Christian Ledig

Sebastian Doerrich, Francesco Di Salvo, Christian Ledig

We introduce unORANIC, an unsupervised approach that uses an adapted loss function to drive the orthogonalization of anatomy and image-characteristic features. The method is versatile for diverse modalities and tasks, as it does not require domain knowledge, paired data samples, or labels. During test time unORANIC is applied to potentially corrupted images, orthogonalizing their anatomy and characteristic components, to subsequently reconstruct corruption-free images, showing their domain-invariant anatomy only. This feature orthogonalization further improves generalization and robustness against corruptions. We confirm this qualitatively and quantitatively on 5 distinct datasets by assessing unORANIC's classification accuracy, corruption detection and revision capabilities. Our approach shows promise for enhancing the generalizability and robustness of practical applications in medical image analysis. The source code is available at https://github.com/sdoerrich97/unORANIC.

Sebastian Doerrich, Francesco Di Salvo, Christian Ledig

Despite notable advancements, the integration of deep learning (DL) techniques into impactful clinical applications, particularly in the realm of digital histopathology, has been hindered by challenges associated with achieving robust generalization across diverse imaging domains and characteristics. Traditional mitigation strategies in this field such as data augmentation and stain color normalization have proven insufficient in addressing this limitation, necessitating the exploration of alternative methodologies. To this end, we propose a novel generative method for domain generalization in histopathology images. Our method employs a generative, self-supervised Vision Transformer to dynamically extract characteristics of image patches and seamlessly infuse them into the original images, thereby creating novel, synthetic images with diverse attributes. By enriching the dataset with such synthesized images, we aim to enhance its holistic nature, facilitating improved generalization of DL models to unseen domains. Extensive experiments conducted on two distinct histopathology datasets demonstrate the effectiveness of our proposed approach, outperforming the state of the art substantially, on the Camelyon17-wilds challenge dataset (+2%) and on a second epithelium-stroma dataset (+26%). Furthermore, we emphasize our method's ability to readily scale with increasingly available unlabeled data samples and more complex, higher parametric architectures. Source code is available at https://github.com/sdoerrich97/vits-are-generative-models .

Francesco Di Salvo, David Tafler, Sebastian Doerrich et al.

Large and well-annotated datasets are essential for advancing deep learning applications, however often costly or impossible to obtain by a single entity. In many areas, including the medical domain, approaches relying on data sharing have become critical to address those challenges. While effective in increasing dataset size and diversity, data sharing raises significant privacy concerns. Commonly employed anonymization methods based on the k-anonymity paradigm often fail to preserve data diversity, affecting model robustness. This work introduces a novel approach using Conditional Variational Autoencoders (CVAEs) trained on feature vectors extracted from large pre-trained vision foundation models. Foundation models effectively detect and represent complex patterns across diverse domains, allowing the CVAE to faithfully capture the embedding space of a given data distribution to generate (sample) a diverse, privacy-respecting, and potentially unbounded set of synthetic feature vectors. Our method notably outperforms traditional approaches in both medical and natural image domains, exhibiting greater dataset diversity and higher robustness against perturbations while preserving sample privacy. These results underscore the potential of generative models to significantly impact deep learning applications in data-scarce and privacy-sensitive environments. The source code is available at https://github.com/francescodisalvo05/cvae-anonymization .

Francesco Di Salvo, Sebastian Doerrich, Ines Rieger et al.

The performance of deep neural networks scales with dataset size and label quality, rendering the efficient mitigation of low-quality data annotations crucial for building robust and cost-effective systems. Existing strategies to address label noise exhibit severe limitations due to computational complexity and application dependency. In this work, we propose WANN, a Weighted Adaptive Nearest Neighbor approach that builds on self-supervised feature representations obtained from foundation models. To guide the weighted voting scheme, we introduce a reliability score $η$, which measures the likelihood of a data label being correct. WANN outperforms reference methods, including a linear layer trained with robust loss functions, on diverse datasets of varying size and under various noise types and severities. WANN also exhibits superior generalization on imbalanced data compared to both Adaptive-NNs (ANN) and fixed k-NNs. Furthermore, the proposed weighting scheme enhances supervised dimensionality reduction under noisy labels. This yields a significant boost in classification performance with 10x and 100x smaller image embeddings, minimizing latency and storage requirements. Our approach, emphasizing efficiency and explainability, emerges as a simple, robust solution to overcome inherent limitations of deep neural network training. The code is available at https://github.com/francescodisalvo05/wann-noisy-labels .

