean samples under various noise. For instance, web images retrieved with queries of tiger cat (a cat species) and drumstick (a musical instrument) are almost dominated by images of tigers and chickens, which exacerbates the challenge of fine-grained visual concept learning. In this case, exploiting both web images and their associated texts is a requisite solution to combat real-world noise. In this paper, we propose Cross-modality Aligned Prototypes (CAPro), a unified prototypical contrastive learning framework to learn visual representations with correct semantics. For one thing, we leverage textual prototypes, which stem from the distinct concept definition of classes, to select clean images by text matching and thus disambiguate the formation of visual prototypes. For another, to handle missing and mismatched noisy texts, we resort to the visual feature space to complete and enhance individual texts and thereafter improve text matching. Such semantically aligned visual prototypes are further polished up with high-quality samples, and engaged in both cluster regularization and noise removal. Besides, we propose collective bootstrapping to encourage smoother and wiser label reference from appearance-similar instances in a manner of dictionary look-up. Extensive experiments on WebVision1k and NUS-WIDE (Web) demonstrate that CAPro well handles realistic noise under both single-label and multi-label scenarios. CAPro achieves new state-of-the-art performance and exhibits robustness to open-set recognition. Codes are available at https://github.com/yuleiqin/capro.

Zhongying Deng, Cheng Tang, Ziyan Huang et al. · pku

Foundation models have demonstrated remarkable success across diverse domains and tasks, primarily due to the thrive of large-scale, diverse, and high-quality datasets. However, in the field of medical imaging, the curation and assembling of such medical datasets are highly challenging due to the reliance on clinical expertise and strict ethical and privacy constraints, resulting in a scarcity of large-scale unified medical datasets and hindering the development of powerful medical foundation models. In this work, we present the largest survey to date of medical image datasets, covering over 1,000 open-access datasets with a systematic catalog of their modalities, tasks, anatomies, annotations, limitations, and potential for integration. Our analysis exposes a landscape that is modest in scale, fragmented across narrowly scoped tasks, and unevenly distributed across organs and modalities, which in turn limits the utility of existing medical image datasets for developing versatile and robust medical foundation models. To turn fragmentation into scale, we propose a metadata-driven fusion paradigm (MDFP) that integrates public datasets with shared modalities or tasks, thereby transforming multiple small data silos into larger, more coherent resources. Building on MDFP, we release an interactive discovery portal that enables end-to-end, automated medical image dataset integration, and compile all surveyed datasets into a unified, structured table that clearly summarizes their key characteristics and provides reference links, offering the community an accessible and comprehensive repository. By charting the current terrain and offering a principled path to dataset consolidation, our survey provides a practical roadmap for scaling medical imaging corpora, supporting faster data discovery, more principled dataset creation, and more capable medical foundation models.

Yulei Qin, Yuncheng Yang, Pengcheng Guo et al.

Instruction tuning plays a critical role in aligning large language models (LLMs) with human preference. Despite the vast amount of open instruction datasets, naively training a LLM on all existing instructions may not be optimal and practical. To pinpoint the most beneficial datapoints, data assessment and selection methods have been proposed in the fields of natural language processing (NLP) and deep learning. However, under the context of instruction tuning, there still exists a gap in knowledge on what kind of data evaluation metrics can be employed and how they can be integrated into the selection mechanism. To bridge this gap, we present a comprehensive review on existing literature of data assessment and selection especially for instruction tuning of LLMs. We systematically categorize all applicable methods into quality-based, diversity-based, and importance-based ones where a unified, fine-grained taxonomy is structured. For each category, representative methods are elaborated to describe the landscape of relevant research. In addition, comparison between the latest methods is conducted on their officially reported results to provide in-depth discussions on their limitations. Finally, we summarize the open challenges and propose the promosing avenues for future studies. All related contents are available at https://github.com/yuleiqin/fantastic-data-engineering.

Hanxiao Zhang, Xiao Gu, Minghui Zhang et al. · oxford

The LIDC-IDRI database is the most popular benchmark for lung cancer prediction. However, with subjective assessment from radiologists, nodules in LIDC may have entirely different malignancy annotations from the pathological ground truth, introducing label assignment errors and subsequent supervision bias during training. The LIDC database thus requires more objective labels for learning-based cancer prediction. Based on an extra small dataset containing 180 nodules diagnosed by pathological examination, we propose to re-label LIDC data to mitigate the effect of original annotation bias verified on this robust benchmark. We demonstrate in this paper that providing new labels by similar nodule retrieval based on metric learning would be an effective re-labeling strategy. Training on these re-labeled LIDC nodules leads to improved model performance, which is enhanced when new labels of uncertain nodules are added. We further infer that re-labeling LIDC is current an expedient way for robust lung cancer prediction while building a large pathological-proven nodule database provides the long-term solution.

Reuben Dorent, Roya Khajavi, Tagwa Idris et al.

Accurate assessment of lymph node size in 3D CT scans is crucial for cancer staging, therapeutic management, and monitoring treatment response. Existing state-of-the-art segmentation frameworks in medical imaging often rely on fully annotated datasets. However, for lymph node segmentation, these datasets are typically small due to the extensive time and expertise required to annotate the numerous lymph nodes in 3D CT scans. Weakly-supervised learning, which leverages incomplete or noisy annotations, has recently gained interest in the medical imaging community as a potential solution. Despite the variety of weakly-supervised techniques proposed, most have been validated only on private datasets or small publicly available datasets. To address this limitation, the Mediastinal Lymph Node Quantification (LNQ) challenge was organized in conjunction with the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to advance weakly-supervised segmentation methods by providing a new, partially annotated dataset and a robust evaluation framework. A total of 16 teams from 5 countries submitted predictions to the validation leaderboard, and 6 teams from 3 countries participated in the evaluation phase. The results highlighted both the potential and the current limitations of weakly-supervised approaches. On one hand, weakly-supervised approaches obtained relatively good performance with a median Dice score of $61.0\%$. On the other hand, top-ranked teams, with a median Dice score exceeding $70\%$, boosted their performance by leveraging smaller but fully annotated datasets to combine weak supervision and full supervision. This highlights both the promise of weakly-supervised methods and the ongoing need for high-quality, fully annotated data to achieve higher segmentation performance.

Puyang Wang, Dazhou Guo, Dandan Zheng et al.

