Jianrui Ding

Fenghe Tang, Jianrui Ding, Lingtao Wang et al.

The U-shaped architecture has emerged as a crucial paradigm in the design of medical image segmentation networks. However, due to the inherent local limitations of convolution, a fully convolutional segmentation network with U-shaped architecture struggles to effectively extract global context information, which is vital for the precise localization of lesions. While hybrid architectures combining CNNs and Transformers can address these issues, their application in real medical scenarios is limited due to the computational resource constraints imposed by the environment and edge devices. In addition, the convolutional inductive bias in lightweight networks adeptly fits the scarce medical data, which is lacking in the Transformer based network. In order to extract global context information while taking advantage of the inductive bias, we propose CMUNeXt, an efficient fully convolutional lightweight medical image segmentation network, which enables fast and accurate auxiliary diagnosis in real scene scenarios. CMUNeXt leverages large kernel and inverted bottleneck design to thoroughly mix distant spatial and location information, efficiently extracting global context information. We also introduce the Skip-Fusion block, designed to enable smooth skip-connections and ensure ample feature fusion. Experimental results on multiple medical image datasets demonstrate that CMUNeXt outperforms existing heavyweight and lightweight medical image segmentation networks in terms of segmentation performance, while offering a faster inference speed, lighter weights, and a reduced computational cost. The code is available at https://github.com/FengheTan9/CMUNeXt.

Fenghe Tang, Lingtao Wang, Chunping Ning et al.

U-Net and its extensions have achieved great success in medical image segmentation. However, due to the inherent local characteristics of ordinary convolution operations, U-Net encoder cannot effectively extract global context information. In addition, simple skip connections cannot capture salient features. In this work, we propose a fully convolutional segmentation network (CMU-Net) which incorporates hybrid convolutions and multi-scale attention gate. The ConvMixer module extracts global context information by mixing features at distant spatial locations. Moreover, the multi-scale attention gate emphasizes valuable features and achieves efficient skip connections. We evaluate the proposed method using both breast ultrasound datasets and a thyroid ultrasound image dataset; and CMU-Net achieves average Intersection over Union (IoU) values of 73.27% and 84.75%, and F1 scores of 84.81% and 91.71%. The code is available at https://github.com/FengheTan9/CMU-Net.

Fenghe Tang, Bingkun Nian, Jianrui Ding et al.

Due to the scarcity and specific imaging characteristics in medical images, light-weighting Vision Transformers (ViTs) for efficient medical image segmentation is a significant challenge, and current studies have not yet paid attention to this issue. This work revisits the relationship between CNNs and Transformers in lightweight universal networks for medical image segmentation, aiming to integrate the advantages of both worlds at the infrastructure design level. In order to leverage the inductive bias inherent in CNNs, we abstract a Transformer-like lightweight CNNs block (ConvUtr) as the patch embeddings of ViTs, feeding Transformer with denoised, non-redundant and highly condensed semantic information. Moreover, an adaptive Local-Global-Local (LGL) block is introduced to facilitate efficient local-to-global information flow exchange, maximizing Transformer's global context information extraction capabilities. Finally, we build an efficient medical image segmentation model (MobileUtr) based on CNN and Transformer. Extensive experiments on five public medical image datasets with three different modalities demonstrate the superiority of MobileUtr over the state-of-the-art methods, while boasting lighter weights and lower computational cost. Code is available at https://github.com/FengheTan9/MobileUtr.

Bingkun Nian, Fenghe Tang, Jianrui Ding et al.

Dynamic convolution demonstrates outstanding representation capabilities, which are crucial for natural image segmentation. However, it fails when applied to medical image segmentation (MIS) and infrared small target segmentation (IRSTS) due to limited data and limited fitting capacity. In this paper, we propose a new type of dynamic convolution called dynamic parameter convolution (DPConv) which shows superior fitting capacity, and it can efficiently leverage features from deep layers of encoder in reconstruction tasks to generate DPConv kernels that adapt to input variations.Moreover, we observe that DPConv, built upon deep features derived from reconstruction tasks, significantly enhances downstream segmentation performance. We refer to the segmentation network integrated with DPConv generated from reconstruction network as the siamese reconstruction-segmentation network (SRS). We conduct extensive experiments on seven datasets including five medical datasets and two infrared datasets, and the experimental results demonstrate that our method can show superior performance over several recently proposed methods. Furthermore, the zero-shot segmentation under unseen modality demonstrates the generalization of DPConv. The code is available at: https://github.com/fidshu/SRSNet.

