Virginia Newcombe

Eamonn Kennedy, Shashank Vadlamani, Hannah M Lindsey et al.

An extensive library of symptom inventories has been developed over time to measure clinical symptoms, but this variety has led to several long standing issues. Most notably, results drawn from different settings and studies are not comparable, which limits reproducibility. Here, we present an artificial intelligence (AI) approach using semantic textual similarity (STS) to link symptoms and scores across previously incongruous symptom inventories. We tested the ability of four pre-trained STS models to screen thousands of symptom description pairs for related content - a challenging task typically requiring expert panels. Models were tasked to predict symptom severity across four different inventories for 6,607 participants drawn from 16 international data sources. The STS approach achieved 74.8% accuracy across five tasks, outperforming other models tested. This work suggests that incorporating contextual, semantic information can assist expert decision-making processes, yielding gains for both general and disease-specific clinical assessment.

Konstantinos Kamnitsas, Stefan Winzeck, Evgenios N. Kornaropoulos et al.

Semi-supervised learning (SSL) uses unlabeled data during training to learn better models. Previous studies on SSL for medical image segmentation focused mostly on improving model generalization to unseen data. In some applications, however, our primary interest is not generalization but to obtain optimal predictions on a specific unlabeled database that is fully available during model development. Examples include population studies for extracting imaging phenotypes. This work investigates an often overlooked aspect of SSL, transduction. It focuses on the quality of predictions made on the unlabeled data of interest when they are included for optimization during training, rather than improving generalization. We focus on the self-training framework and explore its potential for transduction. We analyze it through the lens of Information Gain and reveal that learning benefits from the use of calibrated or under-confident models. Our extensive experiments on a large MRI database for multi-class segmentation of traumatic brain lesions shows promising results when comparing transductive with inductive predictions. We believe this study will inspire further research on transductive learning, a well-suited paradigm for medical image analysis.

Franco Matzkin, Virginia Newcombe, Ben Glocker et al.

Cranial implant design is a challenging task, whose accuracy is crucial in the context of cranioplasty procedures. This task is usually performed manually by experts using computer-assisted design software. In this work, we propose and evaluate alternative automatic deep learning models for cranial implant reconstruction from CT images. The models are trained and evaluated using the database released by the AutoImplant challenge, and compared to a baseline implemented by the organizers. We employ a simulated virtual craniectomy to train our models using complete skulls, and compare two different approaches trained with this procedure. The first one is a direct estimation method based on the UNet architecture. The second method incorporates shape priors to increase the robustness when dealing with out-of-distribution implant shapes. Our direct estimation method outperforms the baselines provided by the organizers, while the model with shape priors shows superior performance when dealing with out-of-distribution cases. Overall, our methods show promising results in the difficult task of cranial implant design.

Franco Matzkin, Virginia Newcombe, Susan Stevenson et al.

Decompressive craniectomy (DC) is a common surgical procedure consisting of the removal of a portion of the skull that is performed after incidents such as stroke, traumatic brain injury (TBI) or other events that could result in acute subdural hemorrhage and/or increasing intracranial pressure. In these cases, CT scans are obtained to diagnose and assess injuries, or guide a certain therapy and intervention. We propose a deep learning based method to reconstruct the skull defect removed during DC performed after TBI from post-operative CT images. This reconstruction is useful in multiple scenarios, e.g. to support the creation of cranioplasty plates, accurate measurements of bone flap volume and total intracranial volume, important for studies that aim to relate later atrophy to patient outcome. We propose and compare alternative self-supervised methods where an encoder-decoder convolutional neural network (CNN) estimates the missing bone flap on post-operative CTs. The self-supervised learning strategy only requires images with complete skulls and avoids the need for annotated DC images. For evaluation, we employ real and simulated images with DC, comparing the results with other state-of-the-art approaches. The experiments show that the proposed model outperforms current manual methods, enabling reconstruction even in highly challenging cases where big skull defects have been removed during surgery.

Konstantinos Kamnitsas, Christian Baumgartner, Christian Ledig et al.

Significant advances have been made towards building accurate automatic segmentation systems for a variety of biomedical applications using machine learning. However, the performance of these systems often degrades when they are applied on new data that differ from the training data, for example, due to variations in imaging protocols. Manually annotating new data for each test domain is not a feasible solution. In this work we investigate unsupervised domain adaptation using adversarial neural networks to train a segmentation method which is more invariant to differences in the input data, and which does not require any annotations on the test domain. Specifically, we learn domain-invariant features by learning to counter an adversarial network, which attempts to classify the domain of the input data by observing the activations of the segmentation network. Furthermore, we propose a multi-connected domain discriminator for improved adversarial training. Our system is evaluated using two MR databases of subjects with traumatic brain injuries, acquired using different scanners and imaging protocols. Using our unsupervised approach, we obtain segmentation accuracies which are close to the upper bound of supervised domain adaptation.

Konstantinos Kamnitsas, Christian Ledig, Virginia F. J. Newcombe et al.

We propose a dual pathway, 11-layers deep, three-dimensional Convolutional Neural Network for the challenging task of brain lesion segmentation. The devised architecture is the result of an in-depth analysis of the limitations of current networks proposed for similar applications. To overcome the computational burden of processing 3D medical scans, we have devised an efficient and effective dense training scheme which joins the processing of adjacent image patches into one pass through the network while automatically adapting to the inherent class imbalance present in the data. Further, we analyze the development of deeper, thus more discriminative 3D CNNs. In order to incorporate both local and larger contextual information, we employ a dual pathway architecture that processes the input images at multiple scales simultaneously. For post-processing of the network's soft segmentation, we use a 3D fully connected Conditional Random Field which effectively removes false positives. Our pipeline is extensively evaluated on three challenging tasks of lesion segmentation in multi-channel MRI patient data with traumatic brain injuries, brain tumors, and ischemic stroke. We improve on the state-of-the-art for all three applications, with top ranking performance on the public benchmarks BRATS 2015 and ISLES 2015. Our method is computationally efficient, which allows its adoption in a variety of research and clinical settings. The source code of our implementation is made publicly available.