Puneet Sharma

Florin Condrea, Saikiran Rapaka, Lucian Itu et al.

Pulmonary Embolisms (PE) represent a leading cause of cardiovascular death. While medical imaging, through computed tomographic pulmonary angiography (CTPA), represents the gold standard for PE diagnosis, it is still susceptible to misdiagnosis or significant diagnosis delays, which may be fatal for critical cases. Despite the recently demonstrated power of deep learning to bring a significant boost in performance in a wide range of medical imaging tasks, there are still very few published researches on automatic pulmonary embolism detection. Herein we introduce a deep learning based approach, which efficiently combines computer vision and deep neural networks for pulmonary embolism detection in CTPA. Our method features novel improvements along three orthogonal axes: 1) automatic detection of anatomical structures; 2) anatomical aware pretraining, and 3) a dual-hop deep neural net for PE detection. We obtain state-of-the-art results on the publicly available multicenter large-scale RSNA dataset.

Athira J Jacob, Puneet Sharma, Daniel Ruckert

Delineation of anatomical structures is often the first step of many medical image analysis workflows. While convolutional neural networks achieve high performance, these do not incorporate anatomical shape information. We introduce a novel segmentation algorithm that uses Deep Conditional Shape models (DCSMs) as a core component. Using deep implicit shape representations, the algorithm learns a modality-agnostic shape model that can generate the signed distance functions for any anatomy of interest. To fit the generated shape to the image, the shape model is conditioned on anatomic landmarks that can be automatically detected or provided by the user. Finally, we add a modality-dependent, lightweight refinement network to capture any fine details not represented by the implicit function. The proposed DCSM framework is evaluated on the problem of cardiac left ventricle (LV) segmentation from multiple 3D modalities (contrast-enhanced CT, non-contrasted CT, 3D echocardiography-3DE). We demonstrate that the automatic DCSM outperforms the baseline for non-contrasted CT without the local refinement, and with the refinement for contrasted CT and 3DE, especially with significant improvement in the Hausdorff distance. The semi-automatic DCSM with user-input landmarks, while only trained on contrasted CT, achieves greater than 92% Dice for all modalities. Both automatic DCSM with refinement and semi-automatic DCSM achieve equivalent or better performance compared to inter-user variability for these modalities.

Abdoul Aziz Amadou, Vivek Singh, Florin C. Ghesu et al.

Transesophageal echocardiography (TEE) plays a pivotal role in cardiology for diagnostic and interventional procedures. However, using it effectively requires extensive training due to the intricate nature of image acquisition and interpretation. To enhance the efficiency of novice sonographers and reduce variability in scan acquisitions, we propose a novel ultrasound (US) navigation assistance method based on contrastive learning as goal-conditioned reinforcement learning (GCRL). We augment the previous framework using a novel contrastive patient batching method (CPB) and a data-augmented contrastive loss, both of which we demonstrate are essential to ensure generalization to anatomical variations across patients. The proposed framework enables navigation to both standard diagnostic as well as intricate interventional views with a single model. Our method was developed with a large dataset of 789 patients and obtained an average error of 6.56 mm in position and 9.36 degrees in angle on a testing dataset of 140 patients, which is competitive or superior to models trained on individual views. Furthermore, we quantitatively validate our method's ability to navigate to interventional views such as the Left Atrial Appendage (LAA) view used in LAA closure. Our approach holds promise in providing valuable guidance during transesophageal ultrasound examinations, contributing to the advancement of skill acquisition for cardiac ultrasound practitioners.

Jinsun Yoo, ChonLam Lao, Lianjie Cao et al.

This paper lays the foundation for Genie, a testing framework that captures the impact of real hardware network behavior on ML workload performance, without requiring expensive GPUs. Genie uses CPU-initiated traffic over a hardware testbed to emulate GPU to GPU communication, and adapts the ASTRA-sim simulator to model interaction between the network and the ML workload.