Intrathoracic airway segmentation in computed tomography (CT) is a prerequisite for various respiratory disease analyses such as chronic obstructive pulmonary disease (COPD), asthma and lung cancer. Unlike other organs with simpler shapes or topology, the airway's complex tree structure imposes an unbearable burden to generate the "ground truth" label (up to 7 or 3 hours of manual or semi-automatic annotation on each case). Most of the existing airway datasets are incompletely labeled/annotated, thus limiting the completeness of computer-segmented airway. In this paper, we propose a new anatomy-aware multi-class airway segmentation method enhanced by topology-guided iterative self-learning. Based on the natural airway anatomy, we formulate a simple yet highly effective anatomy-aware multi-class segmentation task to intuitively handle the severe intra-class imbalance of the airway. To solve the incomplete labeling issue, we propose a tailored self-iterative learning scheme to segment toward the complete airway tree. For generating pseudo-labels to achieve higher sensitivity , we introduce a novel breakage attention map and design a topology-guided pseudo-label refinement method by iteratively connecting breaking branches commonly existed from initial pseudo-labels. Extensive experiments have been conducted on four datasets including two public challenges. The proposed method ranked 1st in both EXACT'09 challenge using average score and ATM'22 challenge on weighted average score. In a public BAS dataset and a private lung cancer dataset, our method significantly improves previous leading approaches by extracting at least (absolute) 7.5% more detected tree length and 4.0% more tree branches, while maintaining similar precision.

Yuncheng Yang, Yulei Qin, Tong Wu et al.

The cultivation of expertise for large language models (LLMs) to solve tasks of specific areas often requires special-purpose tuning with calibrated behaviors on the expected stable outputs. To avoid huge cost brought by manual preparation of instruction datasets and training resources up to hundreds of hours, the exploitation of open knowledge including a wealth of low rank adaptation (LoRA) models and instruction datasets serves as a good starting point. However, existing methods on model and data selection focus on the performance of general-purpose capabilities while neglecting the knowledge gap exposed in domain-specific deployment. In the present study, we propose to bridge such gap by introducing few human-annotated samples (i.e., K-shot) for advancing task expertise of LLMs with open knowledge. Specifically, we develop an efficient and scalable pipeline to cost-efficiently produce task experts where K-shot data intervene in selecting the most promising expert candidates and the task-relevant instructions. A mixture-of-expert (MoE) system is built to make the best use of individual-yet-complementary knowledge between multiple experts. We unveil the two keys to the success of a MoE system, 1) the abidance by K-shot, and 2) the insistence on diversity. For the former, we ensure that models that truly possess problem-solving abilities on K-shot are selected rather than those blind guessers. Besides, during data selection, instructions that share task-relevant contexts with K-shot are prioritized. For the latter, we highlight the diversity of constituting experts and that of the fine-tuning instructions throughout the model and data selection process. Extensive experimental results confirm the superiority of our approach over existing methods on utilization of open knowledge across various tasks. Our codes will be available at https://github.com/Yaphabates/Rocket.

Minghui Zhang, Guang-Zhong Yang, Yun Gu

Detailed pulmonary airway segmentation is a clinically important task for endobronchial intervention and treatment of peripheral located lung cancer lesions. Convolutional Neural Networks (CNNs) are promising tools for medical image analysis but have been performing poorly for cases when existing a significant imbalanced feature distribution, which is true for the airway data as the trachea and principal bronchi dominate most of the voxels whereas the lobar bronchi and distal segmental bronchi occupy a small proportion. In this paper, we propose a Differentiable Topology-Preserved Distance Transform (DTPDT) framework to improve the performance of airway segmentation. A Topology-Preserved Surrogate (TPS) learning strategy is first proposed to balance the training progress within-class distribution. Furthermore, a Convolutional Distance Transform (CDT) is designed to identify the breakage phenomenon with superior sensitivity and minimize the variation of the distance map between the predictionand ground-truth. The proposed method is validated with the publically available reference airway segmentation datasets. The detected rate of branch and length on public EXACT'09 and BAS datasets are 82.1%/79.6% and 96.5%/91.5% respectively, demonstrating the reliability and efficiency of the method in terms of improving the topology completeness of the segmentation performance while maintaining the overall topology accuracy.

Jiasheng Xu, Tianyi Zhang, Yangqian Wu et al.

Endobronchial intervention is increasingly used as a minimally invasive means for the treatment of pulmonary diseases. In order to reduce the difficulty of manipulation in complex airway networks, robust lumen detection is essential for intraoperative guidance. However, these methods are sensitive to visual artifacts which are inevitable during the surgery. In this work, a cross domain feature interaction (CDFI) network is proposed to extract the structural features of lumens, as well as to provide artifact cues to characterize the visual features. To effectively extract the structural and artifact features, the Quadruple Feature Constraints (QFC) module is designed to constrain the intrinsic connections of samples with various imaging-quality. Furthermore, we design a Guided Feature Fusion (GFF) module to supervise the model for adaptive feature fusion based on different types of artifacts. Results show that the features extracted by the proposed method can preserve the structural information of lumen in the presence of large visual variations, bringing much-improved lumen detection accuracy.

Xin You, Yixin Lou, Minghui Zhang et al.

Automatic and precise multi-class vertebrae segmentation from CT images is crucial for various clinical applications. However, due to similar appearances between adjacent vertebrae and the existence of various pathologies, existing single-stage and multi-stage methods suffer from imprecise vertebrae segmentation. Essentially, these methods fail to explicitly impose both contour precision and intra-vertebrae voxel consistency constraints synchronously, resulting in the intra-vertebrae segmentation inconsistency, which refers to multiple label predictions inside a singular vertebra. In this work, we intend to label complete binary masks with sequential indices to address that challenge. Specifically, a contour generation network is proposed based on Structural Low-Rank Descriptors for shape consistency, termed SLoRD. For a structural representation of vertebral contours, we adopt the spherical coordinate system and devise the spherical centroid to calculate contour descriptors. Due to vertebrae's similar appearances, basic contour descriptors can be acquired offline to restore original contours. Therefore, SLoRD leverages these contour priors and explicit shape constraints to facilitate regressed contour points close to vertebral surfaces. Quantitative and qualitative evaluations on VerSe 2019 and 2020 demonstrate the superior performance of our framework over other single-stage and multi-stage state-of-the-art (SOTA) methods. Further, SLoRD is a plug-and-play framework to refine the segmentation inconsistency existing in coarse predictions from other approaches. Source codes are available.

Yaoyu Liu, Minghui Zhang, Xin You et al.

Modeling medical vessel-like anatomy is challenging due to its intricate topology and sensitivity to dataset shifts. Consequently, task-specific models often suffer from topological inconsistencies, including artificial disconnections and spurious merges. Motivated by the promise of multimodal large language models (MLLMs) for zero-shot generalization, we propose TubeMLLM, a unified foundation model that couples structured understanding with controllable generation for medical vessel-like anatomy. By integrating topological priors through explicit natural language prompting and aligning them with visual representations in a shared-attention architecture, TubeMLLM significantly enhances topology-aware perception. Furthermore, we construct TubeMData, a pionner multimodal benchmark comprising comprehensive topology-centric tasks, and introduce an adaptive loss weighting strategy to emphasize topology-critical regions during training. Extensive experiments on fifteen diverse datasets demonstrate our superiority. Quantitatively, TubeMLLM achieves state-of-the-art out-of-distribution performance, substantially reducing global topological discrepancies on color fundus photography (decreasing the $β_{0}$ number error from 37.42 to 8.58 compared to baselines). Notably, TubeMLLM exhibits exceptional zero-shot cross-modality transferring ability on unseen X-ray angiography, achieving a Dice score of 67.50% while significantly reducing the $β_{0}$ error to 1.21. TubeMLLM also maintains robustness against degradations such as blur, noise, and low resolution. Furthermore, in topology-aware understanding tasks, the model achieves 97.38% accuracy in evaluating mask topological quality, significantly outperforming standard vision-language baselines.

