McKell Woodland

McKell Woodland, Austin Castelo, Mais Al Taie et al.

Fréchet Inception Distance (FID) is a widely used metric for assessing synthetic image quality. It relies on an ImageNet-based feature extractor, making its applicability to medical imaging unclear. A recent trend is to adapt FID to medical imaging through feature extractors trained on medical images. Our study challenges this practice by demonstrating that ImageNet-based extractors are more consistent and aligned with human judgment than their RadImageNet counterparts. We evaluated sixteen StyleGAN2 networks across four medical imaging modalities and four data augmentation techniques with Fréchet distances (FDs) computed using eleven ImageNet or RadImageNet-trained feature extractors. Comparison with human judgment via visual Turing tests revealed that ImageNet-based extractors produced rankings consistent with human judgment, with the FD derived from the ImageNet-trained SwAV extractor significantly correlating with expert evaluations. In contrast, RadImageNet-based rankings were volatile and inconsistent with human judgment. Our findings challenge prevailing assumptions, providing novel evidence that medical image-trained feature extractors do not inherently improve FDs and can even compromise their reliability. Our code is available at https://github.com/mckellwoodland/fid-med-eval.

McKell Woodland, John Wood, Brian M. Anderson et al.

Although generative adversarial networks (GANs) have shown promise in medical imaging, they have four main limitations that impeded their utility: computational cost, data requirements, reliable evaluation measures, and training complexity. Our work investigates each of these obstacles in a novel application of StyleGAN2-ADA to high-resolution medical imaging datasets. Our dataset is comprised of liver-containing axial slices from non-contrast and contrast-enhanced computed tomography (CT) scans. Additionally, we utilized four public datasets composed of various imaging modalities. We trained a StyleGAN2 network with transfer learning (from the Flickr-Faces-HQ dataset) and data augmentation (horizontal flipping and adaptive discriminator augmentation). The network's generative quality was measured quantitatively with the Fréchet Inception Distance (FID) and qualitatively with a visual Turing test given to seven radiologists and radiation oncologists. The StyleGAN2-ADA network achieved a FID of 5.22 ($\pm$ 0.17) on our liver CT dataset. It also set new record FIDs of 10.78, 3.52, 21.17, and 5.39 on the publicly available SLIVER07, ChestX-ray14, ACDC, and Medical Segmentation Decathlon (brain tumors) datasets. In the visual Turing test, the clinicians rated generated images as real 42% of the time, approaching random guessing. Our computational ablation study revealed that transfer learning and data augmentation stabilize training and improve the perceptual quality of the generated images. We observed the FID to be consistent with human perceptual evaluation of medical images. Finally, our work found that StyleGAN2-ADA consistently produces high-quality results without hyperparameter searches or retraining.

McKell Woodland, Nihil Patel, Mais Al Taie et al.

Clinically deployed segmentation models are known to fail on data outside of their training distribution. As these models perform well on most cases, it is imperative to detect out-of-distribution (OOD) images at inference to protect against automation bias. This work applies the Mahalanobis distance post hoc to the bottleneck features of a Swin UNETR model that segments the liver on T1-weighted magnetic resonance imaging. By reducing the dimensions of the bottleneck features with principal component analysis, OOD images were detected with high performance and minimal computational load.

McKell Woodland, John Wood, Caleb O'Connor et al.

One barrier to the clinical deployment of deep learning-based models is the presence of images at runtime that lie far outside the training distribution of a given model. We aim to detect these out-of-distribution (OOD) images with a generative adversarial network (GAN). Our training dataset was comprised of 3,234 liver-containing computed tomography (CT) scans from 456 patients. Our OOD test data consisted of CT images of the brain, head and neck, lung, cervix, and abnormal livers. A StyleGAN2-ADA architecture was employed to model the training distribution. Images were reconstructed using backpropagation. Reconstructions were evaluated using the Wasserstein distance, mean squared error, and the structural similarity index measure. OOD detection was evaluated with the area under the receiver operating characteristic curve (AUROC). Our paradigm distinguished between liver and non-liver CT with greater than 90% AUROC. It was also completely unable to reconstruct liver artifacts, such as needles and ascites.

McKell Woodland, Nihil Patel, Austin Castelo et al.

Clinically deployed deep learning-based segmentation models are known to fail on data outside of their training distributions. While clinicians review the segmentations, these models tend to perform well in most instances, which could exacerbate automation bias. Therefore, detecting out-of-distribution images at inference is critical to warn the clinicians that the model likely failed. This work applied the Mahalanobis distance (MD) post hoc to the bottleneck features of four Swin UNETR and nnU-net models that segmented the liver on T1-weighted magnetic resonance imaging and computed tomography. By reducing the dimensions of the bottleneck features with either principal component analysis or uniform manifold approximation and projection, images the models failed on were detected with high performance and minimal computational load. In addition, this work explored a non-parametric alternative to the MD, a k-th nearest neighbors distance (KNN). KNN drastically improved scalability and performance over MD when both were applied to raw and average-pooled bottleneck features.