Daniel L. Rubin

Siyi Tang, Jared A. Dunnmon, Liangqiong Qu et al. · stanford

Multivariate biosignals are prevalent in many medical domains, such as electroencephalography, polysomnography, and electrocardiography. Modeling spatiotemporal dependencies in multivariate biosignals is challenging due to (1) long-range temporal dependencies and (2) complex spatial correlations between the electrodes. To address these challenges, we propose representing multivariate biosignals as time-dependent graphs and introduce GraphS4mer, a general graph neural network (GNN) architecture that improves performance on biosignal classification tasks by modeling spatiotemporal dependencies in biosignals. Specifically, (1) we leverage the Structured State Space architecture, a state-of-the-art deep sequence model, to capture long-range temporal dependencies in biosignals and (2) we propose a graph structure learning layer in GraphS4mer to learn dynamically evolving graph structures in the data. We evaluate our proposed model on three distinct biosignal classification tasks and show that GraphS4mer consistently improves over existing models, including (1) seizure detection from electroencephalographic signals, outperforming a previous GNN with self-supervised pre-training by 3.1 points in AUROC; (2) sleep staging from polysomnographic signals, a 4.1 points improvement in macro-F1 score compared to existing sleep staging models; and (3) 12-lead electrocardiogram classification, outperforming previous state-of-the-art models by 2.7 points in macro-F1 score.

Nandita Bhaskhar, Daniel L. Rubin, Christopher Lee-Messer · stanford

Continuous monitoring of trained ML models to determine when their predictions should and should not be trusted is essential for their safe deployment. Such a framework ought to be high-performing, explainable, post-hoc and actionable. We propose TRUST-LAPSE, a "mistrust" scoring framework for continuous model monitoring. We assess the trustworthiness of each input sample's model prediction using a sequence of latent-space embeddings. Specifically, (a) our latent-space mistrust score estimates mistrust using distance metrics (Mahalanobis distance) and similarity metrics (cosine similarity) in the latent-space and (b) our sequential mistrust score determines deviations in correlations over the sequence of past input representations in a non-parametric, sliding-window based algorithm for actionable continuous monitoring. We evaluate TRUST-LAPSE via two downstream tasks: (1) distributionally shifted input detection, and (2) data drift detection. We evaluate across diverse domains - audio and vision using public datasets and further benchmark our approach on challenging, real-world electroencephalograms (EEG) datasets for seizure detection. Our latent-space mistrust scores achieve state-of-the-art results with AUROCs of 84.1 (vision), 73.9 (audio), and 77.1 (clinical EEGs), outperforming baselines by over 10 points. We expose critical failures in popular baselines that remain insensitive to input semantic content, rendering them unfit for real-world model monitoring. We show that our sequential mistrust scores achieve high drift detection rates; over 90% of the streams show < 20% error for all domains. Through extensive qualitative and quantitative evaluations, we show that our mistrust scores are more robust and provide explainability for easy adoption into practice.

Vignav Ramesh, Blaine Rister, Daniel L. Rubin

Chest X-rays of coronavirus disease 2019 (COVID-19) patients are frequently obtained to determine the extent of lung disease and are a valuable source of data for creating artificial intelligence models. Most work to date assessing disease severity on chest imaging has focused on segmenting computed tomography (CT) images; however, given that CTs are performed much less frequently than chest X-rays for COVID-19 patients, automated lung lesion segmentation on chest X-rays could be clinically valuable. There currently exists a universal shortage of chest X-rays with ground truth COVID-19 lung lesion annotations, and manually contouring lung opacities is a tedious, labor-intensive task. To accelerate severity detection and augment the amount of publicly available chest X-ray training data for supervised deep learning (DL) models, we leverage existing annotated CT images to generate frontal projection "chest X-ray" images for training COVID-19 chest X-ray models. In this paper, we propose an automated pipeline for segmentation of COVID-19 lung lesions on chest X-rays comprised of a Mask R-CNN trained on a mixed dataset of open-source chest X-rays and coronal X-ray projections computed from annotated volumetric CTs. On a test set containing 40 chest X-rays of COVID-19 positive patients, our model achieved IoU scores of 0.81 $\pm$ 0.03 and 0.79 $\pm$ 0.03 when trained on a dataset of 60 chest X-rays and on a mixed dataset of 10 chest X-rays and 50 projections from CTs, respectively. Our model far outperforms current baselines with limited supervised training and may assist in automated COVID-19 severity quantification on chest X-rays.

