Satoshi Kondo

Coen de Vente, Koenraad A. Vermeer, Nicolas Jaccard et al.

The early detection of glaucoma is essential in preventing visual impairment. Artificial intelligence (AI) can be used to analyze color fundus photographs (CFPs) in a cost-effective manner, making glaucoma screening more accessible. While AI models for glaucoma screening from CFPs have shown promising results in laboratory settings, their performance decreases significantly in real-world scenarios due to the presence of out-of-distribution and low-quality images. To address this issue, we propose the Artificial Intelligence for Robust Glaucoma Screening (AIROGS) challenge. This challenge includes a large dataset of around 113,000 images from about 60,000 patients and 500 different screening centers, and encourages the development of algorithms that are robust to ungradable and unexpected input data. We evaluated solutions from 14 teams in this paper, and found that the best teams performed similarly to a set of 20 expert ophthalmologists and optometrists. The highest-scoring team achieved an area under the receiver operating characteristic curve of 0.99 (95% CI: 0.98-0.99) for detecting ungradable images on-the-fly. Additionally, many of the algorithms showed robust performance when tested on three other publicly available datasets. These results demonstrate the feasibility of robust AI-enabled glaucoma screening.

Marc Aubreville, Nikolas Stathonikos, Christof A. Bertram et al.

The density of mitotic figures within tumor tissue is known to be highly correlated with tumor proliferation and thus is an important marker in tumor grading. Recognition of mitotic figures by pathologists is known to be subject to a strong inter-rater bias, which limits the prognostic value. State-of-the-art deep learning methods can support the expert in this assessment but are known to strongly deteriorate when applied in a different clinical environment than was used for training. One decisive component in the underlying domain shift has been identified as the variability caused by using different whole slide scanners. The goal of the MICCAI MIDOG 2021 challenge has been to propose and evaluate methods that counter this domain shift and derive scanner-agnostic mitosis detection algorithms. The challenge used a training set of 200 cases, split across four scanning systems. As a test set, an additional 100 cases split across four scanning systems, including two previously unseen scanners, were given. The best approaches performed on an expert level, with the winning algorithm yielding an F_1 score of 0.748 (CI95: 0.704-0.781). In this paper, we evaluate and compare the approaches that were submitted to the challenge and identify methodological factors contributing to better performance.

Simon Graham, Quoc Dang Vu, Mostafa Jahanifar et al.

Nuclear detection, segmentation and morphometric profiling are essential in helping us further understand the relationship between histology and patient outcome. To drive innovation in this area, we setup a community-wide challenge using the largest available dataset of its kind to assess nuclear segmentation and cellular composition. Our challenge, named CoNIC, stimulated the development of reproducible algorithms for cellular recognition with real-time result inspection on public leaderboards. We conducted an extensive post-challenge analysis based on the top-performing models using 1,658 whole-slide images of colon tissue. With around 700 million detected nuclei per model, associated features were used for dysplasia grading and survival analysis, where we demonstrated that the challenge's improvement over the previous state-of-the-art led to significant boosts in downstream performance. Our findings also suggest that eosinophils and neutrophils play an important role in the tumour microevironment. We release challenge models and WSI-level results to foster the development of further methods for biomarker discovery.

Adrito Das, Danyal Z. Khan, Dimitrios Psychogyios et al.

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

Satoshi Kondo

Unsupervised domain adaptation (UDA) is one of the key technologies to solve a problem where it is hard to obtain ground truth labels needed for supervised learning. In general, UDA assumes that all samples from source and target domains are available during the training process. However, this is not a realistic assumption under applications where data privacy issues are concerned. To overcome this limitation, UDA without source data, referred to source-free unsupervised domain adaptation (SFUDA) has been recently proposed. Here, we propose a SFUDA method for medical image segmentation. In addition to the entropy minimization method, which is commonly used in UDA, we introduce a loss function for avoiding feature norms in the target domain small and a prior to preserve shape constraints of the target organ. We conduct experiments using datasets including multiple types of source-target domain combinations in order to show the versatility and robustness of our method. We confirm that our method outperforms the state-of-the-art in all datasets.