Fenghe Tang, Bingkun Nian, Jianrui Ding et al.

In clinical practice, medical image analysis often requires efficient execution on resource-constrained mobile devices. However, existing mobile models-primarily optimized for natural images-tend to perform poorly on medical tasks due to the significant information density gap between natural and medical domains. Combining computational efficiency with medical imaging-specific architectural advantages remains a challenge when developing lightweight, universal, and high-performing networks. To address this, we propose a mobile model called Mobile U-shaped Vision Transformer (Mobile U-ViT) tailored for medical image segmentation. Specifically, we employ the newly purposed ConvUtr as a hierarchical patch embedding, featuring a parameter-efficient large-kernel CNN with inverted bottleneck fusion. This design exhibits transformer-like representation learning capacity while being lighter and faster. To enable efficient local-global information exchange, we introduce a novel Large-kernel Local-Global-Local (LGL) block that effectively balances the low information density and high-level semantic discrepancy of medical images. Finally, we incorporate a shallow and lightweight transformer bottleneck for long-range modeling and employ a cascaded decoder with downsample skip connections for dense prediction. Despite its reduced computational demands, our medical-optimized architecture achieves state-of-the-art performance across eight public 2D and 3D datasets covering diverse imaging modalities, including zero-shot testing on four unseen datasets. These results establish it as an efficient yet powerful and generalization solution for mobile medical image analysis. Code is available at https://github.com/FengheTan9/Mobile-U-ViT.

Lingtao Wang, Jianrui Ding, Fenghe Tang et al.

Accurate detection of thyroid lesions is a critical aspect of computer-aided diagnosis. However, most existing detection methods perform only one feature extraction process and then fuse multi-scale features, which can be affected by noise and blurred features in ultrasound images. In this study, we propose a novel detection network based on a feature feedback mechanism inspired by clinical diagnosis. The mechanism involves first roughly observing the overall picture and then focusing on the details of interest. It comprises two parts: a feedback feature selection module and a feature feedback pyramid. The feedback feature selection module efficiently selects the features extracted in the first phase in both space and channel dimensions to generate high semantic prior knowledge, which is similar to coarse observation. The feature feedback pyramid then uses this high semantic prior knowledge to enhance feature extraction in the second phase and adaptively fuses the two features, similar to fine observation. Additionally, since radiologists often focus on the shape and size of lesions for diagnosis, we propose an adaptive detection head strategy to aggregate multi-scale features. Our proposed method achieves an AP of 70.3% and AP50 of 99.0% on the thyroid ultrasound dataset and meets the real-time requirement. The code is available at https://github.com/HIT-wanglingtao/Thinking-Twice.

Fenghe Tang, Jianrui Ding, Lingtao Wang et al.

Medical image segmentation is a critical step in computer-aided diagnosis, and convolutional neural networks are popular segmentation networks nowadays. However, the inherent local operation characteristics make it difficult to focus on the global contextual information of lesions with different positions, shapes, and sizes. Semi-supervised learning can be used to learn from both labeled and unlabeled samples, alleviating the burden of manual labeling. However, obtaining a large number of unlabeled images in medical scenarios remains challenging. To address these issues, we propose a Multi-level Global Context Cross-consistency (MGCC) framework that uses images generated by a Latent Diffusion Model (LDM) as unlabeled images for semi-supervised learning. The framework involves of two stages. In the first stage, a LDM is used to generate synthetic medical images, which reduces the workload of data annotation and addresses privacy concerns associated with collecting medical data. In the second stage, varying levels of global context noise perturbation are added to the input of the auxiliary decoder, and output consistency is maintained between decoders to improve the representation ability. Experiments conducted on open-source breast ultrasound and private thyroid ultrasound datasets demonstrate the effectiveness of our framework in bridging the probability distribution and the semantic representation of the medical image. Our approach enables the effective transfer of probability distribution knowledge to the segmentation network, resulting in improved segmentation accuracy. The code is available at https://github.com/FengheTan9/Multi-Level-Global-Context-Cross-Consistency.