Balasubramanian Narasimhan, Daniel L. Rubin, Samuel M. Gross et al.

Bringing together the information latent in distributed medical databases promises to personalize medical care by enabling reliable, stable modeling of outcomes with rich feature sets (including patient characteristics and treatments received). However, there are barriers to aggregation of medical data, due to lack of standardization of ontologies, privacy concerns, proprietary attitudes toward data, and a reluctance to give up control over end use. Aggregation of data is not always necessary for model fitting. In models based on maximizing a likelihood, the computations can be distributed, with aggregation limited to the intermediate results of calculations on local data, rather than raw data. Distributed fitting is also possible for singular value decomposition. There has been work on the technical aspects of shared computation for particular applications, but little has been published on the software needed to support the "social networking" aspect of shared computing, to reduce the barriers to collaboration. We describe a set of software tools that allow the rapid assembly of a collaborative computational project, based on the flexible and extensible R statistical software and other open source packages, that can work across a heterogeneous collection of database environments, with full transparency to allow local officials concerned with privacy protections to validate the safety of the method. We describe the principles, architecture, and successful test results for the site-stratified Cox model and rank-k Singular Value Decomposition (SVD).

Alexander Berdichevsky, Mor Peleg, Daniel L. Rubin

Objective. Mammography reports document the diagnosis of patients' conditions. However, many reports contain non-standard terms (non-BI-RADS descriptors) and incomplete statements, which can lead to conclusions that are not well-supported by the reported findings. Our aim was to develop a tool to detect such discrepancies by comparing the reported conclusions to those that would be expected based on the reported radiology findings. Materials and Methods. A deidentified data set from an academic hospital containing 258 mammography reports supplemented by 120 reports found on the web was used for training and evaluation. Spell checking and term normalization was used to unambiguously determine the reported BI-RADS descriptors. The resulting data were input into seven classifiers that classify mammography reports, based on their Findings sections, into seven BI-RADS final assessment categories. Finally, the semantic similarity score of a report to each BI-RADS category is reported. Results. Our term normalization algorithm correctly identified 97% of the BI-RADS descriptors in mammography reports. Our system provided 76% precision and 83% recall in correctly classifying the reports according to BI-RADS final assessment category. Discussion. The strength of our approach relies on providing high importance to BI-RADS terms in the summarization phase, on the semantic similarity that considers the complex data representation, and on the classification into all seven BI-RADs categories. Conclusion. BI-RADS descriptors and expected final assessment categories could be automatically detected by our approach with fairly good accuracy, which could be used to make users aware that their reported findings do not match well with their conclusion.

Miao Zhang, Liangqiong Qu, Praveer Singh et al.

Federated learning is an emerging research paradigm for enabling collaboratively training deep learning models without sharing patient data. However, the data from different institutions are usually heterogeneous across institutions, which may reduce the performance of models trained using federated learning. In this study, we propose a novel heterogeneity-aware federated learning method, SplitAVG, to overcome the performance drops from data heterogeneity in federated learning. Unlike previous federated methods that require complex heuristic training or hyper parameter tuning, our SplitAVG leverages the simple network split and feature map concatenation strategies to encourage the federated model training an unbiased estimator of the target data distribution. We compare SplitAVG with seven state-of-the-art federated learning methods, using centrally hosted training data as the baseline on a suite of both synthetic and real-world federated datasets. We find that the performance of models trained using all the comparison federated learning methods degraded significantly with the increasing degrees of data heterogeneity. In contrast, SplitAVG method achieves comparable results to the baseline method under all heterogeneous settings, that it achieves 96.2% of the accuracy and 110.4% of the mean absolute error obtained by the baseline in a diabetic retinopathy binary classification dataset and a bone age prediction dataset, respectively, on highly heterogeneous data partitions. We conclude that SplitAVG method can effectively overcome the performance drops from variability in data distributions across institutions. Experimental results also show that SplitAVG can be adapted to different base networks and generalized to various types of medical imaging tasks.

Siyi Tang, Jared A. Dunnmon, Khaled Saab et al.

