Ran Gu

Guotai Wang, Xiangde Luo, Ran Gu et al.

Background and Objective: Open-source deep learning toolkits are one of the driving forces for developing medical image segmentation models. Existing toolkits mainly focus on fully supervised segmentation and require full and accurate pixel-level annotations that are time-consuming and difficult to acquire for segmentation tasks, which makes learning from imperfect labels highly desired for reducing the annotation cost. We aim to develop a new deep learning toolkit to support annotation-efficient learning for medical image segmentation. Methods: Our proposed toolkit named PyMIC is a modular deep learning library for medical image segmentation tasks. In addition to basic components that support development of high-performance models for fully supervised segmentation, it contains several advanced components tailored for learning from imperfect annotations, such as loading annotated and unannounced images, loss functions for unannotated, partially or inaccurately annotated images, and training procedures for co-learning between multiple networks, etc. PyMIC supports development of semi-supervised, weakly supervised and noise-robust learning methods for medical image segmentation. Results: We present several illustrative medical image segmentation tasks based on PyMIC: (1) Achieving competitive performance on fully supervised learning; (2) Semi-supervised cardiac structure segmentation with only 10% training images annotated; (3) Weakly supervised segmentation using scribble annotations; and (4) Learning from noisy labels for chest radiograph segmentation. Conclusions: The PyMIC toolkit is easy to use and facilitates efficient development of medical image segmentation models with imperfect annotations. It is modular and flexible, which enables researchers to develop high-performance models with low annotation cost. The source code is available at: https://github.com/HiLab-git/PyMIC.

Ran Gu, Guotai Wang, Jiangshan Lu et al.

Generalization to previously unseen images with potential domain shifts and different styles is essential for clinically applicable medical image segmentation, and the ability to disentangle domain-specific and domain-invariant features is key for achieving Domain Generalization (DG). However, existing DG methods can hardly achieve effective disentanglement to get high generalizability. To deal with this problem, we propose an efficient Contrastive Domain Disentanglement and Style Augmentation (CDDSA) framework for generalizable medical image segmentation. First, a disentangle network is proposed to decompose an image into a domain-invariant anatomical representation and a domain-specific style code, where the former is sent to a segmentation model that is not affected by the domain shift, and the disentangle network is regularized by a decoder that combines the anatomical and style codes to reconstruct the input image. Second, to achieve better disentanglement, a contrastive loss is proposed to encourage the style codes from the same domain and different domains to be compact and divergent, respectively. Thirdly, to further improve generalizability, we propose a style augmentation method based on the disentanglement representation to synthesize images in various unseen styles with shared anatomical structures. Our method was validated on a public multi-site fundus image dataset for optic cup and disc segmentation and an in-house multi-site Nasopharyngeal Carcinoma Magnetic Resonance Image (NPC-MRI) dataset for nasopharynx Gross Tumor Volume (GTVnx) segmentation. Experimental results showed that the proposed CDDSA achieved remarkable generalizability across different domains, and it outperformed several state-of-the-art methods in domain-generalizable segmentation.

Jianghao Wu, Guotai Wang, Ran Gu et al.

Domain Adaptation (DA) is important for deep learning-based medical image segmentation models to deal with testing images from a new target domain. As the source-domain data are usually unavailable when a trained model is deployed at a new center, Source-Free Domain Adaptation (SFDA) is appealing for data and annotation-efficient adaptation to the target domain. However, existing SFDA methods have a limited performance due to lack of sufficient supervision with source-domain images unavailable and target-domain images unlabeled. We propose a novel Uncertainty-aware Pseudo Label guided (UPL) SFDA method for medical image segmentation. Specifically, we propose Target Domain Growing (TDG) to enhance the diversity of predictions in the target domain by duplicating the pre-trained model's prediction head multiple times with perturbations. The different predictions in these duplicated heads are used to obtain pseudo labels for unlabeled target-domain images and their uncertainty to identify reliable pseudo labels. We also propose a Twice Forward pass Supervision (TFS) strategy that uses reliable pseudo labels obtained in one forward pass to supervise predictions in the next forward pass. The adaptation is further regularized by a mean prediction-based entropy minimization term that encourages confident and consistent results in different prediction heads. UPL-SFDA was validated with a multi-site heart MRI segmentation dataset, a cross-modality fetal brain segmentation dataset, and a 3D fetal tissue segmentation dataset. It improved the average Dice by 5.54, 5.01 and 6.89 percentage points for the three tasks compared with the baseline, respectively, and outperformed several state-of-the-art SFDA methods.

