Michael Gadermayr

Michael Gadermayr, Lukas Koller, Maximilian Tschuchnig et al.

Multiple instance learning exhibits a powerful approach for whole slide image-based diagnosis in the absence of pixel- or patch-level annotations. In spite of the huge size of hole slide images, the number of individual slides is often rather small, leading to a small number of labeled samples. To improve training, we propose and investigate different data augmentation strategies for multiple instance learning based on the idea of linear interpolations of feature vectors (known as MixUp). Based on state-of-the-art multiple instance learning architectures and two thyroid cancer data sets, an exhaustive study is conducted considering a range of common data augmentation strategies. Whereas a strategy based on to the original MixUp approach showed decreases in accuracy, the use of a novel intra-slide interpolation method led to consistent increases in accuracy.

Michael Gadermayr, Maximilian Tschuchnig

Digital whole slides images contain an enormous amount of information providing a strong motivation for the development of automated image analysis tools. Particularly deep neural networks show high potential with respect to various tasks in the field of digital pathology. However, a limitation is given by the fact that typical deep learning algorithms require (manual) annotations in addition to the large amounts of image data, to enable effective training. Multiple instance learning exhibits a powerful tool for learning deep neural networks in a scenario without fully annotated data. These methods are particularly effective in this domain, due to the fact that labels for a complete whole slide image are often captured routinely, whereas labels for patches, regions or pixels are not. This potential already resulted in a considerable number of publications, with the majority published in the last three years. Besides the availability of data and a high motivation from the medical perspective, the availability of powerful graphics processing units exhibits an accelerator in this field. In this paper, we provide an overview of widely and effectively used concepts of used deep multiple instance learning approaches, recent advances and also critically discuss remaining challenges and future potential.

Maximilian E. Tschuchnig, Philipp Grubmüller, Lea M. Stangassinger et al.

Thyroid cancer is currently the fifth most common malignancy diagnosed in women. Since differentiation of cancer sub-types is important for treatment and current, manual methods are time consuming and subjective, automatic computer-aided differentiation of cancer types is crucial. Manual differentiation of thyroid cancer is based on tissue sections, analysed by pathologists using histological features. Due to the enormous size of gigapixel whole slide images, holistic classification using deep learning methods is not feasible. Patch based multiple instance learning approaches, combined with aggregations such as bag-of-words, is a common approach. This work's contribution is to extend a patch based state-of-the-art method by generating and combining feature vectors of three different patch resolutions and analysing three distinct ways of combining them. The results showed improvements in one of the three multi-scale approaches, while the others led to decreased scores. This provides motivation for analysis and discussion of the individual approaches.

Michael Gadermayr, Lukas Koller, Maximilian Tschuchnig et al.

For classifying digital whole slide images in the absence of pixel level annotation, typically multiple instance learning methods are applied. Due to the generic applicability, such methods are currently of very high interest in the research community, however, the issue of data augmentation in this context is rarely explored. Here we investigate linear and multilinear interpolation between feature vectors, a data augmentation technique, which proved to be capable of improving the generalization performance classification networks and also for multiple instance learning. Experiments, however, have been performed on only two rather small data sets and one specific feature extraction approach so far and a strong dependence on the data set has been identified. Here we conduct a large study incorporating 10 different data set configurations, two different feature extraction approaches (supervised and self-supervised), stain normalization and two multiple instance learning architectures. The results showed an extraordinarily high variability in the effect of the method. We identified several interesting aspects to bring light into the darkness and identified novel promising fields of research.

Maximilian E. Tschuchnig, Philipp Steininger, Michael Gadermayr

Medical imaging is vital in computer assisted intervention. Particularly cone beam computed tomography (CBCT) with defacto real time and mobility capabilities plays an important role. However, CBCT images often suffer from artifacts, which pose challenges for accurate interpretation, motivating research in advanced algorithms for more effective use in clinical practice. In this work we present CBCTLiTS, a synthetically generated, labelled CBCT dataset for segmentation with paired and aligned, high quality computed tomography data. The CBCT data is provided in 5 different levels of quality, reaching from a large number of projections with high visual quality and mild artifacts to a small number of projections with severe artifacts. This allows thorough investigations with the quality as a degree of freedom. We also provide baselines for several possible research scenarios like uni- and multimodal segmentation, multitask learning and style transfer followed by segmentation of relatively simple, liver to complex liver tumor segmentation. CBCTLiTS is accesssible via https://www.kaggle.com/datasets/maximiliantschuchnig/cbct-liver-and-liver-tumor-segmentation-train-data.

Maximilian Tschuchnig, Petra Tschuchnig, Cornelia Ferner et al.

