Nicolás Gaggion

Nicolás Gaggion, Lucas Mansilla, Candelaria Mosquera et al.

Anatomical segmentation is a fundamental task in medical image computing, generally tackled with fully convolutional neural networks which produce dense segmentation masks. These models are often trained with loss functions such as cross-entropy or Dice, which assume pixels to be independent of each other, thus ignoring topological errors and anatomical inconsistencies. We address this limitation by moving from pixel-level to graph representations, which allow to naturally incorporate anatomical constraints by construction. To this end, we introduce HybridGNet, an encoder-decoder neural architecture that leverages standard convolutions for image feature encoding and graph convolutional neural networks (GCNNs) to decode plausible representations of anatomical structures. We also propose a novel image-to-graph skip connection layer which allows localized features to flow from standard convolutional blocks to GCNN blocks, and show that it improves segmentation accuracy. The proposed architecture is extensively evaluated in a variety of domain shift and image occlusion scenarios, and audited considering different types of demographic domain shift. Our comprehensive experimental setup compares HybridGNet with other landmark and pixel-based models for anatomical segmentation in chest x-ray images, and shows that it produces anatomically plausible results in challenging scenarios where other models tend to fail.

Nicolás Gaggion, Candelaria Mosquera, Lucas Mansilla et al.

The development of successful artificial intelligence models for chest X-ray analysis relies on large, diverse datasets with high-quality annotations. While several databases of chest X-ray images have been released, most include disease diagnosis labels but lack detailed pixel-level anatomical segmentation labels. To address this gap, we introduce an extensive chest X-ray multi-center segmentation dataset with uniform and fine-grain anatomical annotations for images coming from five well-known publicly available databases: ChestX-ray8, Chexpert, MIMIC-CXR-JPG, Padchest, and VinDr-CXR, resulting in 657,566 segmentation masks. Our methodology utilizes the HybridGNet model to ensure consistent and high-quality segmentations across all datasets. Rigorous validation, including expert physician evaluation and automatic quality control, was conducted to validate the resulting masks. Additionally, we provide individualized quality indices per mask and an overall quality estimation per dataset. This dataset serves as a valuable resource for the broader scientific community, streamlining the development and assessment of innovative methodologies in chest X-ray analysis. The CheXmask dataset is publicly available at: https://physionet.org/content/chexmask-cxr-segmentation-data/

Nicolás Gaggion, Benjamin A. Matheson, Yan Xia et al.

Cardiovascular magnetic resonance imaging is emerging as a crucial tool to examine cardiac morphology and function. Essential to this endeavour are anatomical 3D surface and volumetric meshes derived from CMR images, which facilitate computational anatomy studies, biomarker discovery, and in-silico simulations. Traditional approaches typically follow complex multi-step pipelines, first segmenting images and then reconstructing meshes, making them time-consuming and prone to error propagation. In response, we introduce HybridVNet, a novel architecture for direct image-to-mesh extraction seamlessly integrating standard convolutional neural networks with graph convolutions, which we prove can efficiently handle surface and volumetric meshes by encoding them as graph structures. To further enhance accuracy, we propose a multi-view HybridVNet architecture which processes both long axis and short axis CMR, showing that it can increase the performance of cardiac MR mesh generation. Our model combines traditional convolutional networks with variational graph generative models, deep supervision and mesh-specific regularisation. Experiments on a comprehensive dataset from the UK Biobank confirm the potential of HybridVNet to significantly advance cardiac imaging and computational cardiology by efficiently generating high-fidelity meshes from CMR images. Multi-view HybridVNet outperforms the state-of-the-art, achieving improvements of up to $\sim$27\% reduction in Mean Contour Distance (from 1.86 mm to 1.35 mm for the LV Myocardium), up to $\sim$18\% improvement in Hausdorff distance (from 4.74 mm to 3.89mm, for the LV Endocardium), and up to $\sim$8\% in Dice Coefficient (from 0.78 to 0.84, for the LV Myocardium), highlighting its superior accuracy.

