Thierry Judge

Thierry Judge, Nicolas Duchateau, Andreas Østvik et al.

Speckle tracking echocardiography (STE) is the clinical standard for myocardial strain estimation. Despite good performance on global strain (GLS), its accuracy for regional strain remains limited, even though this biomarker is highly relevant for early diagnosis and the characterization of subtle abnormalities. from clinical data. Deep learning is a promising alternative, but its development is constrained by the lack of reliable motion references. Existing solutions rely either on STE-derived labels or on simulations generated by physics-based models, but these synthetic sequences still have limited realism compared with clinical data.In this paper, we propose a novel simulation strategy that incorporates speckle decorrelation measures from real videos and uses an iterative refinement process to improve the motion realism in the simulations. We created an open-source photorealistic dataset of 1,478 videos with reference motion, which was used to train an echocardiographic motion estimation algorithm. The proposed method achieves unmatched performance on global and regional strain, notably reaching a GLS variability of 1.42% in an inter-expert setting compared to 1.78% for the clinical reference.

Thierry Judge, Olivier Bernard, Mihaela Porumb et al.

Accurate uncertainty estimation is a critical need for the medical imaging community. A variety of methods have been proposed, all direct extensions of classification uncertainty estimations techniques. The independent pixel-wise uncertainty estimates, often based on the probabilistic interpretation of neural networks, do not take into account anatomical prior knowledge and consequently provide sub-optimal results to many segmentation tasks. For this reason, we propose CRISP a ContRastive Image Segmentation for uncertainty Prediction method. At its core, CRISP implements a contrastive method to learn a joint latent space which encodes a distribution of valid segmentations and their corresponding images. We use this joint latent space to compare predictions to thousands of latent vectors and provide anatomically consistent uncertainty maps. Comprehensive studies performed on four medical image databases involving different modalities and organs underlines the superiority of our method compared to state-of-the-art approaches.

Alberto Gomez, Mihaela Porumb, Angela Mumith et al.

We propose a new method to automatically contour the left ventricle on 2D echocardiographic images. Unlike most existing segmentation methods, which are based on predicting segmentation masks, we focus at predicting the endocardial contour and the key landmark points within this contour (basal points and apex). This provides a representation that is closer to how experts perform manual annotations and hence produce results that are physiologically more plausible. Our proposed method uses a two-headed network based on the U-Net architecture. One head predicts the 7 contour points, and the other head predicts a distance map to the contour. This approach was compared to the U-Net and to a point based approach, achieving performance gains of up to 30\% in terms of landmark localisation (<4.5mm) and distance to the ground truth contour (<3.5mm).

Thierry Judge, Olivier Bernard, Woo-Jin Cho Kim et al.

Echocardiography plays a fundamental role in the extraction of important clinical parameters (e.g. left ventricular volume and ejection fraction) required to determine the presence and severity of heart-related conditions. When deploying automated techniques for computing these parameters, uncertainty estimation is crucial for assessing their utility. Since clinical parameters are usually derived from segmentation maps, there is no clear path for converting pixel-wise uncertainty values into uncertainty estimates in the downstream clinical metric calculation. In this work, we propose a novel uncertainty estimation method based on contouring rather than segmentation. Our method explicitly predicts contour location uncertainty from which contour samples can be drawn. Finally, the sampled contours can be used to propagate uncertainty to clinical metrics. Our proposed method not only provides accurate uncertainty estimations for the task of contouring but also for the downstream clinical metrics on two cardiac ultrasound datasets. Code is available at: https://github.com/ThierryJudge/contouring-uncertainty.

Marco Armenta, Thierry Judge, Nathan Painchaud et al.

In this paper, we explore a process called neural teleportation, a mathematical consequence of applying quiver representation theory to neural networks. Neural teleportation "teleports" a network to a new position in the weight space and preserves its function. This phenomenon comes directly from the definitions of representation theory applied to neural networks and it turns out to be a very simple operation that has remarkable properties. We shed light on surprising and counter-intuitive consequences neural teleportation has on the loss landscape. In particular, we show that teleportation can be used to explore loss level curves, that it changes the local loss landscape, sharpens global minima and boosts back-propagated gradients at any moment during the learning process. Our results can be reproduced with the code available here: https://github.com/vitalab/neuralteleportation

Arnaud Judge, Thierry Judge, Nicolas Duchateau et al.

Performance of deep learning segmentation models is significantly challenged in its transferability across different medical imaging domains, particularly when aiming to adapt these models to a target domain with insufficient annotated data for effective fine-tuning. While existing domain adaptation (DA) methods propose strategies to alleviate this problem, these methods do not explicitly incorporate human-verified segmentation priors, compromising the potential of a model to produce anatomically plausible segmentations. We introduce RL4Seg, an innovative reinforcement learning framework that reduces the need to otherwise incorporate large expertly annotated datasets in the target domain, and eliminates the need for lengthy manual human review. Using a target dataset of 10,000 unannotated 2D echocardiographic images, RL4Seg not only outperforms existing state-of-the-art DA methods in accuracy but also achieves 99% anatomical validity on a subset of 220 expert-validated subjects from the target domain. Furthermore, our framework's reward network offers uncertainty estimates comparable with dedicated state-of-the-art uncertainty methods, demonstrating the utility and effectiveness of RL4Seg in overcoming domain adaptation challenges in medical image segmentation.

Nathan Painchaud, Youssef Skandarani, Thierry Judge et al.

Recent publications have shown that the segmentation accuracy of modern-day convolutional neural networks (CNN) applied on cardiac MRI can reach the inter-expert variability, a great achievement in this area of research. However, despite these successes, CNNs still produce anatomically inaccurate segmentations as they provide no guarantee on the anatomical plausibility of their outcome, even when using a shape prior. In this paper, we propose a cardiac MRI segmentation method which always produces anatomically plausible results. At the core of the method is an adversarial variational autoencoder (aVAE) whose latent space encodes a smooth manifold on which lies a large spectrum of valid cardiac shapes. This aVAE is used to automatically warp anatomically inaccurate cardiac shapes towards a close but correct shape. Our method can accommodate any cardiac segmentation method and convert its anatomically implausible results to plausible ones without affecting its overall geometric and clinical metrics. With our method, CNNs can now produce results that are both within the inter-expert variability and always anatomically plausible.