Camila Gonzalez

Camila Gonzalez, Amin Ranem, Ahmed Othman et al.

Most continual learning methods are validated in settings where task boundaries are clearly defined and task identity information is available during training and testing. We explore how such methods perform in a task-agnostic setting that more closely resembles dynamic clinical environments with gradual population shifts. We propose ODEx, a holistic solution that combines out-of-distribution detection with continual learning techniques. Validation on two scenarios of hippocampus segmentation shows that our proposed method reliably maintains performance on earlier tasks without losing plasticity.

Mustafa Kadhim, Viktor Rogowski, Emilia Persson et al.

Artificial intelligence is increasingly integrated into radiotherapy workflows, yet such pipelines remain vulnerable to out-of-distribution image data that may introduce unexpected behavior in clinical tasks. Deep learning-based anomaly detection for pelvic magnetic resonance imaging (MRI) remains largely unexplored, and transparent evaluation of its feasibility for full automation is limited. We developed and evaluated a fully automated, unsupervised anomaly-detection framework for pelvic and brain MRI. A two-stage framework was trained on reference images from public datasets: LUND-PROBE for pelvic MRI, and IXI, fastMRI, and fastMRI+ for brain MRI. In the first stage, MRI slices were compressed into discrete tokens; in the second, the distribution of normal tokens was modeled. Anomaly evidence was estimated by combining perceptual image differences with token-surprisal scores based on negative log-likelihood. Automated detection was evaluated on pelvic MRI with synthetic global and real clinical anomalies, and on brain MRI with clinically annotated fastMRI+ abnormalities. Sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and false-positive behavior in held-out normal cases were assessed. The framework achieved robust detection across hidden evaluation cohorts, with AUCs of 0.97 (95% CI, 0.95-0.98) and 0.81 (95% CI, 0.74-0.87) for pelvic and brain MRI, respectively. Heatmap analysis showed strong spatial agreement between detected anomalies and ground-truth locations, supporting localization accuracy and interpretability. These results support the potential of unsupervised anomaly detection as an automated MRI quality-control layer for radiotherapy workflows, with transparent visualization of image regions likely to compromise downstream AI-based tasks.

Mohammad Areeb Qazi, Anees Ur Rehman Hashmi, Santosh Sanjeev et al.

Deep Learning has shown great success in reshaping medical imaging, yet it faces numerous challenges hindering widespread application. Issues like catastrophic forgetting and distribution shifts in the continuously evolving data stream increase the gap between research and applications. Continual Learning offers promise in addressing these hurdles by enabling the sequential acquisition of new knowledge without forgetting previous learnings in neural networks. In this survey, we comprehensively review the recent literature on continual learning in the medical domain, highlight recent trends, and point out the practical issues. Specifically, we survey the continual learning studies on classification, segmentation, detection, and other tasks in the medical domain. Furthermore, we develop a taxonomy for the reviewed studies, identify the challenges, and provide insights to overcome them. We also critically discuss the current state of continual learning in medical imaging, including identifying open problems and outlining promising future directions. We hope this survey will provide researchers with a useful overview of the developments in the field and will further increase interest in the community. To keep up with the fast-paced advancements in this field, we plan to routinely update the repository with the latest relevant papers at https://github.com/BioMedIA-MBZUAI/awesome-cl-in-medical .

Chih-Ying Liu, Jeya Maria Jose Valanarasu, Camila Gonzalez et al.

Most deep learning models in medical imaging are trained on adult data with unclear performance on pediatric images. In this work, we aim to address this challenge in the context of automated anatomy segmentation in whole-body Computed Tomography (CT). We evaluate the performance of CT organ segmentation algorithms trained on adult data when applied to pediatric CT volumes and identify substantial age-dependent underperformance. We subsequently propose and evaluate strategies, including data augmentation and continual learning approaches, to achieve good segmentation accuracy across all age groups. Our best-performing model, trained using continual learning, achieves high segmentation accuracy on both adult and pediatric data (Dice scores of 0.90 and 0.84 respectively).

Lucas Mansilla, Rodrigo Echeveste, Camila Gonzalez et al.

