Liansheng Wang

Zhi Lin, Junhao Lin, Lei Zhu et al.

Breast lesion detection in ultrasound is critical for breast cancer diagnosis. Existing methods mainly rely on individual 2D ultrasound images or combine unlabeled video and labeled 2D images to train models for breast lesion detection. In this paper, we first collect and annotate an ultrasound video dataset (188 videos) for breast lesion detection. Moreover, we propose a clip-level and video-level feature aggregated network (CVA-Net) for addressing breast lesion detection in ultrasound videos by aggregating video-level lesion classification features and clip-level temporal features. The clip-level temporal features encode local temporal information of ordered video frames and global temporal information of shuffled video frames. In our CVA-Net, an inter-video fusion module is devised to fuse local features from original video frames and global features from shuffled video frames, and an intra-video fusion module is devised to learn the temporal information among adjacent video frames. Moreover, we learn video-level features to classify the breast lesions of the original video as benign or malignant lesions to further enhance the final breast lesion detection performance in ultrasound videos. Experimental results on our annotated dataset demonstrate that our CVA-Net clearly outperforms state-of-the-art methods. The corresponding code and dataset are publicly available at \url{https://github.com/jhl-Det/CVA-Net}.

Hong Liu, Dong Wei, Donghuan Lu et al.

Multimodal magnetic resonance imaging (MRI) provides complementary information for sub-region analysis of brain tumors. Plenty of methods have been proposed for automatic brain tumor segmentation using four common MRI modalities and achieved remarkable performance. In practice, however, it is common to have one or more modalities missing due to image corruption, artifacts, acquisition protocols, allergy to contrast agents, or simply cost. In this work, we propose a novel two-stage framework for brain tumor segmentation with missing modalities. In the first stage, a multimodal masked autoencoder (M3AE) is proposed, where both random modalities (i.e., modality dropout) and random patches of the remaining modalities are masked for a reconstruction task, for self-supervised learning of robust multimodal representations against missing modalities. To this end, we name our framework M3AE. Meanwhile, we employ model inversion to optimize a representative full-modal image at marginal extra cost, which will be used to substitute for the missing modalities and boost performance during inference. Then in the second stage, a memory-efficient self distillation is proposed to distill knowledge between heterogenous missing-modal situations while fine-tuning the model for supervised segmentation. Our M3AE belongs to the 'catch-all' genre where a single model can be applied to all possible subsets of modalities, thus is economic for both training and deployment. Extensive experiments on BraTS 2018 and 2020 datasets demonstrate its superior performance to existing state-of-the-art methods with missing modalities, as well as the efficacy of its components. Our code is available at: https://github.com/ccarliu/m3ae.

Jiacheng Wang, Yueming Jin, Liansheng Wang

Medical image segmentation under federated learning (FL) is a promising direction by allowing multiple clinical sites to collaboratively learn a global model without centralizing datasets. However, using a single model to adapt to various data distributions from different sites is extremely challenging. Personalized FL tackles this issue by only utilizing partial model parameters shared from global server, while keeping the rest to adapt to its own data distribution in the local training of each site. However, most existing methods concentrate on the partial parameter splitting, while do not consider the \textit{inter-site in-consistencies} during the local training, which in fact can facilitate the knowledge communication over sites to benefit the model learning for improving the local accuracy. In this paper, we propose a personalized federated framework with \textbf{L}ocal \textbf{C}alibration (LC-Fed), to leverage the inter-site in-consistencies in both \textit{feature- and prediction- levels} to boost the segmentation. Concretely, as each local site has its alternative attention on the various features, we first design the contrastive site embedding coupled with channel selection operation to calibrate the encoded features. Moreover, we propose to exploit the knowledge of prediction-level in-consistency to guide the personalized modeling on the ambiguous regions, e.g., anatomical boundaries. It is achieved by computing a disagreement-aware map to calibrate the prediction. Effectiveness of our method has been verified on three medical image segmentation tasks with different modalities, where our method consistently shows superior performance to the state-of-the-art personalized FL methods. Code is available at https://github.com/jcwang123/FedLC.

Liansheng Wang, Jiacheng Wang, Lei Zhu et al.

Automated detecting lung infections from computed tomography (CT) data plays an important role for combating COVID-19. However, there are still some challenges for developing AI system. 1) Most current COVID-19 infection segmentation methods mainly relied on 2D CT images, which lack 3D sequential constraint. 2) Existing 3D CT segmentation methods focus on single-scale representations, which do not achieve the multiple level receptive field sizes on 3D volume. 3) The emergent breaking out of COVID-19 makes it hard to annotate sufficient CT volumes for training deep model. To address these issues, we first build a multiple dimensional-attention convolutional neural network (MDA-CNN) to aggregate multi-scale information along different dimension of input feature maps and impose supervision on multiple predictions from different CNN layers. Second, we assign this MDA-CNN as a basic network into a novel dual multi-scale mean teacher network (DM${^2}$T-Net) for semi-supervised COVID-19 lung infection segmentation on CT volumes by leveraging unlabeled data and exploring the multi-scale information. Our DM${^2}$T-Net encourages multiple predictions at different CNN layers from the student and teacher networks to be consistent for computing a multi-scale consistency loss on unlabeled data, which is then added to the supervised loss on the labeled data from multiple predictions of MDA-CNN. Third, we collect two COVID-19 segmentation datasets to evaluate our method. The experimental results show that our network consistently outperforms the compared state-of-the-art methods.

Chinedu Innocent Nwoye, Deepak Alapatt, Tong Yu et al.

