Dong Yang

Yufan He, Pengfei Guo, Yucheng Tang et al.

Since the release of Segment Anything 2 (SAM2), the medical imaging community has been actively evaluating its performance for 3D medical image segmentation. However, different studies have employed varying evaluation pipelines, resulting in conflicting outcomes that obscure a clear understanding of SAM2's capabilities and potential applications. We shortly review existing benchmarks and point out that the SAM2 paper clearly outlines a zero-shot evaluation pipeline, which simulates user clicks iteratively for up to eight iterations. We reproduced this interactive annotation simulation on 3D CT datasets and provided the results and code~\url{https://github.com/Project-MONAI/VISTA}. Our findings reveal that directly applying SAM2 on 3D medical imaging in a zero-shot manner is far from satisfactory. It is prone to generating false positives when foreground objects disappear, and annotating more slices cannot fully offset this tendency. For smaller single-connected objects like kidney and aorta, SAM2 performs reasonably well but for most organs it is still far behind state-of-the-art 3D annotation methods. More research and innovation are needed for 3D medical imaging community to use SAM2 correctly.

Pengfei Guo, Can Zhao, Dong Yang et al.

Medical imaging analysis faces challenges such as data scarcity, high annotation costs, and privacy concerns. This paper introduces the Medical AI for Synthetic Imaging (MAISI), an innovative approach using the diffusion model to generate synthetic 3D computed tomography (CT) images to address those challenges. MAISI leverages the foundation volume compression network and the latent diffusion model to produce high-resolution CT images (up to a landmark volume dimension of 512 x 512 x 768 ) with flexible volume dimensions and voxel spacing. By incorporating ControlNet, MAISI can process organ segmentation, including 127 anatomical structures, as additional conditions and enables the generation of accurately annotated synthetic images that can be used for various downstream tasks. Our experiment results show that MAISI's capabilities in generating realistic, anatomically accurate images for diverse regions and conditions reveal its promising potential to mitigate challenges using synthetic data.

Meng Ye, Dong Yang, Mikael Kanski et al.

We propose a novel neural deformable model (NDM) targeting at the reconstruction and modeling of 3D bi-ventricular shape of the heart from 2D sparse cardiac magnetic resonance (CMR) imaging data. We model the bi-ventricular shape using blended deformable superquadrics, which are parameterized by a set of geometric parameter functions and are capable of deforming globally and locally. While global geometric parameter functions and deformations capture gross shape features from visual data, local deformations, parameterized as neural diffeomorphic point flows, can be learned to recover the detailed heart shape.Different from iterative optimization methods used in conventional deformable model formulations, NDMs can be trained to learn such geometric parameter functions, global and local deformations from a shape distribution manifold. Our NDM can learn to densify a sparse cardiac point cloud with arbitrary scales and generate high-quality triangular meshes automatically. It also enables the implicit learning of dense correspondences among different heart shape instances for accurate cardiac shape registration. Furthermore, the parameters of NDM are intuitive, and can be used by a physician without sophisticated post-processing. Experimental results on a large CMR dataset demonstrate the improved performance of NDM over conventional methods.

Andriy Myronenko, Dong Yang, Yufan He et al.

Kidney and Kidney Tumor Segmentation Challenge (KiTS) 2023 offers a platform for researchers to compare their solutions to segmentation from 3D CT. In this work, we describe our submission to the challenge using automated segmentation of Auto3DSeg available in MONAI. Our solution achieves the average dice of 0.835 and surface dice of 0.723, which ranks first and wins the KiTS 2023 challenge.

Andriy Myronenko, Dong Yang, Yufan He et al.

Aorta provides the main blood supply of the body. Screening of aorta with imaging helps for early aortic disease detection and monitoring. In this work, we describe our solution to the Segmentation of the Aorta (SEG.A.231) from 3D CT challenge. We use automated segmentation method Auto3DSeg available in MONAI. Our solution achieves an average Dice score of 0.920 and 95th percentile of the Hausdorff Distance (HD95) of 6.013, which ranks first and wins the SEG.A. 2023 challenge.

Zhiwei Lin, Zhe Liu, Zhongyu Xia et al.

Three-dimensional object detection is one of the key tasks in autonomous driving. To reduce costs in practice, low-cost multi-view cameras for 3D object detection are proposed to replace the expansive LiDAR sensors. However, relying solely on cameras is difficult to achieve highly accurate and robust 3D object detection. An effective solution to this issue is combining multi-view cameras with the economical millimeter-wave radar sensor to achieve more reliable multi-modal 3D object detection. In this paper, we introduce RCBEVDet, a radar-camera fusion 3D object detection method in the bird's eye view (BEV). Specifically, we first design RadarBEVNet for radar BEV feature extraction. RadarBEVNet consists of a dual-stream radar backbone and a Radar Cross-Section (RCS) aware BEV encoder. In the dual-stream radar backbone, a point-based encoder and a transformer-based encoder are proposed to extract radar features, with an injection and extraction module to facilitate communication between the two encoders. The RCS-aware BEV encoder takes RCS as the object size prior to scattering the point feature in BEV. Besides, we present the Cross-Attention Multi-layer Fusion module to automatically align the multi-modal BEV feature from radar and camera with the deformable attention mechanism, and then fuse the feature with channel and spatial fusion layers. Experimental results show that RCBEVDet achieves new state-of-the-art radar-camera fusion results on nuScenes and view-of-delft (VoD) 3D object detection benchmarks. Furthermore, RCBEVDet achieves better 3D detection results than all real-time camera-only and radar-camera 3D object detectors with a faster inference speed at 21~28 FPS. The source code will be released at https://github.com/VDIGPKU/RCBEVDet.

Can Zhao, Pengfei Guo, Dong Yang et al.

