Dimitris K. Iakovidis

Panagiota Gatoula, George Dimas, Dimitris K. Iakovidis

Synthetic medical image data can unlock the potential of deep learning (DL)-based clinical decision support (CDS) systems through the creation of large scale, privacy-preserving, training sets. Despite the significant progress in this field, there is still a largely unanswered research question: "How can we quantitatively assess the similarity of a synthetically generated set of images with a set of real images in a given application domain?". Today, answers to this question are mainly provided via user evaluation studies, inception-based measures, and the classification performance achieved on synthetic images. This paper proposes a novel measure to assess the similarity between synthetically generated and real sets of images, in terms of their utility for the development of DL-based CDS systems. Inspired by generalized neural additive models, and unlike inception-based measures, the proposed measure is interpretable (Interpretable Utility Similarity, IUS), explaining why a synthetic dataset could be more useful than another one in the context of a CDS system based on clinically relevant image features. The experimental results on publicly available datasets from various color medical imaging modalities including endoscopic, dermoscopic and fundus imaging, indicate that selecting synthetic images of high utility similarity using IUS can result in relative improvements of up to 54.6% in terms of classification performance. The generality of IUS for synthetic data assessment is demonstrated also for greyscale X-ray and ultrasound imaging modalities. IUS implementation is available at https://github.com/innoisys/ius

Dimitrios E. Diamantis, Panagiota Gatoula, Anastasios Koulaouzidis et al.

Medical image synthesis has emerged as a promising solution to address the limited availability of annotated medical data needed for training machine learning algorithms in the context of image-based Clinical Decision Support (CDS) systems. To this end, Generative Adversarial Networks (GANs) have been mainly applied to support the algorithm training process by generating synthetic images for data augmentation. However, in the field of Wireless Capsule Endoscopy (WCE), the limited content diversity and size of existing publicly available annotated datasets, adversely affect both the training stability and synthesis performance of GANs. Aiming to a viable solution for WCE image synthesis, a novel Variational Autoencoder architecture is proposed, namely "This Intestine Does not Exist" (TIDE). The proposed architecture comprises multiscale feature extraction convolutional blocks and residual connections, which enable the generation of high-quality and diverse datasets even with a limited number of training images. Contrary to the current approaches, which are oriented towards the augmentation of the available datasets, this study demonstrates that using TIDE, real WCE datasets can be fully substituted by artificially generated ones, without compromising classification performance. Furthermore, qualitative and user evaluation studies by experienced WCE specialists, validate from a medical viewpoint that both the normal and abnormal WCE images synthesized by TIDE are sufficiently realistic.

George Dimas, Eirini Cholopoulou, Dimitris K. Iakovidis

The adoption of Convolutional Neural Network (CNN) models in high-stake domains is hindered by their inability to meet society's demand for transparency in decision-making. So far, a growing number of methodologies have emerged for developing CNN models that are interpretable by design. However, such models are not capable of providing interpretations in accordance with human perception, while maintaining competent performance. In this paper, we tackle these challenges with a novel, general framework for instantiating inherently interpretable CNN models, named E Pluribus Unum Interpretable CNN (EPU-CNN). An EPU-CNN model consists of CNN sub-networks, each of which receives a different representation of an input image expressing a perceptual feature, such as color or texture. The output of an EPU-CNN model consists of the classification prediction and its interpretation, in terms of relative contributions of perceptual features in different regions of the input image. EPU-CNN models have been extensively evaluated on various publicly available datasets, as well as a contributed benchmark dataset. Medical datasets are used to demonstrate the applicability of EPU-CNN for risk-sensitive decisions in medicine. The experimental results indicate that EPU-CNN models can achieve a comparable or better classification performance than other CNN architectures while providing humanly perceivable interpretations.