Context-aware decision support in the operating room can foster surgical safety and efficiency by leveraging real-time feedback from surgical workflow analysis. Most existing works recognize surgical activities at a coarse-grained level, such as phases, steps or events, leaving out fine-grained interaction details about the surgical activity; yet those are needed for more helpful AI assistance in the operating room. Recognizing surgical actions as triplets of <instrument, verb, target> combination delivers comprehensive details about the activities taking place in surgical videos. This paper presents CholecTriplet2021: an endoscopic vision challenge organized at MICCAI 2021 for the recognition of surgical action triplets in laparoscopic videos. The challenge granted private access to the large-scale CholecT50 dataset, which is annotated with action triplet information. In this paper, we present the challenge setup and assessment of the state-of-the-art deep learning methods proposed by the participants during the challenge. A total of 4 baseline methods from the challenge organizers and 19 new deep learning algorithms by competing teams are presented to recognize surgical action triplets directly from surgical videos, achieving mean average precision (mAP) ranging from 4.2% to 38.1%. This study also analyzes the significance of the results obtained by the presented approaches, performs a thorough methodological comparison between them, in-depth result analysis, and proposes a novel ensemble method for enhanced recognition. Our analysis shows that surgical workflow analysis is not yet solved, and also highlights interesting directions for future research on fine-grained surgical activity recognition which is of utmost importance for the development of AI in surgery.

Junhao Lin, Qian Dai, Lei Zhu et al.

Breast lesion segmentation in ultrasound (US) videos is essential for diagnosing and treating axillary lymph node metastasis. However, the lack of a well-established and large-scale ultrasound video dataset with high-quality annotations has posed a persistent challenge for the research community. To overcome this issue, we meticulously curated a US video breast lesion segmentation dataset comprising 572 videos and 34,300 annotated frames, covering a wide range of realistic clinical scenarios. Furthermore, we propose a novel frequency and localization feature aggregation network (FLA-Net) that learns temporal features from the frequency domain and predicts additional lesion location positions to assist with breast lesion segmentation. We also devise a localization-based contrastive loss to reduce the lesion location distance between neighboring video frames within the same video and enlarge the location distances between frames from different ultrasound videos. Our experiments on our annotated dataset and two public video polyp segmentation datasets demonstrate that our proposed FLA-Net achieves state-of-the-art performance in breast lesion segmentation in US videos and video polyp segmentation while significantly reducing time and space complexity. Our model and dataset are available at https://github.com/jhl-Det/FLA-Net.

Matthias Eisenmann, Annika Reinke, Vivienn Weru et al.

International benchmarking competitions have become fundamental for the comparative performance assessment of image analysis methods. However, little attention has been given to investigating what can be learnt from these competitions. Do they really generate scientific progress? What are common and successful participation strategies? What makes a solution superior to a competing method? To address this gap in the literature, we performed a multi-center study with all 80 competitions that were conducted in the scope of IEEE ISBI 2021 and MICCAI 2021. Statistical analyses performed based on comprehensive descriptions of the submitted algorithms linked to their rank as well as the underlying participation strategies revealed common characteristics of winning solutions. These typically include the use of multi-task learning (63%) and/or multi-stage pipelines (61%), and a focus on augmentation (100%), image preprocessing (97%), data curation (79%), and postprocessing (66%). The "typical" lead of a winning team is a computer scientist with a doctoral degree, five years of experience in biomedical image analysis, and four years of experience in deep learning. Two core general development strategies stood out for highly-ranked teams: the reflection of the metrics in the method design and the focus on analyzing and handling failure cases. According to the organizers, 43% of the winning algorithms exceeded the state of the art but only 11% completely solved the respective domain problem. The insights of our study could help researchers (1) improve algorithm development strategies when approaching new problems, and (2) focus on open research questions revealed by this work.

Zhongying Deng, Cheng Tang, Ziyan Huang et al. · pku

Foundation models have demonstrated remarkable success across diverse domains and tasks, primarily due to the thrive of large-scale, diverse, and high-quality datasets. However, in the field of medical imaging, the curation and assembling of such medical datasets are highly challenging due to the reliance on clinical expertise and strict ethical and privacy constraints, resulting in a scarcity of large-scale unified medical datasets and hindering the development of powerful medical foundation models. In this work, we present the largest survey to date of medical image datasets, covering over 1,000 open-access datasets with a systematic catalog of their modalities, tasks, anatomies, annotations, limitations, and potential for integration. Our analysis exposes a landscape that is modest in scale, fragmented across narrowly scoped tasks, and unevenly distributed across organs and modalities, which in turn limits the utility of existing medical image datasets for developing versatile and robust medical foundation models. To turn fragmentation into scale, we propose a metadata-driven fusion paradigm (MDFP) that integrates public datasets with shared modalities or tasks, thereby transforming multiple small data silos into larger, more coherent resources. Building on MDFP, we release an interactive discovery portal that enables end-to-end, automated medical image dataset integration, and compile all surveyed datasets into a unified, structured table that clearly summarizes their key characteristics and provides reference links, offering the community an accessible and comprehensive repository. By charting the current terrain and offering a principled path to dataset consolidation, our survey provides a practical roadmap for scaling medical imaging corpora, supporting faster data discovery, more principled dataset creation, and more capable medical foundation models.

Jiacheng Wang, Fei Chen, Yuxi Ma et al.

Skin lesion segmentation from dermoscopy images is of great significance in the quantitative analysis of skin cancers, which is yet challenging even for dermatologists due to the inherent issues, i.e., considerable size, shape and color variation, and ambiguous boundaries. Recent vision transformers have shown promising performance in handling the variation through global context modeling. Still, they have not thoroughly solved the problem of ambiguous boundaries as they ignore the complementary usage of the boundary knowledge and global contexts. In this paper, we propose a novel cross-scale boundary-aware transformer, \textbf{XBound-Former}, to simultaneously address the variation and boundary problems of skin lesion segmentation. XBound-Former is a purely attention-based network and catches boundary knowledge via three specially designed learners. We evaluate the model on two skin lesion datasets, ISIC-2016\&PH$^2$ and ISIC-2018, where our model consistently outperforms other convolution- and transformer-based models, especially on the boundary-wise metrics. We extensively verify the generalization ability of polyp lesion segmentation that has similar characteristics, and our model can also yield significant improvement compared to the latest models.

