Dean C. Barratt

Qi Li, Ziyi Shen, Qianye Yang et al.

Reconstructing 2D freehand Ultrasound (US) frames into 3D space without using a tracker has recently seen advances with deep learning. Predicting good frame-to-frame rigid transformations is often accepted as the learning objective, especially when the ground-truth labels from spatial tracking devices are inherently rigid transformations. Motivated by a) the observed nonrigid deformation due to soft tissue motion during scanning, and b) the highly sensitive prediction of rigid transformation, this study investigates the methods and their benefits in predicting nonrigid transformations for reconstructing 3D US. We propose a novel co-optimisation algorithm for simultaneously estimating rigid transformations among US frames, supervised by ground-truth from a tracker, and a nonrigid deformation, optimised by a regularised registration network. We show that these two objectives can be either optimised using meta-learning or combined by weighting. A fast scattered data interpolation is also developed for enabling frequent reconstruction and registration of non-parallel US frames, during training. With a new data set containing over 357,000 frames in 720 scans, acquired from 60 subjects, the experiments demonstrate that, due to an expanded thus easier-to-optimise solution space, the generalisation is improved with the added deformation estimation, with respect to the rigid ground-truth. The global pixel reconstruction error (assessing accumulative prediction) is lowered from 18.48 to 16.51 mm, compared with baseline rigid-transformation-predicting methods. Using manually identified landmarks, the proposed co-optimisation also shows potentials in compensating nonrigid tissue motion at inference, which is not measurable by tracker-provided ground-truth. The code and data used in this paper are made publicly available at https://github.com/QiLi111/NR-Rec-FUS.

Zhe Min, Zachary M. C. Baum, Shaheer U. Saeed et al.

Biomechanical modelling of soft tissue provides a non-data-driven method for constraining medical image registration, such that the estimated spatial transformation is considered biophysically plausible. This has not only been adopted in real-world clinical applications, such as the MR-to-ultrasound registration for prostate intervention of interest in this work, but also provides an explainable means of understanding the organ motion and spatial correspondence establishment. This work instantiates the recently-proposed physics-informed neural networks (PINNs) to a 3D linear elastic model for modelling prostate motion commonly encountered during transrectal ultrasound guided procedures. To overcome a widely-recognised challenge in generalising PINNs to different subjects, we propose to use PointNet as the nodal-permutation-invariant feature extractor, together with a registration algorithm that aligns point sets and simultaneously takes into account the PINN-imposed biomechanics. The proposed method has been both developed and validated in both patient-specific and multi-patient manner.

Shaheer U. Saeed, Tom Syer, Wen Yan et al.

We propose an image synthesis mechanism for multi-sequence prostate MR images conditioned on text, to control lesion presence and sequence, as well as to generate paired bi-parametric images conditioned on images e.g. for generating diffusion-weighted MR from T2-weighted MR for paired data, which are two challenging tasks in pathological image synthesis. Our proposed mechanism utilises and builds upon the recent stable diffusion model by proposing image-based conditioning for paired data generation. We validate our method using 2D image slices from real suspected prostate cancer patients. The realism of the synthesised images is validated by means of a blind expert evaluation for identifying real versus fake images, where a radiologist with 4 years experience reading urological MR only achieves 59.4% accuracy across all tested sequences (where chance is 50%). For the first time, we evaluate the realism of the generated pathology by blind expert identification of the presence of suspected lesions, where we find that the clinician performs similarly for both real and synthesised images, with a 2.9 percentage point difference in lesion identification accuracy between real and synthesised images, demonstrating the potentials in radiological training purposes. Furthermore, we also show that a machine learning model, trained for lesion identification, shows better performance (76.2% vs 70.4%, statistically significant improvement) when trained with real data augmented by synthesised data as opposed to training with only real images, demonstrating usefulness for model training.

Shaheer U. Saeed, Yunguan Fu, Vasilis Stavrinides et al.

In this paper, we consider image quality assessment (IQA) as a measure of how images are amenable with respect to a given downstream task, or task amenability. When the task is performed using machine learning algorithms, such as a neural-network-based task predictor for image classification or segmentation, the performance of the task predictor provides an objective estimate of task amenability. In this work, we use an IQA controller to predict the task amenability which, itself being parameterised by neural networks, can be trained simultaneously with the task predictor. We further develop a meta-reinforcement learning framework to improve the adaptability for both IQA controllers and task predictors, such that they can be fine-tuned efficiently on new datasets or meta-tasks. We demonstrate the efficacy of the proposed task-specific, adaptable IQA approach, using two clinical applications for ultrasound-guided prostate intervention and pneumonia detection on X-ray images.

Zhe Min, Zachary M. C. Baum, Shaheer U. Saeed et al.

