Kathleen M. Curran

Fangyijie Wang, Guénolé Silvestre, Kathleen M. Curran

Fetal head segmentation is a crucial step in measuring the fetal head circumference (HC) during gestation, an important biometric in obstetrics for monitoring fetal growth. However, manual biometry generation is time-consuming and results in inconsistent accuracy. To address this issue, convolutional neural network (CNN) models have been utilized to improve the efficiency of medical biometry. But training a CNN network from scratch is a challenging task, we proposed a Transfer Learning (TL) method. Our approach involves fine-tuning (FT) a U-Net network with a lightweight MobileNet as the encoder to perform segmentation on a set of fetal head ultrasound (US) images with limited effort. This method addresses the challenges associated with training a CNN network from scratch. It suggests that our proposed FT strategy yields segmentation performance that is comparable when trained with a reduced number of parameters by 85.8%. And our proposed FT strategy outperforms other strategies with smaller trainable parameter sizes below 4.4 million. Thus, we contend that it can serve as a dependable FT approach for reducing the size of models in medical image analysis. Our key findings highlight the importance of the balance between model performance and size in developing Artificial Intelligence (AI) applications by TL methods. Code is available at https://github.com/13204942/FT_Methods_for_Fetal_Head_Segmentation.

Niamh Belton, Misgina Tsighe Hagos, Aonghus Lawlor et al.

Recent Anomaly Detection techniques have progressed the field considerably but at the cost of increasingly complex training pipelines. Such techniques require large amounts of training data, resulting in computationally expensive algorithms that are unsuitable for settings where only a small amount of normal samples are available for training. We propose 'Few Shot anOMaly detection' (FewSOME), a deep One-Class Anomaly Detection algorithm with the ability to accurately detect anomalies having trained on 'few' examples of the normal class and no examples of the anomalous class. We describe FewSOME to be of low complexity given its low data requirement and short training time. FewSOME is aided by pretrained weights with an architecture based on Siamese Networks. By means of an ablation study, we demonstrate how our proposed loss, 'Stop Loss', improves the robustness of FewSOME. Our experiments demonstrate that FewSOME performs at state-of-the-art level on benchmark datasets MNIST, CIFAR-10, F-MNIST and MVTec AD while training on only 30 normal samples, a minute fraction of the data that existing methods are trained on. Moreover, our experiments show FewSOME to be robust to contaminated datasets. We also report F1 score and balanced accuracy in addition to AUC as a benchmark for future techniques to be compared against. Code available; https://github.com/niamhbelton/FewSOME.

Niamh Belton, Aonghus Lawlor, Kathleen M. Curran

The diagnostic accuracy and subjectivity of existing Knee Osteoarthritis (OA) ordinal grading systems has been a subject of on-going debate and concern. Existing automated solutions are trained to emulate these imperfect systems, whilst also being reliant on large annotated databases for fully-supervised training. This work proposes a three stage approach for automated continuous grading of knee OA that is built upon the principles of Anomaly Detection (AD); learning a robust representation of healthy knee X-rays and grading disease severity based on its distance to the centre of normality. In the first stage, SS-FewSOME is proposed, a self-supervised AD technique that learns the 'normal' representation, requiring only examples of healthy subjects and <3% of the labels that existing methods require. In the second stage, this model is used to pseudo label a subset of unlabelled data as 'normal' or 'anomalous', followed by denoising of pseudo labels with CLIP. The final stage involves retraining on labelled and pseudo labelled data using the proposed Dual Centre Representation Learning (DCRL) which learns the centres of two representation spaces; normal and anomalous. Disease severity is then graded based on the distance to the learned centres. The proposed methodology outperforms existing techniques by margins of up to 24% in terms of OA detection and the disease severity scores correlate with the Kellgren-Lawrence grading system at the same level as human expert performance. Code available at https://github.com/niamhbelton/SS-FewSOME_Disease_Severity_Knee_Osteoarthritis.

Francesco Chiumento, Julia Dietlmeier, Ronan P. Killeen et al.