Runsheng Liu, Hao Jiang, Yanning Zhou et al.

Instance segmentation plays a vital role in the morphological quantification of biomedical entities such as tissues and cells, enabling precise identification and delineation of different structures. Current methods often address the challenges of touching, overlapping or crossing instances through individual modeling, while neglecting the intrinsic interrelation between these conditions. In this work, we propose a Gradient Anomaly-aware Biomedical Instance Segmentation approach (GAInS), which leverages instance gradient information to perceive local gradient anomaly regions, thus modeling the spatial relationship between instances and refining local region segmentation. Specifically, GAInS is firstly built on a Gradient Anomaly Mapping Module (GAMM), which encodes the radial fields of instances through window sliding to obtain instance gradient anomaly maps. To efficiently refine boundaries and regions with gradient anomaly attention, we propose an Adaptive Local Refinement Module (ALRM) with a gradient anomaly-aware loss function. Extensive comparisons and ablation experiments in three biomedical scenarios demonstrate that our proposed GAInS outperforms other state-of-the-art (SOTA) instance segmentation methods. The code is available at https://github.com/DeepGAInS/GAInS.

Hong-Yu Zhou, Chenyu Lian, Liansheng Wang et al.

Modern studies in radiograph representation learning rely on either self-supervision to encode invariant semantics or associated radiology reports to incorporate medical expertise, while the complementarity between them is barely noticed. To explore this, we formulate the self- and report-completion as two complementary objectives and present a unified framework based on masked record modeling (MRM). In practice, MRM reconstructs masked image patches and masked report tokens following a multi-task scheme to learn knowledge-enhanced semantic representations. With MRM pre-training, we obtain pre-trained models that can be well transferred to various radiography tasks. Specifically, we find that MRM offers superior performance in label-efficient fine-tuning. For instance, MRM achieves 88.5% mean AUC on CheXpert using 1% labeled data, outperforming previous R$^2$L methods with 100% labels. On NIH ChestX-ray, MRM outperforms the best performing counterpart by about 3% under small labeling ratios. Besides, MRM surpasses self- and report-supervised pre-training in identifying the pneumonia type and the pneumothorax area, sometimes by large margins.

Jiansen Guo, Hong-Yu Zhou, Liansheng Wang et al.

Recent medical image segmentation models are mostly hybrid, which integrate self-attention and convolution layers into the non-isomorphic architecture. However, one potential drawback of these approaches is that they failed to provide an intuitive explanation of why this hybrid combination manner is beneficial, making it difficult for subsequent work to make improvements on top of them. To address this issue, we first analyze the differences between the weight allocation mechanisms of the self-attention and convolution. Based on this analysis, we propose to construct a parallel non-isomorphic block that takes the advantages of self-attention and convolution with simple parallelization. We name the resulting U-shape segmentation model as UNet-2022. In experiments, UNet-2022 obviously outperforms its counterparts in a range segmentation tasks, including abdominal multi-organ segmentation, automatic cardiac diagnosis, neural structures segmentation, and skin lesion segmentation, sometimes surpassing the best performing baseline by 4%. Specifically, UNet-2022 surpasses nnUNet, the most recognized segmentation model at present, by large margins. These phenomena indicate the potential of UNet-2022 to become the model of choice for medical image segmentation.

Shuxin Wang, Shilei Cao, Zhizhong Chai et al.

Fully convolutional neural networks have made promising progress in joint liver and liver tumor segmentation. Instead of following the debates over 2D versus 3D networks (for example, pursuing the balance between large-scale 2D pretraining and 3D context), in this paper, we novelly identify the wide variation in the ratio between intra- and inter-slice resolutions as a crucial obstacle to the performance. To tackle the mismatch between the intra- and inter-slice information, we propose a slice-aware 2.5D network that emphasizes extracting discriminative features utilizing not only in-plane semantics but also out-of-plane coherence for each separate slice. Specifically, we present a slice-wise multi-input multi-output architecture to instantiate such a design paradigm, which contains a Multi-Branch Decoder (MD) with a Slice-centric Attention Block (SAB) for learning slice-specific features and a Densely Connected Dice (DCD) loss to regularize the inter-slice predictions to be coherent and continuous. Based on the aforementioned innovations, we achieve state-of-the-art results on the MICCAI 2017 Liver Tumor Segmentation (LiTS) dataset. Besides, we also test our model on the ISBI 2019 Segmentation of THoracic Organs at Risk (SegTHOR) dataset, and the result proves the robustness and generalizability of the proposed method in other segmentation tasks.

Jinghan Sun, Dong Wei, Zhe Xu et al.

