Pingkun Yan

Xuanang Xu, Hannah H. Deng, Tianyi Chen et al.

Federated learning (FL) can collaboratively train deep learning models using isolated patient data owned by different hospitals for various clinical applications, including medical image segmentation. However, a major problem of FL is its performance degradation when dealing with data that are not independently and identically distributed (non-iid), which is often the case in medical images. In this paper, we first conduct a theoretical analysis on the FL algorithm to reveal the problem of model aggregation during training on non-iid data. With the insights gained through the analysis, we propose a simple yet effective method, federated cross learning (FedCross), to tackle this challenging problem. Unlike the conventional FL methods that combine multiple individually trained local models on a server node, our FedCross sequentially trains the global model across different clients in a round-robin manner, and thus the entire training procedure does not involve any model aggregation steps. To further improve its performance to be comparable with the centralized learning method, we combine the FedCross with an ensemble learning mechanism to compose a federated cross ensemble learning (FedCrossEns) method. Finally, we conduct extensive experiments using a set of public datasets. The experimental results show that the proposed FedCross training strategy outperforms the mainstream FL methods on non-iid data. In addition to improving the segmentation performance, our FedCrossEns can further provide a quantitative estimation of the model uncertainty, demonstrating the effectiveness and clinical significance of our designs. Source code is publicly available at https://github.com/DIAL-RPI/FedCross.

Xuanang Xu, Hannah H. Deng, Jaime Gateno et al.

Federated learning is an emerging paradigm allowing large-scale decentralized learning without sharing data across different data owners, which helps address the concern of data privacy in medical image analysis. However, the requirement for label consistency across clients by the existing methods largely narrows its application scope. In practice, each clinical site may only annotate certain organs of interest with partial or no overlap with other sites. Incorporating such partially labeled data into a unified federation is an unexplored problem with clinical significance and urgency. This work tackles the challenge by using a novel federated multi-encoding U-Net (Fed-MENU) method for multi-organ segmentation. In our method, a multi-encoding U-Net (MENU-Net) is proposed to extract organ-specific features through different encoding sub-networks. Each sub-network can be seen as an expert of a specific organ and trained for that client. Moreover, to encourage the organ-specific features extracted by different sub-networks to be informative and distinctive, we regularize the training of the MENU-Net by designing an auxiliary generic decoder (AGD). Extensive experiments on six public abdominal CT datasets show that our Fed-MENU method can effectively obtain a federated learning model using the partially labeled datasets with superior performance to other models trained by either localized or centralized learning methods. Source code is publicly available at https://github.com/DIAL-RPI/Fed-MENU.

Xiang Li, Lin Zhao, Lu Zhang et al.

Large-scale Artificial General Intelligence (AGI) models, including Large Language Models (LLMs) such as ChatGPT/GPT-4, have achieved unprecedented success in a variety of general domain tasks. Yet, when applied directly to specialized domains like medical imaging, which require in-depth expertise, these models face notable challenges arising from the medical field's inherent complexities and unique characteristics. In this review, we delve into the potential applications of AGI models in medical imaging and healthcare, with a primary focus on LLMs, Large Vision Models, and Large Multimodal Models. We provide a thorough overview of the key features and enabling techniques of LLMs and AGI, and further examine the roadmaps guiding the evolution and implementation of AGI models in the medical sector, summarizing their present applications, potentialities, and associated challenges. In addition, we highlight potential future research directions, offering a holistic view on upcoming ventures. This comprehensive review aims to offer insights into the future implications of AGI in medical imaging, healthcare, and beyond.

Zhengliang Liu, Tianyang Zhong, Yiwei Li et al.

The rise of large language models (LLMs) has marked a pivotal shift in the field of natural language processing (NLP). LLMs have revolutionized a multitude of domains, and they have made a significant impact in the medical field. Large language models are now more abundant than ever, and many of these models exhibit bilingual capabilities, proficient in both English and Chinese. However, a comprehensive evaluation of these models remains to be conducted. This lack of assessment is especially apparent within the context of radiology NLP. This study seeks to bridge this gap by critically evaluating thirty two LLMs in interpreting radiology reports, a crucial component of radiology NLP. Specifically, the ability to derive impressions from radiologic findings is assessed. The outcomes of this evaluation provide key insights into the performance, strengths, and weaknesses of these LLMs, informing their practical applications within the medical domain.

Razi Mahmood, Diego Machado Reyes, Ge Wang et al. · berkeley

With advances in generative artificial intelligence (AI), it is now possible to produce realistic-looking automated reports for preliminary reads of radiology images. This can expedite clinical workflows, improve accuracy and reduce overall costs. However, it is also well-known that such models often hallucinate, leading to false findings in the generated reports. In this paper, we propose a new method of fact-checking of AI-generated reports using their associated images. Specifically, the developed examiner differentiates real and fake sentences in reports by learning the association between an image and sentences describing real or potentially fake findings. To train such an examiner, we first created a new dataset of fake reports by perturbing the findings in the original ground truth radiology reports associated with images. Text encodings of real and fake sentences drawn from these reports are then paired with image encodings to learn the mapping to real/fake labels. The utility of such an examiner is demonstrated for verifying automatically generated reports by detecting and removing fake sentences. Future generative AI approaches can use the resulting tool to validate their reports leading to a more responsible use of AI in expediting clinical workflows.

Jungwook Lee, Daeseung Kim, Kevin Gu et al.

Predicting patient-specific facial soft-tissue deformation is critical for iterative orthognathic surgery planning. However, current computational methods face a strict accuracy-efficiency trade-off: high-fidelity Finite Element Methods (FEM) are computationally prohibitive, whereas pure deep learning models often produce biomechanically inconsistent results. While Physics-Informed Neural Networks (PINNs) offer a promising avenue, learning the complex heterogeneous mechanics of bone--soft-tissue interactions with only partial clinical supervision (i.e., outer facial surfaces) remains highly unstable. To overcome these challenges, we present PINNOCHIO, a novel physics-informed framework for facial soft-tissue simulation. PINNOCHIO introduces a hybrid sequential decomposition that explicitly decouples discontinuous bone--soft-tissue interface movements from continuous volumetric hyperelastic deformation. This structural separation enables stable training and facilitates a physics-enabled sim-to-real adaptation strategy, ensuring internal biomechanical consistency without requiring volumetric ground truth. Evaluated on a 40-patient clinical cohort, PINNOCHIO outperforms existing baselines in both surface accuracy and physical validity. Furthermore, it achieves a substantial speedup over FEM, successfully resolving the accuracy-efficiency trade-off to provide a highly reliable and practical tool for interactive surgical planning.

