Marawan Elbatel

Marawan Elbatel, Hualiang Wang, Robert Martí et al.

In the medical field, federated learning commonly deals with highly imbalanced datasets, including skin lesions and gastrointestinal images. Existing federated methods under highly imbalanced datasets primarily focus on optimizing a global model without incorporating the intra-class variations that can arise in medical imaging due to different populations, findings, and scanners. In this paper, we study the inter-client intra-class variations with publicly available self-supervised auxiliary networks. Specifically, we find that employing a shared auxiliary pre-trained model, like MoCo-V2, locally on every client yields consistent divergence measurements. Based on these findings, we derive a dynamic balanced model aggregation via self-supervised priors (MAS) to guide the global model optimization. Fed-MAS can be utilized with different local learning methods for effective model aggregation toward a highly robust and unbiased global model. Our code is available at \url{https://github.com/xmed-lab/Fed-MAS}.

Qi Wu, Yuyao Zhang, Marawan Elbatel · cmu

Recent advancements in large foundation models have shown promising potential in the medical industry due to their flexible prompting capability. One such model, the Segment Anything Model (SAM), a prompt-driven segmentation model, has shown remarkable performance improvements, surpassing state-of-the-art approaches in medical image segmentation. However, existing methods primarily rely on tuning strategies that require extensive data or prior prompts tailored to the specific task, making it particularly challenging when only a limited number of data samples are available. In this paper, we propose a novel perspective on self-prompting in medical vision applications. Specifically, we harness the embedding space of SAM to prompt itself through a simple yet effective linear pixel-wise classifier. By preserving the encoding capabilities of the large model, the contextual information from its decoder, and leveraging its interactive promptability, we achieve competitive results on multiple datasets (i.e. improvement of more than 15% compared to fine-tuning the mask decoder using a few images).

Kaouther Mouheb, Marawan Elbatel, Stefan Klein et al.

Deep learning has achieved impressive performance across various medical imaging tasks. However, its inherent bias against specific groups hinders its clinical applicability in equitable healthcare systems. A recently discovered phenomenon, Neural Collapse (NC), has shown potential in improving the generalization of state-of-the-art deep learning models. Nonetheless, its implications on bias in medical imaging remain unexplored. Our study investigates deep learning fairness through the lens of NC. We analyze the training dynamics of models as they approach NC when training using biased datasets, and examine the subsequent impact on test performance, specifically focusing on label bias. We find that biased training initially results in different NC configurations across subgroups, before converging to a final NC solution by memorizing all data samples. Through extensive experiments on three medical imaging datasets -- PAPILA, HAM10000, and CheXpert -- we find that in biased settings, NC can lead to a significant drop in F1 score across all subgroups. Our code is available at https://gitlab.com/radiology/neuro/neural-collapse-fairness

Marawan Elbatel, Christina Bornberg, Manasi Kattel et al.

In-vitro tests are an alternative to animal testing for the toxicity of medical devices. Detecting cells as a first step, a cell expert evaluates the growth of cells according to cytotoxicity grade under the microscope. Thus, human fatigue plays a role in error making, making the use of deep learning appealing. Due to the high cost of training data annotation, an approach without manual annotation is needed. We propose Seamless Iterative Semi-Supervised correction of Imperfect labels (SISSI), a new method for training object detection models with noisy and missing annotations in a semi-supervised fashion. Our network learns from noisy labels generated with simple image processing algorithms, which are iteratively corrected during self-training. Due to the nature of missing bounding boxes in the pseudo labels, which would negatively affect the training, we propose to train on dynamically generated synthetic-like images using seamless cloning. Our method successfully provides an adaptive early learning correction technique for object detection. The combination of early learning correction that has been applied in classification and semantic segmentation before and synthetic-like image generation proves to be more effective than the usual semi-supervised approach by > 15% AP and > 20% AR across three different readers. Our code is available at https://github.com/marwankefah/SISSI.

Toufiq Musah, Salvatore Calcagno, Federica Proietto Salanitri et al.