Chest X-ray (CXR) anatomical abnormality detection aims at localizing and characterising cardiopulmonary radiological findings in the radiographs, which can expedite clinical workflow and reduce observational oversights. Most existing methods attempted this task in either fully supervised settings which demanded costly mass per-abnormality annotations, or weakly supervised settings which still lagged badly behind fully supervised methods in performance. In this work, we propose a co-evolutionary image and report distillation (CEIRD) framework, which approaches semi-supervised abnormality detection in CXR by grounding the visual detection results with text-classified abnormalities from paired radiology reports, and vice versa. Concretely, based on the classical teacher-student pseudo label distillation (TSD) paradigm, we additionally introduce an auxiliary report classification model, whose prediction is used for report-guided pseudo detection label refinement (RPDLR) in the primary vision detection task. Inversely, we also use the prediction of the vision detection model for abnormality-guided pseudo classification label refinement (APCLR) in the auxiliary report classification task, and propose a co-evolution strategy where the vision and report models mutually promote each other with RPDLR and APCLR performed alternatively. To this end, we effectively incorporate the weak supervision by reports into the semi-supervised TSD pipeline. Besides the cross-modal pseudo label refinement, we further propose an intra-image-modal self-adaptive non-maximum suppression, where the pseudo detection labels generated by the teacher vision model are dynamically rectified by high-confidence predictions by the student. Experimental results on the public MIMIC-CXR benchmark demonstrate CEIRD's superior performance to several up-to-date weakly and semi-supervised methods.

Hong Liu, Dong Wei, Donghuan Lu et al.

Automated surface segmentation of retinal layer is important and challenging in analyzing optical coherence tomography (OCT). Recently, many deep learning based methods have been developed for this task and yield remarkable performance. However, due to large spatial gap and potential mismatch between the B-scans of OCT data, all of them are based on 2D segmentation of individual B-scans, which may loss the continuity information across the B-scans. In addition, 3D surface of the retina layers can provide more diagnostic information, which is crucial in quantitative image analysis. In this study, a novel framework based on hybrid 2D-3D convolutional neural networks (CNNs) is proposed to obtain continuous 3D retinal layer surfaces from OCT. The 2D features of individual B-scans are extracted by an encoder consisting of 2D convolutions. These 2D features are then used to produce the alignment displacement field and layer segmentation by two 3D decoders, which are coupled via a spatial transformer module. The entire framework is trained end-to-end. To the best of our knowledge, this is the first study that attempts 3D retinal layer segmentation in volumetric OCT images based on CNNs. Experiments on a publicly available dataset show that our framework achieves superior results to state-of-the-art 2D methods in terms of both layer segmentation accuracy and cross-B-scan 3D continuity, thus offering more clinical values than previous works.

Hong-Yu Zhou, Chixiang Lu, Liansheng Wang et al.

Self-supervised representation learning has been extremely successful in medical image analysis, as it requires no human annotations to provide transferable representations for downstream tasks. Recent self-supervised learning methods are dominated by noise-contrastive estimation (NCE, also known as contrastive learning), which aims to learn invariant visual representations by contrasting one homogeneous image pair with a large number of heterogeneous image pairs in each training step. Nonetheless, NCE-based approaches still suffer from one major problem that is one homogeneous pair is not enough to extract robust and invariant semantic information. Inspired by the archetypical triplet loss, we propose GraVIS, which is specifically optimized for learning self-supervised features from dermatology images, to group homogeneous dermatology images while separating heterogeneous ones. In addition, a hardness-aware attention is introduced and incorporated to address the importance of homogeneous image views with similar appearance instead of those dissimilar homogeneous ones. GraVIS significantly outperforms its transfer learning and self-supervised learning counterparts in both lesion segmentation and disease classification tasks, sometimes by 5 percents under extremely limited supervision. More importantly, when equipped with the pre-trained weights provided by GraVIS, a single model could achieve better results than winners that heavily rely on ensemble strategies in the well-known ISIC 2017 challenge.

Jinghan Sun, Dong Wei, Liansheng Wang et al.

Medical images are widely used in clinical practice for diagnosis. Automatically generating interpretable medical reports can reduce radiologists' burden and facilitate timely care. However, most existing approaches to automatic report generation require sufficient labeled data for training. In addition, the learned model can only generate reports for the training classes, lacking the ability to adapt to previously unseen novel diseases. To this end, we propose a lesion guided explainable few weak-shot medical report generation framework that learns correlation between seen and novel classes through visual and semantic feature alignment, aiming to generate medical reports for diseases not observed in training. It integrates a lesion-centric feature extractor and a Transformer-based report generation module. Concretely, the lesion-centric feature extractor detects the abnormal regions and learns correlations between seen and novel classes with multi-view (visual and lexical) embeddings. Then, features of the detected regions and corresponding embeddings are concatenated as multi-view input to the report generation module for explainable report generation, including text descriptions and corresponding abnormal regions detected in the images. We conduct experiments on FFA-IR, a dataset providing explainable annotations, showing that our framework outperforms others on report generation for novel diseases.

Lianyu Zhou, Dong Wei, Donghuan Lu et al.

As an essential indicator for cancer progression and treatment response, tumor size is often measured following the response evaluation criteria in solid tumors (RECIST) guideline in CT slices. By marking each lesion with its longest axis and the longest perpendicular one, laborious pixel-wise manual annotation can be avoided. However, such a coarse substitute cannot provide a rich and accurate base to allow versatile quantitative analysis of lesions. To this end, we propose a novel weakly supervised framework to exploit the existing rich RECIST annotations for pixel-wise lesion segmentation. Specifically, a pair of under- and over-segmenting masks are constructed for each lesion based on its RECIST annotation and served as the label for co-training a pair of subnets, respectively, along with the proposed label-space perturbation induced consistency loss to bridge the gap between the two subnets and enable effective co-training. Extensive experiments are conducted on a public dataset to demonstrate the superiority of the proposed framework regarding the RECIST-based weakly supervised segmentation task and its universal applicability to various backbone networks.

Cong Xie, Hualuo Liu, Shilei Cao et al.