Detecting amyloid-$β$ (A$β$) positivity is crucial for early diagnosis of Alzheimer's disease but typically requires PET imaging, which is costly, invasive, and not widely accessible, limiting its use for population-level screening. We address this gap by proposing a PET-guided knowledge distillation framework that enables A$β$ prediction from MRI alone, without requiring non-imaging clinical covariates or PET at inference. Our approach employs a BiomedCLIP-based teacher model that learns PET-MRI alignment via cross-modal attention and triplet contrastive learning with PET-informed (Centiloid-aware) online negative sampling. An MRI-only student then mimics the teacher via feature-level and logit-level distillation. Evaluated across four MRI contrasts (T1w, T2w, FLAIR, T2*) and two independent datasets, our approach demonstrates effective knowledge transfer (best AUC: 0.74 on OASIS-3, 0.68 on ADNI) while maintaining interpretability and eliminating the need for clinical variables. Saliency analysis confirms that predictions focus on anatomically relevant cortical regions, supporting the clinical viability of PET-free A$β$ screening. Code is available at https://github.com/FrancescoChiumento/pet-guided-mri-amyloid-detection.

Misgina Tsighe Hagos, Kathleen M. Curran, Brian Mac Namee

Identifying spurious correlations learned by a trained model is at the core of refining a trained model and building a trustworthy model. We present a simple method to identify spurious correlations that have been learned by a model trained for image classification problems. We apply image-level perturbations and monitor changes in certainties of predictions made using the trained model. We demonstrate this approach using an image classification dataset that contains images with synthetically generated spurious regions and show that the trained model was overdependent on spurious regions. Moreover, we remove the learned spurious correlations with an explanation based learning approach.

Misgina Tsighe Hagos, Kathleen M. Curran, Brian Mac Namee

Explanatory Interactive Learning (XIL) collects user feedback on visual model explanations to implement a Human-in-the-Loop (HITL) based interactive learning scenario. Different user feedback types will have different impacts on user experience and the cost associated with collecting feedback since different feedback types involve different levels of image annotation. Although XIL has been used to improve classification performance in multiple domains, the impact of different user feedback types on model performance and explanation accuracy is not well studied. To guide future XIL work we compare the effectiveness of two different user feedback types in image classification tasks: (1) instructing an algorithm to ignore certain spurious image features, and (2) instructing an algorithm to focus on certain valid image features. We use explanations from a Gradient-weighted Class Activation Mapping (GradCAM) based XIL model to support both feedback types. We show that identifying and annotating spurious image features that a model finds salient results in superior classification and explanation accuracy than user feedback that tells a model to focus on valid image features.

Carles Garcia-Cabrera, Eric Arazo, Kathleen M. Curran et al.

Methods that are resilient to artifacts in the cardiac magnetic resonance imaging (MRI) while performing ventricle segmentation, are crucial for ensuring quality in structural and functional analysis of those tissues. While there has been significant efforts on improving the quality of the algorithms, few works have tackled the harm that the artifacts generate in the predictions. In this work, we study fine tuning of pretrained networks to improve the resilience of previous methods to these artifacts. In our proposed method, we adopted the extensive usage of data augmentations that mimic those artifacts. The results significantly improved the baseline segmentations (up to 0.06 Dice score, and 4mm Hausdorff distance improvement).

Misgina Tsighe Hagos, Niamh Belton, Ronan P. Killeen et al.

Alzheimer's Disease (AD) is a progressive disease preceded by Mild Cognitive Impairment (MCI). Early detection of AD is crucial for making treatment decisions. However, most of the literature on computer-assisted detection of AD focuses on classifying brain images into one of three major categories: healthy, MCI, and AD; or categorizing MCI patients into (1) progressive: those who progress from MCI to AD at a future examination time, and (2) stable: those who stay as MCI and never progress to AD. This misses the opportunity to accurately identify the trajectory of progressive MCI patients. In this paper, we revisit the brain image classification task for AD identification and re-frame it as an ordinal classification task to predict how close a patient is to the severe AD stage. To this end, we select progressive MCI patients from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset and construct an ordinal dataset with a prediction target that indicates the time to progression to AD. We train a Siamese network model to predict the time to onset of AD based on MRI brain images. We also propose a Weighted variety of Siamese network and compare its performance to a baseline model. Our evaluations show that incorporating a weighting factor to Siamese networks brings considerable performance gain at predicting how close input brain MRI images are to progressing to AD. Moreover, we complement our results with an interpretation of the learned embedding space of the Siamese networks using a model explainability technique.