Ultra-low-field (ULF) MRI offers portable and accessible neuroimaging but suffers from reduced signal-to-noise ratio and limited spatial resolution compared to high-field (HF) systems. Acquiring paired ULF-HF data for supervised enhancement is often difficult, particularly in resource-limited settings. We introduce ULF-Synth, a framework that combines: (i) acquisition-based synthesis of realistic ULF images from HF volumes to create large-scale paired training data, (ii) a spatial-frequency domain objective that prioritizes recovery of high-frequency anatomical detail. This formulation is architecture-agnostic, consistently improving structural similarity and perceptual fidelity across encoder-decoder, adversarial, and diffusion-based translation models. When trained exclusively on synthetic data, the resulting models generalize effectively to real 64mT ULF acquisitions, improving downstream multiclass brain segmentation and achieving higher radiologist preference and diagnostic acceptability in a blinded reader study. These findings demonstrate that synthetic paired supervision provides a practical and scalable pathway for enhancing ULF MRI without requiring real paired acquisitions. Code, Models and Dataset: https://github.com/toufiqmusah/ULF-Synth

Marawan Elbatel, Anbang Wang, Keyuan Liu et al.

This paper does not introduce a novel architecture; instead, it revisits a fundamental yet overlooked baseline: adapting human-centric foundation models for anatomical landmark detection in medical imaging. While landmark detection has traditionally relied on domain-specific models, the emergence of large-scale pre-trained vision models presents new opportunities. In this study, we investigate the adaptation of Sapiens, a human-centric foundation model designed for pose estimation, to medical imaging through multi-dataset pretraining, establishing a new state of the art across multiple datasets. Our proposed model, MedSapiens, demonstrates that human-centric foundation models, inherently optimized for spatial pose localization, provide strong priors for anatomical landmark detection, yet this potential has remained largely untapped. We benchmark MedSapiens against existing state-of-the-art models, achieving up to 5.26% improvement over generalist models and up to 21.81% improvement over specialist models in the average success detection rate (SDR). To further assess MedSapiens adaptability to novel downstream tasks with few annotations, we evaluate its performance in limited-data settings, achieving 2.69% improvement over the few-shot state of the art in SDR. Code and model weights are available at https://github.com/xmed-lab/MedSapiens .

Marawan Elbatel, Hualiang Wang, Jixiang Chen et al.

Federated semi-supervised learning (FedSemi) refers to scenarios where there may be clients with fully labeled data, clients with partially labeled, and even fully unlabeled clients while preserving data privacy. However, challenges arise from client drift due to undefined heterogeneous class distributions and erroneous pseudo-labels. Existing FedSemi methods typically fail to aggregate models from unlabeled clients due to their inherent unreliability, thus overlooking unique information from their heterogeneous data distribution, leading to sub-optimal results. In this paper, we enable unlabeled client aggregation through SemiAnAgg, a novel Semi-supervised Anchor-Based federated Aggregation. SemiAnAgg learns unlabeled client contributions via an anchor model, effectively harnessing their informative value. Our key idea is that by feeding local client data to the same global model and the same consistently initialized anchor model (i.e., random model), we can measure the importance of each unlabeled client accordingly. Extensive experiments demonstrate that SemiAnAgg achieves new state-of-the-art results on four widely used FedSemi benchmarks, leading to substantial performance improvements: a 9% increase in accuracy on CIFAR-100 and a 7.6% improvement in recall on the medical dataset ISIC-18, compared with prior state-of-the-art. Code is available at: https://github.com/xmed-lab/SemiAnAgg.

Marawan Elbatel, Konstantinos Kamnitsas, Xiaomeng Li

Generative modeling seeks to approximate the statistical properties of real data, enabling synthesis of new data that closely resembles the original distribution. Generative Adversarial Networks (GANs) and Denoising Diffusion Probabilistic Models (DDPMs) represent significant advancements in generative modeling, drawing inspiration from game theory and thermodynamics, respectively. Nevertheless, the exploration of generative modeling through the lens of biological evolution remains largely untapped. In this paper, we introduce a novel family of models termed Generative Cellular Automata (GeCA), inspired by the evolution of an organism from a single cell. GeCAs are evaluated as an effective augmentation tool for retinal disease classification across two imaging modalities: Fundus and Optical Coherence Tomography (OCT). In the context of OCT imaging, where data is scarce and the distribution of classes is inherently skewed, GeCA significantly boosts the performance of 11 different ophthalmological conditions, achieving a 12% increase in the average F1 score compared to conventional baselines. GeCAs outperform both diffusion methods that incorporate UNet or state-of-the art variants with transformer-based denoising models, under similar parameter constraints. Code is available at: https://github.com/xmed-lab/GeCA.