Semantic segmentation is important in medical image analysis. Inspired by the strong ability of traditional image analysis techniques in capturing shape priors and inter-subject similarity, many deep learning (DL) models have been recently proposed to exploit such prior information and achieved robust performance. However, these two types of important prior information are usually studied separately in existing models. In this paper, we propose a novel DL model to model both type of priors within a single framework. Specifically, we introduce an extra encoder into the classic encoder-decoder structure to form a Siamese structure for the encoders, where one of them takes a target image as input (the image-encoder), and the other concatenates a template image and its foreground regions as input (the template-encoder). The template-encoder encodes the shape priors and appearance characteristics of each foreground class in the template image. A cosine similarity based attention module is proposed to fuse the information from both encoders, to utilize both types of prior information encoded by the template-encoder and model the inter-subject similarity for each foreground class. Extensive experiments on two public datasets demonstrate that our proposed method can produce superior performance to competing methods.

Noha Ghatwary, Pedro Chavarias Solano, Mohamed Ramzy Ibrahim et al.

Colonic polyps are well-recognized precursors to colorectal cancer (CRC), typically detected during colonoscopy. However, the variability in appearance, location, and size of these polyps complicates their detection and removal, leading to challenges in effective surveillance, intervention, and subsequently CRC prevention. The processes of colonoscopy surveillance and polyp removal are highly reliant on the expertise of gastroenterologists and occur within the complexities of the colonic structure. As a result, there is a high rate of missed detections and incomplete removal of colonic polyps, which can adversely impact patient outcomes. Recently, automated methods that use machine learning have been developed to enhance polyps detection and segmentation, thus helping clinical processes and reducing missed rates. These advancements highlight the potential for improving diagnostic accuracy in real-time applications, which ultimately facilitates more effective patient management. Furthermore, integrating sequence data and temporal information could significantly enhance the precision of these methods by capturing the dynamic nature of polyp growth and the changes that occur over time. To rigorously investigate these challenges, data scientists and experts gastroenterologists collaborated to compile a comprehensive dataset that spans multiple centers and diverse populations. This initiative aims to underscore the critical importance of incorporating sequence data and temporal information in the development of robust automated detection and segmentation methods. This study evaluates the applicability of deep learning techniques developed in real-time clinical colonoscopy tasks using sequence data, highlighting the critical role of temporal relationships between frames in improving diagnostic precision.

Zhengrui Guo, Jiabo Ma, Yingxue Xu et al.

Histopathology serves as the gold standard in cancer diagnosis, with clinical reports being vital in interpreting and understanding this process, guiding cancer treatment and patient care. The automation of histopathology report generation with deep learning stands to significantly enhance clinical efficiency and lessen the labor-intensive, time-consuming burden on pathologists in report writing. In pursuit of this advancement, we introduce HistGen, a multiple instance learning-empowered framework for histopathology report generation together with the first benchmark dataset for evaluation. Inspired by diagnostic and report-writing workflows, HistGen features two delicately designed modules, aiming to boost report generation by aligning whole slide images (WSIs) and diagnostic reports from local and global granularity. To achieve this, a local-global hierarchical encoder is developed for efficient visual feature aggregation from a region-to-slide perspective. Meanwhile, a cross-modal context module is proposed to explicitly facilitate alignment and interaction between distinct modalities, effectively bridging the gap between the extensive visual sequences of WSIs and corresponding highly summarized reports. Experimental results on WSI report generation show the proposed model outperforms state-of-the-art (SOTA) models by a large margin. Moreover, the results of fine-tuning our model on cancer subtyping and survival analysis tasks further demonstrate superior performance compared to SOTA methods, showcasing strong transfer learning capability. Dataset, model weights, and source code are available in https://github.com/dddavid4real/HistGen.

Hao Li, Ying Chen, Yifei Chen et al.

Whole Slide Image (WSI) classification is often formulated as a Multiple Instance Learning (MIL) problem. Recently, Vision-Language Models (VLMs) have demonstrated remarkable performance in WSI classification. However, existing methods leverage coarse-grained pathogenetic descriptions for visual representation supervision, which are insufficient to capture the complex visual appearance of pathogenetic images, hindering the generalizability of models on diverse downstream tasks. Additionally, processing high-resolution WSIs can be computationally expensive. In this paper, we propose a novel "Fine-grained Visual-Semantic Interaction" (FiVE) framework for WSI classification. It is designed to enhance the model's generalizability by leveraging the interaction between localized visual patterns and fine-grained pathological semantics. Specifically, with meticulously designed queries, we start by utilizing a large language model to extract fine-grained pathological descriptions from various non-standardized raw reports. The output descriptions are then reconstructed into fine-grained labels used for training. By introducing a Task-specific Fine-grained Semantics (TFS) module, we enable prompts to capture crucial visual information in WSIs, which enhances representation learning and augments generalization capabilities significantly. Furthermore, given that pathological visual patterns are redundantly distributed across tissue slices, we sample a subset of visual instances during training. Our method demonstrates robust generalizability and strong transferability, dominantly outperforming the counterparts on the TCGA Lung Cancer dataset with at least 9.19% higher accuracy in few-shot experiments. The code is available at: https://github.com/ls1rius/WSI_FiVE.

Chenyu Lian, Hong-Yu Zhou, Yizhou Yu et al.

Parameter-efficient fine-tuning (PEFT) that was initially developed for exploiting pre-trained large language models has recently emerged as an effective approach to perform transfer learning on computer vision tasks. However, the effectiveness of PEFT on medical vision foundation models is still unclear and remains to be explored. As a proof of concept, we conducted a detailed empirical study on applying PEFT to chest radiography foundation models. Specifically, we delved into LoRA, a representative PEFT method, and compared it against full-parameter fine-tuning (FFT) on two self-supervised radiography foundation models across three well-established chest radiograph datasets. Our results showed that LoRA outperformed FFT in 13 out of 18 transfer learning tasks by at most 2.9% using fewer than 1% tunable parameters. Combining LoRA with foundation models, we set up new state-of-the-art on a range of data-efficient learning tasks, such as an AUROC score of 80.6% using 1% labeled data on NIH ChestX-ray14. We hope this study can evoke more attention from the community in the use of PEFT for transfer learning on medical imaging tasks. Code and models are available at https://github.com/RL4M/MED-PEFT.