Zikang Xu, Fenghe Tang, Quan Quan et al.

With the rapid expansion of machine learning and deep learning (DL), researchers are increasingly employing learning-based algorithms to alleviate diagnostic challenges across diverse medical tasks and applications. While advancements in diagnostic precision are notable, some researchers have identified a concerning trend: their models exhibit biased performance across subgroups characterized by different sensitive attributes. This bias not only infringes upon the rights of patients but also has the potential to lead to life-altering consequences. In this paper, we inspect a series of DL segmentation models using two ultrasound datasets, aiming to assess the presence of model unfairness in these specific tasks. Our findings reveal that even state-of-the-art DL algorithms demonstrate unfair behavior in ultrasound segmentation tasks. These results serve as a crucial warning, underscoring the necessity for careful model evaluation before their deployment in real-world scenarios. Such assessments are imperative to ensure ethical considerations and mitigate the risk of adverse impacts on patient outcomes.

Jiaqiao Shi, Aleksandar Vakanski, Min Xian et al.

Deep learning-based computer-aided diagnosis has achieved unprecedented performance in breast cancer detection. However, most approaches are computationally intensive, which impedes their broader dissemination in real-world applications. In this work, we propose an efficient and light-weighted multitask learning architecture to classify and segment breast tumors simultaneously. We incorporate a segmentation task into a tumor classification network, which makes the backbone network learn representations focused on tumor regions. Moreover, we propose a new numerically stable loss function that easily controls the balance between the sensitivity and specificity of cancer detection. The proposed approach is evaluated using a breast ultrasound dataset with 1,511 images. The accuracy, sensitivity, and specificity of tumor classification is 88.6%, 94.1%, and 85.3%, respectively. We validate the model using a virtual mobile device, and the average inference time is 0.35 seconds per image.

Fei Xu, Yingtao Zhang, Min Xian et al.

Breast cancer investigation is of great significance, and developing tumor detection methodologies is a critical need. However, it is a challenging task for breast ultrasound due to the complicated breast structure and poor quality of the images. In this paper, we propose a novel tumor saliency estimation model guided by enriched breast anatomy knowledge to localize the tumor. Firstly, the breast anatomy layers are generated by a deep neural network. Then we refine the layers by integrating a non-semantic breast anatomy model to solve the problems of incomplete mammary layers. Meanwhile, a new background map generation method weighted by the semantic probability and spatial distance is proposed to improve the performance. The experiment demonstrates that the proposed method with the new background map outperforms four state-of-the-art TSE models with increasing 10% of F_meansure on the BUS public dataset.

Fei Xu, Yingtao Zhang, Min Xian et al.

Tumor saliency estimation aims to localize tumors by modeling the visual stimuli in medical images. However, it is a challenging task for breast ultrasound due to the complicated anatomic structure of the breast and poor image quality; and existing saliency estimation approaches only model generic visual stimuli, e.g., local and global contrast, location, and feature correlation, and achieve poor performance for tumor saliency estimation. In this paper, we propose a novel optimization model to estimate tumor saliency by utilizing breast anatomy. First, we model breast anatomy and decompose breast ultrasound image into layers using Neutro-Connectedness; then utilize the layers to generate the foreground and background maps; and finally propose a novel objective function to estimate the tumor saliency by integrating the foreground map, background map, adaptive center bias, and region-based correlation cues. The extensive experiments demonstrate that the proposed approach obtains more accurate foreground and background maps with the assistance of the breast anatomy; especially, for the images having large or small tumors; meanwhile, the new objective function can handle the images without tumors. The newly proposed method achieves state-of-the-art performance when compared to eight tumor saliency estimation approaches using two breast ultrasound datasets.

Fei Xu, Min Xian, Yingtao Zhang et al.

