Ortal Senouf

Anand Choudhary, Xiaowu Sun, Thabo Mahendiran et al.

Invasive Coronary Angiography (ICA) is the clinical gold standard for the assessment of coronary artery disease. However, its interpretation remains subjective and prone to intra- and inter-operator variability. In this work, we introduce ODySSeI: an Open-source end-to-end framework for automated Detection, Segmentation, and Severity estimation of lesions in ICA images. ODySSeI integrates deep learning-based lesion detection and lesion segmentation models trained using a novel Pyramidal Augmentation Scheme (PAS) to enhance robustness and real-time performance across diverse patient cohorts (2149 patients from Europe, North America, and Asia). Furthermore, we propose a quantitative coronary angiography-free Lesion Severity Estimation (LSE) technique that directly computes the Minimum Lumen Diameter (MLD) and diameter stenosis from the predicted lesion geometry. Extensive evaluation on both in-distribution and out-of-distribution clinical datasets demonstrates ODySSeI's strong generalizability. Our PAS yields large performance gains in highly complex tasks as compared to relatively simpler ones, notably, a 2.5-fold increase in lesion detection performance versus a 1-3\% increase in lesion segmentation performance over their respective baselines. Our LSE technique achieves high accuracy, with predicted MLD values differing by only $\pm$ 2-3 pixels from the corresponding ground truths. On average, ODySSeI processes a raw ICA image within only a few seconds on a CPU and in a fraction of a second on a GPU and is available as a plug-and-play web interface at swisscardia.epfl.ch. Overall, this work establishes ODySSeI as a comprehensive and open-source framework which supports automated, reproducible, and scalable ICA analysis for real-time clinical decision-making.

Camille Challier, Xiaowu Sun, Thabo Mahendiran et al.

Accurate segmentation of coronary arteries remains a significant challenge in clinical practice, hindering the ability to effectively diagnose and manage coronary artery disease. The lack of large, annotated datasets for model training exacerbates this issue, limiting the development of automated tools that could assist radiologists. To address this, we introduce CM-UNet, which leverages self-supervised pre-training on unannotated datasets and transfer learning on limited annotated data, enabling accurate disease detection while minimizing the need for extensive manual annotations. Fine-tuning CM-UNet with only 18 annotated images instead of 500 resulted in a 15.2% decrease in Dice score, compared to a 46.5% drop in baseline models without pre-training. This demonstrates that self-supervised learning can enhance segmentation performance and reduce dependence on large datasets. This is one of the first studies to highlight the importance of self-supervised learning in improving coronary artery segmentation from X-ray angiography, with potential implications for advancing diagnostic accuracy in clinical practice. By enhancing segmentation accuracy in X-ray angiography images, the proposed approach aims to improve clinical workflows, reduce radiologists' workload, and accelerate disease detection, ultimately contributing to better patient outcomes. The source code is publicly available at https://github.com/CamilleChallier/Contrastive-Masked-UNet.

Tomer Weiss, Sanketh Vedula, Ortal Senouf et al.

Fiber tractography is an important tool of computational neuroscience that enables reconstructing the spatial connectivity and organization of white matter of the brain. Fiber tractography takes advantage of diffusion Magnetic Resonance Imaging (dMRI) which allows measuring the apparent diffusivity of cerebral water along different spatial directions. Unfortunately, collecting such data comes at the price of reduced spatial resolution and substantially elevated acquisition times, which limits the clinical applicability of dMRI. This problem has been thus far addressed using two principal strategies. Most of the efforts have been extended towards improving the quality of signal estimation for any, yet fixed sampling scheme (defined through the choice of diffusion-encoding gradients). On the other hand, optimization over the sampling scheme has also proven to be effective. Inspired by the previous results, the present work consolidates the above strategies into a unified estimation framework, in which the optimization is carried out with respect to both estimation model and sampling design {\it concurrently}. The proposed solution offers substantial improvements in the quality of signal estimation as well as the accuracy of ensuing analysis by means of fiber tractography. While proving the optimality of the learned estimation models would probably need more extensive evaluation, we nevertheless claim that the learned sampling schemes can be of immediate use, offering a way to improve the dMRI analysis without the necessity of deploying the neural network used for their estimation. We present a comprehensive comparative analysis based on the Human Connectome Project data. Code and learned sampling designs aviliable at https://github.com/tomer196/Learned_dMRI.

Xiaowu Sun, Thabo Mahendiran, Ortal Senouf et al.

Cardiovascular disease is the leading global cause of mortality, with coronary artery disease (CAD) as its most prevalent form, necessitating early risk prediction. While 3D coronary artery digital twins reconstructed from imaging offer detailed anatomy for personalized assessment, their analysis relies on computationally intensive computational fluid dynamics (CFD), limiting scalability. Data-driven approaches are hindered by scarce labeled data and lack of physiological priors. To address this, we present PINS-CAD, a physics-informed self-supervised learning framework. It pre-trains graph neural networks on 200,000 synthetic coronary digital twins to predict pressure and flow, guided by 1D Navier-Stokes equations and pressure-drop laws, eliminating the need for CFD or labeled data. When fine-tuned on clinical data from 635 patients in the multicenter FAME2 study, PINS-CAD predicts future cardiovascular events with an AUC of 0.73, outperforming clinical risk scores and data-driven baselines. This demonstrates that physics-informed pretraining boosts sample efficiency and yields physiologically meaningful representations. Furthermore, PINS-CAD generates spatially resolved pressure and fractional flow reserve curves, providing interpretable biomarkers. By embedding physical priors into geometric deep learning, PINS-CAD transforms routine angiography into a simulation-free, physiology-aware framework for scalable, preventive cardiology.

