Carri Glide‐Hurst

Soumyanil Banerjee, Nicholas Summerfield, Ming Dong et al.

U-shaped networks and its variants have demonstrated exceptional results for medical image segmentation. In this paper, we propose a novel dual self-distillation (DSD) framework in U-shaped networks for volumetric medical image segmentation. DSD distills knowledge from the ground-truth segmentation labels to the decoder layers. Additionally, DSD also distills knowledge from the deepest decoder and encoder layer to the shallower decoder and encoder layers respectively of a single U-shaped network. DSD is a general training strategy that could be attached to the backbone architecture of any U-shaped network to further improve its segmentation performance. We attached DSD on several state-of-the-art U-shaped backbones, and extensive experiments on various public 3D medical image segmentation datasets (cardiac substructure, brain tumor and Hippocampus) demonstrated significant improvement over the same backbones without DSD. On average, after attaching DSD to the U-shaped backbones, we observed an increase of 2.82\%, 4.53\% and 1.3\% in Dice similarity score, a decrease of 7.15 mm, 6.48 mm and 0.76 mm in the Hausdorff distance, for cardiac substructure, brain tumor and Hippocampus segmentation, respectively. These improvements were achieved with negligible increase in the number of trainable parameters and training time. Our proposed DSD framework also led to significant qualitative improvements for cardiac substructure, brain tumor and Hippocampus segmentation over the U-shaped backbones. The source code is publicly available at https://github.com/soumbane/DualSelfDistillation.

Qisheng He, Nicholas Summerfield, Ming Dong et al.

Medical image segmentation of tumors and organs at risk is a time-consuming yet critical process in the clinic that utilizes multi-modality imaging (e.g, different acquisitions, data types, and sequences) to increase segmentation precision. In this paper, we propose a novel framework, Modality-Agnostic learning through Multi-modality Self-dist-illation (MAG-MS), to investigate the impact of input modalities on medical image segmentation. MAG-MS distills knowledge from the fusion of multiple modalities and applies it to enhance representation learning for individual modalities. Thus, it provides a versatile and efficient approach to handle limited modalities during testing. Our extensive experiments on benchmark datasets demonstrate the high efficiency of MAG-MS and its superior segmentation performance than current state-of-the-art methods. Furthermore, using MAG-MS, we provide valuable insight and guidance on selecting input modalities for medical image segmentation tasks.

Behzad Hejrati, Soumyanil Banerjee, Carri Glide-Hurst et al.

Diffusion models have been used extensively for high quality image and video generation tasks. In this paper, we propose a novel conditional diffusion model with spatial attention and latent embedding (cDAL) for medical image segmentation. In cDAL, a convolutional neural network (CNN) based discriminator is used at every time-step of the diffusion process to distinguish between the generated labels and the real ones. A spatial attention map is computed based on the features learned by the discriminator to help cDAL generate more accurate segmentation of discriminative regions in an input image. Additionally, we incorporated a random latent embedding into each layer of our model to significantly reduce the number of training and sampling time-steps, thereby making it much faster than other diffusion models for image segmentation. We applied cDAL on 3 publicly available medical image segmentation datasets (MoNuSeg, Chest X-ray and Hippocampus) and observed significant qualitative and quantitative improvements with higher Dice scores and mIoU over the state-of-the-art algorithms. The source code is publicly available at https://github.com/Hejrati/cDAL/.

Nicholas Summerfield, Qisheng He, Alex Kuo et al.