Marawan Elbatel, Mohamed Ghonim, Jiaji Mao et al.

Automated segmentation of liver lesions on non-contrast computed tomography (NCCT) is clinically important but fundamentally challenging, particularly in low-resource settings across Africa and Asia where contrast agents are frequently unavailable. Progress has been limited by the absence of annotated NCCT benchmarks. Here we describe the TriALS challenge for automated liver lesion segmentation under contrast-limited conditions, supported by a multi-centre dataset of 150 cases with four-phase CT acquisitions (600 volumes) from Egyptian and Chinese institutions. Algorithms were evaluated on 70 cases from three institutions, including an independent external cohort. The top-performing method achieved a mean venous-phase Dice of 0.754, consistent with human-level performance, yet dropped to 0.57 on NCCT. On external validation, the leading method outperformed off-the-shelf models by up to 28% in Dice on NCCT. Algorithm performance was most strongly predicted by training data scale and pre-training strategy. A cross-year comparison exposed a persistent perceptual barrier on NCCT that scaling pre-training alone cannot overcome. Data, annotations, and code are available at https://github.com/xmed-lab/TriALS.

Marawan Elbatel, Keyuan Liu, Yanqi Yang et al.

Accurate detection of bone fenestration and dehiscence (FD) is crucial for effective treatment planning in dentistry. While cone-beam computed tomography (CBCT) is the gold standard for evaluating FD, it comes with limitations such as radiation exposure, limited accessibility, and higher cost compared to intraoral images. In intraoral images, dentists face challenges in the differential diagnosis of FD. This paper presents a novel and clinically significant application of FD detection solely from intraoral images. To achieve this, we propose FD-SOS, a novel open-set object detector for FD detection from intraoral images. FD-SOS has two novel components: conditional contrastive denoising (CCDN) and teeth-specific matching assignment (TMA). These modules enable FD-SOS to effectively leverage external dental semantics. Experimental results showed that our method outperformed existing detection methods and surpassed dental professionals by 35% recall under the same level of precision. Code is available at: https://github.com/xmed-lab/FD-SOS.

Jieyun Bai, Zihao Zhou, Zhanhong Ou et al.

Segmentation of the fetal and maternal structures, particularly intrapartum ultrasound imaging as advocated by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for monitoring labor progression, is a crucial first step for quantitative diagnosis and clinical decision-making. This requires specialized analysis by obstetrics professionals, in a task that i) is highly time- and cost-consuming and ii) often yields inconsistent results. The utility of automatic segmentation algorithms for biometry has been proven, though existing results remain suboptimal. To push forward advancements in this area, the Grand Challenge on Pubic Symphysis-Fetal Head Segmentation (PSFHS) was held alongside the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to enhance the development of automatic segmentation algorithms at an international scale, providing the largest dataset to date with 5,101 intrapartum ultrasound images collected from two ultrasound machines across three hospitals from two institutions. The scientific community's enthusiastic participation led to the selection of the top 8 out of 179 entries from 193 registrants in the initial phase to proceed to the competition's second stage. These algorithms have elevated the state-of-the-art in automatic PSFHS from intrapartum ultrasound images. A thorough analysis of the results pinpointed ongoing challenges in the field and outlined recommendations for future work. The top solutions and the complete dataset remain publicly available, fostering further advancements in automatic segmentation and biometry for intrapartum ultrasound imaging.

Muhammad Alberb, Marawan Elbatel, Aya Elgebaly et al.

Digital Breast Tomosynthesis (DBT) is an advanced breast imaging modality that offers superior lesion detection accuracy compared to conventional mammography, albeit at the trade-off of longer reading time. Accelerating lesion detection from DBT using deep learning is hindered by limited data availability and huge annotation costs. A possible solution to this issue could be to leverage the information provided by a more widely available modality, such as mammography, to enhance DBT lesion detection. In this paper, we present a novel framework, CoMoTo, for improving lesion detection in DBT. Our framework leverages unpaired mammography data to enhance the training of a DBT model, improving practicality by eliminating the need for mammography during inference. Specifically, we propose two novel components, Lesion-specific Knowledge Distillation (LsKD) and Intra-modal Point Alignment (ImPA). LsKD selectively distills lesion features from a mammography teacher model to a DBT student model, disregarding background features. ImPA further enriches LsKD by ensuring the alignment of lesion features within the teacher before distilling knowledge to the student. Our comprehensive evaluation shows that CoMoTo is superior to traditional pretraining and image-level KD, improving performance by 7% Mean Sensitivity under low-data setting. Our code is available at https://github.com/Muhammad-Al-Barbary/CoMoTo .