Automated seizure detection and classification from electroencephalography (EEG) can greatly improve seizure diagnosis and treatment. However, several modeling challenges remain unaddressed in prior automated seizure detection and classification studies: (1) representing non-Euclidean data structure in EEGs, (2) accurately classifying rare seizure types, and (3) lacking a quantitative interpretability approach to measure model ability to localize seizures. In this study, we address these challenges by (1) representing the spatiotemporal dependencies in EEGs using a graph neural network (GNN) and proposing two EEG graph structures that capture the electrode geometry or dynamic brain connectivity, (2) proposing a self-supervised pre-training method that predicts preprocessed signals for the next time period to further improve model performance, particularly on rare seizure types, and (3) proposing a quantitative model interpretability approach to assess a model's ability to localize seizures within EEGs. When evaluating our approach on seizure detection and classification on a large public dataset, we find that our GNN with self-supervised pre-training achieves 0.875 Area Under the Receiver Operating Characteristic Curve on seizure detection and 0.749 weighted F1-score on seizure classification, outperforming previous methods for both seizure detection and classification. Moreover, our self-supervised pre-training strategy significantly improves classification of rare seizure types. Furthermore, quantitative interpretability analysis shows that our GNN with self-supervised pre-training precisely localizes 25.4% focal seizures, a 21.9 point improvement over existing CNNs. Finally, by superimposing the identified seizure locations on both raw EEG signals and EEG graphs, our approach could provide clinicians with an intuitive visualization of localized seizure regions.

Sharut Gupta, Praveer Singh, Ken Chang et al.

Model brittleness is a key concern when deploying deep learning models in real-world medical settings. A model that has high performance at one institution may suffer a significant decline in performance when tested at other institutions. While pooling datasets from multiple institutions and retraining may provide a straightforward solution, it is often infeasible and may compromise patient privacy. An alternative approach is to fine-tune the model on subsequent institutions after training on the original institution. Notably, this approach degrades model performance at the original institution, a phenomenon known as catastrophic forgetting. In this paper, we develop an approach to address catastrophic forget-ting based on elastic weight consolidation combined with modulation of batch normalization statistics under two scenarios: first, for expanding the domain from one imaging system's data to another imaging system's, and second, for expanding the domain from a large multi-institutional dataset to another single institution dataset. We show that our approach outperforms several other state-of-the-art approaches and provide theoretical justification for the efficacy of batch normalization modulation. The results of this study are generally applicable to the deployment of any clinical deep learning model which requires domain expansion.

Rikiya Yamashita, Jin Long, Snikitha Banda et al.

Suboptimal generalization of machine learning models on unseen data is a key challenge which hampers the clinical applicability of such models to medical imaging. Although various methods such as domain adaptation and domain generalization have evolved to combat this challenge, learning robust and generalizable representations is core to medical image understanding, and continues to be a problem. Here, we propose STRAP (Style TRansfer Augmentation for histoPathology), a form of data augmentation based on random style transfer from non-medical style source such as artistic paintings, for learning domain-agnostic visual representations in computational pathology. Style transfer replaces the low-level texture content of an image with the uninformative style of randomly selected style source image, while preserving the original high-level semantic content. This improves robustness to domain shift and can be used as a simple yet powerful tool for learning domain-agnostic representations. We demonstrate that STRAP leads to state-of-the-art performance, particularly in the presence of domain shifts, on two particular classification tasks in computational pathology.

Siyi Tang, Amirata Ghorbani, Rikiya Yamashita et al.

The reliability of machine learning models can be compromised when trained on low quality data. Many large-scale medical imaging datasets contain low quality labels extracted from sources such as medical reports. Moreover, images within a dataset may have heterogeneous quality due to artifacts and biases arising from equipment or measurement errors. Therefore, algorithms that can automatically identify low quality data are highly desired. In this study, we used data Shapley, a data valuation metric, to quantify the value of training data to the performance of a pneumonia detection algorithm in a large chest X-ray dataset. We characterized the effectiveness of data Shapley in identifying low quality versus valuable data for pneumonia detection. We found that removing training data with high Shapley values decreased the pneumonia detection performance, whereas removing data with low Shapley values improved the model performance. Furthermore, there were more mislabeled examples in low Shapley value data and more true pneumonia cases in high Shapley value data. Our results suggest that low Shapley value indicates mislabeled or poor quality images, whereas high Shapley value indicates data that are valuable for pneumonia detection. Our method can serve as a framework for using data Shapley to denoise large-scale medical imaging datasets.