Cardiac substructure delineation is emerging in treatment planning to minimize the risk of radiation-induced heart disease. Deep learning offers efficient methods to reduce contouring burden but currently lacks generalizability across different modalities and overlapping structures. This work introduces and validates a Modality-AGnostic Image Cascade (MAGIC) deep-learning pipeline for comprehensive and multi-modal cardiac substructure segmentation. MAGIC is implemented through replicated encoding and decoding branches of an nnU-Net backbone to handle multi-modality inputs and overlapping labels. First benchmarked on the multi-modality whole-heart segmentation (MMWHS) dataset including cardiac CT-angiography (CCTA) and MR modalities, twenty cardiac substructures (heart, chambers, great vessels (GVs), valves, coronary arteries (CAs), and conduction nodes) from clinical simulation CT (Sim-CT), low-field MR-Linac, and cardiac CT-angiography (CCTA) modalities were delineated to train semi-supervised (n=151), validate (n=15), and test (n=30) MAGIC. For comparison, fourteen single-modality comparison models (two MMWHS modalities and four subgroups across three clinical modalities) were trained. Methods were evaluated for efficiency and against reference contours through the Dice similarity coefficient (DSC) and two-tailed Wilcoxon Signed-Rank test (p<0.05). Average MMWHS DSC scores across CCTA and MR inputs were 0.88(0.08) and 0.87(0.04) respectively with significant improvement over unimodal baselines. Average 20-structure DSC scores were 0.75(0.16) for Sim-CT, 0.68(0.21) for MR-Linac, and 0.80(0.16) for CCTA. Furthermore, >80% and >70% reductions in training time and parameters were achieved, respectively. MAGIC offers an efficient, lightweight solution capable of segmenting multiple image modalities and overlapping structures in a single model without compromising segmentation accuracy.

Qisheng He, Nicholas Summerfield, Peiyong Wang et al.

Recent studies have shown that diffusion models produce superior synthetic images when compared to Generative Adversarial Networks (GANs). However, their outputs are often non-deterministic and lack high fidelity to the ground truth due to the inherent randomness. In this paper, we propose a novel High-fidelity Brownian bridge model (HiFi-BBrg) for deterministic medical image translations. Our model comprises two distinct yet mutually beneficial mappings: a generation mapping and a reconstruction mapping. The Brownian bridge training process is guided by the fidelity loss and adversarial training in the reconstruction mapping. This ensures that translated images can be accurately reversed to their original forms, thereby achieving consistent translations with high fidelity to the ground truth. Our extensive experiments on multiple datasets show HiFi-BBrg outperforms state-of-the-art methods in multi-modal image translation and multi-image super-resolution.

Hajar Emami, Ming Dong, Siamak Nejad-Davarani et al.

In medical image synthesis, model training could be challenging due to the inconsistencies between images of different modalities even with the same patient, typically caused by internal status/tissue changes as different modalities are usually obtained at a different time. This paper proposes a novel deep learning method, Structure-aware Generative Adversarial Network (SA-GAN), that preserves the shapes and locations of in-consistent structures when generating medical images. SA-GAN is employed to generate synthetic computed tomography (synCT) images from magnetic resonance imaging (MRI) with two parallel streams: the global stream translates the input from the MRI to the CT domain while the local stream automatically segments the inconsistent organs, maintains their locations and shapes in MRI, and translates the organ intensities to CT. Through extensive experiments on a pelvic dataset, we demonstrate that SA-GAN provides clinically acceptable accuracy on both synCTs and organ segmentation and supports MR-only treatment planning in disease sites with internal organ status changes.

Hajar Emami, Ming Dong, Carri K. Glide-Hurst

Recently, interest in MR-only treatment planning using synthetic CTs (synCTs) has grown rapidly in radiation therapy. However, developing class solutions for medical images that contain atypical anatomy remains a major limitation. In this paper, we propose a novel spatial attention-guided generative adversarial network (attention-GAN) model to generate accurate synCTs using T1-weighted MRI images as the input to address atypical anatomy. Experimental results on fifteen brain cancer patients show that attention-GAN outperformed existing synCT models and achieved an average MAE of 85.22$\pm$12.08, 232.41$\pm$60.86, 246.38$\pm$42.67 Hounsfield units between synCT and CT-SIM across the entire head, bone and air regions, respectively. Qualitative analysis shows that attention-GAN has the ability to use spatially focused areas to better handle outliers, areas with complex anatomy or post-surgical regions, and thus offer strong potential for supporting near real-time MR-only treatment planning.