Jieyun Bai, Zihao Zhou, Yitong Tang et al.

A substantial proportion (45\%) of maternal deaths, neonatal deaths, and stillbirths occur during the intrapartum phase, with a particularly high burden in low- and middle-income countries. Intrapartum biometry plays a critical role in monitoring labor progression; however, the routine use of ultrasound in resource-limited settings is hindered by a shortage of trained sonographers. To address this challenge, the Intrapartum Ultrasound Grand Challenge (IUGC), co-hosted with MICCAI 2024, was launched. The IUGC introduces a clinically oriented multi-task automatic measurement framework that integrates standard plane classification, fetal head-pubic symphysis segmentation, and biometry, enabling algorithms to exploit complementary task information for more accurate estimation. Furthermore, the challenge releases the largest multi-center intrapartum ultrasound video dataset to date, comprising 774 videos (68,106 frames) collected from three hospitals, providing a robust foundation for model training and evaluation. In this study, we present a comprehensive overview of the challenge design, review the submissions from eight participating teams, and analyze their methods from five perspectives: preprocessing, data augmentation, learning strategy, model architecture, and post-processing. In addition, we perform a systematic analysis of the benchmark results to identify key bottlenecks, explore potential solutions, and highlight open challenges for future research. Although encouraging performance has been achieved, our findings indicate that the field remains at an early stage, and further in-depth investigation is required before large-scale clinical deployment. All benchmark solutions and the complete dataset have been publicly released to facilitate reproducible research and promote continued advances in automatic intrapartum ultrasound biometry.

Marawan Elbatel

An advanced reliable low-cost form of screening method, Digital mammography has been used as an effective imaging method for breast cancer detection. With an increased focus on technologies to aid healthcare, Mammogram images have been utilized in developing computer-aided diagnosis systems that will potentially help in clinical diagnosis. Researchers have proved that artificial intelligence with its emerging technologies can be used in the early detection of the disease and improve radiologists' performance in assessing breast cancer. In this paper, we review the methods developed for mammogram mass classification in two categories. The first one is classifying manually provided cropped region of interests (ROI) as either malignant or benign, and the second one is the classification of automatically segmented ROIs as either malignant or benign. We also provide an overview of datasets and evaluation metrics used in the classification task. Finally, we compare and discuss the deep learning approach to classical image processing and learning approach in this domain.

Anbang Wang, Marawan Elbatel, Keyuan Liu et al.

Accurate detection of anatomic landmarks is essential for assessing alveolar bone and root conditions, thereby optimizing clinical outcomes in orthodontics, periodontics, and implant dentistry. Manual annotation of landmarks on cone-beam computed tomography (CBCT) by dentists is time-consuming, labor-intensive, and subject to inter-observer variability. Deep learning-based automated methods present a promising approach to streamline this process efficiently. However, the scarcity of training data and the high cost of expert annotations hinder the adoption of conventional deep learning techniques. To overcome these challenges, we introduce GeoSapiens, a novel few-shot learning framework designed for robust dental landmark detection using limited annotated CBCT of anterior teeth. Our GeoSapiens framework comprises two key components: (1) a robust baseline adapted from Sapiens, a foundational model that has achieved state-of-the-art performance in human-centric vision tasks, and (2) a novel geometric loss function that improves the model's capacity to capture critical geometric relationships among anatomical structures. Experiments conducted on our collected dataset of anterior teeth landmarks revealed that GeoSapiens surpassed existing landmark detection methods, outperforming the leading approach by an 8.18% higher success detection rate at a strict 0.5 mm threshold-a standard widely recognized in dental diagnostics. Code is available at: https://github.com/xmed-lab/GeoSapiens.

Kabir Hamzah Muhammad, Marawan Elbatel, Yi Qin et al.