Medical image synthesis is an important topic for both clinical and research applications. Recently, diffusion models have become a leading approach in this area. Despite their strengths, many existing methods struggle with (1) limited generalizability that only work for specific body regions or voxel spacings, (2) slow inference, which is a common issue for diffusion models, and (3) weak alignment with input conditions, which is a critical issue for medical imaging. MAISI, a previously proposed framework, addresses generalizability issues but still suffers from slow inference and limited condition consistency. In this work, we present MAISI-v2, the first accelerated 3D medical image synthesis framework that integrates rectified flow to enable fast and high quality generation. To further enhance condition fidelity, we introduce a novel region-specific contrastive loss to enhance the sensitivity to region of interest. Our experiments show that MAISI-v2 can achieve SOTA image quality with $33 \times$ acceleration for latent diffusion model. We also conducted a downstream segmentation experiment to show that the synthetic images can be used for data augmentation. We release our code, training details, model weights, and a GUI demo to facilitate reproducibility and promote further development within the community.

Anjany Sekuboyina, Malek E. Husseini, Amirhossein Bayat et al.

Vertebral labelling and segmentation are two fundamental tasks in an automated spine processing pipeline. Reliable and accurate processing of spine images is expected to benefit clinical decision-support systems for diagnosis, surgery planning, and population-based analysis on spine and bone health. However, designing automated algorithms for spine processing is challenging predominantly due to considerable variations in anatomy and acquisition protocols and due to a severe shortage of publicly available data. Addressing these limitations, the Large Scale Vertebrae Segmentation Challenge (VerSe) was organised in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) in 2019 and 2020, with a call for algorithms towards labelling and segmentation of vertebrae. Two datasets containing a total of 374 multi-detector CT scans from 355 patients were prepared and 4505 vertebrae have individually been annotated at voxel-level by a human-machine hybrid algorithm (https://osf.io/nqjyw/, https://osf.io/t98fz/). A total of 25 algorithms were benchmarked on these datasets. In this work, we present the the results of this evaluation and further investigate the performance-variation at vertebra-level, scan-level, and at different fields-of-view. We also evaluate the generalisability of the approaches to an implicit domain shift in data by evaluating the top performing algorithms of one challenge iteration on data from the other iteration. The principal takeaway from VerSe: the performance of an algorithm in labelling and segmenting a spine scan hinges on its ability to correctly identify vertebrae in cases of rare anatomical variations. The content and code concerning VerSe can be accessed at: https://github.com/anjany/verse.

Vishwesh Nath, Wenqi Li, Dong Yang et al.

Generalist vision language models (VLMs) have made significant strides in computer vision, but they fall short in specialized fields like healthcare, where expert knowledge is essential. In traditional computer vision tasks, creative or approximate answers may be acceptable, but in healthcare, precision is paramount.Current large multimodal models like Gemini and GPT-4o are insufficient for medical tasks due to their reliance on memorized internet knowledge rather than the nuanced expertise required in healthcare. VLMs are usually trained in three stages: vision pre-training, vision-language pre-training, and instruction fine-tuning (IFT). IFT has been typically applied using a mixture of generic and healthcare data. In contrast, we propose that for medical VLMs, a fourth stage of specialized IFT is necessary, which focuses on medical data and includes information from domain expert models. Domain expert models developed for medical use are crucial because they are specifically trained for certain clinical tasks, e.g. to detect tumors and classify abnormalities through segmentation and classification, which learn fine-grained features of medical data$-$features that are often too intricate for a VLM to capture effectively especially in radiology. This paper introduces a new framework, VILA-M3, for medical VLMs that utilizes domain knowledge via expert models. Through our experiments, we show an improved state-of-the-art (SOTA) performance with an average improvement of ~9% over the prior SOTA model Med-Gemini and ~6% over models trained on the specific tasks. Our approach emphasizes the importance of domain expertise in creating precise, reliable VLMs for medical applications.

Xinran Li, Yi Shuai, Chen Liu et al.

Tumor synthesis can generate examples that AI often misses or over-detects, improving AI performance by training on these challenging cases. However, existing synthesis methods, which are typically unconditional -- generating images from random variables -- or conditioned only by tumor shapes, lack controllability over specific tumor characteristics such as texture, heterogeneity, boundaries, and pathology type. As a result, the generated tumors may be overly similar or duplicates of existing training data, failing to effectively address AI's weaknesses. We propose a new text-driven tumor synthesis approach, termed TextoMorph, that provides textual control over tumor characteristics. This is particularly beneficial for examples that confuse the AI the most, such as early tumor detection (increasing Sensitivity by +8.5%), tumor segmentation for precise radiotherapy (increasing DSC by +6.3%), and classification between benign and malignant tumors (improving Sensitivity by +8.2%). By incorporating text mined from radiology reports into the synthesis process, we increase the variability and controllability of the synthetic tumors to target AI's failure cases more precisely. Moreover, TextoMorph uses contrastive learning across different texts and CT scans, significantly reducing dependence on scarce image-report pairs (only 141 pairs used in this study) by leveraging a large corpus of 34,035 radiology reports. Finally, we have developed rigorous tests to evaluate synthetic tumors, including Text-Driven Visual Turing Test and Radiomics Pattern Analysis, showing that our synthetic tumors is realistic and diverse in texture, heterogeneity, boundaries, and pathology.

Ziyan Liu, Yuxu Lu, Huashan Yu et al.

Image restoration is critical for improving the quality of degraded images, which is vital for applications like autonomous driving, security surveillance, and digital content enhancement. However, existing methods are often tailored to specific degradation scenarios, limiting their adaptability to the diverse and complex challenges in real-world environments. Moreover, real-world degradations are typically non-uniform, highlighting the need for adaptive and intelligent solutions. To address these issues, we propose a novel vision-language-guided universal restoration (VL-UR) framework. VL-UR leverages a zero-shot contrastive language-image pre-training (CLIP) model to enhance image restoration by integrating visual and semantic information. A scene classifier is introduced to adapt CLIP, generating high-quality language embeddings aligned with degraded images while predicting degraded types for complex scenarios. Extensive experiments across eleven diverse degradation settings demonstrate VL-UR's state-of-the-art performance, robustness, and adaptability. This positions VL-UR as a transformative solution for modern image restoration challenges in dynamic, real-world environments.

