Yiming Xiao

Taha Koleilat, Hojat Asgariandehkordi, Hassan Rivaz et al.

Segmentation of anatomical structures and pathological regions in medical images is essential for modern clinical diagnosis, disease research, and treatment planning. While significant advancements have been made in deep learning-based segmentation techniques, many of these methods still suffer from limitations in data efficiency, generalizability, and interactivity. As a result, developing precise segmentation methods that require fewer labeled datasets remains a critical challenge in medical image analysis. Recently, the introduction of foundation models like CLIP and Segment-Anything-Model (SAM), with robust cross-domain representations, has paved the way for interactive and universal image segmentation. However, further exploration of these models for data-efficient segmentation in medical imaging is still needed and highly relevant. In this paper, we introduce MedCLIP-SAMv2, a novel framework that integrates the CLIP and SAM models to perform segmentation on clinical scans using text prompts, in both zero-shot and weakly supervised settings. Our approach includes fine-tuning the BiomedCLIP model with a new Decoupled Hard Negative Noise Contrastive Estimation (DHN-NCE) loss, and leveraging the Multi-modal Information Bottleneck (M2IB) to create visual prompts for generating segmentation masks from SAM in the zero-shot setting. We also investigate using zero-shot segmentation labels within a weakly supervised paradigm to enhance segmentation quality further. Extensive testing across four diverse segmentation tasks and medical imaging modalities (breast tumor ultrasound, brain tumor MRI, lung X-ray, and lung CT) demonstrates the high accuracy of our proposed framework. Our code is available at https://github.com/HealthX-Lab/MedCLIP-SAMv2.

Amirhossein Rasoulian, Soorena Salari, Yiming Xiao

Intracranial hemorrhage (ICH) is a life-threatening medical emergency that requires timely and accurate diagnosis for effective treatment and improved patient survival rates. While deep learning techniques have emerged as the leading approach for medical image analysis and processing, the most commonly employed supervised learning often requires large, high-quality annotated datasets that can be costly to obtain, particularly for pixel/voxel-wise image segmentation. To address this challenge and facilitate ICH treatment decisions, we introduce a novel weakly supervised method for ICH segmentation, utilizing a Swin transformer trained on an ICH classification task with categorical labels. Our approach leverages a hierarchical combination of head-wise gradient-infused self-attention maps to generate accurate image segmentation. Additionally, we conducted an exploratory study on different learning strategies and showed that binary ICH classification has a more positive impact on self-attention maps compared to full ICH subtyping. With a mean Dice score of 0.44, our technique achieved similar ICH segmentation performance as the popular U-Net and Swin-UNETR models with full supervision and outperformed a similar weakly supervised approach using GradCAM, demonstrating the excellent potential of the proposed framework in challenging medical image segmentation tasks. Our code is available at https://github.com/HealthX-Lab/HGI-SAM.

Yiming Xiao, Ankit Basu, Kai Yin et al.

Disasters are inevitable and increasingly costly, and effective response depends on querying structured tabular data: precise, information-dense records of hazard, exposure, vulnerability, and lifeline infrastructure that underpin disaster management. Current text-to-SQL methods enable natural-language access to such tables but transfer poorly to the disaster domain, where queries span heterogeneous geospatial schemas and require reasoning over causal relations. We introduce DisasterLex, a knowledge-graph-mediated framework that inserts an Expert Knowledge Graph (EKG) of curated concepts and typed causal edges between the user query and the database, bridged to schema by concept-to-table links. The orchestration runs four stages (identifying query entities, routing to the operational domain, planning over causal edges, and grounding the SQL), restricting the schema passed to the model at each step. We instantiate it on a disaster-analytics database (36 geospatial tables, 150 columns) with an EKG of 107 concepts, 117 causal edges, and 52 concept-to-schema links, evaluated on a 75-query test set. On all seven base models spanning proprietary and open-weight families, DisasterLex beats four state-of-the-art baselines (LightRAG, HippoRAG 2, ReFoRCE, CHESS) by 1.4x to 2.75x, with absolute scores of 1.65 to 3.56 (of 5.0). Error analysis shows baseline failures cluster in routing and multi-table SQL composition, the operations our orchestration explicitly addresses. Code, data, and the EKG artifact are available at https://github.com/YimingXiao98/DisasterLex and on Zenodo at https://doi.org/10.5281/zenodo.20388029.