Cardiovascular diseases (CVDs) remain the leading cause of mortality globally, and echocardiography is critical for diagnosis of both common and congenital cardiac conditions. However, echocardiographic data for certain pathologies are scarce, hindering the development of robust automated diagnosis models. In this work, we propose Echo-Path, a novel generative framework to produce echocardiogram videos conditioned on specific cardiac pathologies. Echo-Path can synthesize realistic ultrasound video sequences that exhibit targeted abnormalities, focusing here on atrial septal defect (ASD) and pulmonary arterial hypertension (PAH). Our approach introduces a pathology-conditioning mechanism into a state-of-the-art echo video generator, allowing the model to learn and control disease-specific structural and motion patterns in the heart. Quantitative evaluation demonstrates that the synthetic videos achieve low distribution distances, indicating high visual fidelity. Clinically, the generated echoes exhibit plausible pathology markers. Furthermore, classifiers trained on our synthetic data generalize well to real data and, when used to augment real training sets, it improves downstream diagnosis of ASD and PAH by 7\% and 8\% respectively. Code, weights and dataset are available here https://github.com/Marshall-mk/EchoPathv1

Marawan Elbatel, Robert Martí, Xiaomeng Li

Representational transfer from publicly available models is a promising technique for improving medical image classification, especially in long-tailed datasets with rare diseases. However, existing methods often overlook the frequency-dependent behavior of these models, thereby limiting their effectiveness in transferring representations and generalizations to rare diseases. In this paper, we propose FoPro-KD, a novel framework that leverages the power of frequency patterns learned from frozen pre-trained models to enhance their transferability and compression, presenting a few unique insights: 1) We demonstrate that leveraging representations from publicly available pre-trained models can substantially improve performance, specifically for rare classes, even when utilizing representations from a smaller pre-trained model. 2) We observe that pre-trained models exhibit frequency preferences, which we explore using our proposed Fourier Prompt Generator (FPG), allowing us to manipulate specific frequencies in the input image, enhancing the discriminative representational transfer. 3) By amplifying or diminishing these frequencies in the input image, we enable Effective Knowledge Distillation (EKD). EKD facilitates the transfer of knowledge from pre-trained models to smaller models. Through extensive experiments in long-tailed gastrointestinal image recognition and skin lesion classification, where rare diseases are prevalent, our FoPro-KD framework outperforms existing methods, enabling more accessible medical models for rare disease classification. Code is available at https://github.com/xmed-lab/FoPro-KD.

Kaouther Mouheb, Marawan Elbatel, Janne Papma et al.

While foundation models (FMs) offer strong potential for AI-based dementia diagnosis, their integration into federated learning (FL) systems remains underexplored. In this benchmarking study, we systematically evaluate the impact of key design choices: classification head architecture, fine-tuning strategy, and aggregation method, on the performance and efficiency of federated FM tuning using brain MRI data. Using a large multi-cohort dataset, we find that the architecture of the classification head substantially influences performance, freezing the FM encoder achieves comparable results to full fine-tuning, and advanced aggregation methods outperform standard federated averaging. Our results offer practical insights for deploying FMs in decentralized clinical settings and highlight trade-offs that should guide future method development.

Haonan Wang, Jiaji Mao, Lehan Wang et al.

Medical AI assistants support doctors in disease diagnosis, medical image analysis, and report generation. However, they still face significant challenges in clinical use, including limited accuracy with multimodal content and insufficient validation in real-world settings. We propose RCMed, a full-stack AI assistant that improves multimodal alignment in both input and output, enabling precise anatomical delineation, accurate localization, and reliable diagnosis through hierarchical vision-language grounding. A self-reinforcing correlation mechanism allows visual features to inform language context, while language semantics guide pixel-wise attention, forming a closed loop that refines both modalities. This correlation is enhanced by a color region description strategy, translating anatomical structures into semantically rich text to learn shape-location-text relationships across scales. Trained on 20 million image-mask-description triplets, RCMed achieves state-of-the-art precision in contextualizing irregular lesions and subtle anatomical boundaries, excelling in 165 clinical tasks across 9 modalities. It achieved a 23.5% relative improvement in cell segmentation from microscopy images over prior methods. RCMed's strong vision-language alignment enables exceptional generalization, with state-of-the-art performance in external validation across 20 clinically significant cancer types, including novel tasks. This work demonstrates how integrated multimodal models capture fine-grained patterns, enabling human-level interpretation in complex scenarios and advancing human-centric AI healthcare.