Muhammad Imran, Jonathan R. Krebs, Vishal Balaji Sivaraman et al.

Multi-class segmentation of the aorta in computed tomography angiography (CTA) scans is essential for diagnosing and planning complex endovascular treatments for patients with aortic dissections. However, existing methods reduce aortic segmentation to a binary problem, limiting their ability to measure diameters across different branches and zones. Furthermore, no open-source dataset is currently available to support the development of multi-class aortic segmentation methods. To address this gap, we organized the AortaSeg24 MICCAI Challenge, introducing the first dataset of 100 CTA volumes annotated for 23 clinically relevant aortic branches and zones. This dataset was designed to facilitate both model development and validation. The challenge attracted 121 teams worldwide, with participants leveraging state-of-the-art frameworks such as nnU-Net and exploring novel techniques, including cascaded models, data augmentation strategies, and custom loss functions. We evaluated the submitted algorithms using the Dice Similarity Coefficient (DSC) and Normalized Surface Distance (NSD), highlighting the approaches adopted by the top five performing teams. This paper presents the challenge design, dataset details, evaluation metrics, and an in-depth analysis of the top-performing algorithms. The annotated dataset, evaluation code, and implementations of the leading methods are publicly available to support further research. All resources can be accessed at https://aortaseg24.grand-challenge.org.

Fangqiang Xu, Wenxuan Tu, Fan Feng et al.

Left atrial (LA) segmentation is a crucial technique for irregular heartbeat (i.e., atrial fibrillation) diagnosis. Most current methods for LA segmentation strictly assume that the input data is acquired using object-oriented center cropping, while this assumption may not always hold in practice due to the high cost of manual object annotation. Random cropping is a straightforward data pre-processing approach. However, it 1) introduces significant irregularities and incompleteness in the input data and 2) disrupts the coherence and continuity of object boundary regions. To tackle these issues, we propose a novel Dynamic Position transformation and Boundary refinement Network (DPBNet). The core idea is to dynamically adjust the relative position of irregular targets to construct their contextual relationships and prioritize difficult boundary pixels to enhance foreground-background distinction. Specifically, we design a shuffle-then-reorder attention module to adjust the position of disrupted objects in the latent space using dynamic generation ratios, such that the vital dependencies among these random cropping targets could be well captured and preserved. Moreover, to improve the accuracy of boundary localization, we introduce a dual fine-grained boundary loss with scenario-adaptive weights to handle the ambiguity of the dual boundary at a fine-grained level, promoting the clarity and continuity of the obtained results. Extensive experimental results on benchmark dataset have demonstrated that DPBNet consistently outperforms existing state-of-the-art methods.

Huanrong Liu, Chunlin Tian, Tongyu Jia et al.

Predicting surgical needle trajectories from endoscopic video is critical for robot-assisted suturing, enabling anticipatory planning, real-time guidance, and safer motion execution. Existing methods that directly learn motion distributions from visual observations tend to overlook the sequential dependency among adjacent motion steps. Moreover, sparse waypoint annotations often fail to provide sufficient supervision, further increasing the difficulty of supervised or imitation learning methods. To address these challenges, we formulate image-based needle trajectory prediction as a sequential decision-making problem, in which the needle tip is treated as an agent that moves step by step in pixel space. This formulation naturally captures the continuity of needle motion and enables the explicit modeling of physically plausible pixel-wise state transitions over time. From this perspective, we propose SutureAgent, a goal-conditioned offline reinforcement learning framework that leverages sparse annotations to dense reward signals via cubic spline interpolation, encouraging the policy to exploit limited expert guidance while exploring plausible future motion paths. SutureAgent encodes variable-length clips using an observation encoder to capture both local spatial cues and long-range temporal dynamics, and autoregressively predicts future waypoints through actions composed of discrete directions and continuous magnitudes. To enable stable offline policy optimization from expert demonstrations, we adopt Conservative Q-Learning with Behavioral Cloning regularization. Experiments on a new kidney wound suturing dataset containing 1,158 trajectories from 50 patients show that SutureAgent reduces Average Displacement Error by 58.6% compared with the strongest baseline, demonstrating the effectiveness of modeling needle trajectory prediction as pixel-level sequential action learning.

Yaoyu Liu, Minghui Zhang, Junjun He et al.

Automatic extraction of vessel skeletons is crucial for many clinical applications. However, achieving topologically faithful delineation of thin vessel skeletons remains highly challenging, primarily due to frequent discontinuities and the presence of spurious skeleton segments. To address these difficulties, we propose TopoVST, a topology-fidelitious vessel skeleton tracker. TopoVST constructs multi-scale sphere graphs to sample the input image and employs graph neural networks to jointly estimate tracking directions and vessel radii. The utilization of multi-scale representations is enhanced through a gating-based feature fusion mechanism, while the issue of class imbalance during training is mitigated by embedding a geometry-aware weighting scheme into the directional loss. In addition, we design a wave-propagation-based skeleton tracking algorithm that explicitly mitigates the generation of spurious skeletons through space-occupancy filtering. We evaluate TopoVST on two vessel datasets with different geometries. Extensive comparisons with state-of-the-art baselines demonstrate that TopoVST achieves competitive performance in both overlapping and topological metrics. Our source code is available at: https://github.com/EndoluminalSurgicalVision-IMR/TopoVST.

Minghui Zhang, Yaoyu Liu, Junyang Wu et al.