Francesco Di Salvo, Sebastian Doerrich, Jonas Alle et al.

Robust generalization beyond training distributions remains a critical challenge for deep neural networks. This is especially pronounced in medical image analysis, where data is often scarce and covariate shifts arise from different hardware devices, imaging protocols, and heterogeneous patient populations. These factors collectively hinder reliable performance and slow down clinical adoption. Despite recent progress, existing learning paradigms primarily rely on the Euclidean manifold, whose flat geometry fails to capture the complex, hierarchical structures present in clinical data. In this work, we exploit the advantages of hyperbolic manifolds to model complex data characteristics. We present the first comprehensive validation of hyperbolic representation learning for medical image analysis and demonstrate statistically significant gains across eleven in-distribution datasets and three ViT models. We further propose an unsupervised, domain-invariant hyperbolic cross-branch consistency constraint. Extensive experiments confirm that our proposed method promotes domain-invariant features and outperforms state-of-the-art Euclidean methods by an average of $+2.1\%$ AUC on three domain generalization benchmarks: Fitzpatrick17k, Camelyon17-WILDS, and a cross-dataset setup for retinal imaging. These datasets span different imaging modalities, data sizes, and label granularities, confirming generalization capabilities across substantially different conditions. The code is available at https://github.com/francescodisalvo05/hyperbolic-cross-branch-consistency .

Sebastian Doerrich, Francesco Di Salvo, Christian Ledig

This study introduces unORANIC+, a novel method that integrates unsupervised feature orthogonalization with the ability of a Vision Transformer to capture both local and global relationships for improved robustness and generalizability. The streamlined architecture of unORANIC+ effectively separates anatomical and image-specific attributes, resulting in robust and unbiased latent representations that allow the model to demonstrate excellent performance across various medical image analysis tasks and diverse datasets. Extensive experimentation demonstrates unORANIC+'s reconstruction proficiency, corruption resilience, as well as capability to revise existing image distortions. Additionally, the model exhibits notable aptitude in downstream tasks such as disease classification and corruption detection. We confirm its adaptability to diverse datasets of varying image sources and sample sizes which positions the method as a promising algorithm for advanced medical image analysis, particularly in resource-constrained environments lacking large, tailored datasets. The source code is available at https://github.com/sdoerrich97/unoranic-plus .

Sebastian Doerrich, Francesco Di Salvo, Julius Brockmann et al.

The integration of deep learning based systems in clinical practice is often impeded by challenges rooted in limited and heterogeneous medical datasets. In addition, the field has increasingly prioritized marginal performance gains on a few, narrowly scoped benchmarks over clinical applicability, slowing down meaningful algorithmic progress. This trend often results in excessive fine-tuning of existing methods on selected datasets rather than fostering clinically relevant innovations. In response, this work introduces a comprehensive benchmark for the MedMNIST+ dataset collection, designed to diversify the evaluation landscape across several imaging modalities, anatomical regions, classification tasks and sample sizes. We systematically reassess commonly used Convolutional Neural Networks (CNNs) and Vision Transformer (ViT) architectures across distinct medical datasets, training methodologies, and input resolutions to validate and refine existing assumptions about model effectiveness and development. Our findings suggest that computationally efficient training schemes and modern foundation models offer viable alternatives to costly end-to-end training. Additionally, we observe that higher image resolutions do not consistently improve performance beyond a certain threshold. This highlights the potential benefits of using lower resolutions, particularly in prototyping stages, to reduce computational demands without sacrificing accuracy. Notably, our analysis reaffirms the competitiveness of CNNs compared to ViTs, emphasizing the importance of comprehending the intrinsic capabilities of different architectures. Finally, by establishing a standardized evaluation framework, we aim to enhance transparency, reproducibility, and comparability within the MedMNIST+ dataset collection. Code is available at https://github.com/sdoerrich97/rethinking-model-prototyping-MedMNISTPlus .

Sebastian Doerrich, Tobias Archut, Francesco Di Salvo et al.