Jia Dong, Yao Yao, Yang Dong et al.

Thyroid cancer is the most common endocrine malignancy, and accurately distinguishing between benign and malignant thyroid tumors is crucial for developing effective treatment plans in clinical practice. Pathologically, thyroid tumors pose diagnostic challenges due to improper specimen sampling. In this study, we have designed a three-stage model using representation learning to integrate pixel-level and slice-level annotations for distinguishing thyroid tumors. This structure includes a pathology structure recognition method to predict structures related to thyroid tumors, an encoder-decoder network to extract pixel-level annotation information by learning the feature representations of image blocks, and an attention-based learning mechanism for the final classification task. This mechanism learns the importance of different image blocks in a pathological region, globally considering the information from each block. In the third stage, all information from the image blocks in a region is aggregated using attention mechanisms, followed by classification to determine the category of the region. Experimental results demonstrate that our proposed method can predict microscopic structures more accurately. After color-coding, the method achieves results on unstained pathology slides that approximate the quality of Hematoxylin and eosin staining, reducing the need for stained pathology slides. Furthermore, by leveraging the concept of indirect measurement and extracting polarized features from structures correlated with lesions, the proposed method can also classify samples where membrane structures cannot be obtained through sampling, providing a potential objective and highly accurate indirect diagnostic technique for thyroid tumors.

Dong Yang, Andriy Myronenko, Xiaosong Wang et al.

Lesion segmentation in medical imaging has been an important topic in clinical research. Researchers have proposed various detection and segmentation algorithms to address this task. Recently, deep learning-based approaches have significantly improved the performance over conventional methods. However, most state-of-the-art deep learning methods require the manual design of multiple network components and training strategies. In this paper, we propose a new automated machine learning algorithm, T-AutoML, which not only searches for the best neural architecture, but also finds the best combination of hyper-parameters and data augmentation strategies simultaneously. The proposed method utilizes the modern transformer model, which is introduced to adapt to the dynamic length of the search space embedding and can significantly improve the ability of the search. We validate T-AutoML on several large-scale public lesion segmentation data-sets and achieve state-of-the-art performance.

Andriy Myronenko, Ziyue Xu, Dong Yang et al.

Multiple instance learning (MIL) is a key algorithm for classification of whole slide images (WSI). Histology WSIs can have billions of pixels, which create enormous computational and annotation challenges. Typically, such images are divided into a set of patches (a bag of instances), where only bag-level class labels are provided. Deep learning based MIL methods calculate instance features using convolutional neural network (CNN). Our proposed approach is also deep learning based, with the following two contributions: Firstly, we propose to explicitly account for dependencies between instances during training by embedding self-attention Transformer blocks to capture dependencies between instances. For example, a tumor grade may depend on the presence of several particular patterns at different locations in WSI, which requires to account for dependencies between patches. Secondly, we propose an instance-wise loss function based on instance pseudo-labels. We compare the proposed algorithm to multiple baseline methods, evaluate it on the PANDA challenge dataset, the largest publicly available WSI dataset with over 11K images, and demonstrate state-of-the-art results.

Chen Shen, Pochuan Wang, Holger R. Roth et al.

Federated learning (FL) for medical image segmentation becomes more challenging in multi-task settings where clients might have different categories of labels represented in their data. For example, one client might have patient data with "healthy'' pancreases only while datasets from other clients may contain cases with pancreatic tumors. The vanilla federated averaging algorithm makes it possible to obtain more generalizable deep learning-based segmentation models representing the training data from multiple institutions without centralizing datasets. However, it might be sub-optimal for the aforementioned multi-task scenarios. In this paper, we investigate heterogeneous optimization methods that show improvements for the automated segmentation of pancreas and pancreatic tumors in abdominal CT images with FL settings.

Holger R. Roth, Dong Yang, Wenqi Li et al.

Building robust deep learning-based models requires diverse training data, ideally from several sources. However, these datasets cannot be combined easily because of patient privacy concerns or regulatory hurdles, especially if medical data is involved. Federated learning (FL) is a way to train machine learning models without the need for centralized datasets. Each FL client trains on their local data while only sharing model parameters with a global server that aggregates the parameters from all clients. At the same time, each client's data can exhibit differences and inconsistencies due to the local variation in the patient population, imaging equipment, and acquisition protocols. Hence, the federated learned models should be able to adapt to the local particularities of a client's data. In this work, we combine FL with an AutoML technique based on local neural architecture search by training a "supernet". Furthermore, we propose an adaptation scheme to allow for personalized model architectures at each FL client's site. The proposed method is evaluated on four different datasets from 3D prostate MRI and shown to improve the local models' performance after adaptation through selecting an optimal path through the AutoML supernet.

Vishwesh Nath, Dong Yang, Ali Hatamizadeh et al.

Deep learning models for medical image segmentation are primarily data-driven. Models trained with more data lead to improved performance and generalizability. However, training is a computationally expensive process because multiple hyper-parameters need to be tested to find the optimal setting for best performance. In this work, we focus on accelerating the estimation of hyper-parameters by proposing two novel methodologies: proxy data and proxy networks. Both can be useful for estimating hyper-parameters more efficiently. We test the proposed techniques on CT and MR imaging modalities using well-known public datasets. In both cases using one dataset for building proxy data and another data source for external evaluation. For CT, the approach is tested on spleen segmentation with two datasets. The first dataset is from the medical segmentation decathlon (MSD), where the proxy data is constructed, the secondary dataset is utilized as an external validation dataset. Similarly, for MR, the approach is evaluated on prostate segmentation where the first dataset is from MSD and the second dataset is PROSTATEx. First, we show higher correlation to using full data for training when testing on the external validation set using smaller proxy data than a random selection of the proxy data. Second, we show that a high correlation exists for proxy networks when compared with the full network on validation Dice score. Third, we show that the proposed approach of utilizing a proxy network can speed up an AutoML framework for hyper-parameter search by 3.3x, and by 4.4x if proxy data and proxy network are utilized together.