Medical tubular anatomical structures are inherently three-dimensional conduits with lumens, enclosing walls, and complex branching topologies. Accurate reconstruction of their geometry and topology is crucial for applications such as bronchoscopic navigation and cerebral arterial connectivity assessment. Existing methods often rely on voxel-wise overlap measures, which fail to capture topological correctness and completeness. Although topology-aware losses and persistent homology constraints have shown promise, they are usually applied patch-wise and cannot guarantee global preservation or correct geometric errors at inference. To address these limitations, we propose a novel TopoSculpt, a framework for topological refinement of 3D fine-grained tubular structures. TopoSculpt (i) adopts a holistic whole-region modeling strategy to capture full spatial context, (ii) first introduces a Topological Integrity Betti (TIB) constraint that jointly enforces Betti number priors and global integrity, and (iii) employs a curriculum refinement scheme with persistent homology to progressively correct errors from coarse to fine scales. Extensive experiments on challenging pulmonary airway and Circle of Willis datasets demonstrate substantial improvements in both geometry and topology. For instance, $β_{0}$ errors are reduced from 69.00 to 3.40 on the airway dataset and from 1.65 to 0.30 on the CoW dataset, with Tree length detected and branch detected rates improving by nearly 10\%. These results highlight the effectiveness of TopoSculpt in correcting critical topological errors and advancing the high-fidelity modeling of complex 3D tubular anatomy. The project homepage is available at: https://github.com/Puzzled-Hui/TopoSculpt.

Chuyan Zhang, Kefan Wang, Yun Gu

Low-Rank Adaptation (LoRA) has proven effective in reducing computational costs while maintaining performance comparable to fully fine-tuned foundation models across various tasks. However, its fixed low-rank structure restricts its adaptability in scenarios with substantial domain gaps, where higher ranks are often required to capture domain-specific complexities. Current adaptive LoRA methods attempt to overcome this limitation by dynamically expanding or selectively allocating ranks, but these approaches frequently depend on computationally intensive techniques such as iterative pruning, rank searches, or additional regularization. To address these challenges, we introduce Stable Rank-Guided Low-Rank Adaptation (SR-LoRA), a novel framework that utilizes the stable rank of pre-trained weight matrices as a natural prior for layer-wise rank allocation. By leveraging the stable rank, which reflects the intrinsic dimensionality of the weights, SR-LoRA enables a principled and efficient redistribution of ranks across layers, enhancing adaptability without incurring additional search costs. Empirical evaluations on few-shot tasks with significant domain gaps show that SR-LoRA consistently outperforms recent adaptive LoRA variants, achieving a superior trade-off between performance and efficiency. Our code is available at https://github.com/EndoluminalSurgicalVision-IMR/SR-LoRA.

Chuyan Zhang, Yun Gu

Self-supervised learning (SSL) has achieved remarkable performance in various medical imaging tasks by dint of priors from massive unlabelled data. However, regarding a specific downstream task, there is still a lack of an instruction book on how to select suitable pretext tasks and implementation details throughout the standard ``pretrain-then-finetune'' workflow. In this work, we focus on exploiting the capacity of SSL in terms of four realistic and significant issues: (1) the impact of SSL on imbalanced datasets, (2) the network architecture, (3) the applicability of upstream tasks to downstream tasks and (4) the stacking effect of SSL and common policies for deep learning. We provide a large-scale, in-depth and fine-grained study through extensive experiments on predictive, contrastive, generative and multi-SSL algorithms. Based on the results, we have uncovered several insights. Positively, SSL advances class-imbalanced learning mainly by boosting the performance of the rare class, which is of interest to clinical diagnosis. Unfortunately, SSL offers marginal or even negative returns in some cases, including severely imbalanced and relatively balanced data regimes, as well as combinations with common training policies. Our intriguing findings provide practical guidelines for the usage of SSL in the medical context and highlight the need for developing universal pretext tasks to accommodate diverse application scenarios.

Kaiyuan Yang, Fabio Musio, Yihui Ma et al.

The Circle of Willis (CoW) is an important network of arteries connecting major circulations of the brain. Its vascular architecture is believed to affect the risk, severity, and clinical outcome of serious neurovascular diseases. However, characterizing the highly variable CoW anatomy is still a manual and time-consuming expert task. The CoW is usually imaged by two non-invasive angiographic imaging modalities, magnetic resonance angiography (MRA) and computed tomography angiography (CTA), but there exist limited datasets with annotations on CoW anatomy, especially for CTA. Therefore, we organized the TopCoW challenge with the release of an annotated CoW dataset. The TopCoW dataset is the first public dataset with voxel-level annotations for 13 CoW vessel components, enabled by virtual reality technology. It is also the first large dataset using 200 pairs of MRA and CTA from the same patients. As part of the benchmark, we invited submissions worldwide and attracted over 250 registered participants from six continents. The submissions were evaluated on both internal and external test datasets of 226 scans from over five centers. The top performing teams achieved over 90% Dice scores at segmenting the CoW components, over 80% F1 scores at detecting key CoW components, and over 70% balanced accuracy at classifying CoW variants for nearly all test sets. The best algorithms also showed clinical potential in classifying fetal-type posterior cerebral artery and locating aneurysms with CoW anatomy. TopCoW demonstrated the utility and versatility of CoW segmentation algorithms for a wide range of downstream clinical applications with explainability. The annotated datasets and best performing algorithms have been released as public Zenodo records to foster further methodological development and clinical tool building.

Yang Nan, Xiaodan Xing, Shiyi Wang et al.

Airway-related quantitative imaging biomarkers are crucial for examination, diagnosis, and prognosis in pulmonary diseases. However, the manual delineation of airway trees remains prohibitively time-consuming. While significant efforts have been made towards enhancing airway modelling, current public-available datasets concentrate on lung diseases with moderate morphological variations. The intricate honeycombing patterns present in the lung tissues of fibrotic lung disease patients exacerbate the challenges, often leading to various prediction errors. To address this issue, the 'Airway-Informed Quantitative CT Imaging Biomarker for Fibrotic Lung Disease 2023' (AIIB23) competition was organized in conjunction with the official 2023 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). The airway structures were meticulously annotated by three experienced radiologists. Competitors were encouraged to develop automatic airway segmentation models with high robustness and generalization abilities, followed by exploring the most correlated QIB of mortality prediction. A training set of 120 high-resolution computerised tomography (HRCT) scans were publicly released with expert annotations and mortality status. The online validation set incorporated 52 HRCT scans from patients with fibrotic lung disease and the offline test set included 140 cases from fibrosis and COVID-19 patients. The results have shown that the capacity of extracting airway trees from patients with fibrotic lung disease could be enhanced by introducing voxel-wise weighted general union loss and continuity loss. In addition to the competitive image biomarkers for prognosis, a strong airway-derived biomarker (Hazard ratio>1.5, p<0.0001) was revealed for survival prognostication compared with existing clinical measurements, clinician assessment and AI-based biomarkers.

