Zheyuan Zhang

Debesh Jha, Vanshali Sharma, Debapriya Banik et al. · oxford

Automatic analysis of colonoscopy images has been an active field of research motivated by the importance of early detection of precancerous polyps. However, detecting polyps during the live examination can be challenging due to various factors such as variation of skills and experience among the endoscopists, lack of attentiveness, and fatigue leading to a high polyp miss-rate. Deep learning has emerged as a promising solution to this challenge as it can assist endoscopists in detecting and classifying overlooked polyps and abnormalities in real time. In addition to the algorithm's accuracy, transparency and interpretability are crucial to explaining the whys and hows of the algorithm's prediction. Further, most algorithms are developed in private data, closed source, or proprietary software, and methods lack reproducibility. Therefore, to promote the development of efficient and transparent methods, we have organized the "Medico automatic polyp segmentation (Medico 2020)" and "MedAI: Transparency in Medical Image Segmentation (MedAI 2021)" competitions. We present a comprehensive summary and analyze each contribution, highlight the strength of the best-performing methods, and discuss the possibility of clinical translations of such methods into the clinic. For the transparency task, a multi-disciplinary team, including expert gastroenterologists, accessed each submission and evaluated the team based on open-source practices, failure case analysis, ablation studies, usability and understandability of evaluations to gain a deeper understanding of the models' credibility for clinical deployment. Through the comprehensive analysis of the challenge, we not only highlight the advancements in polyp and surgical instrument segmentation but also encourage qualitative evaluation for building more transparent and understandable AI-based colonoscopy systems.

Zheyuan Zhang, Ulas Bagci

Transformer-based neural networks have surpassed promising performance on many biomedical image segmentation tasks due to a better global information modeling from the self-attention mechanism. However, most methods are still designed for 2D medical images while ignoring the essential 3D volume information. The main challenge for 3D transformer-based segmentation methods is the quadratic complexity introduced by the self-attention mechanism \cite{vaswani2017attention}. In this paper, we propose a novel transformer architecture for 3D medical image segmentation using an encoder-decoder style architecture with linear complexity. Furthermore, we newly introduce a dynamic token concept to further reduce the token numbers for self-attention calculation. Taking advantage of the global information modeling, we provide uncertainty maps from different hierarchy stages. We evaluate this method on multiple challenging CT pancreas segmentation datasets. Our promising results show that our novel 3D Transformer-based segmentor could provide promising highly feasible segmentation performance and accurate uncertainty quantification using single annotation. Code is available https://github.com/freshman97/LinTransUNet.

Linkai Peng, Zheyuan Zhang, Gorkem Durak et al.

Pancreatic cancer remains one of the leading causes of cancer-related mortality worldwide. Precise segmentation of pancreatic tumors from medical images is a bottleneck for effective clinical decision-making. However, achieving a high accuracy is often limited by the small size and availability of real patient data for training deep learning models. Recent approaches have employed synthetic data generation to augment training datasets. While promising, these methods may not yet meet the performance benchmarks required for real-world clinical use. This study critically evaluates the limitations of existing generative-AI based frameworks for pancreatic tumor segmentation. We conduct a series of experiments to investigate the impact of synthetic \textit{tumor size} and \textit{boundary definition} precision on model performance. Our findings demonstrate that: (1) strategically selecting a combination of synthetic tumor sizes is crucial for optimal segmentation outcomes, and (2) generating synthetic tumors with precise boundaries significantly improves model accuracy. These insights highlight the importance of utilizing refined synthetic data augmentation for enhancing the clinical utility of segmentation models in pancreatic cancer decision making including diagnosis, prognosis, and treatment plans. Our code will be available at https://github.com/lkpengcs/SynTumorAnalyzer.

Ugur Demir, Zheyuan Zhang, Bin Wang et al.