Yingda Xia, Dong Yang, Wenqi Li et al.

Federated learning (FL) enables collaborative model training while preserving each participant's privacy, which is particularly beneficial to the medical field. FedAvg is a standard algorithm that uses fixed weights, often originating from the dataset sizes at each client, to aggregate the distributed learned models on a server during the FL process. However, non-identical data distribution across clients, known as the non-i.i.d problem in FL, could make this assumption for setting fixed aggregation weights sub-optimal. In this work, we design a new data-driven approach, namely Auto-FedAvg, where aggregation weights are dynamically adjusted, depending on data distributions across data silos and the current training progress of the models. We disentangle the parameter set into two parts, local model parameters and global aggregation parameters, and update them iteratively with a communication-efficient algorithm. We first show the validity of our approach by outperforming state-of-the-art FL methods for image recognition on a heterogeneous data split of CIFAR-10. Furthermore, we demonstrate our algorithm's effectiveness on two multi-institutional medical image analysis tasks, i.e., COVID-19 lesion segmentation in chest CT and pancreas segmentation in abdominal CT.

Xiaosong Wang, Ziyue Xu, Leo Tam et al.

Pre-trained models, e.g., from ImageNet, have proven to be effective in boosting the performance of many downstream applications. It is too demanding to acquire large-scale annotations to build such models for medical imaging. Meanwhile, there are numerous clinical data (in the form of images and text reports) stored in the hospital information systems. The paired image-text data from the same patient study could be utilized for the pre-training task in a weakly supervised manner. However, the integrity, accessibility, and amount of such raw data vary across different institutes, e.g., paired vs. unpaired (image-only or text-only). In this work, we introduce an image-text pre-training framework that can learn from these raw data with mixed data inputs, i.e., paired image-text data, a mixture of paired and unpaired data. The unpaired data can be sourced from one or multiple institutes (e.g., images from one institute coupled with texts from another). Specifically, we propose a transformer-based training framework for jointly learning the representation of both the image and text data. In addition to the existing masked language modeling, multi-scale masked vision modeling is introduced as a self-supervised training task for image patch regeneration. We not only demonstrate the feasibility of pre-training across mixed data inputs but also illustrate the benefits of adopting such pre-trained models in 3 chest X-ray applications, i.e., classification, retrieval, and image regeneration. Superior results are reported in comparison to prior art using MIMIC-CXR, NIH14-CXR, and OpenI-CXR datasets.

Yufan He, Dong Yang, Holger Roth et al.

Recently, neural architecture search (NAS) has been applied to automatically search high-performance networks for medical image segmentation. The NAS search space usually contains a network topology level (controlling connections among cells with different spatial scales) and a cell level (operations within each cell). Existing methods either require long searching time for large-scale 3D image datasets, or are limited to pre-defined topologies (such as U-shaped or single-path). In this work, we focus on three important aspects of NAS in 3D medical image segmentation: flexible multi-path network topology, high search efficiency, and budgeted GPU memory usage. A novel differentiable search framework is proposed to support fast gradient-based search within a highly flexible network topology search space. The discretization of the searched optimal continuous model in differentiable scheme may produce a sub-optimal final discrete model (discretization gap). Therefore, we propose a topology loss to alleviate this problem. In addition, the GPU memory usage for the searched 3D model is limited with budget constraints during search. Our Differentiable Network Topology Search scheme (DiNTS) is evaluated on the Medical Segmentation Decathlon (MSD) challenge, which contains ten challenging segmentation tasks. Our method achieves the state-of-the-art performance and the top ranking on the MSD challenge leaderboard.

Ali Hatamizadeh, Yucheng Tang, Vishwesh Nath et al.

Fully Convolutional Neural Networks (FCNNs) with contracting and expanding paths have shown prominence for the majority of medical image segmentation applications since the past decade. In FCNNs, the encoder plays an integral role by learning both global and local features and contextual representations which can be utilized for semantic output prediction by the decoder. Despite their success, the locality of convolutional layers in FCNNs, limits the capability of learning long-range spatial dependencies. Inspired by the recent success of transformers for Natural Language Processing (NLP) in long-range sequence learning, we reformulate the task of volumetric (3D) medical image segmentation as a sequence-to-sequence prediction problem. We introduce a novel architecture, dubbed as UNEt TRansformers (UNETR), that utilizes a transformer as the encoder to learn sequence representations of the input volume and effectively capture the global multi-scale information, while also following the successful "U-shaped" network design for the encoder and decoder. The transformer encoder is directly connected to a decoder via skip connections at different resolutions to compute the final semantic segmentation output. We have validated the performance of our method on the Multi Atlas Labeling Beyond The Cranial Vault (BTCV) dataset for multi-organ segmentation and the Medical Segmentation Decathlon (MSD) dataset for brain tumor and spleen segmentation tasks. Our benchmarks demonstrate new state-of-the-art performance on the BTCV leaderboard. Code: https://monai.io/research/unetr

Ping Chen, Yujin Chen, Dong Yang et al.

Reconstructing a high-precision and high-fidelity 3D human hand from a color image plays a central role in replicating a realistic virtual hand in human-computer interaction and virtual reality applications. The results of current methods are lacking in accuracy and fidelity due to various hand poses and severe occlusions. In this study, we propose an I2UV-HandNet model for accurate hand pose and shape estimation as well as 3D hand super-resolution reconstruction. Specifically, we present the first UV-based 3D hand shape representation. To recover a 3D hand mesh from an RGB image, we design an AffineNet to predict a UV position map from the input in an image-to-image translation fashion. To obtain a higher fidelity shape, we exploit an additional SRNet to transform the low-resolution UV map outputted by AffineNet into a high-resolution one. For the first time, we demonstrate the characterization capability of the UV-based hand shape representation. Our experiments show that the proposed method achieves state-of-the-art performance on several challenging benchmarks.