Junyang Wu, Yun Gu

Deep learning models have witnessed depth and pose estimation framework on unannotated datasets as a effective pathway to succeed in endoscopic navigation. Most current techniques are dedicated to developing more advanced neural networks to improve the accuracy. However, existing methods ignore the special properties of endoscopic images, resulting in an inability to fully unleash the power of neural networks. In this study, we conduct a detail analysis of the properties of endoscopic images and improve the compatibility of images and neural networks, to unleash the power of current neural networks. First, we introcude the Mask Image Modelling (MIM) module, which inputs partial image information instead of complete image information, allowing the network to recover global information from partial pixel information. This enhances the network' s ability to perceive global information and alleviates the phenomenon of local overfitting in convolutional neural networks due to local artifacts. Second, we propose a lightweight neural network to enhance the endoscopic images, to explicitly improve the compatibility between images and neural networks. Extensive experiments are conducted on the three public datasets and one inhouse dataset, and the proposed modules improve baselines by a large margin. Furthermore, the enhanced images we proposed, which have higher network compatibility, can serve as an effective data augmentation method and they are able to extract more stable feature points in traditional feature point matching tasks and achieve outstanding performance.

Ming Hu, Chenglong Ma, Wei Li et al. · pku

Scientific Large Language Models (Sci-LLMs) are transforming how knowledge is represented, integrated, and applied in scientific research, yet their progress is shaped by the complex nature of scientific data. This survey presents a comprehensive, data-centric synthesis that reframes the development of Sci-LLMs as a co-evolution between models and their underlying data substrate. We formulate a unified taxonomy of scientific data and a hierarchical model of scientific knowledge, emphasizing the multimodal, cross-scale, and domain-specific challenges that differentiate scientific corpora from general natural language processing datasets. We systematically review recent Sci-LLMs, from general-purpose foundations to specialized models across diverse scientific disciplines, alongside an extensive analysis of over 270 pre-/post-training datasets, showing why Sci-LLMs pose distinct demands -- heterogeneous, multi-scale, uncertainty-laden corpora that require representations preserving domain invariance and enabling cross-modal reasoning. On evaluation, we examine over 190 benchmark datasets and trace a shift from static exams toward process- and discovery-oriented assessments with advanced evaluation protocols. These data-centric analyses highlight persistent issues in scientific data development and discuss emerging solutions involving semi-automated annotation pipelines and expert validation. Finally, we outline a paradigm shift toward closed-loop systems where autonomous agents based on Sci-LLMs actively experiment, validate, and contribute to a living, evolving knowledge base. Collectively, this work provides a roadmap for building trustworthy, continually evolving artificial intelligence (AI) systems that function as a true partner in accelerating scientific discovery.

Xin You, Ming Ding, Minghui Zhang et al.

Precise boundary segmentation of volumetric images is a critical task for image-guided diagnosis and computer-assisted intervention, especially for boundary confusion in clinical practice. However, U-shape networks cannot effectively resolve this challenge due to the lack of boundary shape constraints. Besides, existing methods of refining boundaries overemphasize the slender structure, which results in the overfitting phenomenon due to networks' limited abilities to model tiny objects. In this paper, we reconceptualize the mechanism of boundary generation by encompassing the interaction dynamics with adjacent regions. Moreover, we propose a unified network termed PnPNet to model shape characteristics of the confused boundary region. Core ingredients of PnPNet contain the pushing and pulling branches. Specifically, based on diffusion theory, we devise the semantic difference module (SDM) from the pushing branch to squeeze the boundary region. Explicit and implicit differential information inside SDM significantly boost representation abilities for inter-class boundaries. Additionally, motivated by the K-means algorithm, the class clustering module (CCM) from the pulling branch is introduced to stretch the intersected boundary region. Thus, pushing and pulling branches will shrink and enlarge the boundary uncertainty respectively. They furnish two adversarial forces to promote models to output a more precise delineation of boundaries. We carry out experiments on three challenging public datasets and one in-house dataset, containing three types of boundary confusion in model predictions. Experimental results demonstrate the superiority of PnPNet over other segmentation networks, especially on evaluation metrics of HD and ASSD. Besides, pushing and pulling branches can serve as plug-and-play modules to enhance classic U-shape baseline models. Codes are available.

Minghui Zhang, Chenyu Li, Fangfang Xie et al.

Accurate anatomical labeling and analysis of the pulmonary structure and its surrounding anatomy from thoracic CT is getting increasingly important for understanding the etilogy of abnormalities or supporting targetted therapy and early interventions. Whilst lung and airway cell atlases have been attempted, there is a lack of fine-grained morphological atlases that are clinically deployable. In this work, we introduce AirMorph, a robust, end-to-end deep learning pipeline enabling fully automatic and comprehensive airway anatomical labeling at lobar, segmental, and subsegmental resolutions that can be used to create digital atlases of the lung. Evaluated across large-scale multi-center datasets comprising diverse pulmonary conditions, the AirMorph consistently outperformed existing segmentation and labeling methods in terms of accuracy, topological consistency, and completeness. To simplify clinical interpretation, we further introduce a compact anatomical signature quantifying critical morphological airway features, including stenosis, ectasia, tortuosity, divergence, length, and complexity. When applied to various pulmonary diseases such as pulmonary fibrosis, emphysema, atelectasis, consolidation, and reticular opacities, it demonstrates strong discriminative power, revealing disease-specific morphological patterns with high interpretability and explainability. Additionally, AirMorph supports efficient automated branching pattern analysis, potentially enhancing bronchoscopic navigation planning and procedural safety, offering a valuable clinical tool for improved diagnosis, targeted treatment, and personalized patient care.

Chenyu Li, Minghui Zhang, Chuyan Zhang et al.

Accurate airway anatomical labeling is crucial for clinicians to identify and navigate complex bronchial structures during bronchoscopy. Automatic airway anatomical labeling is challenging due to significant individual variability and anatomical variations. Previous methods are prone to generate inconsistent predictions, which is harmful for preoperative planning and intraoperative navigation. This paper aims to address these challenges by proposing a novel method that enhances topological consistency and improves the detection of abnormal airway branches. We propose a novel approach incorporating two modules: the Soft Subtree Consistency (SSC) and the Abnormal Branch Saliency (ABS). The SSC module constructs a soft subtree to capture clinically relevant topological relationships, allowing for flexible feature aggregation within and across subtrees. The ABS module facilitates the interaction between node features and prototypes to distinguish abnormal branches, preventing the erroneous aggregation of features between normal and abnormal nodes. Evaluated on a challenging dataset characterized by severe airway distortion and atrophy, our method achieves superior performance compared to state-of-the-art approaches. Specifically, it attains a 91.4% accuracy at the segmental level and an 83.7% accuracy at the subsegmental level, representing a 1.4% increase in subsegmental accuracy and a 3.1% increase in topological consistency. Notably, the method demonstrates reliable performance in cases with disease-induced airway deformities, ensuring consistent and accurate labeling.

Minghui Zhang, Xin You, Hanxiao Zhang et al.