Nicolás Gaggion, Maria Vakalopoulou, Diego H. Milone et al.

Learning anatomical segmentation from heterogeneous labels in multi-center datasets is a common situation encountered in clinical scenarios, where certain anatomical structures are only annotated in images coming from particular medical centers, but not in the full database. Here we first show how state-of-the-art pixel-level segmentation models fail in naively learning this task due to domain memorization issues and conflicting labels. We then propose to adopt HybridGNet, a landmark-based segmentation model which learns the available anatomical structures using graph-based representations. By analyzing the latent space learned by both models, we show that HybridGNet naturally learns more domain-invariant feature representations, and provide empirical evidence in the context of chest X-ray multiclass segmentation. We hope these insights will shed light on the training of deep learning models with heterogeneous labels from public and multi-center datasets.

Nicolás Gaggion, Maria J. Ledesma-Carbayo, Stergios Christodoulidis et al.

Graph-based medical image segmentation represents anatomical structures using boundary graphs, providing fixed-topology landmarks and inherent population-level correspondences. However, their clinical adoption has been hindered by a major requirement: training datasets with manually annotated landmarks that maintain point-to-point correspondences across patients rarely exist in practice. We introduce Mask-HybridGNet, a framework that trains graph-based models directly using standard pixel-wise masks, eliminating the need for manual landmark annotations. Our approach aligns variable-length ground truth boundaries with fixed-length landmark predictions by combining Chamfer distance supervision and edge-based regularization to ensure local smoothness and regular landmark distribution, further refined via differentiable rasterization. A significant emergent property of this framework is that predicted landmark positions become consistently associated with specific anatomical locations across patients without explicit correspondence supervision. This implicit atlas learning enables temporal tracking, cross-slice reconstruction, and morphological population analyses. Beyond direct segmentation, Mask-HybridGNet can extract correspondences from existing segmentation masks, allowing it to generate stable anatomical atlases from any high-quality pixel-based model. Experiments across chest radiography, cardiac ultrasound, cardiac MRI, and fetal imaging demonstrate that our model achieves competitive results against state-of-the-art pixel-based methods, while ensuring anatomical plausibility by enforcing boundary connectivity through a fixed graph adjacency matrix. This framework leverages the vast availability of standard segmentation masks to build structured models that maintain topological integrity and provide implicit correspondences.

Nicolás Gaggion, Enzo Ferrante, Beatriz Paniagua et al.

Skeletonization is a popular shape analysis technique that models an object's interior as opposed to just its boundary. Fitting template-based skeletal models is a time-consuming process requiring much manual parameter tuning. Recently, machine learning-based methods have shown promise for generating s-reps from object boundaries. In this work, we propose a new skeletonization method which leverages graph convolutional networks to produce skeletal representations (s-reps) from dense segmentation masks. The method is evaluated on both synthetic data and real hippocampus segmentations, achieving promising results and fast inference.

Matias Cosarinsky, Ramiro Billot, Lucas Mansilla et al.

Assessing the quality of automatic image segmentation is crucial in clinical practice, but often very challenging due to the limited availability of ground truth annotations. Reverse Classification Accuracy (RCA) is an approach that estimates the quality of new predictions on unseen samples by training a segmenter on those predictions, and then evaluating it against existing annotated images. In this work, we introduce Conformal In-Context RCA, a novel method for automatically estimating segmentation quality with statistical guarantees in the absence of ground-truth annotations, which consists of two main innovations. First, In-Context RCA, which leverages recent in-context learning models for image segmentation and incorporates retrieval-augmentation techniques to select the most relevant reference images. This approach enables efficient quality estimation with minimal reference data while avoiding the need of training additional models. Second, we introduce Conformal RCA, which extends both the original RCA framework and In-Context RCA to go beyond point estimation. Using tools from split conformal prediction, Conformal RCA produces prediction intervals for segmentation quality providing statistical guarantees that the true score lies within the estimated interval with a user-specified probability. Validated across 10 different medical imaging tasks in various organs and modalities, our methods demonstrate robust performance and computational efficiency, offering a promising solution for automated quality control in clinical workflows, where fast and reliable segmentation assessment is essential. The code is available at https://github.com/mcosarinsky/Conformal-In-Context-RCA.

