Alan B McMillan

Zachary Huemann, Samuel Church, Joshua D. Warner et al.

Vision-language models can connect the text description of an object to its specific location in an image through visual grounding. This has potential applications in enhanced radiology reporting. However, these models require large annotated image-text datasets, which are lacking for PET/CT. We developed an automated pipeline to generate weak labels linking PET/CT report descriptions to their image locations and used it to train a 3D vision-language visual grounding model. Our pipeline finds positive findings in PET/CT reports by identifying mentions of SUVmax and axial slice numbers. From 25,578 PET/CT exams, we extracted 11,356 sentence-label pairs. Using this data, we trained ConTEXTual Net 3D, which integrates text embeddings from a large language model with a 3D nnU-Net via token-level cross-attention. The model's performance was compared against LLMSeg, a 2.5D version of ConTEXTual Net, and two nuclear medicine physicians. The weak-labeling pipeline accurately identified lesion locations in 98% of cases (246/251), with 7.5% requiring boundary adjustments. ConTEXTual Net 3D achieved an F1 score of 0.80, outperforming LLMSeg (F1=0.22) and the 2.5D model (F1=0.53), though it underperformed both physicians (F1=0.94 and 0.91). The model achieved better performance on FDG (F1=0.78) and DCFPyL (F1=0.75) exams, while performance dropped on DOTATE (F1=0.58) and Fluciclovine (F1=0.66). The model performed consistently across lesion sizes but showed reduced accuracy on lesions with low uptake. Our novel weak labeling pipeline accurately produced an annotated dataset of PET/CT image-text pairs, facilitating the development of 3D visual grounding models. ConTEXTual Net 3D significantly outperformed other models but fell short of the performance of nuclear medicine physicians. Our study suggests that even larger datasets may be needed to close this performance gap.

Zheng Liu, Jinnian Zhang, Varun Jog et al.

Purpose: The purpose of this study is to investigate the robustness of a commonly-used convolutional neural network for image segmentation with respect to visually-subtle adversarial perturbations, and suggest new methods to make these networks more robust to such perturbations. Materials and Methods: In this retrospective study, the accuracy of brain tumor segmentation was studied in subjects with low- and high-grade gliomas. A three-dimensional UNet model was implemented to segment four different MR series (T1-weighted, post-contrast T1-weighted, T2- weighted, and T2-weighted FLAIR) into four pixelwise labels (Gd-enhancing tumor, peritumoral edema, necrotic and non-enhancing tumor, and background). We developed attack strategies based on the Fast Gradient Sign Method (FGSM), iterative FGSM (i-FGSM), and targeted iterative FGSM (ti-FGSM) to produce effective attacks. Additionally, we explored the effectiveness of distillation and adversarial training via data augmentation to counteract adversarial attacks. Robustness was measured by comparing the Dice coefficient for each attack method using Wilcoxon signed-rank tests. Results: Attacks based on FGSM, i-FGSM, and ti-FGSM were effective in significantly reducing the quality of image segmentation with reductions in Dice coefficient by up to 65%. For attack defenses, distillation performed significantly better than adversarial training approaches. However, all defense approaches performed worse compared to unperturbed test images. Conclusion: Segmentation networks can be adversely affected by targeted attacks that introduce visually minor (and potentially undetectable) modifications to existing images. With an increasing interest in applying deep learning techniques to medical imaging data, it is important to quantify the ramifications of adversarial inputs (either intentional or unintentional).