Ortal Senouf, Antoine Wehenkel, Cédric Vincent-Cuaz et al.

Simulation-based inference (SBI) is a statistical inference approach for estimating latent parameters of a physical system when the likelihood is intractable but simulations are available. In practice, SBI is often hindered by model misspecification--the mismatch between simulated and real-world observations caused by inherent modeling simplifications. RoPE, a recent SBI approach, addresses this challenge through a two-stage domain transfer process that combines semi-supervised calibration with optimal transport (OT)-based distribution alignment. However, RoPE operates in a fully transductive setting, requiring access to a batch of test samples at inference time, which limits scalability and generalization. We propose here a fully inductive and amortized SBI framework that integrates calibration and distributional alignment into a single, end-to-end trainable model. Our method leverages mini-batch OT with a closed-form coupling to align real and simulated observations that correspond to the same latent parameters, using both paired calibration data and unpaired samples. A conditional normalizing flow is then trained to approximate the OT-induced posterior, enabling efficient inference without simulation access at test time. Across a range of synthetic and real-world benchmarks--including complex medical biomarker estimation--our approach matches or surpasses the performance of RoPE, as well as other standard SBI and non-SBI estimators, while offering improved scalability and applicability in challenging, misspecified environments.

Jonathan Alush-Aben, Linor Ackerman-Schraier, Tomer Weiss et al.

Magnetic Resonance Imaging (MRI) has long been considered to be among the gold standards of today's diagnostic imaging. The most significant drawback of MRI is long acquisition times, prohibiting its use in standard practice for some applications. Compressed sensing (CS) proposes to subsample the k-space (the Fourier domain dual to the physical space of spatial coordinates) leading to significantly accelerated acquisition. However, the benefit of compressed sensing has not been fully exploited; most of the sampling densities obtained through CS do not produce a trajectory that obeys the stringent constraints of the MRI machine imposed in practice. Inspired by recent success of deep learning based approaches for image reconstruction and ideas from computational imaging on learning-based design of imaging systems, we introduce 3D FLAT, a novel protocol for data-driven design of 3D non-Cartesian accelerated trajectories in MRI. Our proposal leverages the entire 3D k-space to simultaneously learn a physically feasible acquisition trajectory with a reconstruction method. Experimental results, performed as a proof-of-concept, suggest that 3D FLAT achieves higher image quality for a given readout time compared to standard trajectories such as radial, stack-of-stars, or 2D learned trajectories (trajectories that evolve only in the 2D plane while fully sampling along the third dimension). Furthermore, we demonstrate evidence supporting the significant benefit of performing MRI acquisitions using non-Cartesian 3D trajectories over 2D non-Cartesian trajectories acquired slice-wise.

Tomer Weiss, Ortal Senouf, Sanketh Vedula et al.

Magnetic Resonance Imaging (MRI) has long been considered to be among "the gold standards" of diagnostic medical imaging. The long acquisition times, however, render MRI prone to motion artifacts, let alone their adverse contribution to the relative high costs of MRI examination. Over the last few decades, multiple studies have focused on the development of both physical and post-processing methods for accelerated acquisition of MRI scans. These two approaches, however, have so far been addressed separately. On the other hand, recent works in optical computational imaging have demonstrated growing success of concurrent learning-based design of data acquisition and image reconstruction schemes. Such schemes have already demonstrated substantial effectiveness, leading to considerably shorter acquisition times and improved quality of image reconstruction. Inspired by this initial success, in this work, we propose a novel approach to the learning of optimal schemes for conjoint acquisition and reconstruction of MRI scans, with the optimization carried out simultaneously with respect to the time-efficiency of data acquisition and the quality of resulting reconstructions. To be of a practical value, the schemes are encoded in the form of general k-space trajectories, whose associated magnetic gradients are constrained to obey a set of predefined hardware requirements (as defined in terms of, e.g., peak currents and maximum slew rates of magnetic gradients). With this proviso in mind, we propose a novel algorithm for the end-to-end training of a combined acquisition-reconstruction pipeline using a deep neural network with differentiable forward- and back-propagation operators. We demonstrate its effectiveness on image reconstruction and image segmentation tasks, reporting substantial improvements in terms of acceleration factors as well as the quality of these tasks.

Ortal Senouf, Sanketh Vedula, Tomer Weiss et al.