Vishwesh Nath, Dong Yang, Bennett A. Landman et al.

Active learning is a unique abstraction of machine learning techniques where the model/algorithm could guide users for annotation of a set of data points that would be beneficial to the model, unlike passive machine learning. The primary advantage being that active learning frameworks select data points that can accelerate the learning process of a model and can reduce the amount of data needed to achieve full accuracy as compared to a model trained on a randomly acquired data set. Multiple frameworks for active learning combined with deep learning have been proposed, and the majority of them are dedicated to classification tasks. Herein, we explore active learning for the task of segmentation of medical imaging data sets. We investigate our proposed framework using two datasets: 1.) MRI scans of the hippocampus, 2.) CT scans of pancreas and tumors. This work presents a query-by-committee approach for active learning where a joint optimizer is used for the committee. At the same time, we propose three new strategies for active learning: 1.) increasing frequency of uncertain data to bias the training data set; 2.) Using mutual information among the input images as a regularizer for acquisition to ensure diversity in the training dataset; 3.) adaptation of Dice log-likelihood for Stein variational gradient descent (SVGD). The results indicate an improvement in terms of data reduction by achieving full accuracy while only using 22.69 % and 48.85 % of the available data for each dataset, respectively.

Dong Yang, Ziyue Xu, Wenqi Li et al.

The recent outbreak of COVID-19 has led to urgent needs for reliable diagnosis and management of SARS-CoV-2 infection. As a complimentary tool, chest CT has been shown to be able to reveal visual patterns characteristic for COVID-19, which has definite value at several stages during the disease course. To facilitate CT analysis, recent efforts have focused on computer-aided characterization and diagnosis, which has shown promising results. However, domain shift of data across clinical data centers poses a serious challenge when deploying learning-based models. In this work, we attempt to find a solution for this challenge via federated and semi-supervised learning. A multi-national database consisting of 1704 scans from three countries is adopted to study the performance gap, when training a model with one dataset and applying it to another. Expert radiologists manually delineated 945 scans for COVID-19 findings. In handling the variability in both the data and annotations, a novel federated semi-supervised learning technique is proposed to fully utilize all available data (with or without annotations). Federated learning avoids the need for sensitive data-sharing, which makes it favorable for institutions and nations with strict regulatory policy on data privacy. Moreover, semi-supervision potentially reduces the annotation burden under a distributed setting. The proposed framework is shown to be effective compared to fully supervised scenarios with conventional data sharing instead of model weight sharing.

Pochuan Wang, Chen Shen, Holger R. Roth et al.

The performance of deep learning-based methods strongly relies on the number of datasets used for training. Many efforts have been made to increase the data in the medical image analysis field. However, unlike photography images, it is hard to generate centralized databases to collect medical images because of numerous technical, legal, and privacy issues. In this work, we study the use of federated learning between two institutions in a real-world setting to collaboratively train a model without sharing the raw data across national boundaries. We quantitatively compare the segmentation models obtained with federated learning and local training alone. Our experimental results show that federated learning models have higher generalizability than standalone training.

Holger R Roth, Dong Yang, Ziyue Xu et al.

Medical image annotation is a major hurdle for developing precise and robust machine learning models. Annotation is expensive, time-consuming, and often requires expert knowledge, particularly in the medical field. Here, we suggest using minimal user interaction in the form of extreme point clicks to train a segmentation model which, in effect, can be used to speed up medical image annotation. An initial segmentation is generated based on the extreme points utilizing the random walker algorithm. This initial segmentation is then used as a noisy supervision signal to train a fully convolutional network that can segment the organ of interest, based on the provided user clicks. Through experimentation on several medical imaging datasets, we show that the predictions of the network can be refined using several rounds of training with the prediction from the same weakly annotated data. Further improvements are shown utilizing the clicked points within a custom-designed loss and attention mechanism. Our approach has the potential to speed up the process of generating new training datasets for the development of new machine learning and deep learning-based models for, but not exclusively, medical image analysis.

Qiaoying Huang, Dong Yang, Yikun Xian et al.

The accurate reconstruction of under-sampled magnetic resonance imaging (MRI) data using modern deep learning technology, requires significant effort to design the necessary complex neural network architectures. The cascaded network architecture for MRI reconstruction has been widely used, while it suffers from the "vanishing gradient" problem when the network becomes deep. In addition, homogeneous architecture degrades the representation capacity of the network. In this work, we present an enhanced MRI reconstruction network using a residual in residual basic block. For each cell in the basic block, we use the differentiable neural architecture search (NAS) technique to automatically choose the optimal operation among eight variants of the dense block. This new heterogeneous network is evaluated on two publicly available datasets and outperforms all current state-of-the-art methods, which demonstrates the effectiveness of our proposed method.

Meng Ye, Qiaoying Huang, Dong Yang et al.

The 3D volumetric shape of the heart's left ventricle (LV) myocardium (MYO) wall provides important information for diagnosis of cardiac disease and invasive procedure navigation. Many cardiac image segmentation methods have relied on detection of region-of-interest as a pre-requisite for shape segmentation and modeling. With segmentation results, a 3D surface mesh and a corresponding point cloud of the segmented cardiac volume can be reconstructed for further analyses. Although state-of-the-art methods (e.g., U-Net) have achieved decent performance on cardiac image segmentation in terms of accuracy, these segmentation results can still suffer from imaging artifacts and noise, which will lead to inaccurate shape modeling results. In this paper, we propose a PC-U net that jointly reconstructs the point cloud of the LV MYO wall directly from volumes of 2D CT slices and generates its segmentation masks from the predicted 3D point cloud. Extensive experimental results show that by incorporating a shape prior from the point cloud, the segmentation masks are more accurate than the state-of-the-art U-Net results in terms of Dice's coefficient and Hausdorff distance.The proposed joint learning framework of our PC-U net is beneficial for automatic cardiac image analysis tasks because it can obtain simultaneously the 3D shape and segmentation of the LV MYO walls.