Hanqing Chao, Jiajin Zhang, Pingkun Yan

Regression plays an essential role in many medical imaging applications for estimating various clinical risk or measurement scores. While training strategies and loss functions have been studied for the deep neural networks in medical image classification tasks, options for regression tasks are very limited. One of the key challenges is that the high-dimensional feature representation learned by existing popular loss functions like Mean Squared Error or L1 loss is hard to interpret. In this paper, we propose a novel Regression Metric Loss (RM-Loss), which endows the representation space with the semantic meaning of the label space by finding a representation manifold that is isometric to the label space. Experiments on two regression tasks, i.e. coronary artery calcium score estimation and bone age assessment, show that RM-Loss is superior to the existing popular regression losses on both performance and interpretability. Code is available at https://github.com/DIAL-RPI/Regression-Metric-Loss.

Chuang Niu, Qing Lyu, Christopher D. Carothers et al.

Modern medical records include a vast amount of multimodal free text clinical data and imaging data from radiology, cardiology, and digital pathology. Fully mining such big data requires multitasking; otherwise, occult but important aspects may be overlooked, adversely affecting clinical management and population healthcare. Despite remarkable successes of AI in individual tasks with single-modal data, the progress in developing generalist medical AI remains relatively slow to combine multimodal data for multitasks because of the dual challenges of data curation and model architecture. The data challenge involves querying and curating multimodal structured and unstructured text, alphanumeric, and especially 3D tomographic scans on an individual patient level for real-time decisions and on a scale to estimate population health statistics. The model challenge demands a scalable and adaptable network architecture to integrate multimodal datasets for diverse clinical tasks. Here we propose the first-of-its-kind medical multimodal-multitask foundation model (M3FM) with application in lung cancer screening and related tasks. After we curated a comprehensive multimodal multitask dataset consisting of 49 clinical data types including 163,725 chest CT series and 17 medical tasks involved in LCS, we develop a multimodal question-answering framework as a unified training and inference strategy to synergize multimodal information and perform multiple tasks via free-text prompting. M3FM consistently outperforms the state-of-the-art single-modal task-specific models, identifies multimodal data elements informative for clinical tasks and flexibly adapts to new tasks with a small out-of-distribution dataset. As a specialty-oriented generalist medical AI model, M3FM paves the way for similar breakthroughs in other areas of medicine, closing the gap between specialists and the generalist.

Xinrui Song, Xuanang Xu, Sheng Xu et al.

In this work, we propose to explicitly use the landmarks of prostate to guide the MR-TRUS image registration. We first train a deep neural network to automatically localize a set of meaningful landmarks, and then directly generate the affine registration matrix from the location of these landmarks. For landmark localization, instead of directly training a network to predict the landmark coordinates, we propose to regress a full-resolution distance map of the landmark, which is demonstrated effective in avoiding statistical bias to unsatisfactory performance and thus improving performance. We then use the predicted landmarks to generate the affine transformation matrix, which outperforms the clinicians' manual rigid registration by a significant margin in terms of TRE.

Xi Fang, Daeseung Kim, Xuanang Xu et al.

Simulating facial appearance change following bony movement is a critical step in orthognathic surgical planning for patients with jaw deformities. Conventional biomechanics-based methods such as the finite-element method (FEM) are labor intensive and computationally inefficient. Deep learning-based approaches can be promising alternatives due to their high computational efficiency and strong modeling capability. However, the existing deep learning-based method ignores the physical correspondence between facial soft tissue and bony segments and thus is significantly less accurate compared to FEM. In this work, we propose an Attentive Correspondence assisted Movement Transformation network (ACMT-Net) to estimate the facial appearance by transforming the bony movement to facial soft tissue through a point-to-point attentive correspondence matrix. Experimental results on patients with jaw deformity show that our proposed method can achieve comparable facial change prediction accuracy compared with the state-of-the-art FEM-based approach with significantly improved computational efficiency.

Xi Fang, Daeseung Kim, Xuanang Xu et al.

In CMF surgery, the planning of bony movement to achieve a desired facial outcome is a challenging task. Current bone driven approaches focus on normalizing the bone with the expectation that the facial appearance will be corrected accordingly. However, due to the complex non-linear relationship between bony structure and facial soft-tissue, such bone-driven methods are insufficient to correct facial deformities. Despite efforts to simulate facial changes resulting from bony movement, surgical planning still relies on iterative revisions and educated guesses. To address these issues, we propose a soft-tissue driven framework that can automatically create and verify surgical plans. Our framework consists of a bony planner network that estimates the bony movements required to achieve the desired facial outcome and a facial simulator network that can simulate the possible facial changes resulting from the estimated bony movement plans. By combining these two models, we can verify and determine the final bony movement required for planning. The proposed framework was evaluated using a clinical dataset, and our experimental results demonstrate that the soft-tissue driven approach greatly improves the accuracy and efficacy of surgical planning when compared to the conventional bone-driven approach.

Chuang Niu, Giridhar Dasegowda, Pingkun Yan et al.

Although radiographs are the most frequently used worldwide due to their cost-effectiveness and widespread accessibility, the structural superposition along the x-ray paths often renders suspicious or concerning lung nodules difficult to detect. In this study, we apply "X-ray dissectography" to dissect lungs digitally from a few radiographic projections, suppress the interference of irrelevant structures, and improve lung nodule detectability. For this purpose, a collaborative detection network is designed to localize lung nodules in 2D dissected projections and 3D physical space. Our experimental results show that our approach can significantly improve the average precision by 20+% in comparison with the common baseline that detects lung nodules from original projections using a popular detection network. Potentially, this approach could help re-design the current X-ray imaging protocols and workflows and improve the diagnostic performance of chest radiographs in lung diseases.

Jiajin Zhang, Hanqing Chao, Amit Dhurandhar et al.