Yunpeng Gao, Chenhui Li, Zhongrui You et al.

Vision-Language Navigation (VLN) aims to guide agents by leveraging language instructions and visual cues, playing a pivotal role in embodied AI. Indoor VLN has been extensively studied, whereas outdoor aerial VLN remains underexplored. The potential reason is that outdoor aerial view encompasses vast areas, making data collection more challenging, which results in a lack of benchmarks. To address this problem, we propose OpenFly, a platform comprising various rendering engines, a versatile toolchain, and a large-scale benchmark for aerial VLN. Firstly, we integrate diverse rendering engines and advanced techniques for environment simulation, including Unreal Engine, GTA V, Google Earth, and 3D Gaussian Splatting (3D GS). Particularly, 3D GS supports real-to-sim rendering, further enhancing the realism of our environments. Secondly, we develop a highly automated toolchain for aerial VLN data collection, streamlining point cloud acquisition, scene semantic segmentation, flight trajectory creation, and instruction generation. Thirdly, based on the toolchain, we construct a large-scale aerial VLN dataset with 100k trajectories, covering diverse heights and lengths across 18 scenes. Moreover, we propose OpenFly-Agent, a keyframe-aware VLN model emphasizing key observations during flight. For benchmarking, extensive experiments and analyses are conducted, evaluating several recent VLN methods and showcasing the superiority of our OpenFly platform and agent. The toolchain, dataset, and codes will be open-sourced.

Qian Dai, Dong Wei, Hong Liu et al.

Most existing federated learning (FL) methods for medical image analysis only considered intramodal heterogeneity, limiting their applicability to multimodal imaging applications. In practice, it is not uncommon that some FL participants only possess a subset of the complete imaging modalities, posing inter-modal heterogeneity as a challenge to effectively training a global model on all participants' data. In addition, each participant would expect to obtain a personalized model tailored for its local data characteristics from the FL in such a scenario. In this work, we propose a new FL framework with federated modality-specific encoders and multimodal anchors (FedMEMA) to simultaneously address the two concurrent issues. Above all, FedMEMA employs an exclusive encoder for each modality to account for the inter-modal heterogeneity in the first place. In the meantime, while the encoders are shared by the participants, the decoders are personalized to meet individual needs. Specifically, a server with full-modal data employs a fusion decoder to aggregate and fuse representations from all modality-specific encoders, thus bridging the modalities to optimize the encoders via backpropagation reversely. Meanwhile, multiple anchors are extracted from the fused multimodal representations and distributed to the clients in addition to the encoder parameters. On the other end, the clients with incomplete modalities calibrate their missing-modal representations toward the global full-modal anchors via scaled dot-product cross-attention, making up the information loss due to absent modalities while adapting the representations of present ones. FedMEMA is validated on the BraTS 2020 benchmark for multimodal brain tumor segmentation. Results show that it outperforms various up-to-date methods for multimodal and personalized FL and that its novel designs are effective. Our code is available.

Chenyu Lian, Hong-Yu Zhou, Dongyun Liang et al.

Medical vision-language alignment through cross-modal contrastive learning shows promising performance in image-text matching tasks, such as retrieval and zero-shot classification. However, conventional cross-modal contrastive learning (CLIP-based) methods suffer from suboptimal visual representation capabilities, which also limits their effectiveness in vision-language alignment. In contrast, although the models pretrained via multimodal masked modeling struggle with direct cross-modal matching, they excel in visual representation. To address this contradiction, we propose ALTA (ALign Through Adapting), an efficient medical vision-language alignment method that utilizes only about 8% of the trainable parameters and less than 1/5 of the computational consumption required for masked record modeling. ALTA achieves superior performance in vision-language matching tasks like retrieval and zero-shot classification by adapting the pretrained vision model from masked record modeling. Additionally, we integrate temporal-multiview radiograph inputs to enhance the information consistency between radiographs and their corresponding descriptions in reports, further improving the vision-language alignment. Experimental evaluations show that ALTA outperforms the best-performing counterpart by over 4% absolute points in text-to-image accuracy and approximately 6% absolute points in image-to-text retrieval accuracy. The adaptation of vision-language models during efficient alignment also promotes better vision and language understanding. Code is publicly available at https://github.com/DopamineLcy/ALTA.

Hao Li, Zhenfeng Zhuang, Jingyu Lin et al.

Due to the diversity of brain anatomy and the scarcity of annotated data, supervised anomaly detection for brain MRI remains challenging, driving the development of unsupervised anomaly detection (UAD) approaches. Current UAD methods typically utilize artificially generated noise perturbations on healthy MRIs to train generative models for normal anatomy reconstruction, enabling anomaly detection via residual mapping. However, such simulated anomalies lack the biophysical fidelity and morphological complexity characteristic of true clinical lesions. To advance UAD in brain MRI, we conduct the first systematic frequency-domain analysis of pathological signatures, revealing two key properties: (1) anomalies exhibit unique frequency patterns distinguishable from normal anatomy, and (2) low-frequency signals maintain consistent representations across healthy scans. These insights motivate our Frequency-Decomposition Preprocessing (FDP) framework, the first UAD method to leverage frequency-domain reconstruction for simultaneous pathology suppression and anatomical preservation. FDP can integrate seamlessly with existing anomaly simulation techniques, consistently enhancing detection performance across diverse architectures while maintaining diagnostic fidelity. Experimental results demonstrate that FDP consistently improves anomaly detection performance when integrated with existing methods. Notably, FDP achieves a 17.63% increase in DICE score with LDM while maintaining robust improvements across multiple baselines. The code is available at https://github.com/ls1rius/MRI_FDP.