Bulat Maksudov, Vladislav Kurenkov, Kathleen M. Curran et al.

Existing medical-agent benchmarks deliver imaging as pre-selected samples, never as an environment the agent must navigate. We introduce ABRA, a radiology-agent benchmark in which the agent operates an OHIF viewer and an Orthanc DICOM server through twenty-one function-calling tools that span slice navigation, windowing, series selection, pixel-coordinate annotation, and structured reporting. ABRA contains 655 programmatically generated tasks across three difficulty tiers and eight types (viewer control, metadata QA, vision probe, annotation, longitudinal comparison, BI-RADS reporting, and oracle variants of annotation and BI-RADS reporting), drawn from LIDC-IDRI, Duke Breast Cancer MRI, and NLST New-Lesion LongCT. Each episode is scored along Planning, Execution, and Outcome (Bluethgen et al., 2025) by task-type-specific automatic scorers. Ten current models, five closed-weight and five open-weight, reach at least 89% Execution on real annotation but only 0-25% Outcome; on the paired oracle variant where a simulated detector supplies the finding, Outcome on the same task reaches 69-100% across the models evaluated, localising the bottleneck to perception rather than tool orchestration. Code, task generators, and scorers are released at https://github.com/Luab/ABRA

Misgina Tsighe Hagos, Kathleen M. Curran, Brian Mac Namee

Medical image classification models are frequently trained using training datasets derived from multiple data sources. While leveraging multiple data sources is crucial for achieving model generalization, it is important to acknowledge that the diverse nature of these sources inherently introduces unintended confounders and other challenges that can impact both model accuracy and transparency. A notable confounding factor in medical image classification, particularly in musculoskeletal image classification, is skeletal maturation-induced bone growth observed during adolescence. We train a deep learning model using a Covid-19 chest X-ray dataset and we showcase how this dataset can lead to spurious correlations due to unintended confounding regions. eXplanation Based Learning (XBL) is a deep learning approach that goes beyond interpretability by utilizing model explanations to interactively unlearn spurious correlations. This is achieved by integrating interactive user feedback, specifically feature annotations. In our study, we employed two non-demanding manual feedback mechanisms to implement an XBL-based approach for effectively eliminating these spurious correlations. Our results underscore the promising potential of XBL in constructing robust models even in the presence of confounding factors.

Misgina Tsighe Hagos, Niamh Belton, Kathleen M. Curran et al.

eXplanation Based Learning (XBL) is an interactive learning approach that provides a transparent method of training deep learning models by interacting with their explanations. XBL augments loss functions to penalize a model based on deviation of its explanations from user annotation of image features. The literature on XBL mostly depends on the intersection of visual model explanations and image feature annotations. We present a method to add a distance-aware explanation loss to categorical losses that trains a learner to focus on important regions of a training dataset. Distance is an appropriate approach for calculating explanation loss since visual model explanations such as Gradient-weighted Class Activation Mapping (Grad-CAMs) are not strictly bounded as annotations and their intersections may not provide complete information on the deviation of a model's focus from relevant image regions. In addition to assessing our model using existing metrics, we propose an interpretability metric for evaluating visual feature-attribution based model explanations that is more informative of the model's performance than existing metrics. We demonstrate performance of our proposed method on three image classification tasks.

Misgina Tsighe Hagos, Kathleen M. Curran, Brian Mac Namee

eXplanation Based Learning (XBL) is a form of Interactive Machine Learning (IML) that provides a model refining approach via user feedback collected on model explanations. Although the interactivity of XBL promotes model transparency, XBL requires a huge amount of user interaction and can become expensive as feedback is in the form of detailed annotation rather than simple category labelling which is more common in IML. This expense is exacerbated in high stakes domains such as medical image classification. To reduce the effort and expense of XBL we introduce a new approach that uses two input instances and their corresponding Gradient Weighted Class Activation Mapping (GradCAM) model explanations as exemplary explanations to implement XBL. Using a medical image classification task, we demonstrate that, using minimal human input, our approach produces improved explanations (+0.02, +3%) and achieves reduced classification performance (-0.04, -4%) when compared against a model trained without interactions.

Niamh Belton, Victoria Joppin, Aonghus Lawlor et al.