Domain generalization (DG) aims to train a model to perform well in unseen domains under different distributions. This paper considers a more realistic yet more challenging scenario,namely Single Domain Generalization (Single-DG), where only a single source domain is available for training. To tackle this challenge, we first try to understand when neural networks fail to generalize? We empirically ascertain a property of a model that correlates strongly with its generalization that we coin as "model sensitivity". Based on our analysis, we propose a novel strategy of Spectral Adversarial Data Augmentation (SADA) to generate augmented images targeted at the highly sensitive frequencies. Models trained with these hard-to-learn samples can effectively suppress the sensitivity in the frequency space, which leads to improved generalization performance. Extensive experiments on multiple public datasets demonstrate the superiority of our approach, which surpasses the state-of-the-art single-DG methods.

Xinrui Song, Jiajin Zhang, Pingkun Yan et al.

The integration of artificial intelligence (AI) chatbots into higher education marks a shift towards a new generation of pedagogical tools, mirroring the arrival of milestones like the internet. With the launch of ChatGPT-4 Turbo in November 2023, we developed a ChatGPT-based teaching application (https://chat.openai.com/g/g-1imx1py4K-chatge-medical-imaging) and integrated it into our undergraduate medical imaging course in the Spring 2024 semester. This study investigates the use of ChatGPT throughout a semester-long trial, providing insights into students' engagement, perception, and the overall educational effectiveness of the technology. We systematically collected and analyzed data concerning students' interaction with ChatGPT, focusing on their attitudes, concerns, and usage patterns. The findings indicate that ChatGPT offers significant advantages such as improved information access and increased interactivity, but its adoption is accompanied by concerns about the accuracy of the information provided and the necessity for well-defined guidelines to optimize its use.

Zefan Yang, Xuanang Xu, Jiajin Zhang et al.

Chest X-ray (CXR) is the most frequently ordered imaging test, supporting diverse clinical tasks from thoracic disease detection to postoperative monitoring. However, task-specific classification models are limited in scope, require costly labeled data, and lack generalizability to out-of-distribution datasets. To address these challenges, we introduce CheXFound, a self-supervised vision foundation model that learns robust CXR representations and generalizes effectively across a wide range of downstream tasks. We pretrain CheXFound on a curated CXR-1M dataset, comprising over one million unique CXRs from publicly available sources. We propose a Global and Local Representations Integration (GLoRI) module for downstream adaptations, by incorporating disease-specific local features with global image features for enhanced performance in multilabel classification. Our experimental results show that CheXFound outperforms state-of-the-art models in classifying 40 disease findings across different prevalence levels on the CXR-LT 24 dataset and exhibits superior label efficiency on downstream tasks with limited training data. Additionally, CheXFound achieved significant improvements on new tasks with out-of-distribution datasets, including opportunistic cardiovascular disease risk estimation and mortality prediction. These results highlight CheXFound's strong generalization capabilities, enabling diverse adaptations with improved label efficiency. The project source code is publicly available at https://github.com/RPIDIAL/CheXFound.

Xinrui Song, Hengtao Guo, Xuanang Xu et al.

Prostate cancer biopsy benefits from accurate fusion of transrectal ultrasound (TRUS) and magnetic resonance (MR) images. In the past few years, convolutional neural networks (CNNs) have been proved powerful in extracting image features crucial for image registration. However, challenging applications and recent advances in computer vision suggest that CNNs are quite limited in its ability to understand spatial correspondence between features, a task in which the self-attention mechanism excels. This paper aims to develop a self-attention mechanism specifically for cross-modal image registration. Our proposed cross-modal attention block effectively maps each of the features in one volume to all features in the corresponding volume. Our experimental results demonstrate that a CNN network designed with the cross-modal attention block embedded outperforms an advanced CNN network 10 times of its size. We also incorporated visualization techniques to improve the interpretability of our network. The source code of our work is available at https://github.com/DIAL-RPI/Attention-Reg .

Hanqing Chao, Xi Fang, Jiajin Zhang et al.

While image analysis of chest computed tomography (CT) for COVID-19 diagnosis has been intensively studied, little work has been performed for image-based patient outcome prediction. Management of high-risk patients with early intervention is a key to lower the fatality rate of COVID-19 pneumonia, as a majority of patients recover naturally. Therefore, an accurate prediction of disease progression with baseline imaging at the time of the initial presentation can help in patient management. In lieu of only size and volume information of pulmonary abnormalities and features through deep learning based image segmentation, here we combine radiomics of lung opacities and non-imaging features from demographic data, vital signs, and laboratory findings to predict need for intensive care unit (ICU) admission. To our knowledge, this is the first study that uses holistic information of a patient including both imaging and non-imaging data for outcome prediction. The proposed methods were thoroughly evaluated on datasets separately collected from three hospitals, one in the United States, one in Iran, and another in Italy, with a total 295 patients with reverse transcription polymerase chain reaction (RT-PCR) assay positive COVID-19 pneumonia. Our experimental results demonstrate that adding non-imaging features can significantly improve the performance of prediction to achieve AUC up to 0.884 and sensitivity as high as 96.1%, which can be valuable to provide clinical decision support in managing COVID-19 patients. Our methods may also be applied to other lung diseases including but not limited to community acquired pneumonia. The source code of our work is available at https://github.com/DIAL-RPI/COVID19-ICUPrediction.

Hengtao Guo, Sheng Xu, Bradford Wood et al.

Transrectal ultrasound (US) is the most commonly used imaging modality to guide prostate biopsy and its 3D volume provides even richer context information. Current methods for 3D volume reconstruction from freehand US scans require external tracking devices to provide spatial position for every frame. In this paper, we propose a deep contextual learning network (DCL-Net), which can efficiently exploit the image feature relationship between US frames and reconstruct 3D US volumes without any tracking device. The proposed DCL-Net utilizes 3D convolutions over a US video segment for feature extraction. An embedded self-attention module makes the network focus on the speckle-rich areas for better spatial movement prediction. We also propose a novel case-wise correlation loss to stabilize the training process for improved accuracy. Highly promising results have been obtained by using the developed method. The experiments with ablation studies demonstrate superior performance of the proposed method by comparing against other state-of-the-art methods. Source code of this work is publicly available at https://github.com/DIAL-RPI/FreehandUSRecon.