Min Cen, Zhenfeng Zhuang, Yuzhe Zhang et al.

Graph-based Multiple Instance Learning (MIL) is widely used in survival analysis with Hematoxylin and Eosin (H\&E)-stained whole slide images (WSIs) due to its ability to capture topological information. However, variations in staining and scanning can introduce semantic bias, while topological subgraphs that are not relevant to the causal relationships can create noise, resulting in biased slide-level representations. These issues can hinder both the interpretability and generalization of the analysis. To tackle this, we introduce a dual structural causal model as the theoretical foundation and propose a novel and interpretable dual causal graph-based MIL model, C$^2$MIL. C$^2$MIL incorporates a novel cross-scale adaptive feature disentangling module for semantic causal intervention and a new Bernoulli differentiable causal subgraph sampling method for topological causal discovery. A joint optimization strategy combining disentangling supervision and contrastive learning enables simultaneous refinement of both semantic and topological causalities. Experiments demonstrate that C$^2$MIL consistently improves generalization and interpretability over existing methods and can serve as a causal enhancement for diverse MIL baselines. The code is available at https://github.com/mimic0127/C2MIL.

Zheng Wang, Hong Liu, Zheng Wang et al.

Survival analysis based on Whole Slide Images (WSIs) is crucial for evaluating cancer prognosis, as they offer detailed microscopic information essential for predicting patient outcomes. However, traditional WSI-based survival analysis usually faces noisy features and limited data accessibility, hindering their ability to capture critical prognostic features effectively. Although pathology reports provide rich patient-specific information that could assist analysis, their potential to enhance WSI-based survival analysis remains largely unexplored. To this end, this paper proposes a novel Report-auxiliary self-distillation (Rasa) framework for WSI-based survival analysis. First, advanced large language models (LLMs) are utilized to extract fine-grained, WSI-relevant textual descriptions from original noisy pathology reports via a carefully designed task prompt. Next, a self-distillation-based pipeline is designed to filter out irrelevant or redundant WSI features for the student model under the guidance of the teacher model's textual knowledge. Finally, a risk-aware mix-up strategy is incorporated during the training of the student model to enhance both the quantity and diversity of the training data. Extensive experiments carried out on our collected data (CRC) and public data (TCGA-BRCA) demonstrate the superior effectiveness of Rasa against state-of-the-art methods. Our code is available at https://github.com/zhengwang9/Rasa.

Junhao Lin, Lei Zhu, Jiaxing Shen et al.

With the rapid development of depth sensor, more and more RGB-D videos could be obtained. Identifying the foreground in RGB-D videos is a fundamental and important task. However, the existing salient object detection (SOD) works only focus on either static RGB-D images or RGB videos, ignoring the collaborating of RGB-D and video information. In this paper, we first collect a new annotated RGB-D video SOD (ViDSOD-100) dataset, which contains 100 videos within a total of 9,362 frames, acquired from diverse natural scenes. All the frames in each video are manually annotated to a high-quality saliency annotation. Moreover, we propose a new baseline model, named attentive triple-fusion network (ATF-Net), for RGB-D video salient object detection. Our method aggregates the appearance information from an input RGB image, spatio-temporal information from an estimated motion map, and the geometry information from the depth map by devising three modality-specific branches and a multi-modality integration branch. The modality-specific branches extract the representation of different inputs, while the multi-modality integration branch combines the multi-level modality-specific features by introducing the encoder feature aggregation (MEA) modules and decoder feature aggregation (MDA) modules. The experimental findings conducted on both our newly introduced ViDSOD-100 dataset and the well-established DAVSOD dataset highlight the superior performance of the proposed ATF-Net. This performance enhancement is demonstrated both quantitatively and qualitatively, surpassing the capabilities of current state-of-the-art techniques across various domains, including RGB-D saliency detection, video saliency detection, and video object segmentation. Our data and our code are available at github.com/jhl-Det/RGBD_Video_SOD.

Zhenfeng Zhuang, Min Cen, Yanfeng Li et al.

Significant disparities between the features of natural images and those inherent to histopathological images make it challenging to directly apply and transfer pre-trained models from natural images to histopathology tasks. Moreover, the frequent lack of annotations in histopathology patch images has driven researchers to explore self-supervised learning methods like mask reconstruction for learning representations from large amounts of unlabeled data. Crucially, previous mask-based efforts in self-supervised learning have often overlooked the spatial interactions among entities, which are essential for constructing accurate representations of pathological entities. To address these challenges, constructing graphs of entities is a promising approach. In addition, the diffusion reconstruction strategy has recently shown superior performance through its random intensity noise addition technique to enhance the robust learned representation. Therefore, we introduce H-MGDM, a novel self-supervised Histopathology image representation learning method through the Dynamic Entity-Masked Graph Diffusion Model. Specifically, we propose to use complementary subgraphs as latent diffusion conditions and self-supervised targets respectively during pre-training. We note that the graph can embed entities' topological relationships and enhance representation. Dynamic conditions and targets can improve pathological fine reconstruction. Our model has conducted pretraining experiments on three large histopathological datasets. The advanced predictive performance and interpretability of H-MGDM are clearly evaluated on comprehensive downstream tasks such as classification and survival analysis on six datasets. Our code will be publicly available at https://github.com/centurion-crawler/H-MGDM.

Jiacheng Wang, Xiaomeng Li, Yiming Han et al.