Automated liver segmentation from radiology scans (CT, MRI) can improve surgery and therapy planning and follow-up assessment in addition to conventional use for diagnosis and prognosis. Although convolutional neural networks (CNNs) have become the standard image segmentation tasks, more recently this has started to change towards Transformers based architectures because Transformers are taking advantage of capturing long range dependence modeling capability in signals, so called attention mechanism. In this study, we propose a new segmentation approach using a hybrid approach combining the Transformer(s) with the Generative Adversarial Network (GAN) approach. The premise behind this choice is that the self-attention mechanism of the Transformers allows the network to aggregate the high dimensional feature and provide global information modeling. This mechanism provides better segmentation performance compared with traditional methods. Furthermore, we encode this generator into the GAN based architecture so that the discriminator network in the GAN can classify the credibility of the generated segmentation masks compared with the real masks coming from human (expert) annotations. This allows us to extract the high dimensional topology information in the mask for biomedical image segmentation and provide more reliable segmentation results. Our model achieved a high dice coefficient of 0.9433, recall of 0.9515, and precision of 0.9376 and outperformed other Transformer based approaches.

Debesh Jha, Gorkem Durak, Vanshali Sharma et al.

Artificial Intelligence (AI) is poised to transform healthcare delivery through revolutionary advances in clinical decision support and diagnostic capabilities. While human expertise remains foundational to medical practice, AI-powered tools are increasingly matching or exceeding specialist-level performance across multiple domains, paving the way for a new era of democratized healthcare access. These systems promise to reduce disparities in care delivery across demographic, racial, and socioeconomic boundaries by providing high-quality diagnostic support at scale. As a result, advanced healthcare services can be affordable to all populations, irrespective of demographics, race, or socioeconomic background. The democratization of such AI tools can reduce the cost of care, optimize resource allocation, and improve the quality of care. In contrast to humans, AI can potentially uncover complex relationships in the data from a large set of inputs and lead to new evidence-based knowledge in medicine. However, integrating AI into healthcare raises several ethical and philosophical concerns, such as bias, transparency, autonomy, responsibility, and accountability. In this study, we examine recent advances in AI-enabled medical image analysis, current regulatory frameworks, and emerging best practices for clinical integration. We analyze both technical and ethical challenges inherent in deploying AI systems across healthcare institutions, with particular attention to data privacy, algorithmic fairness, and system transparency. Furthermore, we propose practical solutions to address key challenges, including data scarcity, racial bias in training datasets, limited model interpretability, and systematic algorithmic biases. Finally, we outline a conceptual algorithm for responsible AI implementations and identify promising future research and development directions.

Lanhong Yao, Zheyuan Zhang, Ugur Demir et al.

Intraductal Papillary Mucinous Neoplasm (IPMN) cysts are pre-malignant pancreas lesions, and they can progress into pancreatic cancer. Therefore, detecting and stratifying their risk level is of ultimate importance for effective treatment planning and disease control. However, this is a highly challenging task because of the diverse and irregular shape, texture, and size of the IPMN cysts as well as the pancreas. In this study, we propose a novel computer-aided diagnosis pipeline for IPMN risk classification from multi-contrast MRI scans. Our proposed analysis framework includes an efficient volumetric self-adapting segmentation strategy for pancreas delineation, followed by a newly designed deep learning-based classification scheme with a radiomics-based predictive approach. We test our proposed decision-fusion model in multi-center data sets of 246 multi-contrast MRI scans and obtain superior performance to the state of the art (SOTA) in this field. Our ablation studies demonstrate the significance of both radiomics and deep learning modules for achieving the new SOTA performance compared to international guidelines and published studies (81.9\% vs 61.3\% in accuracy). Our findings have important implications for clinical decision-making. In a series of rigorous experiments on multi-center data sets (246 MRI scans from five centers), we achieved unprecedented performance (81.9\% accuracy).

Daniel Zhang-Li, Nianyi Lin, Jifan Yu et al.

Recent advancements in pretraining have demonstrated that modern Large Language Models (LLMs) possess the capability to effectively learn arithmetic operations. However, despite acknowledging the significance of digit order in arithmetic computation, current methodologies predominantly rely on sequential, step-by-step approaches for teaching LLMs arithmetic, resulting in a conclusion where obtaining better performance involves fine-grained step-by-step. Diverging from this conventional path, our work introduces a novel strategy that not only reevaluates the digit order by prioritizing output from the least significant digit but also incorporates a step-by-step methodology to substantially reduce complexity. We have developed and applied this method in a comprehensive set of experiments. Compared to the previous state-of-the-art (SOTA) method, our findings reveal an overall improvement of in accuracy while requiring only a third of the tokens typically used during training. For the purpose of facilitating replication and further research, we have made our code and dataset publicly available at \url{https://anonymous.4open.science/r/RAIT-9FB7/}.