Athira J Jacob, Puneet Sharma, Daniel Rueckert

Detection of hyperenhancement from cardiac LGE MRI images is a complex task requiring significant clinical expertise. Although deep learning-based models have shown promising results for the task, they require large amounts of data with fine-grained annotations. Clinical reports generated for cardiac MR studies contain rich, clinically relevant information, including the location, extent and etiology of any scars present. Although recently developed CLIP-based training enables pretraining models with image-text pairs, it requires large amounts of data and further finetuning strategies on downstream tasks. In this study, we use various strategies rooted in domain knowledge to train a model for LGE detection solely using text from clinical reports, on a relatively small clinical cohort of 965 patients. We improve performance through the use of synthetic data augmentation, by systematically creating scar images and associated text. In addition, we standardize the orientation of the images in an anatomy-informed way to enable better alignment of spatial and text features. We also use a captioning loss to enable fine-grained supervision and explore the effect of pretraining of the vision encoder on performance. Finally, ablation studies are carried out to elucidate the contributions of each design component to the overall performance of the model.

Athira J Jacob, Puneet Sharma, Daniel Rueckert

Segmentation is often the first step in many medical image analyses workflows. Deep learning approaches, while giving state-of-the-art accuracies, are data intensive and do not scale well to low data regimes. We introduce Deep Conditional Shape Models 2.0, which uses an edge detector, along with an implicit shape function conditioned on edge maps, to leverage cross-modality shape information. The shape function is trained exclusively on a source domain (contrasted CT) and applied to the target domain of interest (3D echocardiography). We demonstrate data efficiency in the target domain by varying the amounts of training data used in the edge detection stage. We observe that DCSM 2.0 outperforms the baseline at all data levels in terms of Hausdorff distances, and while using 50% or less of the training data in terms of average mesh distance, and at 10% or less of the data with the dice coefficient. The method scales well to low data regimes, with gains of up to 5% in dice coefficient, 2.58 mm in average surface distance and 21.02 mm in Hausdorff distance when using just 2% (22 volumes) of the training data.

Yifan Wu, Rohit Jena, Mehmet Gulsun et al.

Coronary angiography is the gold standard imaging technique for studying and diagnosing coronary artery disease. However, the resulting 2D X-ray projections lose 3D information and exhibit visual ambiguities. In this work, we aim to establish dense correspondence in multi-view angiography, serving as a fundamental basis for various clinical applications and downstream tasks. To overcome the challenge of unavailable annotated data, we designed a data simulation pipeline using 3D Coronary Computed Tomography Angiography (CCTA). We formulated the problem of dense correspondence estimation as a query matching task over all points of interest in the given views. We established point-to-point query matching and advanced it to curve-to-curve correspondence, significantly reducing errors by minimizing ambiguity and improving topological awareness. The method was evaluated on a set of 1260 image pairs from different views across 8 clinically relevant angulation groups, demonstrating compelling results and indicating the feasibility of establishing dense correspondence in multi-view angiography.

Seung Su Yoon, Elisabeth Preuhs, Michaela Schmidt et al.

Static cardiac imaging such as late gadolinium enhancement, mapping, or 3-D coronary angiography require prior information, e.g., the phase during a cardiac cycle with least motion, called resting phase (RP). The purpose of this work is to propose a fully automated framework that allows the detection of the right coronary artery (RCA) RP within CINE series. The proposed prototype system consists of three main steps. First, the localization of the regions of interest (ROI) is performed. Second, the cropped ROI series are taken for tracking motions over all time points. Third, the output motion values are used to classify RPs. In this work, we focused on the detection of the area with the outer edge of the cross-section of the RCA as our target. The proposed framework was evaluated on 102 clinically acquired dataset at 1.5T and 3T. The automatically classified RPs were compared with the reference RPs annotated manually by a expert for testing the robustness and feasibility of the framework. The predicted RCA RPs showed high agreement with the experts annotated RPs with 92.7% accuracy, 90.5% sensitivity and 95.0% specificity for the unseen study dataset. The mean absolute difference of the start and end RP was 13.6 $\pm$ 18.6 ms for the validation study dataset (n=102). In this work, automated RP detection has been introduced by the proposed framework and demonstrated feasibility, robustness, and applicability for static imaging acquisitions.

Rajeev Bhatt Ambati, Ahmed Ada Hanifi, Ramya Vunikili et al.

Multi-label sentences (text) in the clinical domain result from the rich description of scenarios during patient care. The state-of-theart methods for assertion detection mostly address this task in the setting of a single assertion label per sentence (text). In addition, few rules based and deep learning methods perform negation/assertion scope detection on single-label text. It is a significant challenge extending these methods to address multi-label sentences without diminishing performance. Therefore, we developed a convolutional neural network (CNN) architecture to localize multiple labels and their scopes in a single stage end-to-end fashion, and demonstrate that our model performs atleast 12% better than the state-of-the-art on multi-label clinical text.