Yonghui Xu, Shengjie Sun, Yuan Miao et al.

Knowledge graph embedding, which aims to learn the low-dimensional representations of entities and relationships, has attracted considerable research efforts recently. However, most knowledge graph embedding methods focus on the structural relationships in fixed triples while ignoring the temporal information. Currently, existing time-aware graph embedding methods only focus on the factual plausibility, while ignoring the temporal smoothness which models the interactions between a fact and its contexts, and thus can capture fine-granularity temporal relationships. This leads to the limited performance of embedding related applications. To solve this problem, this paper presents a Robustly Time-aware Graph Embedding (RTGE) method by incorporating temporal smoothness. Two major innovations of our paper are presented here. At first, RTGE integrates a measure of temporal smoothness in the learning process of the time-aware graph embedding. Via the proposed additional smoothing factor, RTGE can preserve both structural information and evolutionary patterns of a given graph. Secondly, RTGE provides a general task-oriented negative sampling strategy associated with temporally-aware information, which further improves the adaptive ability of the proposed algorithm and plays an essential role in obtaining superior performance in various tasks. Extensive experiments conducted on multiple benchmark tasks show that RTGE can increase performance in entity/relationship/temporal scoping prediction tasks.

Yingda Xia, Dong Yang, Zhiding Yu et al.

Although having achieved great success in medical image segmentation, deep learning-based approaches usually require large amounts of well-annotated data, which can be extremely expensive in the field of medical image analysis. Unlabeled data, on the other hand, is much easier to acquire. Semi-supervised learning and unsupervised domain adaptation both take the advantage of unlabeled data, and they are closely related to each other. In this paper, we propose uncertainty-aware multi-view co-training (UMCT), a unified framework that addresses these two tasks for volumetric medical image segmentation. Our framework is capable of efficiently utilizing unlabeled data for better performance. We firstly rotate and permute the 3D volumes into multiple views and train a 3D deep network on each view. We then apply co-training by enforcing multi-view consistency on unlabeled data, where an uncertainty estimation of each view is utilized to achieve accurate labeling. Experiments on the NIH pancreas segmentation dataset and a multi-organ segmentation dataset show state-of-the-art performance of the proposed framework on semi-supervised medical image segmentation. Under unsupervised domain adaptation settings, we validate the effectiveness of this work by adapting our multi-organ segmentation model to two pathological organs from the Medical Segmentation Decathlon Datasets. Additionally, we show that our UMCT-DA model can even effectively handle the challenging situation where labeled source data is inaccessible, demonstrating strong potentials for real-world applications.

Dong Yang, Holger Roth, Ziyue Xu et al.

Deep neural network (DNN) based approaches have been widely investigated and deployed in medical image analysis. For example, fully convolutional neural networks (FCN) achieve the state-of-the-art performance in several applications of 2D/3D medical image segmentation. Even the baseline neural network models (U-Net, V-Net, etc.) have been proven to be very effective and efficient when the training process is set up properly. Nevertheless, to fully exploit the potentials of neural networks, we propose an automated searching approach for the optimal training strategy with reinforcement learning. The proposed approach can be utilized for tuning hyper-parameters, and selecting necessary data augmentation with certain probabilities. The proposed approach is validated on several tasks of 3D medical image segmentation. The performance of the baseline model is boosted after searching, and it can achieve comparable accuracy to other manually-tuned state-of-the-art segmentation approaches.

Dong Yang, Holger Roth, Xiaosong Wang et al.

Object segmentation plays an important role in the modern medical image analysis, which benefits clinical study, disease diagnosis, and surgery planning. Given the various modalities of medical images, the automated or semi-automated segmentation approaches have been used to identify and parse organs, bones, tumors, and other regions-of-interest (ROI). However, these contemporary segmentation approaches tend to fail to predict the boundary areas of ROI, because of the fuzzy appearance contrast caused during the imaging procedure. To further improve the segmentation quality of boundary areas, we propose a boundary enhancement loss to enforce additional constraints on optimizing machine learning models. The proposed loss function is light-weighted and easy to implement without any pre- or post-processing. Our experimental results validate that our loss function are better than, or at least comparable to, other state-of-the-art loss functions in terms of segmentation accuracy.

Qihang Yu, Dong Yang, Holger Roth et al.

3D convolution neural networks (CNN) have been proved very successful in parsing organs or tumours in 3D medical images, but it remains sophisticated and time-consuming to choose or design proper 3D networks given different task contexts. Recently, Neural Architecture Search (NAS) is proposed to solve this problem by searching for the best network architecture automatically. However, the inconsistency between search stage and deployment stage often exists in NAS algorithms due to memory constraints and large search space, which could become more serious when applying NAS to some memory and time consuming tasks, such as 3D medical image segmentation. In this paper, we propose coarse-to-fine neural architecture search (C2FNAS) to automatically search a 3D segmentation network from scratch without inconsistency on network size or input size. Specifically, we divide the search procedure into two stages: 1) the coarse stage, where we search the macro-level topology of the network, i.e. how each convolution module is connected to other modules; 2) the fine stage, where we search at micro-level for operations in each cell based on previous searched macro-level topology. The coarse-to-fine manner divides the search procedure into two consecutive stages and meanwhile resolves the inconsistency. We evaluate our method on 10 public datasets from Medical Segmentation Decalthon (MSD) challenge, and achieve state-of-the-art performance with the network searched using one dataset, which demonstrates the effectiveness and generalization of our searched models.

Holger Roth, Wentao Zhu, Dong Yang et al.