Blaine Rister, Daniel L. Rubin

Neuron death is a complex phenomenon with implications for model trainability: the deeper the network, the lower the probability of finding a valid initialization. In this work, we derive both upper and lower bounds on the probability that a ReLU network is initialized to a trainable point, as a function of model hyperparameters. We show that it is possible to increase the depth of a network indefinitely, so long as the width increases as well. Furthermore, our bounds are asymptotically tight under reasonable assumptions: first, the upper bound coincides with the true probability for a single-layer network with the largest possible input set. Second, the true probability converges to our lower bound as the input set shrinks to a single point, or as the network complexity grows under an assumption about the output variance. We confirm these results by numerical simulation, showing rapid convergence to the lower bound with increasing network depth. Then, motivated by the theory, we propose a practical sign flipping scheme which guarantees that the ratio of living data points in a $k$-layer network is at least $2^{-k}$. Finally, we show how these issues are mitigated by network design features currently seen in practice, such as batch normalization, residual connections, dense networks and skip connections. This suggests that neuron death may provide insight into the efficacy of various model architectures.

Okyaz Eminaga, Mahmoud Abbas, Christian Kunder et al.

Different convolutional neural network (CNN) models have been tested for their application in histological image analyses. However, these models are prone to overfitting due to their large parameter capacity, requiring more data or valuable computational resources for model training. Given these limitations, we introduced a novel architecture (termed PlexusNet). We utilized 310 Hematoxylin and Eosin stained (H&E) annotated histological images of prostate cancer cases from TCGA-PRAD and Stanford University and 398 H&E whole slides images from the Camelyon 2016 challenge. PlexusNet-architecture -derived models were compared to models derived from several existing "state of the art" architectures. We measured discrimination accuracy, calibration, and clinical utility. An ablation study was conducted to study the effect of each component of PlexusNet on model performance. A well-fitted PlexusNet-based model delivered comparable classification performance (AUC: 0.963) in distinguishing prostate cancer from healthy tissues, although it was at least 23 times smaller, had a better model calibration and clinical utility than the comparison models. A separate smaller PlexusNet model accurately detected slides with breast cancer metastases (AUC: 0.978); it helped reduce the slide number to examine by 43.8% without consequences, although its parameter capacity was 200 times smaller than ResNet18. We found that the partitioning of the development set influences the model calibration for all models. However, with PlexusNet architecture, we could achieve comparable well-calibrated models trained on different partitions. In conclusion, PlexusNet represents a novel model architecture for histological image analysis that achieves classification performance comparable to other models while providing orders-of-magnitude parameter reduction.

Assaf Hoogi, Brian Wilcox, Yachee Gupta et al.

We propose a novel architecture for object classification, called Self-Attention Capsule Networks (SACN). SACN is the first model that incorporates the Self-Attention mechanism as an integral layer within the Capsule Network (CapsNet). While the Self-Attention mechanism supplies a long-range dependencies, results in selecting the more dominant image regions to focus on, the CapsNet analyzes the relevant features and their spatial correlations inside these regions only. The features are extracted in the convolutional layer. Then, the Self-Attention layer learns to suppress irrelevant regions based on features analysis and highlights salient features useful for a specific task. The attention map is then fed into the CapsNet primary layer that is followed by a classification layer. The proposed SACN model was designed to solve two main limitations of the baseline CapsNet - analysis of complex data and significant computational load. In this work, we use a shallow CapsNet architecture and compensates for the absence of a deeper network by using the Self-Attention module to significantly improve the results. The proposed Self-Attention CapsNet architecture was extensively evaluated on six different datasets, mainly on three different medical sets, in addition to the natural MNIST, SVHN and CIFAR10. The model was able to classify images and their patches with diverse and complex backgrounds better than the baseline CapsNet. As a result, the proposed Self-Attention CapsNet significantly improved classification performance within and across different datasets and outperformed the baseline CapsNet, ResNet-18 and DenseNet-40 not only in classification accuracy but also in robustness.

Endre Grøvik, Darvin Yi, Michael Iv et al.