Xi Fang, Pingkun Yan

Shortage of fully annotated datasets has been a limiting factor in developing deep learning based image segmentation algorithms and the problem becomes more pronounced in multi-organ segmentation. In this paper, we propose a unified training strategy that enables a novel multi-scale deep neural network to be trained on multiple partially labeled datasets for multi-organ segmentation. In addition, a new network architecture for multi-scale feature abstraction is proposed to integrate pyramid input and feature analysis into a U-shape pyramid structure. To bridge the semantic gap caused by directly merging features from different scales, an equal convolutional depth mechanism is introduced. Furthermore, we employ a deep supervision mechanism to refine the outputs in different scales. To fully leverage the segmentation features from all the scales, we design an adaptive weighting layer to fuse the outputs in an automatic fashion. All these mechanisms together are integrated into a Pyramid Input Pyramid Output Feature Abstraction Network (PIPO-FAN). Our proposed method was evaluated on four publicly available datasets, including BTCV, LiTS, KiTS and Spleen, where very promising performance has been achieved. The source code of this work is publicly shared at https://github.com/DIAL-RPI/PIPO-FAN for others to easily reproduce the work and build their own models with the introduced mechanisms.

Qikui Zhu, Bo Du, Pingkun Yan

Graph Convolutional Networks (GCNs) have made significant advances in semi-supervised learning, especially for classification tasks. However, existing GCN based methods have two main drawbacks. First, to increase the receptive field and improve the representation capability of GCNs, larger kernels or deeper network architectures are used, which greatly increases the computational complexity and the number of parameters. Second, methods working on higher order graphs computed directly from adjacency matrices may alter the relationship between graph nodes, particularly for weighted graphs. In addition, the direct construction of higher-order graphs introduces redundant information, which may result in lower network performance. To address the above weaknesses, in this paper, we propose a new method of multi-hop convolutional network on weighted graphs. The proposed method consists of multiple convolutional branches, where each branch extracts node representation from a $k$-hop graph with small kernels. Such design systematically aggregates multi-scale contextual information without adding redundant information. Furthermore, to efficiently combine the extracted information from the multi-hop branches, an adaptive weight computation (AWC) layer is proposed. We demonstrate the superiority of our MultiHop in six publicly available datasets, including three citation network datasets and three medical image datasets. The experimental results show that our proposed MultiHop method achieves the highest classification accuracy and outperforms the state-of-the-art methods. The source code of this work have been released on GitHub (https://github.com/ahukui/Multi-hop-Convolutions-on-Weighted-Graphs).

Hengtao Guo, Uwe Kruger, Ge Wang et al.

Recent studies have highlighted the high correlation between cardiovascular diseases (CVD) and lung cancer, and both are associated with significant morbidity and mortality. Low-Dose CT (LCDT) scans have led to significant improvements in the accuracy of lung cancer diagnosis and thus the reduction of cancer deaths. However, the high correlation between lung cancer and CVD has not been well explored for mortality prediction. This paper introduces a knowledge-based analytical method using deep convolutional neural network (CNN) for all-cause mortality prediction. The underlying approach combines structural image features extracted from CNNs, based on LDCT volume in different scale, and clinical knowledge obtained from quantitative measurements, to comprehensively predict the mortality risk of lung cancer screening subjects. The introduced method is referred to here as the Knowledge-based Analysis of Mortality Prediction Network, or KAMP-Net. It constitutes a collaborative framework that utilizes both imaging features and anatomical information, instead of completely relying on automatic feature extraction. Our work demonstrates the feasibility of incorporating quantitative clinical measurements to assist CNNs in all-cause mortality prediction from chest LDCT images. The results of this study confirm that radiologist defined features are an important complement to CNNs to achieve a more comprehensive feature extraction. Thus, the proposed KAMP-Net has shown to achieve a superior performance when compared to other methods. Our code is available at https://github.com/DIAL-RPI/KAMP-Net.

Xinrui Song, Xuanang Xu, Pingkun Yan

Existing medical image registration algorithms rely on either dataset specific training or local texture-based features to align images. The former cannot be reliably implemented without large modality-specific training datasets, while the latter lacks global semantics thus could be easily trapped at local minima. In this paper, we present a training-free deformable image registration method, DINO-Reg, leveraging a general purpose image encoder DINOv2 for image feature extraction. The DINOv2 encoder was trained using the ImageNet data containing natural images. We used the pretrained DINOv2 without any finetuning. Our method feeds the DINOv2 encoded features into a discrete optimizer to find the optimal deformable registration field. We conducted a series of experiments to understand the behavior and role of such a general purpose image encoder in the application of image registration. Combined with handcrafted features, our method won the first place in the recent OncoReg Challenge. To our knowledge, this is the first application of general vision foundation models in medical image registration.

Jiajin Zhang, Ge Wang, Mannudeep K. Kalra et al.

In medical image analysis, the expertise scarcity and the high cost of data annotation limits the development of large artificial intelligence models. This paper investigates the potential of transfer learning with pre-trained vision-language models (VLMs) in this domain. Currently, VLMs still struggle to transfer to the underrepresented diseases with minimal presence and new diseases entirely absent from the pretraining dataset. We argue that effective adaptation of VLMs hinges on the nuanced representation learning of disease concepts. By capitalizing on the joint visual-linguistic capabilities of VLMs, we introduce disease-informed contextual prompting in a novel disease prototype learning framework. This approach enables VLMs to grasp the concepts of new disease effectively and efficiently, even with limited data. Extensive experiments across multiple image modalities showcase notable enhancements in performance compared to existing techniques.

Diego Machado Reyes, Hanqing Chao, Juergen Hahn et al.

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease; yet its currently available treatments are limited to stopping disease progression. Moreover, effectiveness of these treatments is not guaranteed due to the heterogenetiy of the disease. Therefore, it is essential to be able to identify the disease subtypes at a very early stage. Current data driven approaches are able to classify the subtypes at later stages of AD or related disorders, but struggle when predicting at the asymptomatic or prodromal stage. Moreover, most existing models either lack explainability behind the classification or only use a single modality for the assessment, limiting scope of its analysis. Thus, we propose a multimodal framework that uses early-stage indicators such as imaging, genetics and clinical assessments to classify AD patients into subtypes at early stages. Similarly, we build prompts and use large language models, such as ChatGPT, to interpret the findings of our model. In our framework, we propose a tri-modal co-attention mechanism (Tri-COAT) to explicitly learn the cross-modal feature associations. Our proposed model outperforms baseline models and provides insight into key cross-modal feature associations supported by known biological mechanisms.

Zefan Yang, Xinrui Song, Xuanang Xu et al.