Automatic tumor segmentation of breast ultrasound (BUS) image is quite challenging due to the complicated anatomic structure of breast and poor image quality. Most tumor segmentation approaches achieve good performance on BUS images collected in controlled settings; however, the performance degrades greatly with BUS images from different sources. Tumor saliency estimation (TSE) has attracted increasing attention to solving the problem by modeling radiologists' attention mechanism. In this paper, we propose a novel hybrid framework for TSE, which integrates both high-level domain-knowledge and robust low-level saliency assumptions and can overcome drawbacks caused by direct mapping in traditional TSE approaches. The new framework integrated the Neutro-Connectedness (NC) map, the adaptive-center, the correlation and the layer structure-based weighted map. The experimental results demonstrate that the proposed approach outperforms state-of-the-art TSE methods.

Min Xian, Yingtao Zhang, H. D. Cheng et al.

Breast ultrasound (BUS) image segmentation is challenging and critical for BUS Comput-er-Aided Diagnosis (CAD) systems. Many BUS segmentation approaches have been studied in the last two decades, but the performances of most approaches have been assessed using relatively small private datasets with different quantitative metrics, which results in a discrepancy in performance comparison. Therefore, there is a pressing need for building a benchmark to compare existing methods using a public dataset objectively, to determine the performance of the best breast tumor segmentation algorithm available today, and to investigate what segmentation strategies are valuable in clinical practice and theoretical study. In this work, a benchmark for B-mode breast ultrasound image segmentation is presented. In the benchmark, 1) we collected 562 breast ultrasound images, prepared a software tool, and involved four radiologists in obtaining accurate annotations through standardized procedures; 2) we extensively compared the performance of sixteen state-of-the-art segmentation methods and discussed their advantages and disadvantages; 3) we proposed a set of valuable quantitative metrics to evaluate both semi-automatic and fully automatic segmentation approaches; and 4) the successful segmentation strategies and possible future improvements are discussed in details.

Min Xian, Yingtao Zhang, H. D. Cheng et al.

Breast cancer is one of the leading causes of cancer death among women worldwide. In clinical routine, automatic breast ultrasound (BUS) image segmentation is very challenging and essential for cancer diagnosis and treatment planning. Many BUS segmentation approaches have been studied in the last two decades, and have been proved to be effective on private datasets. Currently, the advancement of BUS image segmentation seems to meet its bottleneck. The improvement of the performance is increasingly challenging, and only few new approaches were published in the last several years. It is the time to look at the field by reviewing previous approaches comprehensively and to investigate the future directions. In this paper, we study the basic ideas, theories, pros and cons of the approaches, group them into categories, and extensively review each category in depth by discussing the principles, application issues, and advantages/disadvantages.

Min Xian, Yingtao Zhang, H. D. Cheng et al.

Interactive image segmentation is a challenging task and receives increasing attention recently; however, two major drawbacks exist in interactive segmentation approaches. First, the segmentation performance of ROI-based methods is sensitive to the initial ROI: different ROIs may produce results with great difference. Second, most seed-based methods need intense interactions, and are not applicable in many cases. In this work, we generalize the Neutro-Connectedness (NC) to be independent of top-down priors of objects and to model image topology with indeterminacy measurement on image regions, propose a novel method for determining object and background regions, which is applied to exclude isolated background regions and enforce label consistency, and put forward a hybrid interactive segmentation method, Neutro-Connectedness Cut (NC-Cut), which can overcome the above two problems by utilizing both pixel-wise appearance information and region-based NC properties. We evaluate the proposed NC-Cut by employing two image datasets (265 images), and demonstrate that the proposed approach outperforms state-of-the-art interactive image segmentation methods (Grabcut, MILCut, One-Cut, MGC_max^sum and pPBC).

Jianrui Ding, Min Xian, H. D. Cheng et al.

Transesophageal echocardiography (TEE) is widely used to detect left atrium (LA)/left atrial appendage (LAA) thrombi. In this paper, the local binary pattern variance (LBPV) features are extracted from region of interest (ROI). And the dynamic features are formed by using the information of its neighbor frames in the sequence. The sequence is viewed as a bag, and the images in the sequence are considered as the instances. Multiple-instance learning (MIL) method is employed to solve the LAA thrombi detection. The experimental results show that the proposed method can achieve better performance than that by using other methods.