This paper investigates both biomechanical-constrained non-rigid medical image registrations and accurate identifications of material properties for soft tissues, using physics-informed neural networks (PINNs). The complex nonlinear elasticity theory is leveraged to formally establish the partial differential equations (PDEs) representing physics laws of biomechanical constraints that need to be satisfied, with which registration and identification tasks are treated as forward (i.e., data-driven solutions of PDEs) and inverse (i.e., parameter estimation) problems under PINNs respectively. Two net configurations (i.e., Cfg1 and Cfg2) have also been compared for both linear and nonlinear physics model. Two sets of experiments have been conducted, using pairs of undeformed and deformed MR images from clinical cases of prostate cancer biopsy. Our contributions are summarised as follows. 1) We developed a learning-based biomechanical-constrained non-rigid registration algorithm using PINNs, where linear elasticity is generalised to the nonlinear version. 2) We demonstrated extensively that nonlinear elasticity shows no statistical significance against linear models in computing point-wise displacement vectors but their respective benefits may depend on specific patients, with finite-element (FE) computed ground-truth. 3) We formulated and solved the inverse parameter estimation problem, under the joint optimisation scheme of registration and parameter identification using PINNs, whose solutions can be accurately found by locating saddle points.

Wen Yan, Bernard Chiu, Ziyi Shen et al.

One of the distinct characteristics in radiologists' reading of multiparametric prostate MR scans, using reporting systems such as PI-RADS v2.1, is to score individual types of MR modalities, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced, and then combine these image-modality-specific scores using standardised decision rules to predict the likelihood of clinically significant cancer. This work aims to demonstrate that it is feasible for low-dimensional parametric models to model such decision rules in the proposed Combiner networks, without compromising the accuracy of predicting radiologic labels: First, it is shown that either a linear mixture model or a nonlinear stacking model is sufficient to model PI-RADS decision rules for localising prostate cancer. Second, parameters of these (generalised) linear models are proposed as hyperparameters, to weigh multiple networks that independently represent individual image modalities in the Combiner network training, as opposed to end-to-end modality ensemble. A HyperCombiner network is developed to train a single image segmentation network that can be conditioned on these hyperparameters during inference, for much improved efficiency. Experimental results based on data from 850 patients, for the application of automating radiologist labelling multi-parametric MR, compare the proposed combiner networks with other commonly-adopted end-to-end networks. Using the added advantages of obtaining and interpreting the modality combining rules, in terms of the linear weights or odds-ratios on individual image modalities, three clinical applications are presented for prostate cancer segmentation, including modality availability assessment, importance quantification and rule discovery.

Qianye Yang, David Atkinson, Yunguan Fu et al.

In this work, we consider the task of pairwise cross-modality image registration, which may benefit from exploiting additional images available only at training time from an additional modality that is different to those being registered. As an example, we focus on aligning intra-subject multiparametric Magnetic Resonance (mpMR) images, between T2-weighted (T2w) scans and diffusion-weighted scans with high b-value (DWI$_{high-b}$). For the application of localising tumours in mpMR images, diffusion scans with zero b-value (DWI$_{b=0}$) are considered easier to register to T2w due to the availability of corresponding features. We propose a learning from privileged modality algorithm, using a training-only imaging modality DWI$_{b=0}$, to support the challenging multi-modality registration problems. We present experimental results based on 369 sets of 3D multiparametric MRI images from 356 prostate cancer patients and report, with statistical significance, a lowered median target registration error of 4.34 mm, when registering the holdout DWI$_{high-b}$ and T2w image pairs, compared with that of 7.96 mm before registration. Results also show that the proposed learning-based registration networks enabled efficient registration with comparable or better accuracy, compared with a classical iterative algorithm and other tested learning-based methods with/without the additional modality. These compared algorithms also failed to produce any significantly improved alignment between DWI$_{high-b}$ and T2w in this challenging application.

Qi Li, Ziyi Shen, Qian Li et al.

Objective: Reconstructing freehand ultrasound in 3D without any external tracker has been a long-standing challenge in ultrasound-assisted procedures. We aim to define new ways of parameterising long-term dependencies, and evaluate the performance. Methods: First, long-term dependency is encoded by transformation positions within a frame sequence. This is achieved by combining a sequence model with a multi-transformation prediction. Second, two dependency factors are proposed, anatomical image content and scanning protocol, for contributing towards accurate reconstruction. Each factor is quantified experimentally by reducing respective training variances. Results: 1) The added long-term dependency up to 400 frames at 20 frames per second (fps) indeed improved reconstruction, with an up to 82.4% lowered accumulated error, compared with the baseline performance. The improvement was found to be dependent on sequence length, transformation interval and scanning protocol and, unexpectedly, not on the use of recurrent networks with long-short term modules; 2) Decreasing either anatomical or protocol variance in training led to poorer reconstruction accuracy. Interestingly, greater performance was gained from representative protocol patterns, than from representative anatomical features. Conclusion: The proposed algorithm uses hyperparameter tuning to effectively utilise long-term dependency. The proposed dependency factors are of practical significance in collecting diverse training data, regulating scanning protocols and developing efficient networks. Significance: The proposed new methodology with publicly available volunteer data and code for parametersing the long-term dependency, experimentally shown to be valid sources of performance improvement, which could potentially lead to better model development and practical optimisation of the reconstruction application.

Shaheer U. Saeed, João Ramalhinho, Mark Pinnock et al.