Chest X-rays (CXRs) are the most widely used medical imaging modality and play a pivotal role in diagnosing diseases. However, as 2D projection images, CXRs are limited by structural superposition, which constrains their effectiveness in precise disease diagnosis and risk prediction. To address the limitations of 2D CXRs, this study introduces Xray2Xray, a novel World Model that learns latent representations encoding 3D structural information from chest X-rays. Xray2Xray captures the latent representations of the chest volume by modeling the transition dynamics of X-ray projections across different angular positions with a vision model and a transition model. We employed the latent representations of Xray2Xray for downstream risk prediction and disease diagnosis tasks. Experimental results showed that Xray2Xray outperformed both supervised methods and self-supervised pretraining methods for cardiovascular disease risk estimation and achieved competitive performance in classifying five pathologies in CXRs. We also assessed the quality of Xray2Xray's latent representations through synthesis tasks and demonstrated that the latent representations can be used to reconstruct volumetric context.

Razi Mahmood, Pingkun Yan, Diego Machado Reyes et al. · berkeley

Several evaluation metrics have been developed recently to automatically assess the quality of generative AI reports for chest radiographs based only on textual information using lexical, semantic, or clinical named entity recognition methods. In this paper, we develop a new method of report quality evaluation by first extracting fine-grained finding patterns capturing the location, laterality, and severity of a large number of clinical findings. We then performed phrasal grounding to localize their associated anatomical regions on chest radiograph images. The textual and visual measures are then combined to rate the quality of the generated reports. We present results that compare this evaluation metric with other textual metrics on a gold standard dataset derived from the MIMIC collection and show its robustness and sensitivity to factual errors.

Zefan Yang, Ge Wang, James Hendler et al.

Chest X-ray radiography (CXR) is an essential medical imaging technique for disease diagnosis. However, as 2D projectional images, CXRs are limited by structural superposition and hence fail to capture 3D anatomies. This limitation makes representation learning and disease diagnosis challenging. To address this challenge, we propose a novel CXR world model named X-WIN, which distills volumetric knowledge from chest computed tomography (CT) by learning to predict its 2D projections in latent space. The core idea is that a world model with internalized knowledge of 3D anatomical structure can predict CXRs under various transformations in 3D space. During projection prediction, we introduce an affinity-guided contrastive alignment loss that leverages mutual similarities to capture rich, correlated information across projections from the same volume. To improve model adaptability, we incorporate real CXRs into training through masked image modeling and employ a domain classifier to encourage statistically similar representations for real and simulated CXRs. Comprehensive experiments show that X-WIN outperforms existing foundation models on diverse downstream tasks using linear probing and few-shot fine-tuning. X-WIN also demonstrates the ability to render 2D projections for reconstructing a 3D CT volume.

Razi Mahmood, Diego Machado-Reyes, Joy Wu et al. · berkeley

With the emergence of large-scale vision language models (VLM), it is now possible to produce realistic-looking radiology reports for chest X-ray images. However, their clinical translation has been hampered by the factual errors and hallucinations in the produced descriptions during inference. In this paper, we present a novel phrase-grounded fact-checking model (FC model) that detects errors in findings and their indicated locations in automatically generated chest radiology reports. Specifically, we simulate the errors in reports through a large synthetic dataset derived by perturbing findings and their locations in ground truth reports to form real and fake findings-location pairs with images. A new multi-label cross-modal contrastive regression network is then trained on this dataset. We present results demonstrating the robustness of our method in terms of accuracy of finding veracity prediction and localization on multiple X-ray datasets. We also show its effectiveness for error detection in reports of SOTA report generators on multiple datasets achieving a concordance correlation coefficient of 0.997 with ground truth-based verification, thus pointing to its utility during clinical inference in radiology workflows.

Wiebke Heyer, Yannic Elser, Lennart Berkel et al.

In modern cancer research, the vast volume of medical data generated is often underutilised due to challenges related to patient privacy. The OncoReg Challenge addresses this issue by enabling researchers to develop and validate image registration methods through a two-phase framework that ensures patient privacy while fostering the development of more generalisable AI models. Phase one involves working with a publicly available dataset, while phase two focuses on training models on a private dataset within secure hospital networks. OncoReg builds upon the foundation established by the Learn2Reg Challenge by incorporating the registration of interventional cone-beam computed tomography (CBCT) with standard planning fan-beam CT (FBCT) images in radiotherapy. Accurate image registration is crucial in oncology, particularly for dynamic treatment adjustments in image-guided radiotherapy, where precise alignment is necessary to minimise radiation exposure to healthy tissues while effectively targeting tumours. This work details the methodology and data behind the OncoReg Challenge and provides a comprehensive analysis of the competition entries and results. Findings reveal that feature extraction plays a pivotal role in this registration task. A new method emerging from this challenge demonstrated its versatility, while established approaches continue to perform comparably to newer techniques. Both deep learning and classical approaches still play significant roles in image registration, with the combination of methods, particularly in feature extraction, proving most effective.

Vijay Sadashivaiah, Pingkun Yan, James A. Hendler

Deep learning models have revolutionized medical imaging and diagnostics, yet their opaque nature poses challenges for clinical adoption and trust. Amongst approaches to improve model interpretability, concept-based explanations aim to provide concise and human-understandable explanations of any arbitrary classifier. However, such methods usually require a large amount of manually collected data with concept annotation, which is often scarce in the medical domain. In this paper, we propose Conceptual Counterfactual Explanations for Chest X-ray (CoCoX), which leverages the joint embedding space of an existing vision-language model (VLM) to explain black-box classifier outcomes without the need for annotated datasets. Specifically, we utilize textual concepts derived from chest radiography reports and a pre-trained chest radiography-based VLM to explain three common cardiothoracic pathologies. We demonstrate that the explanations generated by our method are semantically meaningful and faithful to underlying pathologies.

Jiajin Zhang, Hanqing Chao, Amit Dhurandhar et al.

Domain shift is a common problem in clinical applications, where the training images (source domain) and the test images (target domain) are under different distributions. Unsupervised Domain Adaptation (UDA) techniques have been proposed to adapt models trained in the source domain to the target domain. However, those methods require a large number of images from the target domain for model training. In this paper, we propose a novel method for Few-Shot Unsupervised Domain Adaptation (FSUDA), where only a limited number of unlabeled target domain samples are available for training. To accomplish this challenging task, first, a spectral sensitivity map is introduced to characterize the generalization weaknesses of models in the frequency domain. We then developed a Sensitivity-guided Spectral Adversarial MixUp (SAMix) method to generate target-style images to effectively suppresses the model sensitivity, which leads to improved model generalizability in the target domain. We demonstrated the proposed method and rigorously evaluated its performance on multiple tasks using several public datasets.