Jingyang Zhang, Peng Xue, Ran Gu et al.

In clinical practice, a segmentation network is often required to continually learn on a sequential data stream from multiple sites rather than a consolidated set, due to the storage cost and privacy restriction. However, during the continual learning process, existing methods are usually restricted in either network memorizability on previous sites or generalizability on unseen sites. This paper aims to tackle the challenging problem of Synchronous Memorizability and Generalizability (SMG) and to simultaneously improve performance on both previous and unseen sites, with a novel proposed SMG-learning framework. First, we propose a Synchronous Gradient Alignment (SGA) objective, which not only promotes the network memorizability by enforcing coordinated optimization for a small exemplar set from previous sites (called replay buffer), but also enhances the generalizability by facilitating site-invariance under simulated domain shift. Second, to simplify the optimization of SGA objective, we design a Dual-Meta algorithm that approximates the SGA objective as dual meta-objectives for optimization without expensive computation overhead. Third, for efficient rehearsal, we configure the replay buffer comprehensively considering additional inter-site diversity to reduce redundancy. Experiments on prostate MRI data sequentially acquired from six institutes demonstrate that our method can simultaneously achieve higher memorizability and generalizability over state-of-the-art methods. Code is available at https://github.com/jingyzhang/SMG-Learning.

Ran Gu, Jingyang Zhang, Guotai Wang et al.

Convolutional Neural Networks (CNNs) have achieved state-of-the-art performance for medical image segmentation, yet need plenty of manual annotations for training. Semi-Supervised Learning (SSL) methods are promising to reduce the requirement of annotations, but their performance is still limited when the dataset size and the number of annotated images are small. Leveraging existing annotated datasets with similar anatomical structures to assist training has a potential for improving the model's performance. However, it is further challenged by the cross-anatomy domain shift due to the different appearance and even imaging modalities from the target structure. To solve this problem, we propose Contrastive Semi-supervised learning for Cross Anatomy Domain Adaptation (CS-CADA) that adapts a model to segment similar structures in a target domain, which requires only limited annotations in the target domain by leveraging a set of existing annotated images of similar structures in a source domain. We use Domain-Specific Batch Normalization (DSBN) to individually normalize feature maps for the two anatomical domains, and propose a cross-domain contrastive learning strategy to encourage extracting domain invariant features. They are integrated into a Self-Ensembling Mean-Teacher (SE-MT) framework to exploit unlabeled target domain images with a prediction consistency constraint. Extensive experiments show that our CS-CADA is able to solve the challenging cross-anatomy domain shift problem, achieving accurate segmentation of coronary arteries in X-ray images with the help of retinal vessel images and cardiac MR images with the help of fundus images, respectively, given only a small number of annotations in the target domain.

Ran Gu, Jiangshan Lu, Jingyang Zhang et al.

Efficiently utilizing discriminative features is crucial for convolutional neural networks to achieve remarkable performance in medical image segmentation and is also important for model generalization across multiple domains, where letting model recognize domain-specific and domain-invariant information among multi-site datasets is a reasonable strategy for domain generalization. Unfortunately, most of the recent disentangle networks are not directly adaptable to unseen-domain datasets because of the limitations of offered data distribution. To tackle this deficiency, we propose Contrastive Domain Disentangle (CDD) network for generalizable medical image segmentation. We first introduce a disentangle network to decompose medical images into an anatomical representation factor and a modality representation factor. Then, a style contrastive loss is proposed to encourage the modality representations from the same domain to distribute as close as possible while different domains are estranged from each other. Finally, we propose a domain augmentation strategy that can randomly generate new domains for model generalization training. Experimental results on multi-site fundus image datasets for optic cup and disc segmentation show that the CDD has good model generalization. Our proposed CDD outperforms several state-of-the-art methods in domain generalizable segmentation.

Qingqing Zhu, Qiao Jin, Tejas S. Mathai et al.

Artificial intelligence (AI) can automatically delineate lesions on computed tomography (CT) and generate radiology report content, yet progress is limited by the scarcity of publicly available CT datasets with lesion-level annotations. To bridge this gap, we introduce CT-Bench, a first-of-its-kind benchmark dataset comprising two components: a Lesion Image and Metadata Set containing 20,335 lesions from 7,795 CT studies with bounding boxes, descriptions, and size information, and a multitask visual question answering benchmark with 2,850 QA pairs covering lesion localization, description, size estimation, and attribute categorization. Hard negative examples are included to reflect real-world diagnostic challenges. We evaluate multiple state-of-the-art multimodal models, including vision-language and medical CLIP variants, by comparing their performance to radiologist assessments, demonstrating the value of CT-Bench as a comprehensive benchmark for lesion analysis. Moreover, fine-tuning models on the Lesion Image and Metadata Set yields significant performance gains across both components, underscoring the clinical utility of CT-Bench.