Supervised machine learning-based medical image computing applications necessitate expert label curation, while unlabelled image data might be relatively abundant. Active learning methods aim to prioritise a subset of available image data for expert annotation, for label-efficient model training. We develop a controller neural network that measures priority of images in a sequence of batches, as in batch-mode active learning, for multi-class segmentation tasks. The controller is optimised by rewarding positive task-specific performance gain, within a Markov decision process (MDP) environment that also optimises the task predictor. In this work, the task predictor is a segmentation network. A meta-reinforcement learning algorithm is proposed with multiple MDPs, such that the pre-trained controller can be adapted to a new MDP that contains data from different institutes and/or requires segmentation of different organs or structures within the abdomen. We present experimental results using multiple CT datasets from more than one thousand patients, with segmentation tasks of nine different abdominal organs, to demonstrate the efficacy of the learnt prioritisation controller function and its cross-institute and cross-organ adaptability. We show that the proposed adaptable prioritisation metric yields converging segmentation accuracy for the novel class of kidney, unseen in training, using between approximately 40\% to 60\% of labels otherwise required with other heuristic or random prioritisation metrics. For clinical datasets of limited size, the proposed adaptable prioritisation offers a performance improvement of 22.6\% and 10.2\% in Dice score, for tasks of kidney and liver vessel segmentation, respectively, compared to random prioritisation and alternative active sampling strategies.

Weixi Yi, Vasilis Stavrinides, Zachary M. C. Baum et al.

We propose Boundary-RL, a novel weakly supervised segmentation method that utilises only patch-level labels for training. We envision the segmentation as a boundary detection problem, rather than a pixel-level classification as in previous works. This outlook on segmentation may allow for boundary delineation under challenging scenarios such as where noise artefacts may be present within the region-of-interest (ROI) boundaries, where traditional pixel-level classification-based weakly supervised methods may not be able to effectively segment the ROI. Particularly of interest, ultrasound images, where intensity values represent acoustic impedance differences between boundaries, may also benefit from the boundary delineation approach. Our method uses reinforcement learning to train a controller function to localise boundaries of ROIs using a reward derived from a pre-trained boundary-presence classifier. The classifier indicates when an object boundary is encountered within a patch, as the controller modifies the patch location in a sequential Markov decision process. The classifier itself is trained using only binary patch-level labels of object presence, which are the only labels used during training of the entire boundary delineation framework, and serves as a weak signal to inform the boundary delineation. The use of a controller function ensures that a sliding window over the entire image is not necessary. It also prevents possible false-positive or -negative cases by minimising number of patches passed to the boundary-presence classifier. We evaluate our proposed approach for a clinically relevant task of prostate gland segmentation on trans-rectal ultrasound images. We show improved performance compared to other tested weakly supervised methods, using the same labels e.g., multiple instance learning.

Qi Li, Ziyi Shen, Qian Li et al.

Three-dimensional (3D) freehand ultrasound (US) reconstruction without using any additional external tracking device has seen recent advances with deep neural networks (DNNs). In this paper, we first investigated two identified contributing factors of the learned inter-frame correlation that enable the DNN-based reconstruction: anatomy and protocol. We propose to incorporate the ability to represent these two factors - readily available during training - as the privileged information to improve existing DNN-based methods. This is implemented in a new multi-task method, where the anatomical and protocol discrimination are used as auxiliary tasks. We further develop a differentiable network architecture to optimise the branching location of these auxiliary tasks, which controls the ratio between shared and task-specific network parameters, for maximising the benefits from the two auxiliary tasks. Experimental results, on a dataset with 38 forearms of 19 volunteers acquired with 6 different scanning protocols, show that 1) both anatomical and protocol variances are enabling factors for DNN-based US reconstruction; 2) learning how to discriminate different subjects (anatomical variance) and predefined types of scanning paths (protocol variance) both significantly improve frame prediction accuracy, volume reconstruction overlap, accumulated tracking error and final drift, using the proposed algorithm.

Iani JMB Gayo, Shaheer U. Saeed, Dean C. Barratt et al.

Clinically significant prostate cancer has a better chance to be sampled during ultrasound-guided biopsy procedures, if suspected lesions found in pre-operative magnetic resonance (MR) images are used as targets. However, the diagnostic accuracy of the biopsy procedure is limited by the operator-dependent skills and experience in sampling the targets, a sequential decision making process that involves navigating an ultrasound probe and placing a series of sampling needles for potentially multiple targets. This work aims to learn a reinforcement learning (RL) policy that optimises the actions of continuous positioning of 2D ultrasound views and biopsy needles with respect to a guiding template, such that the MR targets can be sampled efficiently and sufficiently. We first formulate the task as a Markov decision process (MDP) and construct an environment that allows the targeting actions to be performed virtually for individual patients, based on their anatomy and lesions derived from MR images. A patient-specific policy can thus be optimised, before each biopsy procedure, by rewarding positive sampling in the MDP environment. Experiment results from fifty four prostate cancer patients show that the proposed RL-learned policies obtained a mean hit rate of 93% and an average cancer core length of 11 mm, which compared favourably to two alternative baseline strategies designed by humans, without hand-engineered rewards that directly maximise these clinically relevant metrics. Perhaps more interestingly, it is found that the RL agents learned strategies that were adaptive to the lesion size, where spread of the needles was prioritised for smaller lesions. Such a strategy has not been previously reported or commonly adopted in clinical practice, but led to an overall superior targeting performance when compared with intuitively designed strategies.