Bahareh Behboodi, Francois-Xavier Carton, Matthieu Chabanas et al.

Purpose: Registration and segmentation of magnetic resonance (MR) and ultrasound (US) images play an essential role in surgical planning and resection of brain tumors. However, validating these techniques is challenging due to the scarcity of publicly accessible sources with high-quality ground truth information. To this end, we propose a unique annotation dataset of tumor tissues and resection cavities from the previously published RESECT dataset (Xiao et al. 2017) to encourage a more rigorous assessments of image processing techniques. Acquisition and validation methods: The RESECT database consists of MR and intraoperative US (iUS) images of 23 patients who underwent resection surgeries. The proposed dataset contains tumor tissues and resection cavity annotations of the iUS images. The quality of annotations were validated by two highly experienced neurosurgeons through several assessment criteria. Data format and availability: Annotations of tumor tissues and resection cavities are provided in 3D NIFTI formats. Both sets of annotations are accessible online in the \url{https://osf.io/6y4db}. Discussion and potential applications: The proposed database includes tumor tissue and resection cavity annotations from real-world clinical ultrasound brain images to evaluate segmentation and registration methods. These labels could also be used to train deep learning approaches. Eventually, this dataset should further improve the quality of image guidance in neurosurgery.

Mumu Aktar, Hassan Rivaz, Marta Kersten-Oertel et al.

Angiography is widely used to detect, diagnose, and treat cerebrovascular diseases. While numerous techniques have been proposed to segment the vascular network from different imaging modalities, deep learning (DL) has emerged as a promising approach. However, existing DL methods often depend on proprietary datasets and extensive manual annotation. Moreover, the availability of pre-trained networks specifically for medical domains and 3D volumes is limited. To overcome these challenges, we propose a few-shot learning approach called VesselShot for cerebrovascular segmentation. VesselShot leverages knowledge from a few annotated support images and mitigates the scarcity of labeled data and the need for extensive annotation in cerebral blood vessel segmentation. We evaluated the performance of VesselShot using the publicly available TubeTK dataset for the segmentation task, achieving a mean Dice coefficient (DC) of 0.62(0.03).

Parinaz Roshanzamir, Hassan Rivaz, Joshua Ahn et al.

Recent developments in deep learning (DL) techniques have led to great performance improvement in medical image segmentation tasks, especially with the latest Transformer model and its variants. While labels from fusing multi-rater manual segmentations are often employed as ideal ground truths in DL model training, inter-rater variability due to factors such as training bias, image noise, and extreme anatomical variability can still affect the performance and uncertainty of the resulting algorithms. Knowledge regarding how inter-rater variability affects the reliability of the resulting DL algorithms, a key element in clinical deployment, can help inform better training data construction and DL models, but has not been explored extensively. In this paper, we measure aleatoric and epistemic uncertainties using test-time augmentation (TTA), test-time dropout (TTD), and deep ensemble to explore their relationship with inter-rater variability. Furthermore, we compare UNet and TransUNet to study the impacts of Transformers on model uncertainty with two label fusion strategies. We conduct a case study using multi-class paraspinal muscle segmentation from T2w MRIs. Our study reveals the interplay between inter-rater variability and uncertainties, affected by choices of label fusion strategies and DL models.

Taha Koleilat, Hojat Asgariandehkordi, Hassan Rivaz et al.