The Circle of Willis (CoW) vessels is critical to connecting major circulations of the brain. The topology of the vascular structure is clinical significance to evaluate the risk, severity of the neuro-vascular diseases. The CoW has two representative angiographic imaging modalities, computed tomography angiography (CTA) and magnetic resonance angiography (MRA). TopCow24 provided 125 paired CTA-MRA dataset for the analysis of CoW. To explore both CTA and MRA images in a unified framework to learn the inherent topology of Cow, we construct the universal dataset via independent intensity preprocess, followed by joint resampling and normarlization. Then, we utilize the topology-aware loss to enhance the topology completeness of the CoW and the discrimination between different classes. A complementary topology-aware refinement is further conducted to enhance the connectivity within the same class. Our method was evaluated on all the three tasks and two modalities, achieving competitive results. In the final test phase of TopCow24 Challenge, we achieved the second place in the CTA-Seg-Task, the third palce in the CTA-Box-Task, the first place in the CTA-Edg-Task, the second place in the MRA-Seg-Task, the third palce in the MRA-Box-Task, the second place in the MRA-Edg-Task.

Junyang Wu, Yun Gu, Guang-Zhong Yang

Robot assisted endoluminal intervention is an emerging technique for both benign and malignant luminal lesions. With vision-based navigation, when combined with pre-operative imaging data as priors, it is possible to recover position and pose of the endoscope without the need of additional sensors. In practice, however, aligning pre-operative and intra-operative domains is complicated by significant texture differences. Although methods such as style transfer can be used to address this issue, they require large datasets from both source and target domains with prolonged training times. This paper proposes an efficient domain transfer method based on stylized Gaussian splatting, only requiring a few of real images (10 images) with very fast training time. Specifically, the transfer process includes two phases. In the first phase, the 3D models reconstructed from CT scans are represented as differential Gaussian point clouds. In the second phase, only color appearance related parameters are optimized to transfer the style and preserve the visual content. A novel structure consistency loss is applied to latent features and depth levels to enhance the stability of the transferred images. Detailed validation was performed to demonstrate the performance advantages of the proposed method compared to that of the current state-of-the-art, highlighting the potential for intra-operative surgical navigation.

Minghui Zhang, Hao Zheng, Yawen Huang et al. · tsinghua

Shape modeling of volumetric medical images is crucial for quantitative analysis and surgical planning in computer-aided diagnosis. To alleviate the burden of expert clinicians, reconstructed shapes are typically obtained from deep learning models, such as Convolutional Neural Networks (CNNs) or transformer-based architectures, followed by the marching cube algorithm. However, automatic shape reconstruction often falls short of perfection due to the limited resolution of images and the absence of shape prior constraints. To overcome these limitations, we propose the Reliable Shape Interaction with Implicit Template (ReShapeIT) network, which models anatomical structures in continuous space rather than discrete voxel grids. ReShapeIT represents an anatomical structure with an implicit template field shared within the same category, complemented by a deformation field. It ensures the implicit template field generates valid templates by strengthening the constraint of the correspondence between the instance shape and the template shape. The valid template shape can then be utilized for implicit generalization. A Template Interaction Module (TIM) is introduced to reconstruct unseen shapes by interacting the valid template shapes with the instance-wise latent codes. Experimental results on three datasets demonstrate the superiority of our approach in anatomical structure reconstruction. The Chamfer Distance/Earth Mover's Distance achieved by ReShapeIT are 0.225/0.318 on Liver, 0.125/0.067 on Pancreas, and 0.414/0.098 on Lung Lobe.

Junyang Wu, Mingyi Luo, Fangfang Xie et al.

Accurate intraoperative navigation is essential for robot-assisted endoluminal intervention, but remains difficult because of limited endoscopic field of view and dynamic artifacts. Existing navigation platforms often rely on external localization technologies, such as electromagnetic tracking or shape sensing, which increase hardware complexity and remain vulnerable to intraoperative anatomical mismatch. We present a vision-only autonomy framework that performs long-horizon bronchoscopic navigation using preoperative CT-derived virtual targets and live endoscopic video, without external tracking during navigation. The framework uses hierarchical long-short agents: a short-term reactive agent for continuous low-latency motion control, and a long-term strategic agent for decision support at anatomically ambiguous points. When their recommendations conflict, a world-model critic predicts future visual states for candidate actions and selects the action whose predicted state best matches the target view. We evaluated the system in a high-fidelity airway phantom, three ex vivo porcine lungs, and a live porcine model. The system reached all planned segmental targets in the phantom, maintained 80\% success to the eighth generation ex vivo, and achieved in vivo navigation performance comparable to the expert bronchoscopist. These results support the preclinical feasibility of sensor-free autonomous bronchoscopic navigation.

Minghui Zhang, Yaoyu Liu, Xin You et al.

Accurate multi-class tubular modeling is critical for precise lesion localization and optimal treatment planning. Deep learning methods enable automated shape modeling by prioritizing volumetric overlap accuracy. However, the inherent complexity of fine-grained semantic tubular shapes is not fully emphasized by overlap accuracy, resulting in reduced topological preservation. To address this, we propose the Shapeaware Sampling (SAS), which optimizes patchsize allocation for online sampling and extracts a topology-preserved skeletal representation for the objective function. Fractal Dimension-based Patchsize (FDPS) is first introduced to quantify semantic tubular shape complexity through axis-specific fractal dimension analysis. Axes with higher fractal complexity are then sampled with smaller patchsizes to capture fine-grained features and resolve structural intricacies. In addition, Minimum Path-Cost Skeletonization (MPC-Skel) is employed to sample topologically consistent skeletal representations of semantic tubular shapes for skeleton-weighted objective functions. MPC-Skel reduces artifacts from conventional skeletonization methods and directs the focus to critical topological regions, enhancing tubular topology preservation. SAS is computationally efficient and easily integrable into optimization pipelines. Evaluation on two semantic tubular datasets showed consistent improvements in both volumetric overlap and topological integrity metrics.

Junyang Wu, Fangfang Xie, Jiayuan Sun et al.

Domain adaptation, which bridges the distributions across different modalities, plays a crucial role in multimodal medical image analysis. In endoscopic imaging, combining pre-operative data with intra-operative imaging is important for surgical planning and navigation. However, existing domain adaptation methods are hampered by distribution shift caused by in vivo artifacts, necessitating robust techniques for aligning noisy and artifact abundant patient endoscopic videos with clean virtual images reconstructed from pre-operative tomographic data for pose estimation during intraoperative guidance. This paper presents an artifact-resilient image translation method and an associated benchmark for this purpose. The method incorporates a novel ``local-global'' translation framework and a noise-resilient feature extraction strategy. For the former, it decouples the image translation process into a local step for feature denoising, and a global step for global style transfer. For feature extraction, a new contrastive learning strategy is proposed, which can extract noise-resilient features for establishing robust correspondence across domains. Detailed validation on both public and in-house clinical datasets has been conducted, demonstrating significantly improved performance compared to the current state-of-the-art.

Yuncheng Yang, Chuyan Zhang, Zuopeng Yang et al.