Yunguan Fu, Nina Montaña Brown, Shaheer U. Saeed et al.

DeepReg (https://github.com/DeepRegNet/DeepReg) is a community-supported open-source toolkit for research and education in medical image registration using deep learning.

Eli Gibson, Wenqi Li, Carole Sudre et al.

Medical image analysis and computer-assisted intervention problems are increasingly being addressed with deep-learning-based solutions. Established deep-learning platforms are flexible but do not provide specific functionality for medical image analysis and adapting them for this application requires substantial implementation effort. Thus, there has been substantial duplication of effort and incompatible infrastructure developed across many research groups. This work presents the open-source NiftyNet platform for deep learning in medical imaging. The ambition of NiftyNet is to accelerate and simplify the development of these solutions, and to provide a common mechanism for disseminating research outputs for the community to use, adapt and build upon. NiftyNet provides a modular deep-learning pipeline for a range of medical imaging applications including segmentation, regression, image generation and representation learning applications. Components of the NiftyNet pipeline including data loading, data augmentation, network architectures, loss functions and evaluation metrics are tailored to, and take advantage of, the idiosyncracies of medical image analysis and computer-assisted intervention. NiftyNet is built on TensorFlow and supports TensorBoard visualization of 2D and 3D images and computational graphs by default. We present 3 illustrative medical image analysis applications built using NiftyNet: (1) segmentation of multiple abdominal organs from computed tomography; (2) image regression to predict computed tomography attenuation maps from brain magnetic resonance images; and (3) generation of simulated ultrasound images for specified anatomical poses. NiftyNet enables researchers to rapidly develop and distribute deep learning solutions for segmentation, regression, image generation and representation learning applications, or extend the platform to new applications.

Martynas Pocius, Wen Yan, Dean C. Barratt et al.

In this paper we propose a reinforcement learning based weakly supervised system for localisation. We train a controller function to localise regions of interest within an image by introducing a novel reward definition that utilises non-binarised classification probability, generated by a pre-trained binary classifier which classifies object presence in images or image crops. The object-presence classifier may then inform the controller of its localisation quality by quantifying the likelihood of the image containing an object. Such an approach allows us to minimize any potential labelling or human bias propagated via human labelling for fully supervised localisation. We evaluate our proposed approach for a task of cancerous lesion localisation on a large dataset of real clinical bi-parametric MR images of the prostate. Comparisons to the commonly used multiple-instance learning weakly supervised localisation and to a fully supervised baseline show that our proposed method outperforms the multi-instance learning and performs comparably to fully-supervised learning, using only image-level classification labels for training.

Weixi Yi, Yipei Wang, Natasha Thorley et al.

Current imaging-based prostate cancer diagnosis requires both MR T2-weighted (T2w) and diffusion-weighted imaging (DWI) sequences, with additional sequences for potentially greater accuracy improvement. However, measuring diffusion patterns in DWI sequences can be time-consuming, prone to artifacts and sensitive to imaging parameters. While machine learning (ML) models have demonstrated radiologist-level accuracy in detecting prostate cancer from these two sequences, this study investigates the potential of ML-enabled methods using only the T2w sequence as input during inference time. We first discuss the technical feasibility of such a T2-only approach, and then propose a novel ML formulation, where DWI sequences - readily available for training purposes - are only used to train a meta-learning model, which subsequently only uses T2w sequences at inference. Using multiple datasets from more than 3,000 prostate cancer patients, we report superior or comparable performance in localising radiologist-identified prostate cancer using our proposed T2-only models, compared with alternative models using T2-only or both sequences as input. Real patient cases are presented and discussed to demonstrate, for the first time, the exclusively true-positive cases from models with different input sequences.

Yiwen Li, Yunguan Fu, Iani J. M. B. Gayo et al.

For training registration networks, weak supervision from segmented corresponding regions-of-interest (ROIs) have been proven effective for (a) supplementing unsupervised methods, and (b) being used independently in registration tasks in which unsupervised losses are unavailable or ineffective. This correspondence-informing supervision entails cost in annotation that requires significant specialised effort. This paper describes a semi-weakly-supervised registration pipeline that improves the model performance, when only a small corresponding-ROI-labelled dataset is available, by exploiting unlabelled image pairs. We examine two types of augmentation methods by perturbation on network weights and image resampling, such that consistency-based unsupervised losses can be applied on unlabelled data. The novel WarpDDF and RegCut approaches are proposed to allow commutative perturbation between an image pair and the predicted spatial transformation (i.e. respective input and output of registration networks), distinct from existing perturbation methods for classification or segmentation. Experiments using 589 male pelvic MR images, labelled with eight anatomical ROIs, show the improvement in registration performance and the ablated contributions from the individual strategies. Furthermore, this study attempts to construct one of the first computational atlases for pelvic structures, enabled by registering inter-subject MRs, and quantifies the significant differences due to the proposed semi-weak supervision with a discussion on the potential clinical use of example atlas-derived statistics.