Medical image segmentation of anatomical structures and pathology is crucial in modern clinical diagnosis, disease study, and treatment planning. To date, great progress has been made in deep learning-based segmentation techniques, but most methods still lack data efficiency, generalizability, and interactability. Consequently, the development of new, precise segmentation methods that demand fewer labeled datasets is of utmost importance in medical image analysis. Recently, the emergence of foundation models, such as CLIP and Segment-Anything-Model (SAM), with comprehensive cross-domain representation opened the door for interactive and universal image segmentation. However, exploration of these models for data-efficient medical image segmentation is still limited, but is highly necessary. In this paper, we propose a novel framework, called MedCLIP-SAM that combines CLIP and SAM models to generate segmentation of clinical scans using text prompts in both zero-shot and weakly supervised settings. To achieve this, we employed a new Decoupled Hard Negative Noise Contrastive Estimation (DHN-NCE) loss to fine-tune the BiomedCLIP model and the recent gScoreCAM to generate prompts to obtain segmentation masks from SAM in a zero-shot setting. Additionally, we explored the use of zero-shot segmentation labels in a weakly supervised paradigm to improve the segmentation quality further. By extensively testing three diverse segmentation tasks and medical image modalities (breast tumor ultrasound, brain tumor MRI, and lung X-ray), our proposed framework has demonstrated excellent accuracy. Code is available at https://github.com/HealthX-Lab/MedCLIP-SAM.

Taha Koleilat, Hojat Asgariandehkordi, Hassan Rivaz et al.

Recent advancements in vision-language models (VLMs), such as CLIP, have demonstrated substantial success in self-supervised representation learning for vision tasks. However, effectively adapting VLMs to downstream applications remains challenging, as their accuracy often depends on time-intensive and expertise-demanding prompt engineering, while full model fine-tuning is costly. This is particularly true for biomedical images, which, unlike natural images, typically suffer from limited annotated datasets, unintuitive image contrasts, and nuanced visual features. Recent prompt learning techniques, such as Context Optimization (CoOp) intend to tackle these issues, but still fall short in generalizability. Meanwhile, explorations in prompt learning for biomedical image analysis are still highly limited. In this work, we propose BiomedCoOp, a novel prompt learning framework that enables efficient adaptation of BiomedCLIP for accurate and highly generalizable few-shot biomedical image classification. Our approach achieves effective prompt context learning by leveraging semantic consistency with average prompt ensembles from Large Language Models (LLMs) and knowledge distillation with a statistics-based prompt selection strategy. We conducted comprehensive validation of our proposed framework on 11 medical datasets across 9 modalities and 10 organs against existing state-of-the-art methods, demonstrating significant improvements in both accuracy and generalizability. The code is publicly available at https://github.com/HealthX-Lab/BiomedCoOp.

Pascal Spiegler, Amirhossein Rasoulian, Yiming Xiao

Intracranial hemorrhage (ICH) is a life-threatening condition that requires rapid and accurate diagnosis to improve treatment outcomes and patient survival rates. Recent advancements in supervised deep learning have greatly improved the analysis of medical images, but often rely on extensive datasets with high-quality annotations, which are costly, time-consuming, and require medical expertise to prepare. To mitigate the need for large amounts of expert-prepared segmentation data, we have developed a novel weakly supervised ICH segmentation method that utilizes the YOLO object detection model and an uncertainty-rectified Segment Anything Model (SAM). In addition, we have proposed a novel point prompt generator for this model to further improve segmentation results with YOLO-predicted bounding box prompts. Our approach achieved a high accuracy of 0.933 and an AUC of 0.796 in ICH detection, along with a mean Dice score of 0.629 for ICH segmentation, outperforming existing weakly supervised and popular supervised (UNet and Swin-UNETR) approaches. Overall, the proposed method provides a robust and accurate alternative to the more commonly used supervised techniques for ICH quantification without requiring refined segmentation ground truths during model training.

Amirhossein Rasoulian, Arash Harirpoush, Soorena Salari et al.