Romil Imtiaz, Dimitris K. Iakovidis

We developed a multi-label gastrointestinal video analysis pipeline based on a ResNet-50 frame classifier followed by anatomy-guided temporal event decoding. The system predicts 17 labels, including 5 anatomy classes and 12 pathology classes, from frames resized to 336x336. A major challenge was severe class imbalance, particularly for rare pathology labels. To address this, we used clipped class-wise positive weighting in the training loss, which improved rare-class learning while maintaining stable optimization. At the temporal stage, we found that direct frame-to-event conversion produced fragmented mismatches with the official ground truth. The final submission therefore combined GT-style framewise event composition, anatomy vote smoothing, and anatomy-based pathology gating with a conservative hysteresis decoder. This design improved the final temporal mAP from 0.3801 to 0.4303 on the challenge test set.

Eirini Cholopoulou, Dimitris K. Iakovidis

Anomaly detection (AD) plays a pivotal role in multimedia applications for detecting defective products and automating quality inspection. Deep learning (DL) models typically require large-scale annotated data, which are often highly imbalanced since anomalies are usually scarce. The black box nature of these models prohibits them from being trusted by users. To address these challenges, we propose MeLIAD, a novel methodology for interpretable anomaly detection, which unlike the previous methods is based on metric learning and achieves interpretability by design without relying on any prior distribution assumptions of true anomalies. MeLIAD requires only a few samples of anomalies for training, without employing any augmentation techniques, and is inherently interpretable, providing visualizations that offer insights into why an image is identified as anomalous. This is achieved by introducing a novel trainable entropy-based scoring component for the identification and localization of anomalous instances, and a novel loss function that jointly optimizes the anomaly scoring component with a metric learning objective. Experiments on five public benchmark datasets, including quantitative and qualitative evaluation of interpretability, demonstrate that MeLIAD achieves improved anomaly detection and localization performance compared to state-of-the-art methods.

Georgia Sovatzidi, Michael D. Vasilakakis, Dimitris K. Iakovidis

Several deep learning (DL) approaches have been proposed to deal with image classification tasks. However, despite their effectiveness, they lack interpretability, as they are unable to explain or justify their results. To address the challenge of interpretable image classification, this paper introduces a novel framework, named Interpretable Intuitionistic Fuzzy Cognitive Maps (I2FCMs).Intuitionistic FCMs (iFCMs) have been proposed as an extension of FCMs offering a natural mechanism to assess the quality of their output through the estimation of hesitancy, a concept resembling human hesitation in decision making. In the context of image classification, hesitancy is considered as a degree of unconfidence with which an image is categorized to a class. To the best of our knowledge this is the first time iFCMs are applied for image classification. Further novel contributions of the introduced framework include the following: a) a feature extraction process focusing on the most informative image regions; b) a learning algorithm for automatic data-driven determination of the intuitionistic fuzzy interconnections of the iFCM, thereby reducing human intervention in the definition of the graph structure; c) an inherently interpretable classification approach based on image contents, providing understandable explanations of its predictions, using linguistic terms. Furthermore, the proposed I2FCM framework can be applied to DL models, including Convolutional Neural Network (CNN), rendering them interpretable. The effectiveness of I2FCM is evaluated on publicly available datasets, and the results confirm that it can provide enhanced classification performance, while providing interpretable inferences.

Eirini Cholopoulou, Dimitrios E. Diamantis, Dimitra-Christina C. Koutsiou et al.

Effective shadow removal is pivotal in enhancing the visual quality of images in various applications, ranging from computer vision to digital photography. During the last decades physics and machine learning -based methodologies have been proposed; however, most of them have limited capacity in capturing complex shadow patterns due to restrictive model assumptions, neglecting the fact that shadows usually appear at different scales. Also, current datasets used for benchmarking shadow removal are composed of a limited number of images with simple scenes containing mainly uniform shadows cast by single objects, whereas only a few of them include both manual shadow annotations and paired shadow-free images. Aiming to address all these limitations in the context of natural scene imaging, including urban environments with complex scenes, the contribution of this study is twofold: a) it proposes a novel deep learning architecture, named Soft-Hard Attention U-net (SHAU), focusing on multiscale shadow removal; b) it provides a novel synthetic dataset, named Multiscale Shadow Removal Dataset (MSRD), containing complex shadow patterns of multiple scales, aiming to serve as a privacy-preserving dataset for a more comprehensive benchmarking of future shadow removal methodologies. Key architectural components of SHAU are the soft and hard attention modules, which along with multiscale feature extraction blocks enable effective shadow removal of different scales and intensities. The results demonstrate the effectiveness of SHAU over the relevant state-of-the-art shadow removal methods across various benchmark datasets, improving the Peak Signal-to-Noise Ratio and Root Mean Square Error for the shadow area by 25.1% and 61.3%, respectively.