Wenhui Lei, Haochen Mei, Zhengwentai Sun et al.

Nasopharyngeal Carcinoma (NPC) is a leading form of Head-and-Neck (HAN) cancer in the Arctic, China, Southeast Asia, and the Middle East/North Africa. Accurate segmentation of Organs-at-Risk (OAR) from Computed Tomography (CT) images with uncertainty information is critical for effective planning of radiation therapy for NPC treatment. Despite the stateof-the-art performance achieved by Convolutional Neural Networks (CNNs) for automatic segmentation of OARs, existing methods do not provide uncertainty estimation of the segmentation results for treatment planning, and their accuracy is still limited by several factors, including the low contrast of soft tissues in CT, highly imbalanced sizes of OARs and large inter-slice spacing. To address these problems, we propose a novel framework for accurate OAR segmentation with reliable uncertainty estimation. First, we propose a Segmental Linear Function (SLF) to transform the intensity of CT images to make multiple organs more distinguishable than existing methods based on a simple window width/level that often gives a better visibility of one organ while hiding the others. Second, to deal with the large inter-slice spacing, we introduce a novel 2.5D network (named as 3D-SepNet) specially designed for dealing with clinic HAN CT scans with anisotropic spacing. Thirdly, existing hardness-aware loss function often deal with class-level hardness, but our proposed attention to hard voxels (ATH) uses a voxel-level hardness strategy, which is more suitable to dealing with some hard regions despite that its corresponding class may be easy. Our code is now available at https://github.com/HiLab-git/SepNet.

Wenhui Lei, Wei Xu, Ran Gu et al.

Deep learning networks have shown promising performance for accurate object localization in medial images, but require large amount of annotated data for supervised training, which is expensive and expertise burdensome. To address this problem, we present a one-shot framework for organ and landmark localization in volumetric medical images, which does not need any annotation during the training stage and could be employed to locate any landmarks or organs in test images given a support (reference) image during the inference stage. Our main idea comes from that tissues and organs from different human bodies have a similar relative position and context. Therefore, we could predict the relative positions of their non-local patches, thus locate the target organ. Our framework is composed of three parts: (1) A projection network trained to predict the 3D offset between any two patches from the same volume, where human annotations are not required. In the inference stage, it takes one given landmark in a reference image as a support patch and predicts the offset from a random patch to the corresponding landmark in the test (query) volume. (2) A coarse-to-fine framework contains two projection networks, providing more accurate localization of the target. (3) Based on the coarse-to-fine model, we transfer the organ boundingbox (B-box) detection to locating six extreme points along x, y and z directions in the query volume. Experiments on multi-organ localization from head-and-neck (HaN) CT volumes showed that our method acquired competitive performance in real time, which is more accurate and 10^5 times faster than template matching methods with the same setting. Code is available: https://github.com/LWHYC/RPR-Loc.

Ran Gu, Guotai Wang, Tao Song et al.

Accurate medical image segmentation is essential for diagnosis and treatment planning of diseases. Convolutional Neural Networks (CNNs) have achieved state-of-the-art performance for automatic medical image segmentation. However, they are still challenged by complicated conditions where the segmentation target has large variations of position, shape and scale, and existing CNNs have a poor explainability that limits their application to clinical decisions. In this work, we make extensive use of multiple attentions in a CNN architecture and propose a comprehensive attention-based CNN (CA-Net) for more accurate and explainable medical image segmentation that is aware of the most important spatial positions, channels and scales at the same time. In particular, we first propose a joint spatial attention module to make the network focus more on the foreground region. Then, a novel channel attention module is proposed to adaptively recalibrate channel-wise feature responses and highlight the most relevant feature channels. Also, we propose a scale attention module implicitly emphasizing the most salient feature maps among multiple scales so that the CNN is adaptive to the size of an object. Extensive experiments on skin lesion segmentation from ISIC 2018 and multi-class segmentation of fetal MRI found that our proposed CA-Net significantly improved the average segmentation Dice score from 87.77% to 92.08% for skin lesion, 84.79% to 87.08% for the placenta and 93.20% to 95.88% for the fetal brain respectively compared with U-Net. It reduced the model size to around 15 times smaller with close or even better accuracy compared with state-of-the-art DeepLabv3+. In addition, it has a much higher explainability than existing networks by visualizing the attention weight maps. Our code is available at https://github.com/HiLab-git/CA-Net

Ran Gu, Benjamin Hou, Mélanie Hébert et al.