Accurate identification and quantification of unruptured intracranial aneurysms (UIAs) is crucial for the risk assessment and treatment of this cerebrovascular disorder. Current 2D manual assessment on 3D magnetic resonance angiography (MRA) is suboptimal and time-consuming. In addition, one major issue in medical image segmentation is the need for large well-annotated data, which can be expensive to obtain. Techniques that mitigate this requirement, such as weakly supervised learning with coarse labels are highly desirable. In the paper, we propose FocalSegNet, a novel 3D focal modulation UNet, to detect an aneurysm and offer an initial, coarse segmentation of it from time-of-flight MRA image patches, which is further refined with a dense conditional random field (CRF) post-processing layer to produce a final segmentation map. We trained and evaluated our model on a public dataset, and in terms of UIA detection, our model showed a low false-positive rate of 0.21 and a high sensitivity of 0.80. For voxel-wise aneurysm segmentation, we achieved a Dice score of 0.68 and a 95% Hausdorff distance of ~0.95 mm, demonstrating its strong performance. We evaluated our algorithms against the state-of-the-art 3D Residual-UNet and Swin-UNETR, and illustrated the superior performance of our proposed FocalSegNet, highlighting the advantages of employing focal modulation for this task.

Soorena Salari, Arash Harirpoush, Hassan Rivaz et al.

Anatomical landmark detection in medical images is essential for various clinical and research applications, including disease diagnosis and surgical planning. However, manual landmark annotation is time-consuming and requires significant expertise. Existing deep learning (DL) methods often require large amounts of well-annotated data, which are costly to acquire. In this paper, we introduce CABLD, a novel self-supervised DL framework for 3D brain landmark detection in unlabeled scans with varying contrasts by using only a single reference example. To achieve this, we employed an inter-subject landmark consistency loss with an image registration loss while introducing a 3D convolution-based contrast augmentation strategy to promote model generalization to new contrasts. Additionally, we utilize an adaptive mixed loss function to schedule the contributions of different sub-tasks for optimal outcomes. We demonstrate the proposed method with the intricate task of MRI-based 3D brain landmark detection. With comprehensive experiments on four diverse clinical and public datasets, including both T1w and T2w MRI scans at different MRI field strengths, we demonstrate that CABLD outperforms the state-of-the-art methods in terms of mean radial errors (MREs) and success detection rates (SDRs). Our framework provides a robust and accurate solution for anatomical landmark detection, reducing the need for extensively annotated datasets and generalizing well across different imaging contrasts. Our code is publicly available at https://github.com/HealthX-Lab/CABLD.

Christopher Neves, Yong Zeng, Yiming Xiao

Parkinson's disease (PD) is a debilitating neurodegenerative disease that has severe impacts on an individual's quality of life. Compared with structural and functional MRI-based biomarkers for the disease, electroencephalography (EEG) can provide more accessible alternatives for clinical insights. While deep learning (DL) techniques have provided excellent outcomes, many techniques fail to model spatial information and dynamic brain connectivity, and face challenges in robust feature learning, limited data sizes, and poor explainability. To address these issues, we proposed a novel graph neural network (GNN) technique for explainable PD detection using resting state EEG. Specifically, we employ structured global convolutions with contrastive learning to better model complex features with limited data, a novel multi-head graph structure learner to capture the non-Euclidean structure of EEG data, and a head-wise gradient-weighted graph attention explainer to offer neural connectivity insights. We developed and evaluated our method using the UC San Diego Parkinson's disease EEG dataset, and achieved 69.40% detection accuracy in subject-wise leave-one-out cross-validation while generating intuitive explanations for the learnt graph topology.

Erin Rainville, Amirhossein Rasoulian, Hassan Rivaz et al.