Dimitrios E. Diamantis, Dimitris K. Iakovidis

Gastrointestinal (GI) imaging via Wireless Capsule Endoscopy (WCE) generates a large number of images requiring manual screening. Deep learning-based Clinical Decision Support (CDS) systems can assist screening, yet their performance relies on the existence of large, diverse, training medical datasets. However, the scarcity of such data, due to privacy constraints and annotation costs, hinders CDS development. Generative machine learning offers a viable solution to combat this limitation. While current Synthetic Data Generation (SDG) methods, such as Generative Adversarial Networks and Variational Autoencoders have been explored, they often face challenges with training stability and capturing sufficient visual diversity, especially when synthesizing abnormal findings. This work introduces a novel VAE-based methodology for medical image synthesis and presents its application for the generation of WCE images. The novel contributions of this work include a) multiscale extension of the Vector Quantized VAE model, named as Multiscale Vector Quantized Variational Autoencoder (MSVQ-VAE); b) unlike other VAE-based SDG models for WCE image generation, MSVQ-VAE is used to seamlessly introduce abnormalities into normal WCE images; c) it enables conditional generation of synthetic images, enabling the introduction of different types of abnormalities into the normal WCE images; d) it performs experiments with a variety of abnormality types, including polyps, vascular and inflammatory conditions. The utility of the generated images for CDS is assessed via image classification. Comparative experiments demonstrate that training a CDS classifier using the abnormal images generated by the proposed methodology yield comparable results with a classifier trained with only real data. The generality of the proposed methodology promises its applicability to various domains related to medical multimedia.

Maria Thoma, Michalis A. Savelonas, Dimitris K. Iakovidis

Ischemic stroke is a time-critical medical emergency where rapid diagnosis is essential for improving patient outcomes. Non-contrast computed tomography (NCCT) serves as the frontline imaging tool, yet it often fails to reveal the subtle ischemic changes present in the early, hyperacute phase. This limitation can delay crucial interventions. To address this diagnostic challenge, we introduce a semi-supervised segmentation method using generative adversarial networks (GANs) to accurately delineate early ischemic stroke regions. The proposed method employs an adversarial framework to effectively learn from a limited number of annotated NCCT scans, while simultaneously leveraging a larger pool of unlabeled scans. By employing Dice loss, cross-entropy loss, a feature matching loss and a self-training loss, the model learns to identify and delineate early infarcts, even when they are faint or their size is small. Experiments on the publicly available Acute Ischemic Stroke Dataset (AISD) demonstrate the potential of the proposed method to enhance diagnostic capabilities, reduce the burden of manual annotation, and support more efficient clinical decision-making in stroke care.

Georgios Triantafyllou, Panagiotis G. Kalozoumis, George Dimas et al.