Satoshi Kondo, Satoshi Kasai

To promote the development of medical image segmentation technology, AMOS, a large-scale abdominal multi-organ dataset for versatile medical image segmentation, is provided and AMOS 2022 challenge is held by using the dataset. In this report, we present our solution for the AMOS 2022 challenge. We employ residual U-Net with deep super vision as our base model. The experimental results show that the mean scores of Dice similarity coefficient and normalized surface dice are 0.8504 and 0.8476 for CT only task and CT/MRI task, respectively.

Satoshi Kondo, Satoshi Kasai, Kousuke Hirasawa

Multi-stain whole-slide-image (WSI) registration is an active field of research. It is unclear, however, how the current WSI registration methods would perform on a real-world data set. AutomatiC Registration Of Breast cAncer Tissue (ACROBAT) challenge is held to verify the performance of the current WSI registration methods by using a new dataset that originates from routine diagnostics to assess real-world applicability. In this report, we present our solution for the ACROBAT challenge. We employ a two-step approach including rigid and non-rigid transforms. The experimental results show that the median 90th percentile is 1,250 um for the validation dataset.

Satoshi Kondo

Surgical skill assessment is paramount for ensuring patient safety and enhancing surgical outcomes. This study addresses the need for efficient and objective evaluation methods by introducing ZEAL (surgical skill assessment with Zero-shot surgical tool segmentation with a unifiEd foundAtion modeL). ZEAL uses segmentation masks of surgical instruments obtained through a unified foundation model for proficiency assessment. Through zero-shot inference with text prompts, ZEAL predicts segmentation masks, capturing essential features of both instruments and surroundings. Utilizing sparse convolutional neural networks and segmentation masks, ZEAL extracts feature vectors for foreground (instruments) and background. Long Short-Term Memory (LSTM) networks encode temporal dynamics, modeling sequential data and dependencies in surgical videos. Combining LSTM-encoded vectors, ZEAL produces a surgical skill score, offering an objective measure of proficiency. Comparative analysis with conventional methods using open datasets demonstrates ZEAL's superiority, affirming its potential in advancing surgical training and evaluation. This innovative approach to surgical skill assessment addresses challenges in traditional supervised learning techniques, paving the way for enhanced surgical care quality and patient outcomes.

Navodini Wijethilake, Reuben Dorent, Marina Ivory et al.

The cross-Modality Domain Adaptation (crossMoDA) challenge series, initiated in 2021 in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI), focuses on unsupervised cross-modality segmentation, learning from contrast-enhanced T1 (ceT1) and transferring to T2 MRI. The task is an extreme example of domain shift chosen to serve as a meaningful and illustrative benchmark. From a clinical application perspective, it aims to automate Vestibular Schwannoma (VS) and cochlea segmentation on T2 scans for more cost-effective VS management. Over time, the challenge objectives have evolved to enhance its clinical relevance. The challenge evolved from using single-institutional data and basic segmentation in 2021 to incorporating multi-institutional data and Koos grading in 2022, and by 2023, it included heterogeneous routine data and sub-segmentation of intra- and extra-meatal tumour components. In this work, we report the findings of the 2022 and 2023 editions and perform a retrospective analysis of the challenge progression over the years. The observations from the successive challenge contributions indicate that the number of outliers decreases with an expanding dataset. This is notable since the diversity of scanning protocols of the datasets concurrently increased. The winning approach of the 2023 edition reduced the number of outliers on the 2021 and 2022 testing data, demonstrating how increased data heterogeneity can enhance segmentation performance even on homogeneous data. However, the cochlea Dice score declined in 2023, likely due to the added complexity from tumour sub-annotations affecting overall segmentation performance. While progress is still needed for clinically acceptable VS segmentation, the plateauing performance suggests that a more challenging cross-modal task may better serve future benchmarking.