Costin Ciusdel, Alexandru Turcea, Andrei Puiu et al.

Invasive coronary angiography (ICA) is the gold standard in Coronary Artery Disease (CAD) imaging. Detection of the end-diastolic frame (EDF) and, in general, cardiac phase detection on each temporal frame of a coronary angiography acquisition is of significant importance for the anatomical and non-invasive functional assessment of CAD. This task is generally performed via manual frame selection or semi-automated selection based on simultaneously acquired ECG signals - thus introducing the requirement of simultaneous ECG recordings. We evaluate the performance of a purely image based workflow based on deep neural networks for fully automated cardiac phase and EDF detection on coronary angiographies. A first deep neural network (DNN), trained to detect coronary arteries, is employed to preselect a subset of frames in which coronary arteries are well visible. A second DNN predicts cardiac phase labels for each frame. Only in the training and evaluation phases for the second DNN, ECG signals are used to provide ground truth labels for each angiographic frame. The networks were trained on 17800 coronary angiographies from 3900 patients and evaluated on 27900 coronary angiographies from 6250 patients. No exclusion criteria related to patient state, previous interventions, or pathology were formulated. Cardiac phase detection had an accuracy of 97.6%, a sensitivity of 97.6% and a specificity of 97.5% on the evaluation set. EDF prediction had a precision of 97.4% and a recall of 96.9%. Several sub-group analyses were performed, indicating that the cardiac phase detection performance is largely independent from acquisition angles and the heart rate of the patient. The average execution time of cardiac phase detection for one angiographic series was on average less than five seconds on a standard workstation.

Saeid Asgari Taghanaki, Yefeng Zheng, S. Kevin Zhou et al.

Simultaneous segmentation of multiple organs from different medical imaging modalities is a crucial task as it can be utilized for computer-aided diagnosis, computer-assisted surgery, and therapy planning. Thanks to the recent advances in deep learning, several deep neural networks for medical image segmentation have been introduced successfully for this purpose. In this paper, we focus on learning a deep multi-organ segmentation network that labels voxels. In particular, we examine the critical choice of a loss function in order to handle the notorious imbalance problem that plagues both the input and output of a learning model. The input imbalance refers to the class-imbalance in the input training samples (i.e., small foreground objects embedded in an abundance of background voxels, as well as organs of varying sizes). The output imbalance refers to the imbalance between the false positives and false negatives of the inference model. In order to tackle both types of imbalance during training and inference, we introduce a new curriculum learning based loss function. Specifically, we leverage Dice similarity coefficient to deter model parameters from being held at bad local minima and at the same time gradually learn better model parameters by penalizing for false positives/negatives using a cross entropy term. We evaluated the proposed loss function on three datasets: whole body positron emission tomography (PET) scans with 5 target organs, magnetic resonance imaging (MRI) prostate scans, and ultrasound echocardigraphy images with a single target organ i.e., left ventricular. We show that a simple network architecture with the proposed integrative loss function can outperform state-of-the-art methods and results of the competing methods can be improved when our proposed loss is used.

Saeid Asgari Taghanaki, Aicha Bentaieb, Anmol Sharma et al.

Skip connections in deep networks have improved both segmentation and classification performance by facilitating the training of deeper network architectures, and reducing the risks for vanishing gradients. They equip encoder-decoder-like networks with richer feature representations, but at the cost of higher memory usage, computation, and possibly resulting in transferring non-discriminative feature maps. In this paper, we focus on improving skip connections used in segmentation networks (e.g., U-Net, V-Net, and The One Hundred Layers Tiramisu (DensNet) architectures). We propose light, learnable skip connections which learn to first select the most discriminative channels and then attend to the most discriminative regions of the selected feature maps. The output of the proposed skip connections is a unique feature map which not only reduces the memory usage and network parameters to a high extent, but also improves segmentation accuracy. We evaluate the proposed method on three different 2D and volumetric datasets and demonstrate that the proposed light, learnable skip connections can outperform the traditional heavy skip connections in terms of segmentation accuracy, memory usage, and number of network parameters.