Francisco Lopez-Tiro

Francisco Lopez-Tiro, Juan Pablo Betancur-Rengifo, Arturo Ruiz-Sanchez et al.

Knowing the cause of kidney stone formation is crucial to establish treatments that prevent recurrence. There are currently different approaches for determining the kidney stone type. However, the reference ex-vivo identification procedure can take up to several weeks, while an in-vivo visual recognition requires highly trained specialists. Machine learning models have been developed to provide urologists with an automated classification of kidney stones during an ureteroscopy; however, there is a general lack in terms of quality of the training data and methods. In this work, a two-step transfer learning approach is used to train the kidney stone classifier. The proposed approach transfers knowledge learned on a set of images of kidney stones acquired with a CCD camera (ex-vivo dataset) to a final model that classifies images from endoscopic images (ex-vivo dataset). The results show that learning features from different domains with similar information helps to improve the performance of a model that performs classification in real conditions (for instance, uncontrolled lighting conditions and blur). Finally, in comparison to models that are trained from scratch or by initializing ImageNet weights, the obtained results suggest that the two-step approach extracts features improving the identification of kidney stones in endoscopic images.

Elias Villalvazo-Avila, Francisco Lopez-Tiro, Jonathan El-Beze et al.

This contribution presents a deep learning method for the extraction and fusion of information relating to kidney stone fragments acquired from different viewpoints of the endoscope. Surface and section fragment images are jointly used during the training of the classifier to improve the discrimination power of the features by adding attention layers at the end of each convolutional block. This approach is specifically designed to mimic the morpho-constitutional analysis performed in ex-vivo by biologists to visually identify kidney stones by inspecting both views. The addition of attention mechanisms to the backbone improved the results of single view extraction backbones by 4% on average. Moreover, in comparison to the state-of-the-art, the fusion of the deep features improved the overall results up to 11% in terms of kidney stone classification accuracy.

Mauricio Mendez-Ruiz, Francisco Lopez-Tiro, Jonathan El-Beze et al.

Deep learning has shown great promise in diverse areas of computer vision, such as image classification, object detection and semantic segmentation, among many others. However, as it has been repeatedly demonstrated, deep learning methods trained on a dataset do not generalize well to datasets from other domains or even to similar datasets, due to data distribution shifts. In this work, we propose the use of a meta-learning based few-shot learning approach to alleviate these problems. In order to demonstrate its efficacy, we use two datasets of kidney stones samples acquired with different endoscopes and different acquisition conditions. The results show how such methods are indeed capable of handling domain-shifts by attaining an accuracy of 74.38% and 88.52% in the 5-way 5-shot and 5-way 20-shot settings respectively. Instead, in the same dataset, traditional Deep Learning (DL) methods attain only an accuracy of 45%.

Daniel Flores-Araiza, Francisco Lopez-Tiro, Jonathan El-Beze et al.

Identifying the type of kidney stones can allow urologists to determine their cause of formation, improving the prescription of appropriate treatments to diminish future relapses. Currently, the associated ex-vivo diagnosis (known as Morpho-constitutional Analysis, MCA) is time-consuming, expensive and requires a great deal of experience, as it requires a visual analysis component that is highly operator dependant. Recently, machine learning methods have been developed for in-vivo endoscopic stone recognition. Deep Learning (DL) based methods outperform non-DL methods in terms of accuracy but lack explainability. Despite this trade-off, when it comes to making high-stakes decisions, it's important to prioritize understandable Computer-Aided Diagnosis (CADx) that suggests a course of action based on reasonable evidence, rather than a model prescribing a course of action. In this proposal, we learn Prototypical Parts (PPs) per kidney stone subtype, which are used by the DL model to generate an output classification. Using PPs in the classification task enables case-based reasoning explanations for such output, thus making the model interpretable. In addition, we modify global visual characteristics to describe their relevance to the PPs and the sensitivity of our model's performance. With this, we provide explanations with additional information at the sample, class and model levels in contrast to previous works. Although our implementation's average accuracy is lower than state-of-the-art (SOTA) non-interpretable DL models by 1.5 %, our models perform 2.8% better on perturbed images with a lower standard deviation, without adversarial training. Thus, Learning PPs has the potential to create more robust DL models.

Jorge Gonzalez-Zapata, Francisco Lopez-Tiro, Elias Villalvazo-Avila et al.