This work introduces DyABD, a novel and complex benchmark dataset of dynamic abdominal MRIs from patients with abdominal hernias and associated high quality abdominal muscle annotations. DyABD is the first-of-its-kind in four key ways; (1) it proposes the first abdominal muscle segmentation task, (2) the dynamic MRIs are acquired whilst the patients perform various exercises, introducing extreme anatomical variability, making it one of the most challenging segmentation datasets to date, (3) it includes both pre and post corrective MRIs and (4) DyABD promotes clinical research into the high recurrence rates of abdominal hernias. Beyond dataset introduction, this work provides a comprehensive evaluation of the generalisation capabilities of existing segmentation models across Supervised, Few Shot and Zero Shot paradigms on the unseen DyABD dataset. This work reveals that there is still room for substantial improvement in the field of medical image segmentation, with the majority of techniques achieving a Dice Coefficient of 0.82. This work therefore sheds light on the true progress of the field and redefines the benchmark for progress in medical image segmentation.

Anam Hashmi, Mayug Maniparambil, Julia Dietlmeier et al.

The emergence of large-scale pretrained foundation models has transformed computer vision, enabling strong performance across diverse downstream tasks. However, their potential for physics-based inverse problems, such as accelerated cardiac MRI reconstruction, remains largely underexplored. In this work, we investigate whether natural-domain foundation models can serve as effective image priors for accelerated cardiac MRI reconstruction, and compare the performance obtained against domain-specific counterparts such as BiomedCLIP. We propose an unrolled reconstruction framework that incorporates pretrained, frozen visual encoders, such as CLIP, DINOv2, and BiomedCLIP, within each cascade to guide the reconstruction process. Through extensive experiments, we show that while task-specific state-of-the-art reconstruction models such as E2E-VarNet achieve superior performance in standard in-distribution settings, foundation-model-based approaches remain competitive. More importantly, in challenging cross-domain scenarios, where models are trained on cardiac MRI and evaluated on anatomically distinct knee and brain datasets--foundation models exhibit improved robustness, particularly under high acceleration factors and limited low-frequency sampling. We further observe that natural-image-pretrained models, such as CLIP, learn highly transferable structural representations, while domain-specific pretraining (BiomedCLIP) provides modest additional gains in more ill-posed regimes. Overall, our results suggest that pretrained foundation models offer a promising source of transferable priors, enabling improved robustness and generalization in accelerated MRI reconstruction.

Fangyijie Wang, Guénolé Silvestre, Kathleen M. Curran

Accurate measurement of fetal head circumference is crucial for estimating fetal growth during routine prenatal screening. Prior to measurement, it is necessary to accurately identify and segment the region of interest, specifically the fetal head, in ultrasound images. Recent advancements in deep learning techniques have shown significant progress in segmenting the fetal head using encoder-decoder models. Among these models, U-Net has become a standard approach for accurate segmentation. However, training an encoder-decoder model can be a time-consuming process that demands substantial computational resources. Moreover, fine-tuning these models is particularly challenging when there is a limited amount of data available. There are still no "best-practice" guidelines for optimal fine-tuning of U-net for fetal ultrasound image segmentation. This work summarizes existing fine-tuning strategies with various backbone architectures, model components, and fine-tuning strategies across ultrasound data from Netherlands, Spain, Malawi, Egypt and Algeria. Our study shows that (1) fine-tuning U-Net leads to better performance than training from scratch, (2) fine-tuning strategies in decoder are superior to other strategies, (3) network architecture with less number of parameters can achieve similar or better performance. We also demonstrate the effectiveness of fine-tuning strategies in low-resource settings and further expand our experiments into few-shot learning. Lastly, we publicly released our code and specific fine-tuned weights.

Fangyijie Wang, Kevin Whelan, Félix Balado et al.

Medical image data is less accessible than in other domains due to privacy and regulatory constraints. In addition, labeling requires costly, time-intensive manual image annotation by clinical experts. To overcome these challenges, synthetic medical data generation offers a promising solution. Generative AI (GenAI), employing generative deep learning models, has proven effective at producing realistic synthetic images. This study proposes a novel mask-guided GenAI approach using diffusion models to generate synthetic fetal head ultrasound images paired with segmentation masks. These synthetic pairs augment real datasets for supervised fine-tuning of the Segment Anything Model (SAM). Our results show that the synthetic data captures real image features effectively, and this approach reaches state-of-the-art fetal head segmentation, especially when trained with a limited number of real image-mask pairs. In particular, the segmentation reaches Dice Scores of 94.66\% and 94.38\% using a handful of ultrasound images from the Spanish and African cohorts, respectively. Our code, models, and data are available on GitHub.