Ziliang Hong, Debesh Jha, Koushik Biswas et al.

Identifying peri-pancreatic edema is a pivotal indicator for identifying disease progression and prognosis, emphasizing the critical need for accurate detection and assessment in pancreatitis diagnosis and management. This study \textit{introduces a novel CT dataset sourced from 255 patients with pancreatic diseases, featuring annotated pancreas segmentation masks and corresponding diagnostic labels for peri-pancreatic edema condition}. With the novel dataset, we first evaluate the efficacy of the \textit{LinTransUNet} model, a linear Transformer based segmentation algorithm, to segment the pancreas accurately from CT imaging data. Then, we use segmented pancreas regions with two distinctive machine learning classifiers to identify existence of peri-pancreatic edema: deep learning-based models and a radiomics-based eXtreme Gradient Boosting (XGBoost). The LinTransUNet achieved promising results, with a dice coefficient of 80.85\%, and mIoU of 68.73\%. Among the nine benchmarked classification models for peri-pancreatic edema detection, \textit{Swin-Tiny} transformer model demonstrated the highest recall of $98.85 \pm 0.42$ and precision of $98.38\pm 0.17$. Comparatively, the radiomics-based XGBoost model achieved an accuracy of $79.61\pm4.04$ and recall of $91.05\pm3.28$, showcasing its potential as a supplementary diagnostic tool given its rapid processing speed and reduced training time. Our code is available \url{https://github.com/NUBagciLab/Peri-Pancreatic-Edema-Detection}.

Zheyuan Zhang, Jiwei Zhang, Boyu Zhou et al.

Visual Place Recognition (VPR) aims to determine the geographic location of a query image by retrieving its most visually similar counterpart from a geo-tagged reference database. Recently, the emergence of the powerful visual foundation model, DINOv2, trained in a self-supervised manner on massive datasets, has significantly improved VPR performance. This improvement stems from DINOv2's exceptional feature generalization capabilities but is often accompanied by increased model complexity and computational overhead that impede deployment on resource-constrained devices. To address this challenge, we propose $D^{2}$-VPR, a $D$istillation- and $D$eformable-based framework that retains the strong feature extraction capabilities of visual foundation models while significantly reducing model parameters and achieving a more favorable performance-efficiency trade-off. Specifically, first, we employ a two-stage training strategy that integrates knowledge distillation and fine-tuning. Additionally, we introduce a Distillation Recovery Module (DRM) to better align the feature spaces between the teacher and student models, thereby minimizing knowledge transfer losses to the greatest extent possible. Second, we design a Top-Down-attention-based Deformable Aggregator (TDDA) that leverages global semantic features to dynamically and adaptively adjust the Regions of Interest (ROI) used for aggregation, thereby improving adaptability to irregular structures. Extensive experiments demonstrate that our method achieves competitive performance compared to state-of-the-art approaches. Meanwhile, it reduces the parameter count by approximately 64.2% and FLOPs by about 62.6% (compared to CricaVPR).Code is available at https://github.com/tony19980810/D2VPR.

Bin Wang, Hongyi Pan, Armstrong Aboah et al.

Eye tracking research is important in computer vision because it can help us understand how humans interact with the visual world. Specifically for high-risk applications, such as in medical imaging, eye tracking can help us to comprehend how radiologists and other medical professionals search, analyze, and interpret images for diagnostic and clinical purposes. Hence, the application of eye tracking techniques in disease classification has become increasingly popular in recent years. Contemporary works usually transform gaze information collected by eye tracking devices into visual attention maps (VAMs) to supervise the learning process. However, this is a time-consuming preprocessing step, which stops us from applying eye tracking to radiologists' daily work. To solve this problem, we propose a novel gaze-guided graph neural network (GNN), GazeGNN, to leverage raw eye-gaze data without being converted into VAMs. In GazeGNN, to directly integrate eye gaze into image classification, we create a unified representation graph that models both images and gaze pattern information. With this benefit, we develop a real-time, real-world, end-to-end disease classification algorithm for the first time in the literature. This achievement demonstrates the practicality and feasibility of integrating real-time eye tracking techniques into the daily work of radiologists. To our best knowledge, GazeGNN is the first work that adopts GNN to integrate image and eye-gaze data. Our experiments on the public chest X-ray dataset show that our proposed method exhibits the best classification performance compared to existing methods. The code is available at https://github.com/ukaukaaaa/GazeGNN.