Weixi Yi, Yipei Wang, Wen Yan et al.

Multiparametric MRI is increasingly recommended as a first-line noninvasive approach to detect and localize prostate cancer, requiring at minimum diffusion-weighted (DWI) and T2-weighted (T2w) MR sequences. Early machine learning attempts using only T2w images have shown promising diagnostic performance in segmenting radiologist-annotated lesions. Such uni-modal T2-only approaches deliver substantial clinical benefits by reducing costs and expertise required to acquire other sequences. This work investigates an arguably more challenging application using only T2w at inference, but to localize individual cancers based on independent histopathology labels. We formulate DWI images as a latent modality (readily available during training) to classify cancer presence at local Barzell zones, given only T2w images as input. In the resulting expectation-maximization algorithm, a latent modality generator (implemented using a flow matching-based generative model) approximates the latent DWI image posterior distribution in the E-steps, while in M-steps a cancer localizer is simultaneously optimized with the generative model to maximize the expected likelihood of cancer presence. The proposed approach provides a novel theoretical framework for learning from a privileged DWI modality, yielding superior cancer localization performance compared to approaches that lack training DWI images or existing frameworks for privileged learning and incomplete modalities. The proposed T2-only methods perform competitively or better than baseline methods using multiple input sequences (e.g., improving the patient-level F1 score by 14.4\% and zone-level QWK by 5.3\% over the T2w+DWI baseline). We present quantitative evaluations using internal and external datasets from 4,133 prostate cancer patients with histopathology-verified labels.

Qi Li, Shaheer U. Saeed, Yuliang Huang et al.

Trackerless freehand ultrasound reconstruction aims to reconstruct 3D volumes from sequences of 2D ultrasound images without relying on external tracking systems. By eliminating the need for optical or electromagnetic trackers, this approach offers a low-cost, portable, and widely deployable alternative to more expensive volumetric ultrasound imaging systems, particularly valuable in resource-constrained clinical settings. However, predicting long-distance transformations and handling complex probe trajectories remain challenging. The TUS-REC2024 Challenge establishes the first benchmark for trackerless 3D freehand ultrasound reconstruction by providing a large publicly available dataset, along with a baseline model and a rigorous evaluation framework. By the submission deadline, the Challenge had attracted 43 registered teams, of which 6 teams submitted 21 valid dockerized solutions. The submitted methods span a wide range of approaches, including the state space model, the recurrent model, the registration-driven volume refinement, the attention mechanism, and the physics-informed model. This paper provides a comprehensive background introduction and literature review in the field, presents an overview of the challenge design and dataset, and offers a comparative analysis of submitted methods across multiple evaluation metrics. These analyses highlight both the progress and the current limitations of state-of-the-art approaches in this domain and provide insights for future research directions. All data and code are publicly available to facilitate ongoing development and reproducibility. As a live and evolving benchmark, it is designed to be continuously iterated and improved. The Challenge was held at MICCAI 2024 and is organised again at MICCAI 2025, reflecting its sustained commitment to advancing this field.

Wen Yan, Qianye Yang, Tom Syer et al.

Dice similarity coefficient (DSC) and Hausdorff distance (HD) are widely used for evaluating medical image segmentation. They have also been criticised, when reported alone, for their unclear or even misleading clinical interpretation. DSCs may also differ substantially from HDs, due to boundary smoothness or multiple regions of interest (ROIs) within a subject. More importantly, either metric can also have a nonlinear, non-monotonic relationship with outcomes based on Type 1 and 2 errors, designed for specific clinical decisions that use the resulting segmentation. Whilst cases causing disagreement between these metrics are not difficult to postulate. This work first proposes a new asymmetric detection metric, adapting those used in object detection, for planning prostate cancer procedures. The lesion-level metrics is then compared with the voxel-level DSC and HD, whereas a 3D UNet is used for segmenting lesions from multiparametric MR (mpMR) images. Based on experimental results we report pairwise agreement and correlation 1) between DSC and HD, and 2) between voxel-level DSC and recall-controlled precision at lesion-level, with Cohen's [0.49, 0.61] and Pearson's [0.66, 0.76] (p-values}<0.001) at varying cut-offs. However, the differences in false-positives and false-negatives, between the actual errors and the perceived counterparts if DSC is used, can be as high as 152 and 154, respectively, out of the 357 test set lesions. We therefore carefully conclude that, despite of the significant correlations, voxel-level metrics such as DSC can misrepresent lesion-level detection accuracy for evaluating localisation of multifocal prostate cancer and should be interpreted with caution.

Shaheer U. Saeed, Wen Yan, Yunguan Fu et al.