M. A. D. Buser, D. C. Simons, M. Fitski et al.

Surgery plays an important role within the treatment for neuroblastoma, a common pediatric cancer. This requires careful planning, often via magnetic resonance imaging (MRI)-based anatomical 3D models. However, creating these models is often time-consuming and user dependent. We organized the Surgical Planning in Pediatric Neuroblastoma (SPPIN) challenge, to stimulate developments on this topic, and set a benchmark for fully automatic segmentation of neuroblastoma on multi-model MRI. The challenge started with a training phase, where teams received 78 sets of MRI scans from 34 patients, consisting of both diagnostic and post-chemotherapy MRI scans. The final test phase, consisting of 18 MRI sets from 9 patients, determined the ranking of the teams. Ranking was based on the Dice similarity coefficient (Dice score), the 95th percentile of the Hausdorff distance (HD95) and the volumetric similarity (VS). The SPPIN challenge was hosted at MICCAI 2023. The final leaderboard consisted of 9 teams. The highest-ranking team achieved a median Dice score 0.82, a median HD95 of 7.69 mm and a VS of 0.91, utilizing a large, pretrained network called STU-Net. A significant difference for the segmentation results between diagnostic and post-chemotherapy MRI scans was observed (Dice = 0.89 vs Dice = 0.59, P = 0.01) for the highest-ranking team. SPPIN is the first medical segmentation challenge in extracranial pediatric oncology. The highest-ranking team used a large pre-trained network, suggesting that pretraining can be of use in small, heterogenous datasets. Although the results of the highest-ranking team were high for most patients, segmentation especially in small, pre-treated tumors were insufficient. Therefore, more reliable segmentation methods are needed to create clinically applicable models to aid surgical planning in pediatric neuroblastoma.

Philippe Weitz, Masi Valkonen, Leslie Solorzano et al.

The alignment of tissue between histopathological whole-slide-images (WSI) is crucial for research and clinical applications. Advances in computing, deep learning, and availability of large WSI datasets have revolutionised WSI analysis. Therefore, the current state-of-the-art in WSI registration is unclear. To address this, we conducted the ACROBAT challenge, based on the largest WSI registration dataset to date, including 4,212 WSIs from 1,152 breast cancer patients. The challenge objective was to align WSIs of tissue that was stained with routine diagnostic immunohistochemistry to its H&E-stained counterpart. We compare the performance of eight WSI registration algorithms, including an investigation of the impact of different WSI properties and clinical covariates. We find that conceptually distinct WSI registration methods can lead to highly accurate registration performances and identify covariates that impact performances across methods. These results establish the current state-of-the-art in WSI registration and guide researchers in selecting and developing methods.

Satoshi Kondo, Satoshi Kasai, Kosuke Hirasawa

Artificial Intelligence for RObust Glaucoma Screening (AIROGS) Challenge is held for developing solutions for glaucoma screening from color fundus photography that are robust to real-world scenarios. This report describes our method submitted to the AIROGS challenge. Our method employs convolutional neural networks to classify input images to "referable glaucoma" or "no referable glaucoma". In addition, we introduce an inference-time out-of-distribution (OOD) detection method to identify ungradable images. Our OOD detection is based on an energy-based method combined with activation rectification.

Satoshi Kondo, Satoshi Kasai

Nuclear segmentation, classification and quantification within Haematoxylin & Eosin stained histology images enables the extraction of interpretable cell-based features that can be used in downstream explainable models in computational pathology. The Colon Nuclei Identification and Counting (CoNIC) Challenge is held to help drive forward research and innovation for automatic nuclei recognition in computational pathology. This report describes our proposed method submitted to the CoNIC challenge. Our method employs a multi-task learning framework, which performs a panoptic segmentation task and a regression task. For the panoptic segmentation task, we use encoder-decoder type deep neural networks predicting a direction map in addition to a segmentation map in order to separate neighboring nuclei into different instances

Arnaud Huaulmé, Duygu Sarikaya, Kévin Le Mut et al.