Inflation is a major determinant for allocation decisions and its forecast is a fundamental aim of governments and central banks. However, forecasting inflation is not a trivial task, as its prediction relies on low frequency, highly fluctuating data with unclear explanatory variables. While classical models show some possibility of predicting inflation, reliably beating the random walk benchmark remains difficult. Recently, (deep) neural networks have shown impressive results in a multitude of applications, increasingly setting the new state-of-the-art. This paper investigates the potential of the transformer deep neural network architecture to forecast different inflation rates. The results are compared to a study on classical time series and machine learning models. We show that our adapted transformer, on average, outperforms the baseline in 6 out of 16 experiments, showing best scores in two out of four investigated inflation rates. Our results demonstrate that a transformer based neural network can outperform classical regression and machine learning models in certain inflation rates and forecasting horizons.

Katja Löwenstein, Johanna Rehrl, Anja Schuster et al.

The in vitro scratch assay is a widely used assay in cell biology to assess the rate of wound closure related to a variety of therapeutic interventions. While manual measurement is subjective and vulnerable to intra- and interobserver variability, computer-based tools are theoretically objective, but in practice often contain parameters which are manually adjusted (individually per image or data set) and thereby provide a source for subjectivity. Modern deep learning approaches typically require large annotated training data which complicates instant applicability. In this paper, we make use of the segment anything model, a deep foundation model based on interactive point-prompts, which enables class-agnostic segmentation without tuning the network's parameters based on domain specific training data. The proposed method clearly outperformed a semi-objective baseline method that required manual inspection and, if necessary, adjustment of parameters per image. Even though the point prompts of the proposed approach are theoretically also a source for subjectivity, results attested very low intra- and interobserver variability, even compared to manual segmentation of domain experts.

Maximilian Ernst Tschuchnig, Julia Coste-Marin, Philipp Steininger et al.

Semantic segmentation is a crucial task in medical image processing, essential for segmenting organs or lesions such as tumors. In this study we aim to improve automated segmentation in CBCTs through multi-task learning. To evaluate effects on different volume qualities, a CBCT dataset is synthesised from the CT Liver Tumor Segmentation Benchmark (LiTS) dataset. To improve segmentation, two approaches are investigated. First, we perform multi-task learning to add morphology based regularization through a volume reconstruction task. Second, we use this reconstruction task to reconstruct the best quality CBCT (most similar to the original CT), facilitating denoising effects. We explore both holistic and patch-based approaches. Our findings reveal that, especially using a patch-based approach, multi-task learning improves segmentation in most cases and that these results can further be improved by our denoising approach.

Maximilian Tschuchnig, Lukas Lamminger, Philipp Steininger et al.

Cone-Beam Computed Tomography (CBCT) is widely used for real-time intraoperative imaging due to its low radiation dose and high acquisition speed. However, despite its high resolution, CBCT suffers from significant artifacts and thereby lower visual quality, compared to conventional Computed Tomography (CT). A recent approach to mitigate these artifacts is synthetic CT (sCT) generation, translating CBCT volumes into the CT domain. In this work, we enhance sCT generation through multimodal learning, integrating intraoperative CBCT with preoperative CT. Beyond validation on two real-world datasets, we use a versatile synthetic dataset, to analyze how CBCT-CT alignment and CBCT quality affect sCT quality. The results demonstrate that multimodal sCT consistently outperform unimodal baselines, with the most significant gains observed in well-aligned, low-quality CBCT-CT cases. Finally, we demonstrate that these findings are highly reproducible in real-world clinical datasets.

Maximilian Tschuchnig, Michael Gadermayr, Khalifa Djemal

Automated breast cancer classification from mammography remains a significant challenge due to subtle distinctions between benign and malignant tissue. In this work, we present a hybrid framework combining deep convolutional features from a ResNet-50 backbone with handcrafted descriptors and transformer-based embeddings. Using the CBIS-DDSM dataset, we benchmark our ResNet-50 baseline (AUC: 78.1%) and demonstrate that fusing handcrafted features with deep ResNet-50 and DINOv2 features improves AUC to 79.6% (setup d1), with a peak recall of 80.5% (setup d1) and highest F1 score of 67.4% (setup d1). Our experiments show that handcrafted features not only complement deep representations but also enhance performance beyond transformer-based embeddings. This hybrid fusion approach achieves results comparable to state-of-the-art methods while maintaining architectural simplicity and computational efficiency, making it a practical and effective solution for clinical decision support.

Maximilian Tschuchnig, Lukas Lamminger, Philipp Steininger et al.