Image quality assessment (IQA) in medical imaging can be used to ensure that downstream clinical tasks can be reliably performed. Quantifying the impact of an image on the specific target tasks, also named as task amenability, is needed. A task-specific IQA has recently been proposed to learn an image-amenability-predicting controller simultaneously with a target task predictor. This allows for the trained IQA controller to measure the impact an image has on the target task performance, when this task is performed using the predictor, e.g. segmentation and classification neural networks in modern clinical applications. In this work, we propose an extension to this task-specific IQA approach, by adding a task-agnostic IQA based on auto-encoding as the target task. Analysing the intersection between low-quality images, deemed by both the task-specific and task-agnostic IQA, may help to differentiate the underpinning factors that caused the poor target task performance. For example, common imaging artefacts may not adversely affect the target task, which would lead to a low task-agnostic quality and a high task-specific quality, whilst individual cases considered clinically challenging, which can not be improved by better imaging equipment or protocols, is likely to result in a high task-agnostic quality but a low task-specific quality. We first describe a flexible reward shaping strategy which allows for the adjustment of weighting between task-agnostic and task-specific quality scoring. Furthermore, we evaluate the proposed algorithm using a clinically challenging target task of prostate tumour segmentation on multiparametric magnetic resonance (mpMR) images, from 850 patients. The proposed reward shaping strategy, with appropriately weighted task-specific and task-agnostic qualities, successfully identified samples that need re-acquisition due to defected imaging process.

Ester Bonmati, Yipeng Hu, Alexander Grimwood et al.

Ultrasound imaging is a commonly used technology for visualising patient anatomy in real-time during diagnostic and therapeutic procedures. High operator dependency and low reproducibility make ultrasound imaging and interpretation challenging with a steep learning curve. Automatic image classification using deep learning has the potential to overcome some of these challenges by supporting ultrasound training in novices, as well as aiding ultrasound image interpretation in patient with complex pathology for more experienced practitioners. However, the use of deep learning methods requires a large amount of data in order to provide accurate results. Labelling large ultrasound datasets is a challenging task because labels are retrospectively assigned to 2D images without the 3D spatial context available in vivo or that would be inferred while visually tracking structures between frames during the procedure. In this work, we propose a multi-modal convolutional neural network (CNN) architecture that labels endoscopic ultrasound (EUS) images from raw verbal comments provided by a clinician during the procedure. We use a CNN composed of two branches, one for voice data and another for image data, which are joined to predict image labels from the spoken names of anatomical landmarks. The network was trained using recorded verbal comments from expert operators. Our results show a prediction accuracy of 76% at image level on a dataset with 5 different labels. We conclude that the addition of spoken commentaries can increase the performance of ultrasound image classification, and eliminate the burden of manually labelling large EUS datasets necessary for deep learning applications.

Shaheer U. Saeed, Yunguan Fu, Vasilis Stavrinides et al.

The performance of many medical image analysis tasks are strongly associated with image data quality. When developing modern deep learning algorithms, rather than relying on subjective (human-based) image quality assessment (IQA), task amenability potentially provides an objective measure of task-specific image quality. To predict task amenability, an IQA agent is trained using reinforcement learning (RL) with a simultaneously optimised task predictor, such as a classification or segmentation neural network. In this work, we develop transfer learning or adaptation strategies to increase the adaptability of both the IQA agent and the task predictor so that they are less dependent on high-quality, expert-labelled training data. The proposed transfer learning strategy re-formulates the original RL problem for task amenability in a meta-reinforcement learning (meta-RL) framework. The resulting algorithm facilitates efficient adaptation of the agent to different definitions of image quality, each with its own Markov decision process environment including different images, labels and an adaptable task predictor. Our work demonstrates that the IQA agents pre-trained on non-expert task labels can be adapted to predict task amenability as defined by expert task labels, using only a small set of expert labels. Using 6644 clinical ultrasound images from 249 prostate cancer patients, our results for image classification and segmentation tasks show that the proposed IQA method can be adapted using data with as few as respective 19.7% and 29.6% expert-reviewed consensus labels and still achieve comparable IQA and task performance, which would otherwise require a training dataset with 100% expert labels.

Shaheer U. Saeed, Yunguan Fu, Zachary M. C. Baum et al.

In this paper, we consider a type of image quality assessment as a task-specific measurement, which can be used to select images that are more amenable to a given target task, such as image classification or segmentation. We propose to train simultaneously two neural networks for image selection and a target task using reinforcement learning. A controller network learns an image selection policy by maximising an accumulated reward based on the target task performance on the controller-selected validation set, whilst the target task predictor is optimised using the training set. The trained controller is therefore able to reject those images that lead to poor accuracy in the target task. In this work, we show that the controller-predicted image quality can be significantly different from the task-specific image quality labels that are manually defined by humans. Furthermore, we demonstrate that it is possible to learn effective image quality assessment without using a ``clean'' validation set, thereby avoiding the requirement for human labelling of images with respect to their amenability for the task. Using $6712$, labelled and segmented, clinical ultrasound images from $259$ patients, experimental results on holdout data show that the proposed image quality assessment achieved a mean classification accuracy of $0.94\pm0.01$ and a mean segmentation Dice of $0.89\pm0.02$, by discarding $5\%$ and $15\%$ of the acquired images, respectively. The significantly improved performance was observed for both tested tasks, compared with the respective $0.90\pm0.01$ and $0.82\pm0.02$ from networks without considering task amenability. This enables image quality feedback during real-time ultrasound acquisition among many other medical imaging applications.