Several Deep Learning (DL) methods have recently been proposed for an automated identification of kidney stones during an ureteroscopy to enable rapid therapeutic decisions. Even if these DL approaches led to promising results, they are mainly appropriate for kidney stone types for which numerous labelled data are available. However, only few labelled images are available for some rare kidney stone types. This contribution exploits Deep Metric Learning (DML) methods i) to handle such classes with few samples, ii) to generalize well to out of distribution samples, and iii) to cope better with new classes which are added to the database. The proposed Guided Deep Metric Learning approach is based on a novel architecture which was designed to learn data representations in an improved way. The solution was inspired by Few-Shot Learning (FSL) and makes use of a teacher-student approach. The teacher model (GEMINI) generates a reduced hypothesis space based on prior knowledge from the labeled data, and is used it as a guide to a student model (i.e., ResNet50) through a Knowledge Distillation scheme. Extensive tests were first performed on two datasets separately used for the recognition, namely a set of images acquired for the surfaces of the kidney stone fragments, and a set of images of the fragment sections. The proposed DML-approach improved the identification accuracy by 10% and 12% in comparison to DL-methods and other DML-approaches, respectively. Moreover, model embeddings from the two dataset types were merged in an organized way through a multi-view scheme to simultaneously exploit the information of surface and section fragments. Test with the resulting mixed model improves the identification accuracy by at least 3% and up to 30% with respect to DL-models and shallow machine learning methods, respectively.

Daniel Flores-Araiza, Francisco Lopez-Tiro, Elias Villalvazo-Avila et al.

Identifying the type of kidney stones can allow urologists to determine their formation cause, improving the early prescription of appropriate treatments to diminish future relapses. However, currently, the associated ex-vivo diagnosis (known as morpho-constitutional analysis, MCA) is time-consuming, expensive, and requires a great deal of experience, as it requires a visual analysis component that is highly operator dependant. Recently, machine learning methods have been developed for in-vivo endoscopic stone recognition. Shallow methods have been demonstrated to be reliable and interpretable but exhibit low accuracy, while deep learning-based methods yield high accuracy but are not explainable. However, high stake decisions require understandable computer-aided diagnosis (CAD) to suggest a course of action based on reasonable evidence, rather than merely prescribe one. Herein, we investigate means for learning part-prototypes (PPs) that enable interpretable models. Our proposal suggests a classification for a kidney stone patch image and provides explanations in a similar way as those used on the MCA method.

Francisco Lopez-Tiro, Elias Villalvazo-Avila, Juan Pablo Betancur-Rengifo et al.

This contribution presents a deep-learning method for extracting and fusing image information acquired from different viewpoints, with the aim to produce more discriminant object features for the identification of the type of kidney stones seen in endoscopic images. The model was further improved with a two-step transfer learning approach and by attention blocks to refine the learned feature maps. Deep feature fusion strategies improved the results of single view extraction backbone models by more than 6% in terms of accuracy of the kidney stones classification.

Elias Villalvazo-Avila, Francisco Lopez-Tiro, Daniel Flores-Araiza et al.

This contribution presents a deep-learning method for extracting and fusing image information acquired from different viewpoints with the aim to produce more discriminant object features. Our approach was specifically designed to mimic the morpho-constitutional analysis used by urologists to visually classify kidney stones by inspecting the sections and surfaces of their fragments. Deep feature fusion strategies improved the results of single view extraction backbone models by more than 10\% in terms of precision of the kidney stones classification.

Armando Villegas-Jimenez, Daniel Flores-Araiza, Francisco Lopez-Tiro et al.

On the promise that if human users know the cause of an output, it would enable them to grasp the process responsible for the output, and hence provide understanding, many explainable methods have been proposed to indicate the cause for the output of a model based on its input. Nonetheless, little has been reported on quantitative measurements of such causal relationships between the inputs, the explanations, and the outputs of a model, leaving the assessment to the user, independent of his level of expertise in the subject. To address this situation, we explore a technique for measuring the causal relationship between the features from the area of the object of interest in the images of a class and the output of a classifier. Our experiments indicate improvement in the causal relationships measured when the area of the object of interest per class is indicated by a mask from an explainable method than when it is indicated by human annotators. Hence the chosen name of Causal Explanation Score (CaES)

Daniel Flores-Araiza, Francisco Lopez-Tiro, Clément Larose et al.