Traditional deep learning models implicity encode knowledge limiting their transparency and ability to adapt to data changes. Yet, this adaptability is vital for addressing user data privacy concerns. We address this limitation by storing embeddings of the underlying training data independently of the model weights, enabling dynamic data modifications without retraining. Specifically, our approach integrates the $k$-Nearest Neighbor ($k$-NN) classifier with a vision-based foundation model, pre-trained self-supervised on natural images, enhancing interpretability and adaptability. We share open-source implementations of a previously unpublished baseline method as well as our performance-improving contributions. Quantitative experiments confirm improved classification across established benchmark datasets and the method's applicability to distinct medical image classification tasks. Additionally, we assess the method's robustness in continual learning and data removal scenarios. The approach exhibits great promise for bridging the gap between foundation models' performance and challenges tied to data privacy. The source code is available at https://github.com/TobArc/privacy-aware-image-classification-with-kNN.

Francesco Di Salvo, Sebastian Doerrich, Christian Ledig

The integration of neural-network-based systems into clinical practice is limited by challenges related to domain generalization and robustness. The computer vision community established benchmarks such as ImageNet-C as a fundamental prerequisite to measure progress towards those challenges. Similar datasets are largely absent in the medical imaging community which lacks a comprehensive benchmark that spans across imaging modalities and applications. To address this gap, we create and open-source MedMNIST-C, a benchmark dataset based on the MedMNIST+ collection covering 12 datasets and 9 imaging modalities. We simulate task and modality-specific image corruptions of varying severity to comprehensively evaluate the robustness of established algorithms against real-world artifacts and distribution shifts. We further provide quantitative evidence that our simple-to-use artificial corruptions allow for highly performant, lightweight data augmentation to enhance model robustness. Unlike traditional, generic augmentation strategies, our approach leverages domain knowledge, exhibiting significantly higher robustness when compared to widely adopted methods. By introducing MedMNIST-C and open-sourcing the corresponding library allowing for targeted data augmentations, we contribute to the development of increasingly robust methods tailored to the challenges of medical imaging. The code is available at https://github.com/francescodisalvo05/medmnistc-api .

Francesco Di Salvo, Hanh Huyen My Nguyen, Christian Ledig

Deep Learning (DL) has revolutionized medical imaging, yet its adoption is constrained by data scarcity and privacy regulations, limiting access to diverse datasets. Federated Learning (FL) enables decentralized training but suffers from high communication costs and is often restricted to a single downstream task, reducing flexibility. We propose a data-sharing method via Differentially Private (DP) generative models. By adopting foundation models, we extract compact, informative embeddings, reducing redundancy and lowering computational overhead. Clients collaboratively train a Differentially Private Conditional Variational Autoencoder (DP-CVAE) to model a global, privacy-aware data distribution, supporting diverse downstream tasks. Our approach, validated across multiple feature extractors, enhances privacy, scalability, and efficiency, outperforming traditional FL classifiers while ensuring differential privacy. Additionally, DP-CVAE produces higher-fidelity embeddings than DP-CGAN while requiring $5{\times}$ fewer parameters.

Carlo Biffi, Juan J. Cerrolaza, Giacomo Tarroni et al.

Quantification of anatomical shape changes currently relies on scalar global indexes which are largely insensitive to regional or asymmetric modifications. Accurate assessment of pathology-driven anatomical remodeling is a crucial step for the diagnosis and treatment of many conditions. Deep learning approaches have recently achieved wide success in the analysis of medical images, but they lack interpretability in the feature extraction and decision processes. In this work, we propose a new interpretable deep learning model for shape analysis. In particular, we exploit deep generative networks to model a population of anatomical segmentations through a hierarchy of conditional latent variables. At the highest level of this hierarchy, a two-dimensional latent space is simultaneously optimised to discriminate distinct clinical conditions, enabling the direct visualisation of the classification space. Moreover, the anatomical variability encoded by this discriminative latent space can be visualised in the segmentation space thanks to the generative properties of the model, making the classification task transparent. This approach yielded high accuracy in the categorisation of healthy and remodelled left ventricles when tested on unseen segmentations from our own multi-centre dataset as well as in an external validation set, and on hippocampi from healthy controls and patients with Alzheimer's disease when tested on ADNI data. More importantly, it enabled the visualisation in three-dimensions of both global and regional anatomical features which better discriminate between the conditions under exam. The proposed approach scales effectively to large populations, facilitating high-throughput analysis of normal anatomy and pathology in large-scale studies of volumetric imaging.