Biases in machine learning pose significant challenges, particularly when models amplify disparities that affect disadvantaged groups. Traditional bias mitigation techniques often lead to a {\itshape leveling-down effect}, whereby improving outcomes of disadvantaged groups comes at the expense of reduced performance for advantaged groups. This study introduces Bias Mitigation through Continual Learning (BM-CL), a novel framework that leverages the principles of continual learning to address this trade-off. We postulate that mitigating bias is conceptually similar to domain-incremental continual learning, where the model must adjust to changing fairness conditions, improving outcomes for disadvantaged groups without forgetting the knowledge that benefits advantaged groups. Drawing inspiration from techniques such as Learning without Forgetting and Elastic Weight Consolidation, we reinterpret bias mitigation as a continual learning problem. This perspective allows models to incrementally balance fairness objectives, enhancing outcomes for disadvantaged groups while preserving performance for advantaged groups. Experiments on synthetic and real-world image datasets, characterized by diverse sources of bias, demonstrate that the proposed framework mitigates biases while minimizing the loss of original knowledge. Our approach bridges the fields of fairness and continual learning, offering a promising pathway for developing machine learning systems that are both equitable and effective.

Yash Shah, Camila Gonzalez, Mohammad H. Abbasi et al.

Confounders are extraneous variables that affect both the input and the target, resulting in spurious correlations and biased predictions. There are recent advances in dealing with or removing confounders in traditional models, such as metadata normalization (MDN), where the distribution of the learned features is adjusted based on the study confounders. However, in the context of continual learning, where a model learns continuously from new data over time without forgetting, learning feature representations that are invariant to confounders remains a significant challenge. To remove their influence from intermediate feature representations, we introduce the Recursive MDN (R-MDN) layer, which can be integrated into any deep learning architecture, including vision transformers, and at any model stage. R-MDN performs statistical regression via the recursive least squares algorithm to maintain and continually update an internal model state with respect to changing distributions of data and confounding variables. Our experiments demonstrate that R-MDN promotes equitable predictions across population groups, both within static learning and across different stages of continual learning, by reducing catastrophic forgetting caused by confounder effects changing over time.

Niklas Babendererde, Moritz Fuchs, Camila Gonzalez et al.

Federated and Continual Learning have emerged as potential paradigms for the robust and privacy-aware use of Deep Learning in dynamic environments. However, Client Drift and Catastrophic Forgetting are fundamental obstacles to guaranteeing consistent performance. Existing work only addresses these problems separately, which neglects the fact that the root cause behind both forms of performance deterioration is connected. We propose a unified analysis framework for building a controlled test environment for Client Drift -- by perturbing a defined ratio of clients -- and Catastrophic Forgetting -- by shifting all clients with a particular strength. Our framework further leverages this new combined analysis by generating a 3D landscape of the combined performance impact from both. We demonstrate that the performance drop through Client Drift, caused by a certain share of shifted clients, is correlated to the drop from Catastrophic Forgetting resulting from a corresponding shift strength. Correlation tests between both problems for Computer Vision (CelebA) and Medical Imaging (PESO) support this new perspective, with an average Pearson rank correlation coefficient of over 0.94. Our framework's novel ability of combined spatio-temporal shift analysis allows us to investigate how both forms of distribution shift behave in mixed scenarios, opening a new pathway for better generalization. We show that a combination of moderate Client Drift and Catastrophic Forgetting can even improve the performance of the resulting model (causing a "Generalization Bump") compared to when only one of the shifts occurs individually. We apply a simple and commonly used method from Continual Learning in the federated setting and observe this phenomenon to be reoccurring, leveraging the ability of our framework to analyze existing and novel methods for Federated and Continual Learning.

Camila Gonzalez, Karol Gotkowski, Moritz Fuchs et al.

Automatic segmentation of ground glass opacities and consolidations in chest computer tomography (CT) scans can potentially ease the burden of radiologists during times of high resource utilisation. However, deep learning models are not trusted in the clinical routine due to failing silently on out-of-distribution (OOD) data. We propose a lightweight OOD detection method that leverages the Mahalanobis distance in the feature space and seamlessly integrates into state-of-the-art segmentation pipelines. The simple approach can even augment pre-trained models with clinically relevant uncertainty quantification. We validate our method across four chest CT distribution shifts and two magnetic resonance imaging applications, namely segmentation of the hippocampus and the prostate. Our results show that the proposed method effectively detects far- and near-OOD samples across all explored scenarios.

Camila Gonzalez, Christian Harder, Amin Ranem et al.

Federated Learning is the most promising way to train robust Deep Learning models for the segmentation of Covid-19-related findings in chest CTs. By learning in a decentralized fashion, heterogeneous data can be leveraged from a variety of sources and acquisition protocols whilst ensuring patient privacy. It is, however, crucial to continuously monitor the performance of the model. Yet when it comes to the segmentation of diffuse lung lesions, a quick visual inspection is not enough to assess the quality, and thorough monitoring of all network outputs by expert radiologists is not feasible. In this work, we present an array of lightweight metrics that can be calculated locally in each hospital and then aggregated for central monitoring of a federated system. Our linear model detects over 70% of low-quality segmentations on an out-of-distribution dataset and thus reliably signals a decline in model performance.