Matias Cosarinsky, Nicolas Gaggion, Rodrigo Echeveste et al.

In this work, we study uncertainty estimation for anatomical landmark-based segmentation on chest X-rays. Inspired by hybrid neural network architectures that combine standard image convolutional encoders with graph-based generative decoders, and leveraging their variational latent space, we derive two complementary measures: (i) latent uncertainty, captured directly from the learned distribution parameters, and (ii) predictive uncertainty, obtained by generating multiple stochastic output predictions from latent samples. Through controlled corruption experiments we show that both uncertainty measures increase with perturbation severity, reflecting both global and local degradation. We demonstrate that these uncertainty signals can identify unreliable predictions by comparing with manual ground-truth, and support out-of-distribution detection on the CheXmask dataset. More importantly, we release CheXmask-U (huggingface.co/datasets/mcosarinsky/CheXmask-U), a large scale dataset of 657,566 chest X-ray landmark segmentations with per-node uncertainty estimates, enabling researchers to account for spatial variations in segmentation quality when using these anatomical masks. Our findings establish uncertainty estimation as a promising direction to enhance robustness and safe deployment of landmark-based anatomical segmentation methods in chest X-ray. A fully working interactive demo of the method is available at huggingface.co/spaces/matiasky/CheXmask-U and the source code at github.com/mcosarinsky/CheXmask-U.

Nicolás Gaggion, Rodrigo Bonazzola, María Florencia Legascue et al.

The analysis of plant developmental plasticity, including root system architecture, is fundamental to understanding plant adaptability and development, particularly in the context of climate change and agricultural sustainability. While significant advances have been made in plant phenotyping technologies, comprehensive temporal analysis of root development remains challenging, with most existing solutions providing either limited throughput or restricted structural analysis capabilities. Here, we present ChronoRoot 2.0, an integrated open-source platform that combines affordable hardware with advanced artificial intelligence to enable sophisticated temporal plant phenotyping. The system introduces several major advances, offering an integral perspective of seedling development: (i) simultaneous multi-organ tracking of six distinct plant structures, (ii) quality control through real-time validation, (iii) comprehensive architectural measurements including novel gravitropic response parameters, and (iv) dual specialized user interfaces for both architectural analysis and high-throughput screening. We demonstrate the system's capabilities through three use cases for Arabidopsis thaliana: characterization of circadian growth patterns under different light conditions, detailed analysis of gravitropic responses in transgenic plants, and high-throughput screening of etiolation responses across multiple genotypes. ChronoRoot 2.0 maintains its predecessor's advantages of low cost and modularity while significantly expanding its capabilities, making sophisticated temporal phenotyping more accessible to the broader plant science community. The system's open-source nature, combined with extensive documentation and containerized deployment options, ensures reproducibility and enables community-driven development of new analytical capabilities.

Nicolás Gaggion, Rodrigo Echeveste, Lucas Mansilla et al.

It has recently been shown that deep learning models for anatomical segmentation in medical images can exhibit biases against certain sub-populations defined in terms of protected attributes like sex or ethnicity. In this context, auditing fairness of deep segmentation models becomes crucial. However, such audit process generally requires access to ground-truth segmentation masks for the target population, which may not always be available, especially when going from development to deployment. Here we propose a new method to anticipate model biases in biomedical image segmentation in the absence of ground-truth annotations. Our unsupervised bias discovery method leverages the reverse classification accuracy framework to estimate segmentation quality. Through numerical experiments in synthetic and realistic scenarios we show how our method is able to successfully anticipate fairness issues in the absence of ground-truth labels, constituting a novel and valuable tool in this field.