Zachary M. C. Baum, Yipeng Hu, Dean C. Barratt

We describe a point-set registration algorithm based on a novel free point transformer (FPT) network, designed for points extracted from multimodal biomedical images for registration tasks, such as those frequently encountered in ultrasound-guided interventional procedures. FPT is constructed with a global feature extractor which accepts unordered source and target point-sets of variable size. The extracted features are conditioned by a shared multilayer perceptron point transformer module to predict a displacement vector for each source point, transforming it into the target space. The point transformer module assumes no vicinity or smoothness in predicting spatial transformation and, together with the global feature extractor, is trained in a data-driven fashion with an unsupervised loss function. In a multimodal registration task using prostate MR and sparsely acquired ultrasound images, FPT yields comparable or improved results over other rigid and non-rigid registration methods. This demonstrates the versatility of FPT to learn registration directly from real, clinical training data and to generalize to a challenging task, such as the interventional application presented.

Shaheer U. Saeed, Zeike A. Taylor, Mark A. Pinnock et al.

In this paper, we propose to train deep neural networks with biomechanical simulations, to predict the prostate motion encountered during ultrasound-guided interventions. In this application, unstructured points are sampled from segmented pre-operative MR images to represent the anatomical regions of interest. The point sets are then assigned with point-specific material properties and displacement loads, forming the un-ordered input feature vectors. An adapted PointNet can be trained to predict the nodal displacements, using finite element (FE) simulations as ground-truth data. Furthermore, a versatile bootstrap aggregating mechanism is validated to accommodate the variable number of feature vectors due to different patient geometries, comprised of a training-time bootstrap sampling and a model averaging inference. This results in a fast and accurate approximation to the FE solutions without requiring subject-specific solid meshing. Based on 160,000 nonlinear FE simulations on clinical imaging data from 320 patients, we demonstrate that the trained networks generalise to unstructured point sets sampled directly from holdout patient segmentation, yielding a near real-time inference and an expected error of 0.017 mm in predicted nodal displacement.

Yipeng Hu, Eli Gibson, Dean C. Barratt et al.

Classical pairwise image registration methods search for a spatial transformation that optimises a numerical measure that indicates how well a pair of moving and fixed images are aligned. Current learning-based registration methods have adopted the same paradigm and typically predict, for any new input image pair, dense correspondences in the form of a dense displacement field or parameters of a spatial transformation model. However, in many applications of registration, the spatial transformation itself is only required to propagate points or regions of interest (ROIs). In such cases, detailed pixel- or voxel-level correspondence within or outside of these ROIs often have little clinical value. In this paper, we propose an alternative paradigm in which the location of corresponding image-specific ROIs, defined in one image, within another image is learnt. This results in replacing image registration by a conditional segmentation algorithm, which can build on typical image segmentation networks and their widely-adopted training strategies. Using the registration of 3D MRI and ultrasound images of the prostate as an example to demonstrate this new approach, we report a median target registration error (TRE) of 2.1 mm between the ground-truth ROIs defined on intraoperative ultrasound images and those propagated from the preoperative MR images. Significantly lower (>34%) TREs were obtained using the proposed conditional segmentation compared with those obtained from a previously-proposed spatial-transformation-predicting registration network trained with the same multiple ROI labels for individual image pairs. We conclude this work by using a quantitative bias-variance analysis to provide one explanation of the observed improvement in registration accuracy.

Yipeng Hu, Marc Modat, Eli Gibson et al.

One of the fundamental challenges in supervised learning for multimodal image registration is the lack of ground-truth for voxel-level spatial correspondence. This work describes a method to infer voxel-level transformation from higher-level correspondence information contained in anatomical labels. We argue that such labels are more reliable and practical to obtain for reference sets of image pairs than voxel-level correspondence. Typical anatomical labels of interest may include solid organs, vessels, ducts, structure boundaries and other subject-specific ad hoc landmarks. The proposed end-to-end convolutional neural network approach aims to predict displacement fields to align multiple labelled corresponding structures for individual image pairs during the training, while only unlabelled image pairs are used as the network input for inference. We highlight the versatility of the proposed strategy, for training, utilising diverse types of anatomical labels, which need not to be identifiable over all training image pairs. At inference, the resulting 3D deformable image registration algorithm runs in real-time and is fully-automated without requiring any anatomical labels or initialisation. Several network architecture variants are compared for registering T2-weighted magnetic resonance images and 3D transrectal ultrasound images from prostate cancer patients. A median target registration error of 3.6 mm on landmark centroids and a median Dice of 0.87 on prostate glands are achieved from cross-validation experiments, in which 108 pairs of multimodal images from 76 patients were tested with high-quality anatomical labels.

Yipeng Hu, Eli Gibson, Nooshin Ghavami et al.