Antoine Sanner, Camila Gonzalez, Anirban Mukhopadhyay

The recent achievements of Deep Learning rely on the test data being similar in distribution to the training data. In an ideal case, Deep Learning models would achieve Out-of-Distribution (OoD) Generalization, i.e. reliably make predictions on out-of-distribution data. Yet in practice, models usually fail to generalize well when facing a shift in distribution. Several methods were thereby designed to improve the robustness of the features learned by a model through Regularization- or Domain-Prediction-based schemes. Segmenting medical images such as MRIs of the hippocampus is essential for the diagnosis and treatment of neuropsychiatric disorders. But these brain images often suffer from distribution shift due to the patient's age and various pathologies affecting the shape of the organ. In this work, we evaluate OoD Generalization solutions for the problem of hippocampus segmentation in MR data using both fully- and semi-supervised training. We find that no method performs reliably in all experiments. Only the V-REx loss stands out as it remains easy to tune, while it outperforms a standard U-Net in most cases.

Marius Memmel, Camila Gonzalez, Anirban Mukhopadhyay

Deep learning for medical imaging suffers from temporal and privacy-related restrictions on data availability. To still obtain viable models, continual learning aims to train in sequential order, as and when data is available. The main challenge that continual learning methods face is to prevent catastrophic forgetting, i.e., a decrease in performance on the data encountered earlier. This issue makes continuous training of segmentation models for medical applications extremely difficult. Yet, often, data from at least two different domains is available which we can exploit to train the model in a way that it disregards domain-specific information. We propose an architecture that leverages the simultaneous availability of two or more datasets to learn a disentanglement between the content and domain in an adversarial fashion. The domain-invariant content representation then lays the base for continual semantic segmentation. Our approach takes inspiration from domain adaptation and combines it with continual learning for hippocampal segmentation in brain MRI. We showcase that our method reduces catastrophic forgetting and outperforms state-of-the-art continual learning methods.

Camila Gonzalez, Karol Gotkowski, Andreas Bucher et al.

Automatic segmentation of lung lesions in computer tomography has the potential to ease the burden of clinicians during the Covid-19 pandemic. Yet predictive deep learning models are not trusted in the clinical routine due to failing silently in out-of-distribution (OOD) data. We propose a lightweight OOD detection method that exploits the Mahalanobis distance in the feature space. The proposed approach can be seamlessly integrated into state-of-the-art segmentation pipelines without requiring changes in model architecture or training procedure, and can therefore be used to assess the suitability of pre-trained models to new data. We validate our method with a patch-based nnU-Net architecture trained with a multi-institutional dataset and find that it effectively detects samples that the model segments incorrectly.

Camila Gonzalez, Nick Lemke, Georgios Sakas et al.

Continual learning protocols are attracting increasing attention from the medical imaging community. In continual environments, datasets acquired under different conditions arrive sequentially; and each is only available for a limited period of time. Given the inherent privacy risks associated with medical data, this setup reflects the reality of deployment for deep learning diagnostic radiology systems. Many techniques exist to learn continuously for image classification, and several have been adapted to semantic segmentation. Yet most struggle to accumulate knowledge in a meaningful manner. Instead, they focus on preventing the problem of catastrophic forgetting, even when this reduces model plasticity and thereon burdens the training process. This puts into question whether the additional overhead of knowledge preservation is worth it - particularly for medical image segmentation, where computation requirements are already high - or if maintaining separate models would be a better solution. We propose UNEG, a simple and widely applicable multi-model benchmark that maintains separate segmentation and autoencoder networks for each training stage. The autoencoder is built from the same architecture as the segmentation network, which in our case is a full-resolution nnU-Net, to bypass any additional design decisions. During inference, the reconstruction error is used to select the most appropriate segmenter for each test image. Open this concept, we develop a fair evaluation scheme for different continual learning settings that moves beyond the prevention of catastrophic forgetting. Our results across three regions of interest (prostate, hippocampus, and right ventricle) show that UNEG outperforms several continual learning methods, reinforcing the need for strong baselines in continual learning research.

Karol Gotkowski, Camila Gonzalez, Andreas Bucher et al.

M3d-CAM is an easy to use library for generating attention maps of CNN-based PyTorch models improving the interpretability of model predictions for humans. The attention maps can be generated with multiple methods like Guided Backpropagation, Grad-CAM, Guided Grad-CAM and Grad-CAM++. These attention maps visualize the regions in the input data that influenced the model prediction the most at a certain layer. Furthermore, M3d-CAM supports 2D and 3D data for the task of classification as well as for segmentation. A key feature is also that in most cases only a single line of code is required for generating attention maps for a model making M3d-CAM basically plug and play.