Hengtao Guo, Xuanang Xu, Sheng Xu et al.

Fusing intra-operative 2D transrectal ultrasound (TRUS) image with pre-operative 3D magnetic resonance (MR) volume to guide prostate biopsy can significantly increase the yield. However, such a multimodal 2D/3D registration problem is a very challenging task. In this paper, we propose an end-to-end frame-to-volume registration network (FVR-Net), which can efficiently bridge the previous research gaps by aligning a 2D TRUS frame with a 3D TRUS volume without requiring hardware tracking. The proposed FVR-Net utilizes a dual-branch feature extraction module to extract the information from TRUS frame and volume to estimate transformation parameters. We also introduce a differentiable 2D slice sampling module which allows gradients backpropagating from an unsupervised image similarity loss for content correspondence learning. Our model shows superior efficiency for real-time interventional guidance with highly competitive registration accuracy.

Nkechinyere N. Agu, Joy T. Wu, Hanqing Chao et al.

Radiologists usually observe anatomical regions of chest X-ray images as well as the overall image before making a decision. However, most existing deep learning models only look at the entire X-ray image for classification, failing to utilize important anatomical information. In this paper, we propose a novel multi-label chest X-ray classification model that accurately classifies the image finding and also localizes the findings to their correct anatomical regions. Specifically, our model consists of two modules, the detection module and the anatomical dependency module. The latter utilizes graph convolutional networks, which enable our model to learn not only the label dependency but also the relationship between the anatomical regions in the chest X-ray. We further utilize a method to efficiently create an adjacency matrix for the anatomical regions using the correlation of the label across the different regions. Detailed experiments and analysis of our results show the effectiveness of our method when compared to the current state-of-the-art multi-label chest X-ray image classification methods while also providing accurate location information.

Jiajin Zhang, Hanqing Chao, Xuanang Xu et al.

The extensive use of medical CT has raised a public concern over the radiation dose to the patient. Reducing the radiation dose leads to increased CT image noise and artifacts, which can adversely affect not only the radiologists judgement but also the performance of downstream medical image analysis tasks. Various low-dose CT denoising methods, especially the recent deep learning based approaches, have produced impressive results. However, the existing denoising methods are all downstream-task-agnostic and neglect the diverse needs of the downstream applications. In this paper, we introduce a novel Task-Oriented Denoising Network (TOD-Net) with a task-oriented loss leveraging knowledge from the downstream tasks. Comprehensive empirical analysis shows that the task-oriented loss complements other task agnostic losses by steering the denoiser to enhance the image quality in the task related regions of interest. Such enhancement in turn brings general boosts on the performance of various methods for the downstream task. The presented work may shed light on the future development of context-aware image denoising methods.

Erim Yanik, Xavier Intes, Uwe Kruger et al.

Surgical training in medical school residency programs has followed the apprenticeship model. The learning and assessment process is inherently subjective and time-consuming. Thus, there is a need for objective methods to assess surgical skills. Here, we use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to systematically survey the literature on the use of Deep Neural Networks for automated and objective surgical skill assessment, with a focus on kinematic data as putative markers of surgical competency. There is considerable recent interest in deep neural networks (DNN) due to the availability of powerful algorithms, multiple datasets, some of which are publicly available, as well as efficient computational hardware to train and host them. We have reviewed 530 papers, of which we selected 25 for this systematic review. Based on this review, we concluded that DNNs are powerful tools for automated, objective surgical skill assessment using both kinematic and video data. The field would benefit from large, publicly available, annotated datasets that are representative of the surgical trainee and expert demographics and multimodal data beyond kinematics and videos.

Chuang Niu, Ge Wang, Pingkun Yan et al.

We propose a Noise Entangled GAN (NE-GAN) for simulating low-dose computed tomography (CT) images from a higher dose CT image. First, we present two schemes to generate a clean CT image and a noise image from the high-dose CT image. Then, given these generated images, an NE-GAN is proposed to simulate different levels of low-dose CT images, where the level of generated noise can be continuously controlled by a noise factor. NE-GAN consists of a generator and a set of discriminators, and the number of discriminators is determined by the number of noise levels during training. Compared with the traditional methods based on the projection data that are usually unavailable in real applications, NE-GAN can directly learn from the real and/or simulated CT images and may create low-dose CT images quickly without the need of raw data or other proprietary CT scanner information. The experimental results show that the proposed method has the potential to simulate realistic low-dose CT images.

Jiajin Zhang, Hanqing Chao, Pingkun Yan

Unsupervised domain adaptation (UDA) is widely used to transfer knowledge from a labeled source domain to an unlabeled target domain with different data distribution. While extensive studies attested that deep learning models are vulnerable to adversarial attacks, the adversarial robustness of models in domain adaptation application has largely been overlooked. This paper points out that the inevitable domain distribution deviation in UDA is a critical barrier to model robustness on the target domain. To address the problem, we propose a novel Class-consistent Unsupervised Robust Domain Adaptation (CURDA) framework for training robust UDA models. With the introduced contrastive robust training and source anchored adversarial contrastive losses, our proposed CURDA framework can effectively robustify UDA models by simultaneously minimizing the data distribution deviation and the distance between target domain clean-adversarial pairs without creating classification confusion. Experiments on several public benchmarks show that CURDA can significantly improve model robustness in the target domain with only minor cost of accuracy on the clean samples.

Hengtao Guo, Sheng Xu, Bradford J. Wood et al.

Reconstructed 3D ultrasound volume provides more context information compared to a sequence of 2D scanning frames, which is desirable for various clinical applications such as ultrasound-guided prostate biopsy. Nevertheless, 3D volume reconstruction from freehand 2D scans is a very challenging problem, especially without the use of external tracking devices. Recent deep learning based methods demonstrate the potential of directly estimating inter-frame motion between consecutive ultrasound frames. However, such algorithms are specific to particular transducers and scanning trajectories associated with the training data, which may not be generalized to other image acquisition settings. In this paper, we tackle the data acquisition difference as a domain shift problem and propose a novel domain adaptation strategy to adapt deep learning algorithms to data acquired with different transducers. Specifically, feature extractors that generate transducer-invariant features from different datasets are trained by minimizing the discrepancy between deep features of paired samples in a latent space. Our results show that the proposed domain adaptation method can successfully align different feature distributions while preserving the transducer-specific information for universal freehand ultrasound volume reconstruction.