The in-vivo identification of the kidney stone types during an ureteroscopy would be a major medical advance in urology, as it could reduce the time of the tedious renal calculi extraction process, while diminishing infection risks. Furthermore, such an automated procedure would make possible to prescribe anti-recurrence treatments immediately. Nowadays, only few experienced urologists are able to recognize the kidney stone types in the images of the videos displayed on a screen during the endoscopy. Thus, several deep learning (DL) models have recently been proposed to automatically recognize the kidney stone types using ureteroscopic images. However, these DL models are of black box nature whicl limits their applicability in clinical settings. This contribution proposes a case-based reasoning DL model which uses prototypical parts (PPs) and generates local and global descriptors. The PPs encode for each class (i.e., kidney stone type) visual feature information (hue, saturation, intensity and textures) similar to that used by biologists. The PPs are optimally generated due a new loss function used during the model training. Moreover, the local and global descriptors of PPs allow to explain the decisions ("what" information, "where in the images") in an understandable way for biologists and urologists. The proposed DL model has been tested on a database including images of the six most widespread kidney stone types. The overall average classification accuracy was 90.37. When comparing this results with that of the eight other DL models of the kidney stone state-of-the-art, it can be seen that the valuable gain in explanability was not reached at the expense of accuracy which was even slightly increased with respect to that (88.2) of the best method of the literature. These promising and interpretable results also encourage urologists to put their trust in AI-based solutions.

Ivan Reyes-Amezcua, Francisco Lopez-Tiro, Clément Larose et al.

The reliability of artificial intelligence (AI) in medical imaging critically depends on its robustness to heterogeneous and corrupted images acquired with diverse devices across different hospitals which is highly challenging. Therefore, this paper introduces FedAgain, a trust-based Federated Learning (Federated Learning) strategy designed to enhance robustness and generalization for automated kidney stone identification from endoscopic images. FedAgain integrates a dual trust mechanism that combines benchmark reliability and model divergence to dynamically weight client contributions, mitigating the impact of noisy or adversarial updates during aggregation. The framework enables the training of collaborative models across multiple institutions while preserving data privacy and promoting stable convergence under real-world conditions. Extensive experiments across five datasets, including two canonical benchmarks (MNIST and CIFAR-10), two private multi-institutional kidney stone datasets, and one public dataset (MyStone), demonstrate that FedAgain consistently outperforms standard Federated Learning baselines under non-identically and independently distributed (non-IID) data and corrupted-client scenarios. By maintaining diagnostic accuracy and performance stability under varying conditions, FedAgain represents a practical advance toward reliable, privacy-preserving, and clinically deployable federated AI for medical imaging.

Ruben Gonzalez-Perez, Francisco Lopez-Tiro, Ivan Reyes-Amezcua et al.

Currently, the Morpho-Constitutional Analysis (MCA) is the de facto approach for the etiological diagnosis of kidney stone formation, and it is an important step for establishing personalized treatment to avoid relapses. More recently, research has focused on performing such tasks intra-operatively, an approach known as Endoscopic Stone Recognition (ESR). Both methods rely on features observed in the surface and the section of kidney stones to separate the analyzed samples into several sub-groups. However, given the high intra-observer variability and the complex operating conditions found in ESR, there is a lot of interest in using AI for computer-aided diagnosis. However, current AI models require large datasets to attain a good performance and for generalizing to unseen distributions. This is a major problem as large labeled datasets are very difficult to acquire, and some classes of kidney stones are very rare. Thus, in this paper, we present a method based on diffusion as a way of augmenting pre-existing ex-vivo kidney stone datasets. Our aim is to create plausible diverse kidney stone images that can be used for pre-training models using ex-vivo data. We show that by mixing natural and synthetic images of CCD images, it is possible to train models capable of performing very well on unseen intra-operative data. Our results show that is possible to attain an improvement of 10% in terms of accuracy compared to a baseline model pre-trained only on ImageNet. Moreover, our results show an improvement of 6% for surface images and 10% for section images compared to a model train on CCD images only, which demonstrates the effectiveness of using synthetic images.

Ivan Reyes-Amezcua, Francisco Lopez-Tiro, Clement Larose et al.

Kidney stone classification from endoscopic images is critical for personalized treatment and recurrence prevention. While convolutional neural networks (CNNs) have shown promise in this task, their limited ability to capture long-range dependencies can hinder performance under variable imaging conditions. This study presents a comparative analysis between Vision Transformers (ViTs) and CNN-based models, evaluating their performance on two ex vivo datasets comprising CCD camera and flexible ureteroscope images. The ViT-base model pretrained on ImageNet-21k consistently outperformed a ResNet50 baseline across multiple imaging conditions. For instance, in the most visually complex subset (Section patches from endoscopic images), the ViT model achieved 95.2% accuracy and 95.1% F1-score, compared to 64.5% and 59.3% with ResNet50. In the mixed-view subset from CCD-camera images, ViT reached 87.1% accuracy versus 78.4% with CNN. These improvements extend across precision and recall as well. The results demonstrate that ViT-based architectures provide superior classification performance and offer a scalable alternative to conventional CNNs for kidney stone image analysis.