Cone-Beam Computed Tomography (CBCT) is widely used for intraoperative imaging due to its rapid acquisition and low radiation dose. However, CBCT images typically suffer from artifacts and lower visual quality compared to conventional Computed Tomography (CT). A promising solution is synthetic CT (sCT) generation, where CBCT volumes are translated into the CT domain. In this work, we enhance sCT generation through multimodal learning by jointly leveraging intraoperative CBCT and preoperative CT data. To overcome the inherent misalignment between modalities, we introduce an end-to-end learnable registration module within the sCT pipeline. This model is evaluated on a controlled synthetic dataset, allowing precise manipulation of data quality and alignment parameters. Further, we validate its robustness and generalizability on two real-world clinical datasets. Experimental results demonstrate that integrating registration in multimodal sCT generation improves sCT quality, outperforming baseline multimodal methods in 79 out of 90 evaluation settings. Notably, the improvement is most significant in cases where CBCT quality is low and the preoperative CT is moderately misaligned.

Maximilian E. Tschuchnig, Philipp Steininger, Michael Gadermayr

Computer-Assisted Interventions enable clinicians to perform precise, minimally invasive procedures, often relying on advanced imaging methods. Cone-beam computed tomography (CBCT) can be used to facilitate computer-assisted interventions, despite often suffering from artifacts that pose challenges for accurate interpretation. While the degraded image quality can affect image analysis, the availability of high quality, preoperative scans offers potential for improvements. Here we consider a setting where preoperative CT and intraoperative CBCT scans are available, however, the alignment (registration) between the scans is imperfect to simulate a real world scenario. We propose a multimodal learning method that fuses roughly aligned CBCT and CT scans and investigate the effect on segmentation performance. For this experiment we use synthetically generated data containing real CT and synthetic CBCT volumes with corresponding voxel annotations. We show that this fusion setup improves segmentation performance in $18$ out of $20$ investigated setups.

Maximilian E. Tschuchnig, Philipp Steininger, Michael Gadermayr

Cone-beam computed tomography (CBCT) is an important tool facilitating computer aided interventions, despite often suffering from artifacts that pose challenges for accurate interpretation. While the degraded image quality can affect downstream segmentation, the availability of high quality, preoperative scans represents potential for improvements. Here we consider a setting where preoperative CT and intraoperative CBCT scans are available, however, the alignment (registration) between the scans is imperfect. We propose a multimodal learning method that fuses roughly aligned CBCT and CT scans and investigate the effect of CBCT quality and misalignment on the final segmentation performance. For that purpose, we make use of a synthetically generated data set containing real CT and synthetic CBCT volumes. As an application scenario, we focus on liver and liver tumor segmentation. We show that the fusion of preoperative CT and simulated, intraoperative CBCT mostly improves segmentation performance (compared to using intraoperative CBCT only) and that even clearly misaligned preoperative data has the potential to improve segmentation performance.

Martin Uray, Eduard Hirsch, Gerold Katzinger et al.

Enterprises and labs performing computationally expensive data science applications sooner or later face the problem of scale but unconnected infrastructure. For this up-scaling process, an IT service provider can be hired or in-house personnel can attempt to implement a software stack. The first option can be quite expensive if it is just about connecting several machines. For the latter option often experience is missing with the data science staff in order to navigate through the software jungle. In this technical report, we illustrate the decision process towards an on-premises infrastructure, our implemented system architecture, and the transformation of the software stack towards a scaleable GPU cluster system.

Maximilian E. Tschuchnig, Michael Gadermayr

The increasing digitization of medical imaging enables machine learning based improvements in detecting, visualizing and segmenting lesions, easing the workload for medical experts. However, supervised machine learning requires reliable labelled data, which is is often difficult or impossible to collect or at least time consuming and thereby costly. Therefore methods requiring only partly labeled data (semi-supervised) or no labeling at all (unsupervised methods) have been applied more regularly. Anomaly detection is one possible methodology that is able to leverage semi-supervised and unsupervised methods to handle medical imaging tasks like classification and segmentation. This paper uses a semi-exhaustive literature review of relevant anomaly detection papers in medical imaging to cluster into applications, highlight important results, establish lessons learned and give further advice on how to approach anomaly detection in medical imaging. The qualitative analysis is based on google scholar and 4 different search terms, resulting in 120 different analysed papers. The main results showed that the current research is mostly motivated by reducing the need for labelled data. Also, the successful and substantial amount of research in the brain MRI domain shows the potential for applications in further domains like OCT and chest X-ray.

Michael Gadermayr, Maximilian Tschuchnig, Lea Maria Stangassinger et al.

