Aurélio Campilho

Jianning Li, Zongwei Zhou, Jiancheng Yang et al.

Prior to the deep learning era, shape was commonly used to describe the objects. Nowadays, state-of-the-art (SOTA) algorithms in medical imaging are predominantly diverging from computer vision, where voxel grids, meshes, point clouds, and implicit surface models are used. This is seen from numerous shape-related publications in premier vision conferences as well as the growing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models). For the medical domain, we present a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D models of surgical instrument, called MedShapeNet, created to facilitate the translation of data-driven vision algorithms to medical applications and to adapt SOTA vision algorithms to medical problems. As a unique feature, we directly model the majority of shapes on the imaging data of real patients. As of today, MedShapeNet includes 23 dataset with more than 100,000 shapes that are paired with annotations (ground truth). Our data is freely accessible via a web interface and a Python application programming interface (API) and can be used for discriminative, reconstructive, and variational benchmarks as well as various applications in virtual, augmented, or mixed reality, and 3D printing. Exemplary, we present use cases in the fields of classification of brain tumors, facial and skull reconstructions, multi-class anatomy completion, education, and 3D printing. In future, we will extend the data and improve the interfaces. The project pages are: https://medshapenet.ikim.nrw/ and https://github.com/Jianningli/medshapenet-feedback

Elvin Johnson, Shreshta Mohan, Alex Gaudio et al.

Advances in data-driven deep learning for chest X-ray image analysis underscore the need for explainability, privacy, large datasets and significant computational resources. We frame privacy and explainability as a lossy single-image compression problem to reduce both computational and data requirements without training. For Cardiomegaly detection in chest X-ray images, we propose HeartSpot and four spatial bias priors. HeartSpot priors define how to sample pixels based on domain knowledge from medical literature and from machines. HeartSpot privatizes chest X-ray images by discarding up to 97% of pixels, such as those that reveal the shape of the thoracic cage, bones, small lesions and other sensitive features. HeartSpot priors are ante-hoc explainable and give a human-interpretable image of the preserved spatial features that clearly outlines the heart. HeartSpot offers strong compression, with up to 32x fewer pixels and 11x smaller filesize. Cardiomegaly detectors using HeartSpot are up to 9x faster to train or at least as accurate (up to +.01 AUC ROC) when compared to a baseline DenseNet121. HeartSpot is post-hoc explainable by re-using existing attribution methods without requiring access to the original non-privatized image. In summary, HeartSpot improves speed and accuracy, reduces image size, improves privacy and ensures explainability. Source code: https://www.github.com/adgaudio/HeartSpot

Simon Graham, Quoc Dang Vu, Mostafa Jahanifar et al.

Nuclear detection, segmentation and morphometric profiling are essential in helping us further understand the relationship between histology and patient outcome. To drive innovation in this area, we setup a community-wide challenge using the largest available dataset of its kind to assess nuclear segmentation and cellular composition. Our challenge, named CoNIC, stimulated the development of reproducible algorithms for cellular recognition with real-time result inspection on public leaderboards. We conducted an extensive post-challenge analysis based on the top-performing models using 1,658 whole-slide images of colon tissue. With around 700 million detected nuclei per model, associated features were used for dysplasia grading and survival analysis, where we demonstrated that the challenge's improvement over the previous state-of-the-art led to significant boosts in downstream performance. Our findings also suggest that eosinophils and neutrophils play an important role in the tumour microevironment. We release challenge models and WSI-level results to foster the development of further methods for biomarker discovery.

Pedro Costa, Yongpan Fu, João Nunes et al.

Cancer is one of the leading causes of death in the developed world. Cancer diagnosis is performed through the microscopic analysis of a sample of suspicious tissue. This process is time consuming and error prone, but Deep Learning models could be helpful for pathologists during cancer diagnosis. We propose to change the CenterNet2 object detection model to also perform instance segmentation, which we call SegCenterNet2. We train SegCenterNet2 in the CoNIC challenge dataset and show that it performs better than Mask R-CNN in the competition metrics.

Alex Gaudio, Asim Smailagic, Aurélio Campilho

We propose a pixel color amplification theory and family of enhancement methods to facilitate segmentation tasks on retinal images. Our novel re-interpretation of the image distortion model underlying dehazing theory shows how three existing priors commonly used by the dehazing community and a novel fourth prior are related. We utilize the theory to develop a family of enhancement methods for retinal images, including novel methods for whole image brightening and darkening. We show a novel derivation of the Unsharp Masking algorithm. We evaluate the enhancement methods as a pre-processing step to a challenging multi-task segmentation problem and show large increases in performance on all tasks, with Dice score increases over a no-enhancement baseline by as much as 0.491. We provide evidence that our enhancement preprocessing is useful for unbalanced and difficult data. We show that the enhancements can perform class balancing by composing them together.