We describe an adversarial learning approach to constrain convolutional neural network training for image registration, replacing heuristic smoothness measures of displacement fields often used in these tasks. Using minimally-invasive prostate cancer intervention as an example application, we demonstrate the feasibility of utilizing biomechanical simulations to regularize a weakly-supervised anatomical-label-driven registration network for aligning pre-procedural magnetic resonance (MR) and 3D intra-procedural transrectal ultrasound (TRUS) images. A discriminator network is optimized to distinguish the registration-predicted displacement fields from the motion data simulated by finite element analysis. During training, the registration network simultaneously aims to maximize similarity between anatomical labels that drives image alignment and to minimize an adversarial generator loss that measures divergence between the predicted- and simulated deformation. The end-to-end trained network enables efficient and fully-automated registration that only requires an MR and TRUS image pair as input, without anatomical labels or simulated data during inference. 108 pairs of labelled MR and TRUS images from 76 prostate cancer patients and 71,500 nonlinear finite-element simulations from 143 different patients were used for this study. We show that, with only gland segmentation as training labels, the proposed method can help predict physically plausible deformation without any other smoothness penalty. Based on cross-validation experiments using 834 pairs of independent validation landmarks, the proposed adversarial-regularized registration achieved a target registration error of 6.3 mm that is significantly lower than those from several other regularization methods.

Yipeng Hu, Marc Modat, Eli Gibson et al.

Spatially aligning medical images from different modalities remains a challenging task, especially for intraoperative applications that require fast and robust algorithms. We propose a weakly-supervised, label-driven formulation for learning 3D voxel correspondence from higher-level label correspondence, thereby bypassing classical intensity-based image similarity measures. During training, a convolutional neural network is optimised by outputting a dense displacement field (DDF) that warps a set of available anatomical labels from the moving image to match their corresponding counterparts in the fixed image. These label pairs, including solid organs, ducts, vessels, point landmarks and other ad hoc structures, are only required at training time and can be spatially aligned by minimising a cross-entropy function of the warped moving label and the fixed label. During inference, the trained network takes a new image pair to predict an optimal DDF, resulting in a fully-automatic, label-free, real-time and deformable registration. For interventional applications where large global transformation prevails, we also propose a neural network architecture to jointly optimise the global- and local displacements. Experiment results are presented based on cross-validating registrations of 111 pairs of T2-weighted magnetic resonance images and 3D transrectal ultrasound images from prostate cancer patients with a total of over 4000 anatomical labels, yielding a median target registration error of 4.2 mm on landmark centroids and a median Dice of 0.88 on prostate glands.

Yipeng Hu, Eli Gibson, Tom Vercauteren et al.

In this paper, we describe how a patient-specific, ultrasound-probe-induced prostate motion model can be directly generated from a single preoperative MR image. Our motion model allows for sampling from the conditional distribution of dense displacement fields, is encoded by a generative neural network conditioned on a medical image, and accepts random noise as additional input. The generative network is trained by a minimax optimisation with a second discriminative neural network, tasked to distinguish generated samples from training motion data. In this work, we propose that 1) jointly optimising a third conditioning neural network that pre-processes the input image, can effectively extract patient-specific features for conditioning; and 2) combining multiple generative models trained separately with heuristically pre-disjointed training data sets can adequately mitigate the problem of mode collapse. Trained with diagnostic T2-weighted MR images from 143 real patients and 73,216 3D dense displacement fields from finite element simulations of intraoperative prostate motion due to transrectal ultrasound probe pressure, the proposed models produced physically-plausible patient-specific motion of prostate glands. The ability to capture biomechanically simulated motion was evaluated using two errors representing generalisability and specificity of the model. The median values, calculated from a 10-fold cross-validation, were 2.8+/-0.3 mm and 1.7+/-0.1 mm, respectively. We conclude that the introduced approach demonstrates the feasibility of applying state-of-the-art machine learning algorithms to generate organ motion models from patient images, and shows significant promise for future research.

Yipeng Hu, Eli Gibson, Li-Lin Lee et al.

Sonography synthesis has a wide range of applications, including medical procedure simulation, clinical training and multimodality image registration. In this paper, we propose a machine learning approach to simulate ultrasound images at given 3D spatial locations (relative to the patient anatomy), based on conditional generative adversarial networks (GANs). In particular, we introduce a novel neural network architecture that can sample anatomically accurate images conditionally on spatial position of the (real or mock) freehand ultrasound probe. To ensure an effective and efficient spatial information assimilation, the proposed spatially-conditioned GANs take calibrated pixel coordinates in global physical space as conditioning input, and utilise residual network units and shortcuts of conditioning data in the GANs' discriminator and generator, respectively. Using optically tracked B-mode ultrasound images, acquired by an experienced sonographer on a fetus phantom, we demonstrate the feasibility of the proposed method by two sets of quantitative results: distances were calculated between corresponding anatomical landmarks identified in the held-out ultrasound images and the simulated data at the same locations unseen to the networks; a usability study was carried out to distinguish the simulated data from the real images. In summary, we present what we believe are state-of-the-art visually realistic ultrasound images, simulated by the proposed GAN architecture that is stable to train and capable of generating plausibly diverse image samples.