Anant Gupta, Srivas Venkatesh, Sumit Chopra et al.

Insufficient training data and severe class imbalance are often limiting factors when developing machine learning models for the classification of rare diseases. In this work, we address the problem of classifying bone lesions from X-ray images by increasing the small number of positive samples in the training set. We propose a generative data augmentation approach based on a cycle-consistent generative adversarial network that synthesizes bone lesions on images without pathology. We pose the generative task as an image-patch translation problem that we optimize specifically for distinct bones (humerus, tibia, femur). In experimental results, we confirm that the described method mitigates the class imbalance problem in the binary classification task of bone lesion detection. We show that the augmented training sets enable the training of superior classifiers achieving better performance on a held-out test set. Additionally, we demonstrate the feasibility of transfer learning and apply a generative model that was trained on one body part to another.

Jelmer M. Wolterink, Konstantinos Kamnitsas, Christian Ledig et al.

Generative adversarial networks (GANs) and other adversarial methods are based on a game-theoretical perspective on joint optimization of two neural networks as players in a game. Adversarial techniques have been extensively used to synthesize and analyze biomedical images. We provide an introduction to GANs and adversarial methods, with an overview of biomedical image analysis tasks that have benefited from such methods. We conclude with a discussion of strengths and limitations of adversarial methods in biomedical image analysis, and propose potential future research directions.

Martin Rajchl, Lisa M. Koch, Christian Ledig et al.

To efficiently establish training databases for machine learning methods, collaborative and crowdsourcing platforms have been investigated to collectively tackle the annotation effort. However, when this concept is ported to the medical imaging domain, reading expertise will have a direct impact on the annotation accuracy. In this study, we examine the impact of expertise and the amount of available annotations on the accuracy outcome of a liver segmentation problem in an abdominal computed tomography (CT) image database. In controlled experiments, we study this impact for different types of weak annotations. To address the decrease in accuracy associated with lower expertise, we propose a method for outlier correction making use of a weakly labelled atlas. Using this approach, we demonstrate that weak annotations subject to high error rates can achieve a similarly high accuracy as state-of-the-art multi-atlas segmentation approaches relying on a large amount of expert manual segmentations. Annotations of this nature can realistically be obtained from a non-expert crowd and can potentially enable crowdsourcing of weak annotation tasks for medical image analysis.

Andrew Aitken, Christian Ledig, Lucas Theis et al.

The most prominent problem associated with the deconvolution layer is the presence of checkerboard artifacts in output images and dense labels. To combat this problem, smoothness constraints, post processing and different architecture designs have been proposed. Odena et al. highlight three sources of checkerboard artifacts: deconvolution overlap, random initialization and loss functions. In this note, we proposed an initialization method for sub-pixel convolution known as convolution NN resize. Compared to sub-pixel convolution initialized with schemes designed for standard convolution kernels, it is free from checkerboard artifacts immediately after initialization. Compared to resize convolution, at the same computational complexity, it has more modelling power and converges to solutions with smaller test errors.

Konstantinos Kamnitsas, Christian Baumgartner, Christian Ledig et al.

Significant advances have been made towards building accurate automatic segmentation systems for a variety of biomedical applications using machine learning. However, the performance of these systems often degrades when they are applied on new data that differ from the training data, for example, due to variations in imaging protocols. Manually annotating new data for each test domain is not a feasible solution. In this work we investigate unsupervised domain adaptation using adversarial neural networks to train a segmentation method which is more invariant to differences in the input data, and which does not require any annotations on the test domain. Specifically, we learn domain-invariant features by learning to counter an adversarial network, which attempts to classify the domain of the input data by observing the activations of the segmentation network. Furthermore, we propose a multi-connected domain discriminator for improved adversarial training. Our system is evaluated using two MR databases of subjects with traumatic brain injuries, acquired using different scanners and imaging protocols. Using our unsupervised approach, we obtain segmentation accuracies which are close to the upper bound of supervised domain adaptation.

Jose Caballero, Christian Ledig, Andrew Aitken et al.