Despite strong performance of deep learning models in retinal disease detection, most systems produce static predictions without clinical reasoning or interactive explanation. Recent advances in multimodal large language models (MLLMs) integrate diagnostic predictions with clinically meaningful dialogue to support clinical decision-making and patient counseling. In this study, OcularChat, an MLLM, was fine-tuned from Qwen2.5-VL using simulated patient-physician dialogues to diagnose age-related macular degeneration (AMD) through visual question answering on color fundus photographs (CFPs). A total of 705,850 simulated dialogues paired with 46,167 CFPs were generated to train OcularChat to identify key AMD features and produce reasoned predictions. OcularChat demonstrated strong classification performance in AREDS, achieving accuracies of 0.954, 0.849, and 0.678 for the three diagnostic tasks: advanced AMD, pigmentary abnormalities, and drusen size, significantly outperforming existing MLLMs. On AREDS2, OcularChat remained the top-performing method on all tasks. Across three independent ophthalmologist graders, OcularChat achieved higher mean scores than a strong baseline model for advanced AMD (3.503 vs. 2.833), pigmentary abnormalities (3.272 vs. 2.828), drusen size (3.064 vs. 2.433), and overall impression (2.978 vs. 2.464) on a 5-point clinical grading rubric. Beyond strong objective performance in AMD severity classification, OcularChat demonstrated the ability to provide diagnostic reasoning, clinically relevant explanations, and interactive dialogue, with high performance in subjective ophthalmologist evaluation. These findings suggest that MLLMs may enable accurate, interpretable, and clinically useful image-based diagnosis and classification of AMD.

Tianhao Qian, Guilin Qi, Z. Y. Wu et al.

This work investigated the capabilities of different models, including the Llama-3 series of models and CHATGPT, with different forms of expression in solving discrete optimization problems by testing natural language datasets. In contrast to formal datasets with a limited scope of parameters, our dataset included a variety of problem types in discrete optimization problems and featured a wide range of parameter magnitudes, including instances with large parameter sets, integrated with augmented data. It aimed to (1) provide an overview of LLMs' ability in large-scale problems, (2) offer suggestions to those who want to solve discrete optimization problems automatically, and (3) regard the performance as a benchmark for future research. These datasets included original, expanded and augmented datasets. Among these three datasets, the original and augmented ones aimed for evaluation while the expanded one may help finetune a new model. In the experiment, comparisons were made between strong and week models, CoT methods and No-CoT methods on various datasets. The result showed that stronger model performed better reasonably. Contrary to general agreement, it also showed that CoT technique was not always effective regarding the capability of models and disordered datasets improved performance of models on easy to-understand problems, even though they were sometimes with high variance, a manifestation of instability. Therefore, for those who seek to enhance the automatic resolution of discrete optimization problems, it is recommended to consult the results, including the line charts presented in the Appendix, as well as the conclusions drawn in this study for relevant suggestions.

Jiarui Cao, Zhiyang Zhang, Heming Wang et al.

Nowadays, the nanostructure inverse problem is an attractive problem that helps researchers to understand the relationship between the properties and the structure of nanomaterials. This article focuses on the problem of using PDF to recover the nanostructure, which this article views as a conditional generation problem. This article propose a deep learning model CbLDM, Condition-based Latent Diffusion Model. Based on the original latent diffusion model, the sampling steps of the diffusion model are reduced and the sample generation efficiency is improved by using the conditional prior to estimate conditional posterior distribution, which is the approximated distribution of p(z|x). In addition, this article uses the Laplacian matrix instead of the distance matrix to recover the nanostructure, which can reduce the reconstruction error. Finally, this article compares CbLDM with existing models which were used to solve the nanostructure inverse problem, and find that CbLDM demonstrates significantly higher prediction accuracy than these models, which reflects the ability of CbLDM to solve the nanostructure inverse problem and the potential to cope with other continuous conditional generation tasks.

Wenhui Lei, Qi Su, Ran Gu et al.