Hanqing Chao, Hongming Shan, Fatemeh Homayounieh et al.

Cancer patients have a higher risk of cardiovascular disease (CVD) mortality than the general population. Low dose computed tomography (LDCT) for lung cancer screening offers an opportunity for simultaneous CVD risk estimation in at-risk patients. Our deep learning CVD risk prediction model, trained with 30,286 LDCTs from the National Lung Cancer Screening Trial, achieved an area under the curve (AUC) of 0.871 on a separate test set of 2,085 subjects and identified patients with high CVD mortality risks (AUC of 0.768). We validated our model against ECG-gated cardiac CT based markers, including coronary artery calcification (CAC) score, CAD-RADS score, and MESA 10-year risk score from an independent dataset of 335 subjects. Our work shows that, in high-risk patients, deep learning can convert LDCT for lung cancer screening into a dual-screening quantitative tool for CVD risk estimation.

Weiwen Wu, Dianlin Hu, Wenxiang Cong et al.

Tomographic image reconstruction with deep learning is an emerging field, but a recent landmark study reveals that several deep reconstruction networks are unstable for computed tomography (CT) and magnetic resonance imaging (MRI). Specifically, three kinds of instabilities were reported: (1) strong image artefacts from tiny perturbations, (2) small features missing in a deeply reconstructed image, and (3) decreased imaging performance with increased input data. On the other hand, compressed sensing (CS) inspired reconstruction methods do not suffer from these instabilities because of their built-in kernel awareness. For deep reconstruction to realize its full potential and become a mainstream approach for tomographic imaging, it is thus critically important to meet this challenge by stabilizing deep reconstruction networks. Here we propose an Analytic Compressed Iterative Deep (ACID) framework to address this challenge. ACID synergizes a deep reconstruction network trained on big data, kernel awareness from CS-inspired processing, and iterative refinement to minimize the data residual relative to real measurement. Our study demonstrates that the deep reconstruction using ACID is accurate and stable, and sheds light on the converging mechanism of the ACID iteration under a Bounded Relative Error Norm (BREN) condition. In particular, the study shows that ACID-based reconstruction is resilient against adversarial attacks, superior to classic sparsity-regularized reconstruction alone, and eliminates the three kinds of instabilities. We anticipate that this integrative data-driven approach will help promote development and translation of deep tomographic image reconstruction networks into clinical applications.

Qikui Zhu, Bo Du, Pingkun Yan

Graph Convolutional Networks (GCNs) have been successfully applied to analyze non-grid data, where the classical convolutional neural networks (CNNs) cannot be directly used. One similarity shared by GCNs and CNNs is the requirement of massive amount of labeled data for network training. In addition, GCNs need the adjacency matrix as input to define the relationship between those non-grid data, which leads to all of data including training, validation and test data typically forms only one graph structures data for training. Furthermore, the adjacency matrix is usually pre-defined and stationary, which makes the data augmentation strategies cannot be employed on the constructed graph structures data to augment the amount of training data. To further improve the learning capacity and model performance under the limited training data, in this paper, we propose two types of self-supervised learning strategies to exploit available information from the input graph structure data itself. Our proposed self-supervised learning strategies are examined on two representative GCN models with three public citation network datasets - Citeseer, Cora and Pubmed. The experimental results demonstrate the generalization ability as well as the portability of our proposed strategies, which can significantly improve the performance of GCNs with the power of self-supervised learning in improving feature learning.

Qikui Zhu, Bo Du, Pingkun Yan

Medical image segmentation is a fundamental task in medical image analysis. Despite that deep convolutional neural networks have gained stellar performance in this challenging task, they typically rely on large labeled datasets, which have limited their extension to customized applications. By revisiting the superiority of atlas based segmentation methods, we present a new framework of One-pass aligned Atlas Set for Images Segmentation (OASIS). To address the problem of time-consuming iterative image registration used for atlas warping, the proposed method takes advantage of the power of deep learning to achieve one-pass image registration. In addition, by applying label constraint, OASIS also makes the registration process to be focused on the regions to be segmented for improving the performance of segmentation. Furthermore, instead of using image based similarity for label fusion, which can be distracted by the large background areas, we propose a novel strategy to compute the label similarity based weights for label fusion. Our experimental results on the challenging task of prostate MR image segmentation demonstrate that OASIS is able to significantly increase the segmentation performance compared to other state-of-the-art methods.

Xi Fang, Bo Du, Sheng Xu et al.

Automatic medical image segmentation, an essential component of medical image analysis, plays an importantrole in computer-aided diagnosis. For example, locating and segmenting the liver can be very helpful in livercancer diagnosis and treatment. The state-of-the-art models in medical image segmentation are variants ofthe encoder-decoder architecture such as fully convolutional network (FCN) and U-Net.1A major focus ofthe FCN based segmentation methods has been on network structure engineering by incorporating the latestCNN structures such as ResNet2and DenseNet.3In addition to exploring new network structures for efficientlyabstracting high level features, incorporating structures for multi-scale image feature extraction in FCN hashelped to improve performance in segmentation tasks. In this paper, we design a new multi-scale networkarchitecture, which takes multi-scale inputs with dedicated convolutional paths to efficiently combine featuresfrom different scales to better utilize the hierarchical information.

Xueying Chen, Rong Zhang, Pingkun Yan

Liver lesion segmentation is a difficult yet critical task for medical image analysis. Recently, deep learning based image segmentation methods have achieved promising performance, which can be divided into three categories: 2D, 2.5D and 3D, based on the dimensionality of the models. However, 2.5D and 3D methods can have very high complexity and 2D methods may not perform satisfactorily. To obtain competitive performance with low complexity, in this paper, we propose a Feature-fusion Encoder-Decoder Network (FED-Net) based 2D segmentation model to tackle the challenging problem of liver lesion segmentation from CT images. Our feature fusion method is based on the attention mechanism, which fuses high-level features carrying semantic information with low-level features having image details. Additionally, to compensate for the information loss during the upsampling process, a dense upsampling convolution and a residual convolutional structure are proposed. We tested our method on the dataset of MICCAI 2017 Liver Tumor Segmentation (LiTS) Challenge and achieved competitive results compared with other state-of-the-art methods.