Zheyuan Zhang, Fengyuan Hu, Jayjun Lee et al.

Spatial expressions in situated communication can be ambiguous, as their meanings vary depending on the frames of reference (FoR) adopted by speakers and listeners. While spatial language understanding and reasoning by vision-language models (VLMs) have gained increasing attention, potential ambiguities in these models are still under-explored. To address this issue, we present the COnsistent Multilingual Frame Of Reference Test (COMFORT), an evaluation protocol to systematically assess the spatial reasoning capabilities of VLMs. We evaluate nine state-of-the-art VLMs using COMFORT. Despite showing some alignment with English conventions in resolving ambiguities, our experiments reveal significant shortcomings of VLMs: notably, the models (1) exhibit poor robustness and consistency, (2) lack the flexibility to accommodate multiple FoRs, and (3) fail to adhere to language-specific or culture-specific conventions in cross-lingual tests, as English tends to dominate other languages. With a growing effort to align vision-language models with human cognitive intuitions, we call for more attention to the ambiguous nature and cross-cultural diversity of spatial reasoning.

Hongyi Pan, Ziliang Hong, Gorkem Durak et al.

Accurate classification of Intraductal Papillary Mucinous Neoplasms (IPMN) is essential for identifying high-risk cases that require timely intervention. In this study, we develop a federated learning framework for multi-center IPMN classification utilizing a comprehensive pancreas MRI dataset. This dataset includes 652 T1-weighted and 655 T2-weighted MRI images, accompanied by corresponding IPMN risk scores from 7 leading medical institutions, making it the largest and most diverse dataset for IPMN classification to date. We assess the performance of DenseNet-121 in both centralized and federated settings for training on distributed data. Our results demonstrate that the federated learning approach achieves high classification accuracy comparable to centralized learning while ensuring data privacy across institutions. This work marks a significant advancement in collaborative IPMN classification, facilitating secure and high-accuracy model training across multiple centers.

Hongyi Pan, Gorkem Durak, Zheyuan Zhang et al.

Federated learning (FL) enables collaborative model training across institutions without sharing sensitive data, making it an attractive solution for medical imaging tasks. However, traditional FL methods, such as Federated Averaging (FedAvg), face difficulties in generalizing across domains due to variations in imaging protocols and patient demographics across institutions. This challenge is particularly evident in pancreas MRI segmentation, where anatomical variability and imaging artifacts significantly impact performance. In this paper, we conduct a comprehensive evaluation of FL algorithms for pancreas MRI segmentation and introduce a novel approach that incorporates adaptive aggregation weights. By dynamically adjusting the contribution of each client during model aggregation, our method accounts for domain-specific differences and improves generalization across heterogeneous datasets. Experimental results demonstrate that our approach enhances segmentation accuracy and reduces the impact of domain shift compared to conventional FL methods while maintaining privacy-preserving capabilities. Significant performance improvements are observed across multiple hospitals (centers).

Debesh Jha, Nikhil Kumar Tomar, Koushik Biswas et al.

Accurate segmentation of organs from abdominal CT scans is essential for clinical applications such as diagnosis, treatment planning, and patient monitoring. To handle challenges of heterogeneity in organ shapes, sizes, and complex anatomical relationships, we propose a \textbf{\textit{\ac{MDNet}}}, an encoder-decoder network that uses the pre-trained \textit{MiT-B2} as the encoder and multiple different decoder networks. Each decoder network is connected to a different part of the encoder via a multi-scale feature enhancement dilated block. With each decoder, we increase the depth of the network iteratively and refine segmentation masks, enriching feature maps by integrating previous decoders' feature maps. To refine the feature map further, we also utilize the predicted masks from the previous decoder to the current decoder to provide spatial attention across foreground and background regions. MDNet effectively refines the segmentation mask with a high dice similarity coefficient (DSC) of 0.9013 and 0.9169 on the Liver Tumor segmentation (LiTS) and MSD Spleen datasets. Additionally, it reduces Hausdorff distance (HD) to 3.79 for the LiTS dataset and 2.26 for the spleen segmentation dataset, underscoring the precision of MDNet in capturing the complex contours. Moreover, \textit{\ac{MDNet}} is more interpretable and robust compared to the other baseline models.