In this work, we attempt the segmentation of cardiac structures in late gadolinium-enhanced (LGE) magnetic resonance images (MRI) using only minimal supervision in a two-step approach. In the first step, we register a small set of five LGE cardiac magnetic resonance (CMR) images with ground truth labels to a set of 40 target LGE CMR images without annotation. Each manually annotated ground truth provides labels of the myocardium and the left ventricle (LV) and right ventricle (RV) cavities, which are used as atlases. After multi-atlas label fusion by majority voting, we possess noisy labels for each of the targeted LGE images. A second set of manual labels exists for 30 patients of the target LGE CMR images, but are annotated on different MRI sequences (bSSFP and T2-weighted). Again, we use multi-atlas label fusion with a consistency constraint to further refine our noisy labels if additional annotations in other modalities are available for a given patient. In the second step, we train a deep convolutional network for semantic segmentation on the target data while using data augmentation techniques to avoid over-fitting to the noisy labels. After inference and simple post-processing, we achieve our final segmentation for the targeted LGE CMR images, resulting in an average Dice of 0.890, 0.780, and 0.844 for LV cavity, LV myocardium, and RV cavity, respectively.

Holger Roth, Ling Zhang, Dong Yang et al.

Annotation of medical images has been a major bottleneck for the development of accurate and robust machine learning models. Annotation is costly and time-consuming and typically requires expert knowledge, especially in the medical domain. Here, we propose to use minimal user interaction in the form of extreme point clicks in order to train a segmentation model that can, in turn, be used to speed up the annotation of medical images. We use extreme points in each dimension of a 3D medical image to constrain an initial segmentation based on the random walker algorithm. This segmentation is then used as a weak supervisory signal to train a fully convolutional network that can segment the organ of interest based on the provided user clicks. We show that the network's predictions can be refined through several iterations of training and prediction using the same weakly annotated data. Ultimately, our method has the potential to speed up the generation process of new training datasets for the development of new machine learning and deep learning-based models for, but not exclusively, medical image analysis.

Ziyue Xu, Xiaosong Wang, Hoo-Chang Shin et al.

Radiogenomic map linking image features and gene expression profiles is useful for noninvasively identifying molecular properties of a particular type of disease. Conventionally, such map is produced in three separate steps: 1) gene-clustering to "metagenes", 2) image feature extraction, and 3) statistical correlation between metagenes and image features. Each step is independently performed and relies on arbitrary measurements. In this work, we investigate the potential of an end-to-end method fusing gene data with image features to generate synthetic image and learn radiogenomic map simultaneously. To achieve this goal, we develop a generative adversarial network (GAN) conditioned on both background images and gene expression profiles, synthesizing the corresponding image. Image and gene features are fused at different scales to ensure the realism and quality of the synthesized image. We tested our method on non-small cell lung cancer (NSCLC) dataset. Results demonstrate that the proposed method produces realistic synthetic images, and provides a promising way to find gene-image relationship in a holistic end-to-end manner.

Andriy Myronenko, Dong Yang, Varun Buch et al.

We propose a 4D convolutional neural network (CNN) for the segmentation of retrospective ECG-gated cardiac CT, a series of single-channel volumetric data over time. While only a small subset of volumes in the temporal sequence is annotated, we define a sparse loss function on available labels to allow the network to leverage unlabeled images during training and generate a fully segmented sequence. We investigate the accuracy of the proposed 4D network to predict temporally consistent segmentations and compare with traditional 3D segmentation approaches. We demonstrate the feasibility of the 4D CNN and establish its performance on cardiac 4D CCTA.

Ling Zhang, Xiaosong Wang, Dong Yang et al.

Recent advances in deep learning for medical image segmentation demonstrate expert-level accuracy. However, in clinically realistic environments, such methods have marginal performance due to differences in image domains, including different imaging protocols, device vendors and patient populations. Here we consider the problem of domain generalization, when a model is trained once, and its performance generalizes to unseen domains. Intuitively, within a specific medical imaging modality the domain differences are smaller relative to natural images domain variability. We rethink data augmentation for medical 3D images and propose a deep stacked transformations (DST) approach for domain generalization. Specifically, a series of n stacked transformations are applied to each image in each mini-batch during network training to account for the contribution of domain-specific shifts in medical images. We comprehensively evaluate our method on three tasks: segmentation of whole prostate from 3D MRI, left atrial from 3D MRI, and left ventricle from 3D ultrasound. We demonstrate that when trained on a small source dataset, (i) on average, DST models on unseen datasets degrade only by 11% (Dice score change), compared to the conventional augmentation (degrading 39%) and CycleGAN-based domain adaptation method (degrading 25%); (ii) when evaluation on the same domain, DST is also better albeit only marginally. (iii) When training on large-sized data, DST on unseen domains reaches performance of state-of-the-art fully supervised models. These findings establish a strong benchmark for the study of domain generalization in medical imaging, and can be generalized to the design of robust deep segmentation models for clinical deployment.

Zhuotun Zhu, Chenxi Liu, Dong Yang et al.

Deep learning algorithms, in particular 2D and 3D fully convolutional neural networks (FCNs), have rapidly become the mainstream methodology for volumetric medical image segmentation. However, 2D convolutions cannot fully leverage the rich spatial information along the third axis, while 3D convolutions suffer from the demanding computation and high GPU memory consumption. In this paper, we propose to automatically search the network architecture tailoring to volumetric medical image segmentation problem. Concretely, we formulate the structure learning as differentiable neural architecture search, and let the network itself choose between 2D, 3D or Pseudo-3D (P3D) convolutions at each layer. We evaluate our method on 3 public datasets, i.e., the NIH Pancreas dataset, the Lung and Pancreas dataset from the Medical Segmentation Decathlon (MSD) Challenge. Our method, named V-NAS, consistently outperforms other state-of-the-arts on the segmentation task of both normal organ (NIH Pancreas) and abnormal organs (MSD Lung tumors and MSD Pancreas tumors), which shows the power of chosen architecture. Moreover, the searched architecture on one dataset can be well generalized to other datasets, which demonstrates the robustness and practical use of our proposed method.

Fengze Liu, Yingda Xia, Dong Yang et al.