In contrast to paraffin sections, frozen sections can be quickly generated during surgical interventions. This procedure allows surgeons to wait for histological findings during the intervention to base intra-operative decisions on the outcome of the histology. However, compared to paraffin sections, the quality of frozen sections is typically lower, leading to a higher ratio of miss-classification. In this work, we investigated the effect of the section type on automated decision support approaches for classification of thyroid cancer. This was enabled by a data set consisting of pairs of sections for individual patients. Moreover, we investigated, whether a frozen-to-paraffin translation could help to optimize classification scores. Finally, we propose a specific data augmentation strategy to deal with a small amount of training data and to increase classification accuracy even further.

Maximilian Ernst Tschuchnig, Gertie Janneke Oostingh, Michael Gadermayr

Image analysis in the field of digital pathology has recently gained increased popularity. The use of high-quality whole slide scanners enables the fast acquisition of large amounts of image data, showing extensive context and microscopic detail at the same time. Simultaneously, novel machine learning algorithms have boosted the performance of image analysis approaches. In this paper, we focus on a particularly powerful class of architectures, called Generative Adversarial Networks (GANs), applied to histological image data. Besides improving performance, GANs also enable application scenarios in this field, which were previously intractable. However, GANs could exhibit a potential for introducing bias. Hereby, we summarize the recent state-of-the-art developments in a generalizing notation, present the main applications of GANs and give an outlook of some chosen promising approaches and their possible future applications. In addition, we identify currently unavailable methods with potential for future applications.

Georg Wimmer, Michael Gadermayr, Andreas Vécsei et al.

Novel imaging technologies raise many questions concerning the adaptation of computer-aided decision support systems. Classification models either need to be adapted or even newly trained from scratch to exploit the full potential of enhanced techniques. Both options typically require the acquisition of new labeled training data. In this work we investigate the applicability of image-to-image translation to endoscopic images showing different imaging modalities, namely conventional white-light and narrow-band imaging. In a study on computer-aided celiac disease diagnosis, we explore whether image-to-image translation is capable of effectively performing the translation between the domains. We investigate if models can be trained on virtual (or a mixture of virtual and real) samples to improve overall accuracy in a setting with limited labeled training data. Finally, we also ask whether a translation of testing images to another domain is capable of improving accuracy by exploiting the enhanced imaging characteristics.

Michael Gadermayr, Maximilian Tschuchnig, Laxmi Gupta et al.

Generative adversarial networks using a cycle-consistency loss facilitate unpaired training of image-translation models and thereby exhibit a very high potential in manifold medical applications. However, the fact that images in one domain potentially map to more than one image in another domain (e.g. in case of pathological changes) exhibits a major challenge for training the networks. In this work, we offer a solution to improve the training process in case of many-to-one mappings by modifying the cycle-consistency loss. We show formally and empirically that the proposed method improves the performance significantly without radically changing the architecture and without increasing the overall complexity. We evaluate our method on thigh MRI scans with the final goal of segmenting the muscle in fat-infiltrated patients' data.

Michael Gadermayr, Laxmi Gupta, Barbara M. Klinkhammer et al.

Recently, generative adversarial networks exhibited excellent performances in semi-supervised image analysis scenarios. In this paper, we go even further by proposing a fully unsupervised approach for segmentation applications with prior knowledge of the objects' shapes. We propose and investigate different strategies to generate simulated label data and perform image-to-image translation between the image and the label domain using an adversarial model. Specifically, we assess the impact of the annotation model's accuracy as well as the effect of simulating additional low-level image features. For experimental evaluation, we consider the segmentation of the glomeruli, an application scenario from renal pathology. Experiments provide proof of concept and also confirm that the strategy for creating the simulated label data is of particular relevance considering the stability of GAN trainings.

Michael Gadermayr, Ann-Kathrin Dombrowski, Barbara Mara Klinkhammer et al.

Due to the increasing availability of whole slide scanners facilitating digitization of histopathological tissue, there is a strong demand for the development of computer based image analysis systems. In this work, the focus is on the segmentation of the glomeruli constituting a highly relevant structure in renal histopathology, which has not been investigated before in combination with CNNs. We propose two different CNN cascades for segmentation applications with sparse objects. These approaches are applied to the problem of glomerulus segmentation and compared with conventional fully-convolutional networks. Overall, with the best performing cascade approach, single CNNs are outperformed and a pixel-level Dice similarity coefficient of 0.90 is obtained. Combined with qualitative and further object-level analyses the obtained results are assessed as excellent also compared to recent approaches. In conclusion, we can state that especially one of the proposed cascade networks proved to be a highly powerful tool for segmenting the renal glomeruli providing best segmentation accuracies and also keeping the computing time at a low level.