Elif Keles, Merve Yazol, Gorkem Durak et al.

Objective: Our study aimed to evaluate and validate PanSegNet, a deep learning (DL) algorithm for pediatric pancreas segmentation on MRI in children with acute pancreatitis (AP), chronic pancreatitis (CP), and healthy controls. Methods: With IRB approval, we retrospectively collected 84 MRI scans (1.5T/3T Siemens Aera/Verio) from children aged 2-19 years at Gazi University (2015-2024). The dataset includes healthy children as well as patients diagnosed with AP or CP based on clinical criteria. Pediatric and general radiologists manually segmented the pancreas, then confirmed by a senior pediatric radiologist. PanSegNet-generated segmentations were assessed using Dice Similarity Coefficient (DSC) and 95th percentile Hausdorff distance (HD95). Cohen's kappa measured observer agreement. Results: Pancreas MRI T2W scans were obtained from 42 children with AP/CP (mean age: 11.73 +/- 3.9 years) and 42 healthy children (mean age: 11.19 +/- 4.88 years). PanSegNet achieved DSC scores of 88% (controls), 81% (AP), and 80% (CP), with HD95 values of 3.98 mm (controls), 9.85 mm (AP), and 15.67 mm (CP). Inter-observer kappa was 0.86 (controls), 0.82 (pancreatitis), and intra-observer agreement reached 0.88 and 0.81. Strong agreement was observed between automated and manual volumes (R^2 = 0.85 in controls, 0.77 in diseased), demonstrating clinical reliability. Conclusion: PanSegNet represents the first validated deep learning solution for pancreatic MRI segmentation, achieving expert-level performance across healthy and diseased states. This tool, algorithm, along with our annotated dataset, are freely available on GitHub and OSF, advancing accessible, radiation-free pediatric pancreatic imaging and fostering collaborative research in this underserved domain.

Ziliang Hong, Halil Ertugrul Aktas, Andrea Mia Bejar et al.

We present the first federated learning (FL) approach for pancreas part(head, body and tail) segmentation in MRI, addressing a critical clinical challenge as a significant innovation. Pancreatic diseases exhibit marked regional heterogeneity cancers predominantly occur in the head region while chronic pancreatitis causes tissue loss in the tail, making accurate segmentation of the organ into head, body, and tail regions essential for precise diagnosis and treatment planning. This segmentation task remains exceptionally challenging in MRI due to variable morphology, poor soft-tissue contrast, and anatomical variations across patients. Our novel contribution tackles two fundamental challenges: first, the technical complexity of pancreas part delineation in MRI, and second the data scarcity problem that has hindered prior approaches. We introduce a privacy-preserving FL framework that enables collaborative model training across seven medical institutions without direct data sharing, leveraging a diverse dataset of 711 T1W and 726 T2W MRI scans. Our key innovations include: (1) a systematic evaluation of three state-of-the-art segmentation architectures (U-Net, Attention U-Net,Swin UNETR) paired with two FL algorithms (FedAvg, FedProx), revealing Attention U-Net with FedAvg as optimal for pancreatic heterogeneity, which was never been done before; (2) a novel anatomically-informed loss function prioritizing region-specific texture contrasts in MRI. Comprehensive evaluation demonstrates that our approach achieves clinically viable performance despite training on distributed, heterogeneous datasets.

Zheyuan Zhang, Ulas Bagci

Current medical image segmentation relies on the region-based (Dice, F1-score) and boundary-based (Hausdorff distance, surface distance) metrics as the de-facto standard. While these metrics are widely used, they lack a unified interpretation, particularly regarding volume agreement. Clinicians often lack clear benchmarks to gauge the "goodness" of segmentation results based on these metrics. Recognizing the clinical relevance of volumetry, we utilize relative volume prediction error (vpe) to directly assess the accuracy of volume predictions derived from segmentation tasks. Our work integrates theoretical analysis and empirical validation across diverse datasets. We delve into the often-ambiguous relationship between segmentation quality (measured by Dice) and volumetric accuracy in clinical practice. Our findings highlight the critical role of incorporating volumetric prediction accuracy into segmentation evaluation. This approach empowers clinicians with a more nuanced understanding of segmentation performance, ultimately improving the interpretation and utility of these metrics in real-world healthcare settings.