Prompt learning is effective for fine-tuning foundation models to improve their generalization across a variety of downstream tasks. However, the prompts that are independently optimized along a single modality path, may sacrifice the vision-language alignment of pre-trained models in return for improved performance on specific tasks and classes, leading to poorer generalization. In this paper, we first demonstrate that prompt tuning along only one single branch of CLIP (e.g., language or vision) is the reason why the misalignment occurs. Without proper regularization across the learnable parameters in different modalities, prompt learning violates the original pre-training constraints inherent in the two-tower architecture. To address such misalignment, we first propose feature shift, which is defined as the variation of embeddings after introducing the learned prompts, to serve as an explanatory tool. We dive into its relation with generalizability and thereafter propose RESTORE, a multi-modal prompt learning method that exerts explicit constraints on cross-modal consistency. To be more specific, to prevent feature misalignment, a feature shift consistency is introduced to synchronize inter-modal feature shifts by measuring and regularizing the magnitude of discrepancy during prompt tuning. In addition, we propose a "surgery" block to avoid short-cut hacking, where cross-modal misalignment can still be severe if the feature shift of each modality varies drastically at the same rate. It is implemented as feed-forward adapters upon both modalities to alleviate the misalignment problem. Extensive experiments on 15 datasets demonstrate that our method outperforms the state-of-the-art prompt tuning methods without compromising feature alignment.

Hanxiao Zhang, Liang Chen, Xiao Gu et al.

Recent evolution in deep learning has proven its value for CT-based lung nodule classification. Most current techniques are intrinsically black-box systems, suffering from two generalizability issues in clinical practice. First, benign-malignant discrimination is often assessed by human observers without pathologic diagnoses at the nodule level. We termed these data as "unsure data". Second, a classifier does not necessarily acquire reliable nodule features for stable learning and robust prediction with patch-level labels during learning. In this study, we construct a sure dataset with pathologically-confirmed labels and propose a collaborative learning framework to facilitate sure nodule classification by integrating unsure data knowledge through nodule segmentation and malignancy score regression. A loss function is designed to learn reliable features by introducing interpretability constraints regulated with nodule segmentation maps. Furthermore, based on model inference results that reflect the understanding from both machine and experts, we explore a new nodule analysis method for similar historical nodule retrieval and interpretable diagnosis. Detailed experimental results demonstrate that our approach is beneficial for achieving improved performance coupled with faithful model reasoning for lung cancer prediction. Extensive cross-evaluation results further illustrate the effect of unsure data for deep-learning-based methods in lung nodule classification.

Yangqian Wu, Minghui Zhang, Weihao Yu et al.

Purpose: Bronchoscopic intervention is a widely-used clinical technique for pulmonary diseases, which requires an accurate and topological complete airway map for its localization and guidance. The airway map could be extracted from chest computed tomography (CT) scans automatically by airway segmentation methods. Due to the complex tree-like structure of the airway, preserving its topology completeness while maintaining the segmentation accuracy is a challenging task. Methods: In this paper, a long-term slice propagation (LTSP) method is proposed for accurate airway segmentation from pathological CT scans. We also design a two-stage end-to-end segmentation framework utilizing the LTSP method in the decoding process. Stage 1 is used to generate a coarse feature map by an encoder-decoder architecture. Stage 2 is to adopt the proposed LTSP method for exploiting the continuity information and enhancing the weak airway features in the coarse feature map. The final segmentation result is predicted from the refined feature map. Results: Extensive experiments were conducted to evaluate the performance of the proposed method on 70 clinical CT scans. The results demonstrate the considerable improvements of the proposed method compared to some state-of-the-art methods as most breakages are eliminated and more tiny bronchi are detected. The ablation studies further confirm the effectiveness of the constituents of the proposed method. Conclusion: Slice continuity information is beneficial to accurate airway segmentation. Furthermore, by propagating the long-term slice feature, the airway topology connectivity is preserved with overall segmentation accuracy maintained.

Minghui Zhang, Xin Yu, Hanxiao Zhang et al.

3D Convolutional Neural Networks (CNNs) have been widely adopted for airway segmentation. The performance of 3D CNNs is greatly influenced by the dataset while the public airway datasets are mainly clean CT scans with coarse annotation, thus difficult to be generalized to noisy CT scans (e.g. COVID-19 CT scans). In this work, we proposed a new dual-stream network to address the variability between the clean domain and noisy domain, which utilizes the clean CT scans and a small amount of labeled noisy CT scans for airway segmentation. We designed two different encoders to extract the transferable clean features and the unique noisy features separately, followed by two independent decoders. Further on, the transferable features are refined by the channel-wise feature recalibration and Signed Distance Map (SDM) regression. The feature recalibration module emphasizes critical features and the SDM pays more attention to the bronchi, which is beneficial to extracting the transferable topological features robust to the coarse labels. Extensive experimental results demonstrated the obvious improvement brought by our proposed method. Compared to other state-of-the-art transfer learning methods, our method accurately segmented more bronchi in the noisy CT scans.

Yulei Qin, Yun Gu, Hanxiao Zhang et al.

To investigate whether the pleurae, airways and vessels surrounding a nodule on non-contrast computed tomography (CT) can discriminate benign and malignant pulmonary nodules. The LIDC-IDRI dataset, one of the largest publicly available CT database, was exploited for study. A total of 1556 nodules from 694 patients were involved in statistical analysis, where nodules with average scorings <3 and >3 were respectively denoted as benign and malignant. Besides, 339 nodules from 113 patients with diagnosis ground-truth were independently evaluated. Computer algorithms were developed to segment pulmonary structures and quantify the distances to pleural surface, airways and vessels, as well as the counting number and normalized volume of airways and vessels near a nodule. Odds ratio (OR) and Chi-square (χ^2) testing were performed to demonstrate the correlation between features of surrounding structures and nodule malignancy. A non-parametric receiver operating characteristic (ROC) analysis was conducted in logistic regression to evaluate discrimination ability of each structure. For benign and malignant groups, the average distances from nodules to pleural surface, airways and vessels are respectively (6.56, 5.19), (37.08, 26.43) and (1.42, 1.07) mm. The correlation between nodules and the counting number of airways and vessels that contact or project towards nodules are respectively (OR=22.96, χ^2=105.04) and (OR=7.06, χ^2=290.11). The correlation between nodules and the volume of airways and vessels are (OR=9.19, χ^2=159.02) and (OR=2.29, χ^2=55.89). The areas-under-curves (AUCs) for pleurae, airways and vessels are respectively 0.5202, 0.6943 and 0.6529. Our results show that malignant nodules are often surrounded by more pulmonary structures compared with benign ones, suggesting that features of these structures could be viewed as lung cancer biomarkers.

Yulei Qin, Hao Zheng, Yun Gu et al.