Fangyijie Wang, Yuan Liang, Sourav Bhattacharjee et al.

Accurate gestational age (GA) estimation, ideally through fetal ultrasound measurement, is a crucial aspect of providing excellent antenatal care. However, deriving GA from manual fetal biometric measurements depends on the operator and is time-consuming. Hence, automatic computer-assisted methods are demanded in clinical practice. In this paper, we present a novel feature fusion framework to estimate GA using fetal ultrasound images without any measurement information. We adopt a deep learning model to extract deep representations from ultrasound images. We extract radiomic features to reveal patterns and characteristics of fetal brain growth. To harness the interpretability of radiomics in medical imaging analysis, we estimate GA by fusing radiomic features and deep representations. Our framework estimates GA with a mean absolute error of 8.0 days across three trimesters, outperforming current machine learning-based methods at these gestational ages. Experimental results demonstrate the robustness of our framework across different populations in diverse geographical regions. Our code is publicly available on \href{https://github.com/13204942/RadiomicsImageFusion_FetalUS}.

Fangyijie Wang, Kathleen M. Curran, Guénolé Silvestre

Accurate segmentation of ultrasound (US) images of the cervical muscles is crucial for precision healthcare. The demand for automatic computer-assisted methods is high. However, the scarcity of labeled data hinders the development of these methods. Advanced semi-supervised learning approaches have displayed promise in overcoming this challenge by utilizing labeled and unlabeled data. This study introduces a novel semi-supervised learning (SSL) framework that integrates dual neural networks. This SSL framework utilizes both networks to generate pseudo-labels and cross-supervise each other at the pixel level. Additionally, a self-supervised contrastive learning strategy is introduced, which employs a pair of deep representations to enhance feature learning capabilities, particularly on unlabeled data. Our framework demonstrates competitive performance in cervical segmentation tasks. Our codes are publicly available on https://github.com/13204942/SSL\_Cervical\_Segmentation.

Niamh Belton, Ivan Welaratne, Adil Dahlan et al.

This work employs a pre-trained, multi-view Convolutional Neural Network (CNN) with a spatial attention block to optimise knee injury detection. An open-source Magnetic Resonance Imaging (MRI) data set with image-level labels was leveraged for this analysis. As MRI data is acquired from three planes, we compare our technique using data from a single-plane and multiple planes (multi-plane). For multi-plane, we investigate various methods of fusing the planes in the network. This analysis resulted in the novel 'MPFuseNet' network and state-of-the-art Area Under the Curve (AUC) scores for detecting Anterior Cruciate Ligament (ACL) tears and Abnormal MRIs, achieving AUC scores of 0.977 and 0.957 respectively. We then developed an objective metric, Penalised Localisation Accuracy (PLA), to validate the model's localisation ability. This metric compares binary masks generated from Grad-Cam output and the radiologist's annotations on a sample of MRIs. We also extracted explainability features in a model-agnostic approach that were then verified as clinically relevant by the radiologist.

Fangyijie Wang, Tanya Akumu, Vien Ngoc Dang et al.

Foundation models promise to unify multiple clinical tasks within a single framework, but recent ultrasound studies report that unified models can underperform task-specific baselines. We hypothesize that this degradation arises not from model capacity limitations, but from task aggregation strategies that ignore interactions between task heterogeneity and available training data scale. In this work, we systematically analyze when heterogeneous ultrasound tasks can be jointly learned without performance loss, establishing practical criteria for task aggregation in unified clinical imaging models. We introduce M2DINO, a multi-organ, multi-task framework built on DINOv3 with task-conditioned Mixture-of-Experts blocks for adaptive capacity allocation. We systematically evaluate 27 ultrasound tasks spanning segmentation, classification, detection, and regression under three paradigms: task-specific, clinically-grouped, and all-task unified training. Our results show that aggregation effectiveness depends strongly on training data scale. While clinically-grouped training can improve performance in data-rich settings, it may induce substantial negative transfer in low-data settings. In contrast, all-task unified training exhibits more consistent performance across clinical groups. We further observe that task sensitivity varies by task type in our experiments: segmentation shows the largest performance drops compared with regression and classification. These findings provide practical guidance for ultrasound foundation models, emphasizing that aggregation strategies should jointly consider training data availability and task characteristics rather than relying on clinical taxonomy alone.