The "MIcro-Surgical Anastomose Workflow recognition on training sessions" (MISAW) challenge provided a data set of 27 sequences of micro-surgical anastomosis on artificial blood vessels. This data set was composed of videos, kinematics, and workflow annotations described at three different granularity levels: phase, step, and activity. The participants were given the option to use kinematic data and videos to develop workflow recognition models. Four tasks were proposed to the participants: three of them were related to the recognition of surgical workflow at three different granularity levels, while the last one addressed the recognition of all granularity levels in the same model. One ranking was made for each task. We used the average application-dependent balanced accuracy (AD-Accuracy) as the evaluation metric. This takes unbalanced classes into account and it is more clinically relevant than a frame-by-frame score. Six teams, including a non-competing team, participated in at least one task. All models employed deep learning models, such as CNN or RNN. The best models achieved more than 95% AD-Accuracy for phase recognition, 80% for step recognition, 60% for activity recognition, and 75% for all granularity levels. For high levels of granularity (i.e., phases and steps), the best models had a recognition rate that may be sufficient for applications such as prediction of remaining surgical time or resource management. However, for activities, the recognition rate was still low for applications that can be employed clinically. The MISAW data set is publicly available to encourage further research in surgical workflow recognition. It can be found at www.synapse.org/MISAW

Aneeq Zia, Kiran Bhattacharyya, Xi Liu et al.

Surgical data science is revolutionizing minimally invasive surgery by enabling context-aware applications. However, many challenges exist around surgical data (and health data, more generally) needed to develop context-aware models. This work - presented as part of the Endoscopic Vision (EndoVis) challenge at the Medical Image Computing and Computer Assisted Intervention (MICCAI) 2020 conference - seeks to explore the potential for visual domain adaptation in surgery to overcome data privacy concerns. In particular, we propose to use video from virtual reality (VR) simulations of surgical exercises in robotic-assisted surgery to develop algorithms to recognize tasks in a clinical-like setting. We present the performance of the different approaches to solve visual domain adaptation developed by challenge participants. Our analysis shows that the presented models were unable to learn meaningful motion based features form VR data alone, but did significantly better when small amount of clinical-like data was also made available. Based on these results, we discuss promising methods and further work to address the problem of visual domain adaptation in surgical data science. We also release the challenge dataset publicly at https://www.synapse.org/surgvisdom2020.

Max Allan, Satoshi Kondo, Sebastian Bodenstedt et al.

In 2015 we began a sub-challenge at the EndoVis workshop at MICCAI in Munich using endoscope images of ex-vivo tissue with automatically generated annotations from robot forward kinematics and instrument CAD models. However, the limited background variation and simple motion rendered the dataset uninformative in learning about which techniques would be suitable for segmentation in real surgery. In 2017, at the same workshop in Quebec we introduced the robotic instrument segmentation dataset with 10 teams participating in the challenge to perform binary, articulating parts and type segmentation of da Vinci instruments. This challenge included realistic instrument motion and more complex porcine tissue as background and was widely addressed with modifications on U-Nets and other popular CNN architectures. In 2018 we added to the complexity by introducing a set of anatomical objects and medical devices to the segmented classes. To avoid over-complicating the challenge, we continued with porcine data which is dramatically simpler than human tissue due to the lack of fatty tissue occluding many organs.

Mitko Veta, Paul J. van Diest, Stefan M. Willems et al.

The proliferative activity of breast tumors, which is routinely estimated by counting of mitotic figures in hematoxylin and eosin stained histology sections, is considered to be one of the most important prognostic markers. However, mitosis counting is laborious, subjective and may suffer from low inter-observer agreement. With the wider acceptance of whole slide images in pathology labs, automatic image analysis has been proposed as a potential solution for these issues. In this paper, the results from the Assessment of Mitosis Detection Algorithms 2013 (AMIDA13) challenge are described. The challenge was based on a data set consisting of 12 training and 11 testing subjects, with more than one thousand annotated mitotic figures by multiple observers. Short descriptions and results from the evaluation of eleven methods are presented. The top performing method has an error rate that is comparable to the inter-observer agreement among pathologists.