Intracranial aneurysms (IAs) are abnormal dilations of cerebral blood vessels that, if ruptured, can lead to life-threatening consequences. However, their small size and soft contrast in radiological scans often make it difficult to perform accurate and efficient detection and morphological analyses, which are critical in the clinical care of the disorder. Furthermore, the lack of large public datasets with voxel-wise expert annotations pose challenges for developing deep learning algorithms to address the issues. Therefore, we proposed a novel weakly supervised 3D multi-task UNet that integrates vesselness priors to jointly perform aneurysm detection and segmentation in time-of-flight MR angiography (TOF-MRA). Specifically, to robustly guide IA detection and segmentation, we employ the popular Frangi's vesselness filter to derive soft cerebrovascular priors for both network input and an attention block to conduct segmentation from the decoder and detection from an auxiliary branch. We train our model on the Lausanne dataset with coarse ground truth segmentation, and evaluate it on the test set with refined labels from the same database. To further assess our model's generalizability, we also validate it externally on the ADAM dataset. Our results demonstrate the superior performance of the proposed technique over the SOTA techniques for aneurysm segmentation (Dice = 0.614, 95%HD =1.38mm) and detection (false positive rate = 1.47, sensitivity = 92.9%).

Xiwei Zhang, Chunjin Yang, Yiming Xiao et al.

Unsupervised domain adaptive object detection (UDAOD) from the visible domain to the infrared (RGB-IR) domain is challenging. Existing methods regard the RGB domain as a unified domain and neglect the multiple subdomains within it, such as daytime, nighttime, and foggy scenes. We argue that decoupling the domain-invariant (DI) and domain-specific (DS) features across these multiple subdomains is beneficial for RGB-IR domain adaptation. To this end, this paper proposes a new SS-DC framework based on a decoupling-coupling strategy. In terms of decoupling, we design a Spectral Adaptive Idempotent Decoupling (SAID) module in the aspect of spectral decomposition. Due to the style and content information being highly embedded in different frequency bands, this module can decouple DI and DS components more accurately and interpretably. A novel filter bank-based spectral processing paradigm and a self-distillation-driven decoupling loss are proposed to improve the spectral domain decoupling. In terms of coupling, a new spatial-spectral coupling method is proposed, which realizes joint coupling through spatial and spectral DI feature pyramids. Meanwhile, this paper introduces DS from decoupling to reduce the domain bias. Extensive experiments demonstrate that our method can significantly improve the baseline performance and outperform existing UDAOD methods on multiple RGB-IR datasets, including a new experimental protocol proposed in this paper based on the FLIR-ADAS dataset.

Alessa Hering, Lasse Hansen, Tony C. W. Mok et al.

Image registration is a fundamental medical image analysis task, and a wide variety of approaches have been proposed. However, only a few studies have comprehensively compared medical image registration approaches on a wide range of clinically relevant tasks. This limits the development of registration methods, the adoption of research advances into practice, and a fair benchmark across competing approaches. The Learn2Reg challenge addresses these limitations by providing a multi-task medical image registration data set for comprehensive characterisation of deformable registration algorithms. A continuous evaluation will be possible at https://learn2reg.grand-challenge.org. Learn2Reg covers a wide range of anatomies (brain, abdomen, and thorax), modalities (ultrasound, CT, MR), availability of annotations, as well as intra- and inter-patient registration evaluation. We established an easily accessible framework for training and validation of 3D registration methods, which enabled the compilation of results of over 65 individual method submissions from more than 20 unique teams. We used a complementary set of metrics, including robustness, accuracy, plausibility, and runtime, enabling unique insight into the current state-of-the-art of medical image registration. This paper describes datasets, tasks, evaluation methods and results of the challenge, as well as results of further analysis of transferability to new datasets, the importance of label supervision, and resulting bias. While no single approach worked best across all tasks, many methodological aspects could be identified that push the performance of medical image registration to new state-of-the-art performance. Furthermore, we demystified the common belief that conventional registration methods have to be much slower than deep-learning-based methods.