Finite Element Analysis (FEA) is a powerful but computationally intensive method for simulating physical phenomena. Recent advancements in machine learning have led to surrogate models capable of accelerating FEA. Yet there are still limitations in developing surrogates of transient FEA models that can simultaneously predict the solutions for both nodes and elements with applicability on both the 2D and 3D domains. Motivated by this research gap, this study proposes DeepFEA, a deep learning-based framework that leverages a multilayer Convolutional Long Short-Term Memory (ConvLSTM) network branching into two parallel convolutional neural networks to predict the solutions for both nodes and elements of FEA models. The proposed network is optimized using a novel adaptive learning algorithm, called Node-Element Loss Optimization (NELO). NELO minimizes the error occurring at both branches of the network enabling the prediction of solutions for transient FEA simulations. The experimental evaluation of DeepFEA is performed on three datasets in the context of structural mechanics, generated to serve as publicly available reference datasets. The results show that DeepFEA can achieve less than 3% normalized mean and root mean squared error for 2D and 3D simulation scenarios, and inference times that are two orders of magnitude faster than FEA. In contrast, relevant state-of-the-art methods face challenges with multi-dimensional output and dynamic input prediction. Furthermore, DeepFEA's robustness was demonstrated in a real-life biomedical scenario, confirming its suitability for accurate and efficient predictions of FEA simulations.

Panagiota Gatoula, Dimitrios E. Diamantis, Anastasios Koulaouzidis et al.

Synthetic Data Generation (SDG) based on Artificial Intelligence (AI) can transform the way clinical medicine is delivered by overcoming privacy barriers that currently render clinical data sharing difficult. This is the key to accelerating the development of digital tools contributing to enhanced patient safety. Such tools include robust data-driven clinical decision support systems, and example-based digital training tools that will enable healthcare professionals to improve their diagnostic performance for enhanced patient safety. This study focuses on the clinical evaluation of medical SDG, with a proof-of-concept investigation on diagnosing Inflammatory Bowel Disease (IBD) using Wireless Capsule Endoscopy (WCE) images. Its scientific contributions include a) a novel protocol for the systematic Clinical Evaluation of Medical Image Synthesis (CEMIS); b) a novel variational autoencoder-based model for the generation of high-resolution synthetic WCE images; and c) a comprehensive evaluation of the synthetic images using the CEMIS protocol by 10 international WCE specialists, in terms of image quality, diversity, and realism, as well as their utility for clinical decision-making. The results show that TIDE-II generates clinically plausible, very realistic WCE images, of improved quality compared to relevant state-of-the-art generative models. Concludingly, CEMIS can serve as a reference for future research on medical image-generation techniques, while the adaptation/extension of the architecture of TIDE-II to other imaging domains can be promising.

Dimitrios E. Diamantis, Dimitris K. Iakovidis

Convolutional Neural Networks (CNNs) are artificial learning systems typically based on two operations: convolution, which implements feature extraction through filtering, and pooling, which implements dimensionality reduction. The impact of pooling in the classification performance of the CNNs has been highlighted in several previous works, and a variety of alternative pooling operators have been proposed. However, only a few of them tackle with the uncertainty that is naturally propagated from the input layer to the feature maps of the hidden layers through convolutions. In this paper we present a novel pooling operation based on (type-1) fuzzy sets to cope with the local imprecision of the feature maps, and we investigate its performance in the context of image classification. Fuzzy pooling is performed by fuzzification, aggregation and defuzzification of feature map neighborhoods. It is used for the construction of a fuzzy pooling layer that can be applied as a drop-in replacement of the current, crisp, pooling layers of CNN architectures. Several experiments using publicly available datasets show that the proposed approach can enhance the classification performance of a CNN. A comparative evaluation shows that it outperforms state-of-the-art pooling approaches.

George Pantazis, George Dimas, Dimitris K. Iakovidis

The huge amount of video data produced daily by camera-based systems, such as surveilance, medical and telecommunication systems, emerges the need for effective video summarization (VS) methods. These methods should be capable of creating an overview of the video content. In this paper, we propose a novel VS method based on a Generative Adversarial Network (GAN) model pre-trained with human eye fixations. The main contribution of the proposed method is that it can provide perceptually compatible video summaries by combining both perceived color and spatiotemporal visual attention cues in a unsupervised scheme. Several fusion approaches are considered for robustness under uncertainty, and personalization. The proposed method is evaluated in comparison to state-of-the-art VS approaches on the benchmark dataset VSUMM. The experimental results conclude that SalSum outperforms the state-of-the-art approaches by providing the highest f-measure score on the VSUMM benchmark.