It is usually hard for a learning system to predict correctly on rare events that never occur in the training data, and there is no exception for segmentation algorithms. Meanwhile, manual inspection of each case to locate the failures becomes infeasible due to the trend of large data scale and limited human resource. Therefore, we build an alarm system that will set off alerts when the segmentation result is possibly unsatisfactory, assuming no corresponding ground truth mask is provided. One plausible solution is to project the segmentation results into a low dimensional feature space; then learn classifiers/regressors to predict their qualities. Motivated by this, in this paper, we learn a feature space using the shape information which is a strong prior shared among different datasets and robust to the appearance variation of input data.The shape feature is captured using a Variational Auto-Encoder (VAE) network that trained with only the ground truth masks. During testing, the segmentation results with bad shapes shall not fit the shape prior well, resulting in large loss values. Thus, the VAE is able to evaluate the quality of segmentation result on unseen data, without using ground truth. Finally, we learn a regressor in the one-dimensional feature space to predict the qualities of segmentation results. Our alarm system is evaluated on several recent state-of-art segmentation algorithms for 3D medical segmentation tasks. Compared with other standard quality assessment methods, our system consistently provides more reliable prediction on the qualities of segmentation results.

Yingda Xia, Fengze Liu, Dong Yang et al.

While making a tremendous impact in various fields, deep neural networks usually require large amounts of labeled data for training which are expensive to collect in many applications, especially in the medical domain. Unlabeled data, on the other hand, is much more abundant. Semi-supervised learning techniques, such as co-training, could provide a powerful tool to leverage unlabeled data. In this paper, we propose a novel framework, uncertainty-aware multi-view co-training (UMCT), to address semi-supervised learning on 3D data, such as volumetric data from medical imaging. In our work, co-training is achieved by exploiting multi-viewpoint consistency of 3D data. We generate different views by rotating or permuting the 3D data and utilize asymmetrical 3D kernels to encourage diversified features in different sub-networks. In addition, we propose an uncertainty-weighted label fusion mechanism to estimate the reliability of each view's prediction with Bayesian deep learning. As one view requires the supervision from other views in co-training, our self-adaptive approach computes a confidence score for the prediction of each unlabeled sample in order to assign a reliable pseudo label. Thus, our approach can take advantage of unlabeled data during training. We show the effectiveness of our proposed semi-supervised method on several public datasets from medical image segmentation tasks (NIH pancreas & LiTS liver tumor dataset). Meanwhile, a fully-supervised method based on our approach achieved state-of-the-art performances on both the LiTS liver tumor segmentation and the Medical Segmentation Decathlon (MSD) challenge, demonstrating the robustness and value of our framework, even when fully supervised training is feasible.

Qiaoying Huang, Dong Yang, Pengxiang Wu et al.

We consider an MRI reconstruction problem with input of k-space data at a very low undersampled rate. This can practically benefit patient due to reduced time of MRI scan, but it is also challenging since quality of reconstruction may be compromised. Currently, deep learning based methods dominate MRI reconstruction over traditional approaches such as Compressed Sensing, but they rarely show satisfactory performance in the case of low undersampled k-space data. One explanation is that these methods treat channel-wise features equally, which results in degraded representation ability of the neural network. To solve this problem, we propose a new model called MRI Cascaded Channel-wise Attention Network (MICCAN), highlighted by three components: (i) a variant of U-net with Channel-wise Attention (UCA) module, (ii) a long skip connection and (iii) a combined loss. Our model is able to attend to salient information by filtering irrelevant features and also concentrate on high-frequency information by enforcing low-frequency information bypassed to the final output. We conduct both quantitative evaluation and qualitative analysis of our method on a cardiac dataset. The experiment shows that our method achieves very promising results in terms of three common metrics on the MRI reconstruction with low undersampled k-space data.

Shengjie Sun, Dong Yang, Hongchun Zhang et al.

The knowledge graph(KG) composed of entities with their descriptions and attributes, and relationship between entities, is finding more and more application scenarios in various natural language processing tasks. In a typical knowledge graph like Wikidata, entities usually have a large number of attributes, but it is difficult to know which ones are important. The importance of attributes can be a valuable piece of information in various applications spanning from information retrieval to natural language generation. In this paper, we propose a general method of using external user generated text data to evaluate the relative importance of an entity's attributes. To be more specific, we use the word/sub-word embedding techniques to match the external textual data back to entities' attribute name and values and rank the attributes by their matching cohesiveness. To our best knowledge, this is the first work of applying vector based semantic matching to important attribute identification, and our method outperforms the previous traditional methods. We also apply the outcome of the detected important attributes to a language generation task; compared with previous generated text, the new method generates much more customized and informative messages.

Dong Yang, Tao Xiong, Daguang Xu et al.

Automatic localization and labeling of vertebra in 3D medical images plays an important role in many clinical tasks, including pathological diagnosis, surgical planning and postoperative assessment. However, the unusual conditions of pathological cases, such as the abnormal spine curvature, bright visual imaging artifacts caused by metal implants, and the limited field of view, increase the difficulties of accurate localization. In this paper, we propose an automatic and fast algorithm to localize and label the vertebra centroids in 3D CT volumes. First, we deploy a deep image-to-image network (DI2IN) to initialize vertebra locations, employing the convolutional encoder-decoder architecture together with multi-level feature concatenation and deep supervision. Next, the centroid probability maps from DI2IN are iteratively evolved with the message passing schemes based on the mutual relation of vertebra centroids. Finally, the localization results are refined with sparsity regularization. The proposed method is evaluated on a public dataset of 302 spine CT volumes with various pathologies. Our method outperforms other state-of-the-art methods in terms of localization accuracy. The run time is around 3 seconds on average per case. To further boost the performance, we retrain the DI2IN on additional 1000+ 3D CT volumes from different patients. To the best of our knowledge, this is the first time more than 1000 3D CT volumes with expert annotation are adopted in experiments for the anatomic landmark detection tasks. Our experimental results show that training with such a large dataset significantly improves the performance and the overall identification rate, for the first time by our knowledge, reaches 90 %.