Detecting and segmenting brain metastases is a tedious and time-consuming task for many radiologists, particularly with the growing use of multi-sequence 3D imaging. This study demonstrates automated detection and segmentation of brain metastases on multi-sequence MRI using a deep learning approach based on a fully convolution neural network (CNN). In this retrospective study, a total of 156 patients with brain metastases from several primary cancers were included. Pre-therapy MR images (1.5T and 3T) included pre- and post-gadolinium T1-weighted 3D fast spin echo, post-gadolinium T1-weighted 3D axial IR-prepped FSPGR, and 3D fluid attenuated inversion recovery. The ground truth was established by manual delineation by two experienced neuroradiologists. CNN training/development was performed using 100 and 5 patients, respectively, with a 2.5D network based on a GoogLeNet architecture. The results were evaluated in 51 patients, equally separated into those with few (1-3), multiple (4-10), and many (>10) lesions. Network performance was evaluated using precision, recall, Dice/F1 score, and ROC-curve statistics. For an optimal probability threshold, detection and segmentation performance was assessed on a per metastasis basis. The area under the ROC-curve (AUC), averaged across all patients, was 0.98. The AUC in the subgroups was 0.99, 0.97, and 0.97 for patients having 1-3, 4-10, and >10 metastases, respectively. Using an average optimal probability threshold determined by the development set, precision, recall, and Dice-score were 0.79, 0.53, and 0.79, respectively. At the same probability threshold, the network showed an average false positive rate of 8.3/patient (no lesion-size limit) and 3.4/patient (10 mm3 lesion size limit). In conclusion, a deep learning approach using multi-sequence MRI can aid in the detection and segmentation of brain metastases.

Blaine Rister, Darvin Yi, Kaushik Shivakumar et al.

Fully-convolutional neural networks have achieved superior performance in a variety of image segmentation tasks. However, their training requires laborious manual annotation of large datasets, as well as acceleration by parallel processors with high-bandwidth memory, such as GPUs. We show that simple models can achieve competitive accuracy for organ segmentation on CT images when trained with extensive data augmentation, which leverages existing graphics hardware to quickly apply geometric and photometric transformations to 3D image data. On 3 mm^3 CT volumes, our GPU implementation is 2.6-8X faster than a widely-used CPU version, including communication overhead. We also show how to automatically generate training labels using rudimentary morphological operations, which are efficiently computed by 3D Fourier transforms. We combined fully-automatic labels for the lungs and bone with semi-automatic ones for the liver, kidneys and bladder, to create a dataset of 130 labeled CT scans. To achieve the best results from data augmentation, our model uses the intersection-over-union (IOU) loss function, a close relative of the Dice loss. We discuss its mathematical properties and explain why it outperforms the usual weighted cross-entropy loss for unbalanced segmentation tasks. We conclude that there is no unique IOU loss function, as the naive one belongs to a broad family of functions with the same essential properties. When combining data augmentation with the IOU loss, our model achieves a Dice score of 78-92% for each organ. The trained model, code and dataset will be made publicly available, to further medical imaging research.

Imon Banerjee, Hailey H. Choi, Terry Desser et al.

We propose a scalable computerized approach for large-scale inference of Liver Imaging Reporting and Data System (LI-RADS) final assessment categories in narrative ultrasound (US) reports. Although our model was trained on reports created using a LI-RADS template, it was also able to infer LI-RADS scoring for unstructured reports that were created before the LI-RADS guidelines were established. No human-labelled data was required in any step of this study; for training, LI-RADS scores were automatically extracted from those reports that contained structured LI-RADS scores, and it translated the derived knowledge to reasoning on unstructured radiology reports. By providing automated LI-RADS categorization, our approach may enable standardizing screening recommendations and treatment planning of patients at risk for hepatocellular carcinoma, and it may facilitate AI-based healthcare research with US images by offering large scale text mining and data gathering opportunities from standard hospital clinical data repositories.

Imon Banerjee, Michael Francis Gensheimer, Douglas J. Wood et al.

We propose a deep learning model - Probabilistic Prognostic Estimates of Survival in Metastatic Cancer Patients (PPES-Met) for estimating short-term life expectancy (3 months) of the patients by analyzing free-text clinical notes in the electronic medical record, while maintaining the temporal visit sequence. In a single framework, we integrated semantic data mapping and neural embedding technique to produce a text processing method that extracts relevant information from heterogeneous types of clinical notes in an unsupervised manner, and we designed a recurrent neural network to model the temporal dependency of the patient visits. The model was trained on a large dataset (10,293 patients) and validated on a separated dataset (1818 patients). Our method achieved an area under the ROC curve (AUC) of 0.89. To provide explain-ability, we developed an interactive graphical tool that may improve physician understanding of the basis for the model's predictions. The high accuracy and explain-ability of the PPES-Met model may enable our model to be used as a decision support tool to personalize metastatic cancer treatment and provide valuable assistance to the physicians.

Imon Banerjee, Sriraman Madhavan, Roger Eric Goldman et al.