In the past few years, deep learning-based methods have demonstrated enormous success for solving inverse problems in medical imaging. In this work, we address the following question:\textit{Given a set of measurements obtained from real imaging experiments, what is the best way to use a learnable model and the physics of the modality to solve the inverse problem and reconstruct the latent image?} Standard supervised learning based methods approach this problem by collecting data sets of known latent images and their corresponding measurements. However, these methods are often impractical due to the lack of availability of appropriately sized training sets, and, more generally, due to the inherent difficulty in measuring the "groundtruth" latent image. In light of this, we propose a self-supervised approach to training inverse models in medical imaging in the absence of aligned data. Our method only requiring access to the measurements and the forward model at training. We showcase its effectiveness on inverse problems arising in accelerated magnetic resonance imaging (MRI).

Tomer Weiss, Sanketh Vedula, Ortal Senouf et al.

Magnetic Resonance Imaging (MRI) is considered today the golden-standard modality for soft tissues. The long acquisition times, however, make it more prone to motion artifacts as well as contribute to the relatively high costs of this examination. Over the years, multiple studies concentrated on designing reduced measurement schemes and image reconstruction schemes for MRI, however, these problems have been so far addressed separately. On the other hand, recent works in optical computational imaging have demonstrated growing success of the simultaneous learning-based design of the acquisition and reconstruction schemes manifesting significant improvement in the reconstruction quality with a constrained time budget. Inspired by these successes, in this work, we propose to learn accelerated MR acquisition schemes (in the form of Cartesian trajectories) jointly with the image reconstruction operator. To this end, we propose an algorithm for training the combined acquisition-reconstruction pipeline end-to-end in a differentiable way. We demonstrate the significance of using the learned Cartesian trajectories at different speed up rates.

Sanketh Vedula, Ortal Senouf, Grigoriy Zurakhov et al.

Medical ultrasound (US) is a widespread imaging modality owing its popularity to cost efficiency, portability, speed, and lack of harmful ionizing radiation. In this paper, we demonstrate that replacing the traditional ultrasound processing pipeline with a data-driven, learnable counterpart leads to significant improvement in image quality. Moreover, we demonstrate that greater improvement can be achieved through a learning-based design of the transmitted beam patterns simultaneously with learning an image reconstruction pipeline. We evaluate our method on an in-vivo first-harmonic cardiac ultrasound dataset acquired from volunteers and demonstrate the significance of the learned pipeline and transmit beam patterns on the image quality when compared to standard transmit and receive beamformers used in high frame-rate US imaging. We believe that the presented methodology provides a fundamentally different perspective on the classical problem of ultrasound beam pattern design.

Ortal Senouf, Sanketh Vedula, Grigoriy Zurakhov et al.

Cardiac ultrasound imaging requires a high frame rate in order to capture rapid motion. This can be achieved by multi-line acquisition (MLA), where several narrow-focused received lines are obtained from each wide-focused transmitted line. This shortens the acquisition time at the expense of introducing block artifacts. In this paper, we propose a data-driven learning-based approach to improve the MLA image quality. We train an end-to-end convolutional neural network on pairs of real ultrasound cardiac data, acquired through MLA and the corresponding single-line acquisition (SLA). The network achieves a significant improvement in image quality for both $5-$ and $7-$line MLA resulting in a decorrelation measure similar to that of SLA while having the frame rate of MLA.

Sanketh Vedula, Ortal Senouf, Grigoriy Zurakhov et al.

Frame rate is a crucial consideration in cardiac ultrasound imaging and 3D sonography. Several methods have been proposed in the medical ultrasound literature aiming at accelerating the image acquisition. In this paper, we consider one such method called \textit{multi-line transmission} (MLT), in which several evenly separated focused beams are transmitted simultaneously. While MLT reduces the acquisition time, it comes at the expense of a heavy loss of contrast due to the interactions between the beams (cross-talk artifact). In this paper, we introduce a data-driven method to reduce the artifacts arising in MLT. To this end, we propose to train an end-to-end convolutional neural network consisting of correction layers followed by a constant apodization layer. The network is trained on pairs of raw data obtained through MLT and the corresponding \textit{single-line transmission} (SLT) data. Experimental evaluation demonstrates significant improvement both in the visual image quality and in objective measures such as contrast ratio and contrast-to-noise ratio, while preserving resolution unlike traditional apodization-based methods. We show that the proposed method is able to generalize well across different patients and anatomies on real and phantom data.

Sanketh Vedula, Ortal Senouf, Alex M. Bronstein et al.

The cost-effectiveness and practical harmlessness of ultrasound imaging have made it one of the most widespread tools for medical diagnosis. Unfortunately, the beam-forming based image formation produces granular speckle noise, blurring, shading and other artifacts. To overcome these effects, the ultimate goal would be to reconstruct the tissue acoustic properties by solving a full wave propagation inverse problem. In this work, we make a step towards this goal, using Multi-Resolution Convolutional Neural Networks (CNN). As a result, we are able to reconstruct CT-quality images from the reflected ultrasound radio-frequency(RF) data obtained by simulation from real CT scans of a human body. We also show that CNN is able to imitate existing computationally heavy despeckling methods, thereby saving orders of magnitude in computations and making them amenable to real-time applications.