Deep neural networks usually require accurate and a large number of annotations to achieve outstanding performance in medical image segmentation. One-shot segmentation and weakly-supervised learning are promising research directions that lower labeling effort by learning a new class from only one annotated image and utilizing coarse labels instead, respectively. Previous works usually fail to leverage the anatomical structure and suffer from class imbalance and low contrast problems. Hence, we present an innovative framework for 3D medical image segmentation with one-shot and weakly-supervised settings. Firstly a propagation-reconstruction network is proposed to project scribbles from annotated volume to unlabeled 3D images based on the assumption that anatomical patterns in different human bodies are similar. Then a dual-level feature denoising module is designed to refine the scribbles based on anatomical- and pixel-level features. After expanding the scribbles to pseudo masks, we could train a segmentation model for the new class with the noisy label training strategy. Experiments on one abdomen and one head-and-neck CT dataset show the proposed method obtains significant improvement over the state-of-the-art methods and performs robustly even under severe class imbalance and low contrast.

Ran Gu, Jingyang Zhang, Rui Huang et al.

Domain generalizable model is attracting increasing attention in medical image analysis since data is commonly acquired from different institutes with various imaging protocols and scanners. To tackle this challenging domain generalization problem, we propose a Domain Composition and Attention-based network (DCA-Net) to improve the ability of domain representation and generalization. First, we present a domain composition method that represents one certain domain by a linear combination of a set of basis representations (i.e., a representation bank). Second, a novel plug-and-play parallel domain preceptor is proposed to learn these basis representations and we introduce a divergence constraint function to encourage the basis representations to be as divergent as possible. Then, a domain attention module is proposed to learn the linear combination coefficients of the basis representations. The result of linear combination is used to calibrate the feature maps of an input image, which enables the model to generalize to different and even unseen domains. We validate our method on public prostate MRI dataset acquired from six different institutions with apparent domain shift. Experimental results show that our proposed model can generalize well on different and even unseen domains and it outperforms state-of-the-art methods on the multi-domain prostate segmentation task.

Jingyang Zhang, Ran Gu, Guotai Wang et al.

The segmentation of coronary arteries by convolutional neural network is promising yet requires a large amount of labor-intensive manual annotations. Transferring knowledge from retinal vessels in widely-available public labeled fundus images (FIs) has a potential to reduce the annotation requirement for coronary artery segmentation in X-ray angiograms (XAs) due to their common tubular structures. However, it is challenged by the cross-anatomy domain shift due to the intrinsically different vesselness characteristics in different anatomical regions under even different imaging protocols. To solve this problem, we propose a Semi-Supervised Cross-Anatomy Domain Adaptation (SS-CADA) which requires only limited annotations for coronary arteries in XAs. With the supervision from a small number of labeled XAs and publicly available labeled FIs, we propose a vesselness-specific batch normalization (VSBN) to individually normalize feature maps for them considering their different cross-anatomic vesselness characteristics. In addition, to further facilitate the annotation efficiency, we employ a self-ensembling mean-teacher (SEMT) to exploit abundant unlabeled XAs by imposing a prediction consistency constraint. Extensive experiments show that our SS-CADA is able to solve the challenging cross-anatomy domain shift, achieving accurate segmentation for coronary arteries given only a small number of labeled XAs.

Haochen Mei, Wenhui Lei, Ran Gu et al.

Radiotherapy is the main treatment modality for nasopharynx cancer. Delineation of Gross Target Volume (GTV) from medical images such as CT and MRI images is a prerequisite for radiotherapy. As manual delineation is time-consuming and laborious, automatic segmentation of GTV has a potential to improve this process. Currently, most of the deep learning-based automatic delineation methods of GTV are mainly performed on medical images like CT images. However, it is challenged by the low contrast between the pathology regions and surrounding soft tissues, small target region, and anisotropic resolution of clinical CT images. To deal with these problems, we propose a 2.5D Convolutional Neural Network (CNN) to handle the difference of inplane and through-plane resolution. Furthermore, we propose a spatial attention module to enable the network to focus on small target, and use channel attention to further improve the segmentation performance. Moreover, we use multi-scale sampling method for training so that the networks can learn features at different scales, which are combined with a multi-model ensemble method to improve the robustness of segmentation results. We also estimate the uncertainty of segmentation results based on our model ensemble, which is of great importance for indicating the reliability of automatic segmentation results for radiotherapy planning.

Chia-Hao Liu, Christopher J. Wright, Ran Gu et al.

We validate the use of matrix factorization for the automatic identification of relevant components from atomic pair distribution function (PDF) data. We also present a newly developed software infrastructure for analyzing the PDF data arriving in streaming manner. We then apply two matrix factorization techniques, Principal Component Analysis (PCA) and Non-negative Matrix Factorization (NMF), to study simulated and experiment datasets in the context of in situ experiment.