Asim Smailagic, Anupma Sharan, Pedro Costa et al.

Diabetic Retinopathy is the leading cause of blindness in the working-age population of the world. The main aim of this paper is to improve the accuracy of Diabetic Retinopathy detection by implementing a shadow removal and color correction step as a preprocessing stage from eye fundus images. For this, we rely on recent findings indicating that application of image dehazing on the inverted intensity domain amounts to illumination compensation. Inspired by this work, we propose a Shadow Removal Layer that allows us to learn the pre-processing function for a particular task. We show that learning the pre-processing function improves the performance of the network on the Diabetic Retinopathy detection task.

João Pedrosa, Guilherme Aresta, Carlos Ferreira et al.

Lung cancer is the deadliest type of cancer worldwide and late detection is the major factor for the low survival rate of patients. Low dose computed tomography has been suggested as a potential screening tool but manual screening is costly, time-consuming and prone to variability. This has fueled the development of automatic methods for the detection, segmentation and characterisation of pulmonary nodules but its application to clinical routine is challenging. In this study, a new database for the development and testing of pulmonary nodule computer-aided strategies is presented which intends to complement current databases by giving additional focus to radiologist variability and local clinical reality. State-of-the-art nodule detection, segmentation and characterization methods are tested and compared to manual annotations as well as collaborative strategies combining multiple radiologists and radiologists and computer-aided systems. It is shown that state-of-the-art methodologies can determine a patient's follow-up recommendation as accurately as a radiologist, though the nodule detection method used shows decreased performance in this database.

Teresa Araújo, Guilherme Aresta, Luís Mendonça et al.

Diabetic retinopathy (DR) grading is crucial in determining the adequate treatment and follow up of patients, but the screening process can be tiresome and prone to errors. Deep learning approaches have shown promising performance as computer-aided diagnosis(CAD) systems, but their black-box behaviour hinders the clinical application. We propose DR$\vert$GRADUATE, a novel deep learning-based DR grading CAD system that supports its decision by providing a medically interpretable explanation and an estimation of how uncertain that prediction is, allowing the ophthalmologist to measure how much that decision should be trusted. We designed DR$\vert$GRADUATE taking into account the ordinal nature of the DR grading problem. A novel Gaussian-sampling approach built upon a Multiple Instance Learning framework allow DR$\vert$GRADUATE to infer an image grade associated with an explanation map and a prediction uncertainty while being trained only with image-wise labels. DR$\vert$GRADUATE was trained on the Kaggle training set and evaluated across multiple datasets. In DR grading, a quadratic-weighted Cohen's kappa (QWK) between 0.71 and 0.84 was achieved in five different datasets. We show that high QWK values occur for images with low prediction uncertainty, thus indicating that this uncertainty is a valid measure of the predictions' quality. Further, bad quality images are generally associated with higher uncertainties, showing that images not suitable for diagnosis indeed lead to less trustworthy predictions. Additionally, tests on unfamiliar medical image data types suggest that DR$\vert$GRADUATE allows outlier detection. The attention maps generally highlight regions of interest for diagnosis. These results show the great potential of DR$\vert$GRADUATE as a second-opinion system in DR severity grading.

Guilherme Aresta, Carlos Ferreira, João Pedrosa et al.

Early diagnosis of lung cancer via computed tomography can significantly reduce the morbidity and mortality rates associated with the pathology. However, search lung nodules is a high complexity task, which affects the success of screening programs. Whilst computer-aided detection systems can be used as second observers, they may bias radiologists and introduce significant time overheads. With this in mind, this study assesses the potential of using gaze information for integrating automatic detection systems in the clinical practice. For that purpose, 4 radiologists were asked to annotate 20 scans from a public dataset while being monitored by an eye tracker device and an automatic lung nodule detection system was developed. Our results show that radiologists follow a similar search routine and tend to have lower fixation periods in regions where finding errors occur. The overall detection sensitivity of the specialists was 0.67$\pm$0.07, whereas the system achieved 0.69. Combining the annotations of one radiologist with the automatic system significantly improves the detection performance to similar levels of two annotators. Likewise, combining the findings of radiologist with the detection algorithm only for low fixation regions still significantly improves the detection sensitivity without increasing the number of false-positives. The combination of the automatic system with the gaze information allows to mitigate possible errors of the radiologist without some of the issues usually associated with automatic detection system.

Asim Smailagic, Pedro Costa, Alex Gaudio et al.

Active Learning methods create an optimized labeled training set from unlabeled data. We introduce a novel Online Active Deep Learning method for Medical Image Analysis. We extend our MedAL active learning framework to present new results in this paper. Our novel sampling method queries the unlabeled examples that maximize the average distance to all training set examples. Our online method enhances performance of its underlying baseline deep network. These novelties contribute significant performance improvements, including improving the model's underlying deep network accuracy by 6.30%, using only 25% of the labeled dataset to achieve baseline accuracy, reducing backpropagated images during training by as much as 67%, and demonstrating robustness to class imbalance in binary and multi-class tasks.