Anam Hashmi, Julia Dietlmeier, Kathleen M. Curran et al.

Attention is a fundamental component of the human visual recognition system. The inclusion of attention in a convolutional neural network amplifies relevant visual features and suppresses the less important ones. Integrating attention mechanisms into convolutional neural networks enhances model performance and interpretability. Spatial and channel attention mechanisms have shown significant advantages across many downstream tasks in medical imaging. While existing attention modules have proven to be effective, their design often lacks a robust theoretical underpinning. In this study, we address this gap by proposing a non-linear attention architecture for cardiac MRI reconstruction and hypothesize that insights from ecological principles can guide the development of effective and efficient attention mechanisms. Specifically, we investigate a non-linear ecological difference equation that describes single-species population growth to devise a parameter-free attention module surpassing current state-of-the-art parameter-free methods.

Niamh Belton, Misgina Tsighe Hagos, Aonghus Lawlor et al.

Knee Osteoarthritis (OA) is a debilitating disease affecting over 250 million people worldwide. Currently, radiologists grade the severity of OA on an ordinal scale from zero to four using the Kellgren-Lawrence (KL) system. Recent studies have raised concern in relation to the subjectivity of the KL grading system, highlighting the requirement for an automated system, while also indicating that five ordinal classes may not be the most appropriate approach for assessing OA severity. This work presents preliminary results of an automated system with a continuous grading scale. This system, namely SS-FewSOME, uses self-supervised pre-training to learn robust representations of the features of healthy knee X-rays. It then assesses the OA severity by the X-rays' distance to the normal representation space. SS-FewSOME initially trains on only 'few' examples of healthy knee X-rays, thus reducing the barriers to clinical implementation by eliminating the need for large training sets and costly expert annotations that existing automated systems require. The work reports promising initial results, obtaining a positive Spearman Rank Correlation Coefficient of 0.43, having had access to only 30 ground truth labels at training time.

Anam Hashmi, Julia Dietlmeier, Kathleen M. Curran et al.

Cine cardiac magnetic resonance (CMR) imaging is recognised as the benchmark modality for the comprehensive assessment of cardiac function. Nevertheless, the acquisition process of cine CMR is considered as an impediment due to its prolonged scanning time. One commonly used strategy to expedite the acquisition process is through k-space undersampling, though it comes with a drawback of introducing aliasing effects in the reconstructed image. Lately, deep learning-based methods have shown remarkable results over traditional approaches in rapidly achieving precise CMR reconstructed images. This study aims to explore the untapped potential of attention mechanisms incorporated with a deep learning model within the context of the CMR reconstruction problem. We are motivated by the fact that attention has proven beneficial in downstream tasks such as image classification and segmentation, but has not been systematically analysed in the context of CMR reconstruction. Our primary goal is to identify the strengths and potential limitations of attention algorithms when integrated with a convolutional backbone model such as a U-Net. To achieve this, we benchmark different state-of-the-art spatial and channel attention mechanisms on the CMRxRecon dataset and quantitatively evaluate the quality of reconstruction using objective metrics. Furthermore, inspired by the best performing attention mechanism, we propose a new, simple yet effective, attention pipeline specifically optimised for the task of cardiac image reconstruction that outperforms other state-of-the-art attention methods. The layer and model code will be made publicly available.

Niamh Belton, Aonghus Lawlor, Kathleen M. Curran

Noisy data present in medical imaging datasets can often aid the development of robust models that are equipped to handle real-world data. However, if the bad data contains insufficient anatomical information, it can have a severe negative effect on the model's performance. We propose a novel methodology using a semi-supervised Siamese network to identify bad data. This method requires only a small pool of 'reference' medical images to be reviewed by a non-expert human to ensure the major anatomical structures are present in the Field of View. The model trains on this reference set and identifies bad data by using the Siamese network to compute the distance between the reference set and all other medical images in the dataset. This methodology achieves an Area Under the Curve (AUC) of 0.989 for identifying bad data. Code will be available at https://git.io/JYFuV.