Grant Haskins, Uwe Kruger, Pingkun Yan

The establishment of image correspondence through robust image registration is critical to many clinical tasks such as image fusion, organ atlas creation, and tumor growth monitoring, and is a very challenging problem. Since the beginning of the recent deep learning renaissance, the medical imaging research community has developed deep learning based approaches and achieved the state-of-the-art in many applications, including image registration. The rapid adoption of deep learning for image registration applications over the past few years necessitates a comprehensive summary and outlook, which is the main scope of this survey. This requires placing a focus on the different research areas as well as highlighting challenges that practitioners face. This survey, therefore, outlines the evolution of deep learning based medical image registration in the context of both research challenges and relevant innovations in the past few years. Further, this survey highlights future research directions to show how this field may be possibly moved forward to the next level.

Qikui Zhu, Bo Du, Pingkun Yan

Accurate segmentation of the prostate from magnetic resonance (MR) images provides useful information for prostate cancer diagnosis and treatment. However, automated prostate segmentation from 3D MR images still faces several challenges. For instance, a lack of clear edge between the prostate and other anatomical structures makes it challenging to accurately extract the boundaries. The complex background texture and large variation in size, shape and intensity distribution of the prostate itself make segmentation even further complicated. With deep learning, especially convolutional neural networks (CNNs), emerging as commonly used methods for medical image segmentation, the difficulty in obtaining large number of annotated medical images for training CNNs has become much more pronounced that ever before. Since large-scale dataset is one of the critical components for the success of deep learning, lack of sufficient training data makes it difficult to fully train complex CNNs. To tackle the above challenges, in this paper, we propose a boundary-weighted domain adaptive neural network (BOWDA-Net). To make the network more sensitive to the boundaries during segmentation, a boundary-weighted segmentation loss (BWL) is proposed. Furthermore, an advanced boundary-weighted transfer leaning approach is introduced to address the problem of small medical imaging datasets. We evaluate our proposed model on the publicly available MICCAI 2012 Prostate MR Image Segmentation (PROMISE12) challenge dataset. Our experimental results demonstrate that the proposed model is more sensitive to boundary information and outperformed other state-of-the-art methods.

Fenglei Fan, Dayang Wang, Hengtao Guo et al.

In established network architectures, shortcut connections are often used to take the outputs of earlier layers as additional inputs to later layers. Despite the extraordinary effectiveness of shortcuts, there remain open questions on the mechanism and characteristics. For example, why are shortcuts powerful? Why do shortcuts generalize well? In this paper, we investigate the expressivity and generalizability of a novel sparse shortcut topology. First, we demonstrate that this topology can empower a one-neuron-wide deep network to approximate any univariate continuous function. Then, we present a novel width-bounded universal approximator in contrast to depth-bounded universal approximators and extend the approximation result to a family of equally competent networks. Furthermore, with generalization bound theory, we show that the proposed shortcut topology enjoys excellent generalizability. Finally, we corroborate our theoretical analyses by comparing the proposed topology with popular architectures, including ResNet and DenseNet, on well-known benchmarks and perform a saliency map analysis to interpret the proposed topology. Our work helps enhance the understanding of the role of shortcuts and suggests further opportunities to innovate neural architectures.

Pingkun Yan, Hengtao Guo, Ge Wang et al.

Known for its high morbidity and mortality rates, lung cancer poses a significant threat to human health and well-being. However, the same population is also at high risk for other deadly diseases, such as cardiovascular disease. Since Low-Dose CT (LDCT) has been shown to significantly improve the lung cancer diagnosis accuracy, it will be very useful for clinical practice to predict the all-cause mortality for lung cancer patients to take corresponding actions. In this paper, we propose a deep learning based method, which takes both chest LDCT image patches and coronary artery calcification risk scores as input, for direct prediction of mortality risk of lung cancer subjects. The proposed method is called Hybrid Risk Network (HyRiskNet) for mortality risk prediction, which is an end-to-end framework utilizing hybrid imaging features, instead of completely relying on automatic feature extraction. Our work demonstrates the feasibility of using deep learning techniques for all-cause lung cancer mortality prediction from chest LDCT images. The experimental results show that the proposed HyRiskNet can achieve superior performance compared with the neural networks with only image input and with other traditional semi-automatic scoring methods. The study also indicates that radiologist defined features can well complement convolutional neural networks for more comprehensive feature extraction.

Grant Haskins, Jochen Kruecker, Uwe Kruger et al.

Purpose: The fusion of transrectal ultrasound (TRUS) and magnetic resonance (MR) images for guiding targeted prostate biopsy has significantly improved the biopsy yield of aggressive cancers. A key component of MR-TRUS fusion is image registration. However, it is very challenging to obtain a robust automatic MR-TRUS registration due to the large appearance difference between the two imaging modalities. The work presented in this paper aims to tackle this problem by addressing two challenges: (i) the definition of a suitable similarity metric and (ii) the determination of a suitable optimization strategy. Methods: This work proposes the use of a deep convolutional neural network to learn a similarity metric for MR-TRUS registration. We also use a composite optimization strategy that explores the solution space in order to search for a suitable initialization for the second-order optimization of the learned metric. Further, a multi-pass approach is used in order to smooth the metric for optimization. Results: The learned similarity metric outperforms the classical mutual information and also the state-of-the-art MIND feature based methods. The results indicate that the overall registration framework has a large capture range. The proposed deep similarity metric based approach obtained a mean TRE of 3.86mm (with an initial TRE of 16mm) for this challenging problem. Conclusion: A similarity metric that is learned using a deep neural network can be used to assess the quality of any given image registration and can be used in conjunction with the aforementioned optimization framework to perform automatic registration that is robust to poor initialization.

Pingkun Yan, Sheng Xu, Ardeshir R. Rastinehad et al.

Robust and accurate alignment of multimodal medical images is a very challenging task, which however is very useful for many clinical applications. For example, magnetic resonance (MR) and transrectal ultrasound (TRUS) image registration is a critical component in MR-TRUS fusion guided prostate interventions. However, due to the huge difference between the image appearances and the large variation in image correspondence, MR-TRUS image registration is a very challenging problem. In this paper, an adversarial image registration (AIR) framework is proposed. By training two deep neural networks simultaneously, one being a generator and the other being a discriminator, we can obtain not only a network for image registration, but also a metric network which can help evaluate the quality of image registration. The developed AIR-net is then evaluated using clinical datasets acquired through image-fusion guided prostate biopsy procedures and promising results are demonstrated.