Convolutional neural networks have enabled accurate image super-resolution in real-time. However, recent attempts to benefit from temporal correlations in video super-resolution have been limited to naive or inefficient architectures. In this paper, we introduce spatio-temporal sub-pixel convolution networks that effectively exploit temporal redundancies and improve reconstruction accuracy while maintaining real-time speed. Specifically, we discuss the use of early fusion, slow fusion and 3D convolutions for the joint processing of multiple consecutive video frames. We also propose a novel joint motion compensation and video super-resolution algorithm that is orders of magnitude more efficient than competing methods, relying on a fast multi-resolution spatial transformer module that is end-to-end trainable. These contributions provide both higher accuracy and temporally more consistent videos, which we confirm qualitatively and quantitatively. Relative to single-frame models, spatio-temporal networks can either reduce the computational cost by 30% whilst maintaining the same quality or provide a 0.2dB gain for a similar computational cost. Results on publicly available datasets demonstrate that the proposed algorithms surpass current state-of-the-art performance in both accuracy and efficiency.

Wenzhe Shi, Jose Caballero, Lucas Theis et al.

In this note, we want to focus on aspects related to two questions most people asked us at CVPR about the network we presented. Firstly, What is the relationship between our proposed layer and the deconvolution layer? And secondly, why are convolutions in low-resolution (LR) space a better choice? These are key questions we tried to answer in the paper, but we were not able to go into as much depth and clarity as we would have liked in the space allowance. To better answer these questions in this note, we first discuss the relationships between the deconvolution layer in the forms of the transposed convolution layer, the sub-pixel convolutional layer and our efficient sub-pixel convolutional layer. We will refer to our efficient sub-pixel convolutional layer as a convolutional layer in LR space to distinguish it from the common sub-pixel convolutional layer. We will then show that for a fixed computational budget and complexity, a network with convolutions exclusively in LR space has more representation power at the same speed than a network that first upsamples the input in high resolution space.

Christian Ledig, Lucas Theis, Ferenc Huszar et al.

Despite the breakthroughs in accuracy and speed of single image super-resolution using faster and deeper convolutional neural networks, one central problem remains largely unsolved: how do we recover the finer texture details when we super-resolve at large upscaling factors? The behavior of optimization-based super-resolution methods is principally driven by the choice of the objective function. Recent work has largely focused on minimizing the mean squared reconstruction error. The resulting estimates have high peak signal-to-noise ratios, but they are often lacking high-frequency details and are perceptually unsatisfying in the sense that they fail to match the fidelity expected at the higher resolution. In this paper, we present SRGAN, a generative adversarial network (GAN) for image super-resolution (SR). To our knowledge, it is the first framework capable of inferring photo-realistic natural images for 4x upscaling factors. To achieve this, we propose a perceptual loss function which consists of an adversarial loss and a content loss. The adversarial loss pushes our solution to the natural image manifold using a discriminator network that is trained to differentiate between the super-resolved images and original photo-realistic images. In addition, we use a content loss motivated by perceptual similarity instead of similarity in pixel space. Our deep residual network is able to recover photo-realistic textures from heavily downsampled images on public benchmarks. An extensive mean-opinion-score (MOS) test shows hugely significant gains in perceptual quality using SRGAN. The MOS scores obtained with SRGAN are closer to those of the original high-resolution images than to those obtained with any state-of-the-art method.

Konstantinos Kamnitsas, Christian Ledig, Virginia F. J. Newcombe et al.

We propose a dual pathway, 11-layers deep, three-dimensional Convolutional Neural Network for the challenging task of brain lesion segmentation. The devised architecture is the result of an in-depth analysis of the limitations of current networks proposed for similar applications. To overcome the computational burden of processing 3D medical scans, we have devised an efficient and effective dense training scheme which joins the processing of adjacent image patches into one pass through the network while automatically adapting to the inherent class imbalance present in the data. Further, we analyze the development of deeper, thus more discriminative 3D CNNs. In order to incorporate both local and larger contextual information, we employ a dual pathway architecture that processes the input images at multiple scales simultaneously. For post-processing of the network's soft segmentation, we use a 3D fully connected Conditional Random Field which effectively removes false positives. Our pipeline is extensively evaluated on three challenging tasks of lesion segmentation in multi-channel MRI patient data with traumatic brain injuries, brain tumors, and ischemic stroke. We improve on the state-of-the-art for all three applications, with top ranking performance on the public benchmarks BRATS 2015 and ISLES 2015. Our method is computationally efficient, which allows its adoption in a variety of research and clinical settings. The source code of our implementation is made publicly available.