Training convolutional neural networks (CNNs) for segmentation of pulmonary airway, artery, and vein is challenging due to sparse supervisory signals caused by the severe class imbalance between tubular targets and background. We present a CNNs-based method for accurate airway and artery-vein segmentation in non-contrast computed tomography. It enjoys superior sensitivity to tenuous peripheral bronchioles, arterioles, and venules. The method first uses a feature recalibration module to make the best use of features learned from the neural networks. Spatial information of features is properly integrated to retain relative priority of activated regions, which benefits the subsequent channel-wise recalibration. Then, attention distillation module is introduced to reinforce representation learning of tubular objects. Fine-grained details in high-resolution attention maps are passing down from one layer to its previous layer recursively to enrich context. Anatomy prior of lung context map and distance transform map is designed and incorporated for better artery-vein differentiation capacity. Extensive experiments demonstrated considerable performance gains brought by these components. Compared with state-of-the-art methods, our method extracted much more branches while maintaining competitive overall segmentation performance. Codes and models are available at http://www.pami.sjtu.edu.cn/News/56

Hao Zheng, Yulei Qin, Yun Gu et al.

Automated airway segmentation is a prerequisite for pre-operative diagnosis and intra-operative navigation for pulmonary intervention. Due to the small size and scattered spatial distribution of peripheral bronchi, this is hampered by severe class imbalance between foreground and background regions, which makes it challenging for CNN-based methods to parse distal small airways. In this paper, we demonstrate that this problem is arisen by gradient erosion and dilation of the neighborhood voxels. During back-propagation, if the ratio of the foreground gradient to background gradient is small while the class imbalance is local, the foreground gradients can be eroded by their neighborhoods. This process cumulatively increases the noise information included in the gradient flow from top layers to the bottom ones, limiting the learning of small structures in CNNs. To alleviate this problem, we use group supervision and the corresponding WingsNet to provide complementary gradient flows to enhance the training of shallow layers. To further address the intra-class imbalance between large and small airways, we design a General Union loss function which obviates the impact of airway size by distance-based weights and adaptively tunes the gradient ratio based on the learning process. Extensive experiments on public datasets demonstrate that the proposed method can predict the airway structures with higher accuracy and better morphological completeness than the baselines.

Tianyi Zhang, Yun Gu, Xiaolin Huang et al.

With the popularity of stereo cameras in computer assisted surgery techniques, a second viewpoint would provide additional information in surgery. However, how to effectively access and use stereo information for the super-resolution (SR) purpose is often a challenge. In this paper, we propose a disparity-constrained stereo super-resolution network (DCSSRnet) to simultaneously compute a super-resolved image in a stereo image pair. In particular, we incorporate a disparity-based constraint mechanism into the generation of SR images in a deep neural network framework with an additional atrous parallax-attention modules. Experiment results on laparoscopic images demonstrate that the proposed framework outperforms current SR methods on both quantitative and qualitative evaluations. Our DCSSRnet provides a promising solution on enhancing spatial resolution of stereo image pairs, which will be extremely beneficial for the endoscopic surgery.

Yulei Qin, Mingjian Chen, Hao Zheng et al.

Airway segmentation on CT scans is critical for pulmonary disease diagnosis and endobronchial navigation. Manual extraction of airway requires strenuous efforts due to the complicated structure and various appearance of airway. For automatic airway extraction, convolutional neural networks (CNNs) based methods have recently become the state-of-the-art approach. However, there still remains a challenge for CNNs to perceive the tree-like pattern and comprehend the connectivity of airway. To address this, we propose a voxel-connectivity aware approach named AirwayNet for accurate airway segmentation. By connectivity modeling, conventional binary segmentation task is transformed into 26 tasks of connectivity prediction. Thus, our AirwayNet learns both airway structure and relationship between neighboring voxels. To take advantage of context knowledge, lung distance map and voxel coordinates are fed into AirwayNet as additional semantic information. Compared to existing approaches, AirwayNet achieved superior performance, demonstrating the effectiveness of the network's awareness of voxel connectivity.

Yang Hu, Yun Gu, Jie Yang et al.

In robotic surgery, task automation and learning from demonstration combined with human supervision is an emerging trend for many new surgical robot platforms. One such task is automated anastomosis, which requires bimanual needle handling and suture detection. Due to the complexity of the surgical environment and varying patient anatomies, reliable suture detection is difficult, which is further complicated by occlusion and thread topologies. In this paper, we propose a multi-stage framework for suture thread detection based on deep learning. Fully convolutional neural networks are used to obtain the initial detection and the overlapping status of suture thread, which are later fused with the original image to learn a gradient road map of the thread. Based on the gradient road map, multiple segments of the thread are extracted and linked to form the whole thread using a curvilinear structure detector. Experiments on two different types of sutures demonstrate the accuracy of the proposed framework.

Yun Gu, Guang-Zhong Yang, Jie Yang et al.

Echocardiography plays an important part in diagnostic aid in cardiac diseases. A critical step in echocardiography-aided diagnosis is to extract the standard planes since they tend to provide promising views to present different structures that are benefit to diagnosis. To this end, this paper proposes a spatial-temporal embedding framework to extract the standard view planes from 4D STIC (spatial-temporal image corre- lation) volumes. The proposed method is comprised of three stages, the frame smoothing, spatial-temporal embedding and final classification. In first stage, an L 0 smoothing filter is used to preprocess the frames that removes the noise and preserves the boundary. Then a compact repre- sentation is learned via embedding spatial and temporal features into a latent space in the supervised scheme considering both standard plane information and diagnosis result. In last stage, the learned features are fed into support vector machine to identify the standard plane. We eval- uate the proposed method on a 4D STIC volume dataset with 92 normal cases and 93 abnormal cases in three standard planes. It demonstrates that our method outperforms the baselines in both classification accuracy and computational efficiency.

Wei Liu, Yun Gu, Chunhua Shen et al.

Depth maps captured by modern depth cameras such as Kinect and Time-of-Flight (ToF) are usually contaminated by missing data, noises and suffer from being of low resolution. In this paper, we present a robust method for high-quality restoration of a degraded depth map with the guidance of the corresponding color image. We solve the problem in an energy optimization framework that consists of a novel robust data term and smoothness term. To accommodate not only the noise but also the inconsistency between depth discontinuities and the color edges, we model both the data term and smoothness term with a robust exponential error norm function. We propose to use Iteratively Re-weighted Least Squares (IRLS) methods for efficiently solving the resulting highly non-convex optimization problem. More importantly, we further develop a data-driven adaptive parameter selection scheme to properly determine the parameter in the model. We show that the proposed approach can preserve fine details and sharp depth discontinuities even for a large upsampling factor ($8\times$ for example). Experimental results on both simulated and real datasets demonstrate that the proposed method outperforms recent state-of-the-art methods in coping with the heavy noise, preserving sharp depth discontinuities and suppressing the texture copy artifacts.