Guilherme Aresta, Colin Jacobs, Teresa Araújo et al.

We propose iW-Net, a deep learning model that allows for both automatic and interactive segmentation of lung nodules in computed tomography images. iW-Net is composed of two blocks: the first one provides an automatic segmentation and the second one allows to correct it by analyzing 2 points introduced by the user in the nodule's boundary. For this purpose, a physics inspired weight map that takes the user input into account is proposed, which is used both as a feature map and in the system's loss function. Our approach is extensively evaluated on the public LIDC-IDRI dataset, where we achieve a state-of-the-art performance of 0.55 intersection over union vs the 0.59 inter-observer agreement. Also, we show that iW-Net allows to correct the segmentation of small nodules, essential for proper patient referral decision, as well as improve the segmentation of the challenging non-solid nodules and thus may be an important tool for increasing the early diagnosis of lung cancer.

Teresa Araújo, Guilherme Aresta, Adrian Galdran et al.

We propose UOLO, a novel framework for the simultaneous detection and segmentation of structures of interest in medical images. UOLO consists of an object segmentation module which intermediate abstract representations are processed and used as input for object detection. The resulting system is optimized simultaneously for detecting a class of objects and segmenting an optionally different class of structures. UOLO is trained on a set of bounding boxes enclosing the objects to detect, as well as pixel-wise segmentation information, when available. A new loss function is devised, taking into account whether a reference segmentation is accessible for each training image, in order to suitably backpropagate the error. We validate UOLO on the task of simultaneous optic disc (OD) detection, fovea detection, and OD segmentation from retinal images, achieving state-of-the-art performance on public datasets.

Guilherme Aresta, Teresa Araújo, Scotty Kwok et al.

Breast cancer is the most common invasive cancer in women, affecting more than 10% of women worldwide. Microscopic analysis of a biopsy remains one of the most important methods to diagnose the type of breast cancer. This requires specialized analysis by pathologists, in a task that i) is highly time- and cost-consuming and ii) often leads to nonconsensual results. The relevance and potential of automatic classification algorithms using hematoxylin-eosin stained histopathological images has already been demonstrated, but the reported results are still sub-optimal for clinical use. With the goal of advancing the state-of-the-art in automatic classification, the Grand Challenge on BreAst Cancer Histology images (BACH) was organized in conjunction with the 15th International Conference on Image Analysis and Recognition (ICIAR 2018). A large annotated dataset, composed of both microscopy and whole-slide images, was specifically compiled and made publicly available for the BACH challenge. Following a positive response from the scientific community, a total of 64 submissions, out of 677 registrations, effectively entered the competition. From the submitted algorithms it was possible to push forward the state-of-the-art in terms of accuracy (87%) in automatic classification of breast cancer with histopathological images. Convolutional neuronal networks were the most successful methodology in the BACH challenge. Detailed analysis of the collective results allowed the identification of remaining challenges in the field and recommendations for future developments. The BACH dataset remains publically available as to promote further improvements to the field of automatic classification in digital pathology.

Adrian Galdran, Aitor Alvarez-Gila, Maria Ines Meyer et al.

Dermoscopic skin images are often obtained with different imaging devices, under varying acquisition conditions. In this work, instead of attempting to perform intensity and color normalization, we propose to leverage computational color constancy techniques to build an artificial data augmentation technique suitable for this kind of images. Specifically, we apply the \emph{shades of gray} color constancy technique to color-normalize the entire training set of images, while retaining the estimated illuminants. We then draw one sample from the distribution of training set illuminants and apply it on the normalized image. We employ this technique for training two deep convolutional neural networks for the tasks of skin lesion segmentation and skin lesion classification, in the context of the ISIC 2017 challenge and without using any external dermatologic image set. Our results on the validation set are promising, and will be supplemented with extended results on the hidden test set when available.

Pedro Costa, Adrian Galdran, Maria Inês Meyer et al.

Synthesizing images of the eye fundus is a challenging task that has been previously approached by formulating complex models of the anatomy of the eye. New images can then be generated by sampling a suitable parameter space. In this work, we propose a method that learns to synthesize eye fundus images directly from data. For that, we pair true eye fundus images with their respective vessel trees, by means of a vessel segmentation technique. These pairs are then used to learn a mapping from a binary vessel tree to a new retinal image. For this purpose, we use a recent image-to-image translation technique, based on the idea of adversarial learning. Experimental results show that the original and the generated images are visually different in terms of their global appearance, in spite of sharing the same vessel tree. Additionally, a quantitative quality analysis of the synthetic retinal images confirms that the produced images retain a high proportion of the true image set quality.