Carlos Salazar-Ruiz, Francisco Lopez-Tiro, Ivan Reyes-Amezcua et al.

Determining the type of kidney stones is crucial for prescribing appropriate treatments to prevent recurrence. Currently, various approaches exist to identify the type of kidney stones. However, obtaining results through the reference ex vivo identification procedure can take several weeks, while in vivo visual recognition requires highly trained specialists. For this reason, deep learning models have been developed to provide urologists with an automated classification of kidney stones during ureteroscopies. Nevertheless, a common issue with these models is the lack of training data. This contribution presents a deep learning method based on few-shot learning, aimed at producing sufficiently discriminative features for identifying kidney stone types in endoscopic images, even with a very limited number of samples. This approach was specifically designed for scenarios where endoscopic images are scarce or where uncommon classes are present, enabling classification even with a limited training dataset. The results demonstrate that Prototypical Networks, using up to 25% of the training data, can achieve performance equal to or better than traditional deep learning models trained with the complete dataset.

Martin Villagrana, Francisco Lopez-Tiro, Clement Larose et al.

The segmentation of kidney stones is regarded as a critical preliminary step to enable the identification of urinary stone types through machine- or deep-learning-based approaches. In urology, manual segmentation is considered tedious and impractical due to the typically large scale of image databases and the continuous generation of new data. In this study, the potential of the Segment Anything Model (SAM) -- a state-of-the-art deep learning framework -- is investigated for the automation of kidney stone segmentation. The performance of SAM is evaluated in comparison to traditional models, including U-Net, Residual U-Net, and Attention U-Net, which, despite their efficiency, frequently exhibit limitations in generalizing to unseen datasets. The findings highlight SAM's superior adaptability and efficiency. While SAM achieves comparable performance to U-Net on in-distribution data (Accuracy: 97.68 + 3.04; Dice: 97.78 + 2.47; IoU: 95.76 + 4.18), it demonstrates significantly enhanced generalization capabilities on out-of-distribution data, surpassing all U-Net variants by margins of up to 23 percent.

Mauricio Mendez-Ruiz, Jorge Gonzalez-Zapata, Ivan Reyes-Amezcua et al.

Few-shot learning is a challenging area of research that aims to learn new concepts with only a few labeled samples of data. Recent works based on metric-learning approaches leverage the meta-learning approach, which is encompassed by episodic tasks that make use a support (training) and query set (test) with the objective of learning a similarity comparison metric between those sets. Due to the lack of data, the learning process of the embedding network becomes an important part of the few-shot task. Previous works have addressed this problem using metric learning approaches, but the properties of the underlying latent space and the separability of the difference classes on it was not entirely enforced. In this work, we propose two different loss functions which consider the importance of the embedding vectors by looking at the intra-class and inter-class distance between the few data. The first loss function is the Proto-Triplet Loss, which is based on the original triplet loss with the modifications needed to better work on few-shot scenarios. The second loss function, which we dub ICNN loss is based on an inter and intra class nearest neighbors score, which help us to assess the quality of embeddings obtained from the trained network. Our results, obtained from a extensive experimental setup show a significant improvement in accuracy in the miniImagenNet benchmark compared to other metric-based few-shot learning methods by a margin of 2%, demonstrating the capability of these loss functions to allow the network to generalize better to previously unseen classes. In our experiments, we demonstrate competitive generalization capabilities to other domains, such as the Caltech CUB, Dogs and Cars datasets compared with the state of the art.

Francisco Lopez-Tiro, Vincent Estrade, Jacques Hubert et al.

Determining the type of kidney stones allows urologists to prescribe a treatment to avoid recurrence of renal lithiasis. An automated in-vivo image-based classification method would be an important step towards an immediate identification of the kidney stone type required as a first phase of the diagnosis. In the literature it was shown on ex-vivo data (i.e., in very controlled scene and image acquisition conditions) that an automated kidney stone classification is indeed feasible. This pilot study compares the kidney stone recognition performances of six shallow machine learning methods and three deep-learning architectures which were tested with in-vivo images of the four most frequent urinary calculi types acquired with an endoscope during standard ureteroscopies. This contribution details the database construction and the design of the tested kidney stones classifiers. Even if the best results were obtained by the Inception v3 architecture (weighted precision, recall and F1-score of 0.97, 0.98 and 0.97, respectively), it is also shown that choosing an appropriate colour space and texture features allows a shallow machine learning method to approach closely the performances of the most promising deep-learning methods (the XGBoost classifier led to weighted precision, recall and F1-score values of 0.96). This paper is the first one that explores the most discriminant features to be extracted from images acquired during ureteroscopies.