Radiology reports are a rich resource for advancing deep learning applications in medicine by leveraging the large volume of data continuously being updated, integrated, and shared. However, there are significant challenges as well, largely due to the ambiguity and subtlety of natural language. We propose a hybrid strategy that combines semantic-dictionary mapping and word2vec modeling for creating dense vector embeddings of free-text radiology reports. Our method leverages the benefits of both semantic-dictionary mapping as well as unsupervised learning. Using the vector representation, we automatically classify the radiology reports into three classes denoting confidence in the diagnosis of intracranial hemorrhage by the interpreting radiologist. We performed experiments with varying hyperparameter settings of the word embeddings and a range of different classifiers. Best performance achieved was a weighted precision of 88% and weighted recall of 90%. Our work offers the potential to leverage unstructured electronic health record data by allowing direct analysis of narrative clinical notes.

Paroma Varma, Bryan He, Payal Bajaj et al.

Obtaining enough labeled data to robustly train complex discriminative models is a major bottleneck in the machine learning pipeline. A popular solution is combining multiple sources of weak supervision using generative models. The structure of these models affects training label quality, but is difficult to learn without any ground truth labels. We instead rely on these weak supervision sources having some structure by virtue of being encoded programmatically. We present Coral, a paradigm that infers generative model structure by statically analyzing the code for these heuristics, thus reducing the data required to learn structure significantly. We prove that Coral's sample complexity scales quasilinearly with the number of heuristics and number of relations found, improving over the standard sample complexity, which is exponential in $n$ for identifying $n^{\textrm{th}}$ degree relations. Experimentally, Coral matches or outperforms traditional structure learning approaches by up to 3.81 F1 points. Using Coral to model dependencies instead of assuming independence results in better performance than a fully supervised model by 3.07 accuracy points when heuristics are used to label radiology data without ground truth labels.

Assaf Hoogi, John W. Lambert, Yefeng Zheng et al.

We propose a fully-automated method for accurate and robust detection and segmentation of potentially cancerous lesions found in the liver and in lymph nodes. The process is performed in three steps, including organ detection, lesion detection and lesion segmentation. Our method applies machine learning techniques such as marginal space learning and convolutional neural networks, as well as active contour models. The method proves to be robust in its handling of extremely high lesion diversity. We tested our method on volumetric computed tomography (CT) images, including 42 volumes containing liver lesions and 86 volumes containing 595 pathological lymph nodes. Preliminary results under 10-fold cross validation show that for both the liver lesions and the lymph nodes, a total detection sensitivity of 0.53 and average Dice score of $0.71 \pm 0.15$ for segmentation were obtained.

Imon Banerjee, Lewis Hahn, Geoffrey Sonn et al.

We propose an automated method for detecting aggressive prostate cancer(CaP) (Gleason score >=7) based on a comprehensive analysis of the lesion and the surrounding normal prostate tissue which has been simultaneously captured in T2-weighted MR images, diffusion-weighted images (DWI) and apparent diffusion coefficient maps (ADC). The proposed methodology was tested on a dataset of 79 patients (40 aggressive, 39 non-aggressive). We evaluated the performance of a wide range of popular quantitative imaging features on the characterization of aggressive versus non-aggressive CaP. We found that a group of 44 discriminative predictors among 1464 quantitative imaging features can be used to produce an area under the ROC curve of 0.73.

Assaf Hoogi, Christopher F. Beaulieu, Guilherme M. Cunha et al.

We propose a novel method, the adaptive local window, for improving level set segmentation technique. The window is estimated separately for each contour point, over iterations of the segmentation process, and for each individual object. Our method considers the object scale, the spatial texture, and changes of the energy functional over iterations. Global and local statistics are considered by calculating several gray level co-occurrence matrices. We demonstrate the capabilities of the method in the domain of medical imaging for segmenting 233 images with liver lesions. To illustrate the strength of our method, those images were obtained by either Computed Tomography or Magnetic Resonance Imaging. Moreover, we analyzed images using three different energy models. We compare our method to a global level set segmentation and to local framework that uses predefined fixed-size square windows. The results indicate that our proposed method outperforms the other methods in terms of agreement with the manual marking and dependence on contour initialization or the energy model used. In case of complex lesions, such as low contrast lesions, heterogeneous lesions, or lesions with a noisy background, our method shows significantly better segmentation with an improvement of 0.25+- 0.13 in Dice similarity coefficient, compared with state of the art fixed-size local windows (Wilcoxon, p < 0.001).