Sheng He

Sheng He, Rina Bao, Jingpeng Li et al.

Background: The segment-anything model (SAM), introduced in April 2023, shows promise as a benchmark model and a universal solution to segment various natural images. It comes without previously-required re-training or fine-tuning specific to each new dataset. Purpose: To test SAM's accuracy in various medical image segmentation tasks and investigate potential factors that may affect its accuracy in medical images. Methods: SAM was tested on 12 public medical image segmentation datasets involving 7,451 subjects. The accuracy was measured by the Dice overlap between the algorithm-segmented and ground-truth masks. SAM was compared with five state-of-the-art algorithms specifically designed for medical image segmentation tasks. Associations of SAM's accuracy with six factors were computed, independently and jointly, including segmentation difficulties as measured by segmentation ability score and by Dice overlap in U-Net, image dimension, size of the target region, image modality, and contrast. Results: The Dice overlaps from SAM were significantly lower than the five medical-image-based algorithms in all 12 medical image segmentation datasets, by a margin of 0.1-0.5 and even 0.6-0.7 Dice. SAM-Semantic was significantly associated with medical image segmentation difficulty and the image modality, and SAM-Point and SAM-Box were significantly associated with image segmentation difficulty, image dimension, target region size, and target-vs-background contrast. All these 3 variations of SAM were more accurate in 2D medical images, larger target region sizes, easier cases with a higher Segmentation Ability score and higher U-Net Dice, and higher foreground-background contrast.

Sheng He, Rina Bao, P. Ellen Grant et al.

The combination of the U-Net based deep learning models and Transformer is a new trend for medical image segmentation. U-Net can extract the detailed local semantic and texture information and Transformer can learn the long-rang dependencies among pixels in the input image. However, directly adapting the Transformer for segmentation has ``token-flatten" problem (flattens the local patches into 1D tokens which losses the interaction among pixels within local patches) and ``scale-sensitivity" problem (uses a fixed scale to split the input image into local patches). Compared to directly combining U-Net and Transformer, we propose a new global-local fashion combination of U-Net and Transformer, named U-Netmer, to solve the two problems. The proposed U-Netmer splits an input image into local patches. The global-context information among local patches is learnt by the self-attention mechanism in Transformer and U-Net segments each local patch instead of flattening into tokens to solve the `token-flatten" problem. The U-Netmer can segment the input image with different patch sizes with the identical structure and the same parameter. Thus, the U-Netmer can be trained with different patch sizes to solve the ``scale-sensitivity" problem. We conduct extensive experiments in 7 public datasets on 7 organs (brain, heart, breast, lung, polyp, pancreas and prostate) and 4 imaging modalities (MRI, CT, ultrasound, and endoscopy) to show that the proposed U-Netmer can be generally applied to improve accuracy of medical image segmentation. These experimental results show that U-Netmer provides state-of-the-art performance compared to baselines and other models. In addition, the discrepancy among the outputs of U-Netmer with different scales is linearly correlated to the segmentation accuracy which can be considered as a confidence score to rank test images by difficulty without ground-truth.