Automatic delineation of organ-at-risk (OAR) and gross-tumor-volume (GTV) is of great significance for radiotherapy planning. However, it is a challenging task to learn powerful representations for accurate delineation under limited pixel (voxel)-wise annotations. Contrastive learning at pixel-level can alleviate the dependency on annotations by learning dense representations from unlabeled data. Recent studies in this direction design various contrastive losses on the feature maps, to yield discriminative features for each pixel in the map. However, pixels in the same map inevitably share semantics to be closer than they actually are, which may affect the discrimination of pixels in the same map and lead to the unfair comparison to pixels in other maps. To address these issues, we propose a separated region-level contrastive learning scheme, namely SepaReg, the core of which is to separate each image into regions and encode each region separately. Specifically, SepaReg comprises two components: a structure-aware image separation (SIS) module and an intra- and inter-organ distillation (IID) module. The SIS is proposed to operate on the image set to rebuild a region set under the guidance of structural information. The inter-organ representation will be learned from this set via typical contrastive losses cross regions. On the other hand, the IID is proposed to tackle the quantity imbalance in the region set as tiny organs may produce fewer regions, by exploiting intra-organ representations. We conducted extensive experiments to evaluate the proposed model on a public dataset and two private datasets. The experimental results demonstrate the effectiveness of the proposed model, consistently achieving better performance than state-of-the-art approaches. Code is available at https://github.com/jcwang123/Separate_CL.

Zhenfeng Zhuang, Fangyu Zhou, Liansheng Wang

While Large Language Models (LLMs) are emerging as a promising direction in computational pathology, the substantial computational cost of giga-pixel Whole Slide Images (WSIs) necessitates the use of Multi-Instance Learning (MIL) to enable effective modeling. A key challenge is that pathological tasks typically provide only bag-level labels, while instance-level descriptions generated by LLMs often suffer from bias due to a lack of fine-grained medical knowledge. To address this, we propose that constructing task-specific pathological entity prototypes is crucial for learning generalizable features and enhancing model interpretability. Furthermore, existing vision-language MIL methods often employ unidirectional guidance, limiting cross-modal synergy. In this paper, we introduce a novel approach, Multimodal Prototype-based Multi-Instance Learning, that promotes bidirectional interaction through a balanced information compression scheme. Specifically, we leverage a frozen LLM to generate task-specific pathological entity descriptions, which are learned as text prototypes. Concurrently, the vision branch learns instance-level prototypes to mitigate the model's reliance on redundant data. For the fusion stage, we employ the Stereoscopic Optimal Transport (SOT) algorithm, which is based on a similarity metric, thereby facilitating broader semantic alignment in a higher-dimensional space. We conduct few-shot classification and explainability experiments on three distinct cancer datasets, and the results demonstrate the superior generalization capabilities of our proposed method.

Hong Liu, Dong Wei, Donghuan Lu et al.

Layer segmentation is important to quantitative analysis of retinal optical coherence tomography (OCT). Recently, deep learning based methods have been developed to automate this task and yield remarkable performance. However, due to the large spatial gap and potential mismatch between the B-scans of an OCT volume, all of them were based on 2D segmentation of individual B-scans, which may lose the continuity and diagnostic information of the retinal layers in 3D space. Besides, most of these methods required dense annotation of the OCT volumes, which is labor-intensive and expertise-demanding. This work presents a novel framework based on hybrid 2D-3D convolutional neural networks (CNNs) to obtain continuous 3D retinal layer surfaces from OCT volumes, which works well with both full and sparse annotations. The 2D features of individual B-scans are extracted by an encoder consisting of 2D convolutions. These 2D features are then used to produce the alignment displacement vectors and layer segmentation by two 3D decoders coupled via a spatial transformer module. Two losses are proposed to utilize the retinal layers' natural property of being smooth for B-scan alignment and layer segmentation, respectively, and are the key to the semi-supervised learning with sparse annotation. The entire framework is trained end-to-end. To the best of our knowledge, this is the first work that attempts 3D retinal layer segmentation in volumetric OCT images based on CNNs. Experiments on a synthetic dataset and three public clinical datasets show that our framework can effectively align the B-scans for potential motion correction, and achieves superior performance to state-of-the-art 2D deep learning methods in terms of both layer segmentation accuracy and cross-B-scan 3D continuity in both fully and semi-supervised settings, thus offering more clinical values than previous works.

Soumick Chatterjee, Hendrik Mattern, Marc Dörner et al.

The human brain receives nutrients and oxygen through an intricate network of blood vessels. Pathology affecting small vessels, at the mesoscopic scale, represents a critical vulnerability within the cerebral blood supply and can lead to severe conditions, such as Cerebral Small Vessel Diseases. The advent of 7 Tesla MRI systems has enabled the acquisition of higher spatial resolution images, making it possible to visualise such vessels in the brain. However, the lack of publicly available annotated datasets has impeded the development of robust, machine learning-driven segmentation algorithms. To address this, the SMILE-UHURA challenge was organised. This challenge, held in conjunction with the ISBI 2023, in Cartagena de Indias, Colombia, aimed to provide a platform for researchers working on related topics. The SMILE-UHURA challenge addresses the gap in publicly available annotated datasets by providing an annotated dataset of Time-of-Flight angiography acquired with 7T MRI. This dataset was created through a combination of automated pre-segmentation and extensive manual refinement. In this manuscript, sixteen submitted methods and two baseline methods are compared both quantitatively and qualitatively on two different datasets: held-out test MRAs from the same dataset as the training data (with labels kept secret) and a separate 7T ToF MRA dataset where both input volumes and labels are kept secret. The results demonstrate that most of the submitted deep learning methods, trained on the provided training dataset, achieved reliable segmentation performance. Dice scores reached up to 0.838 $\pm$ 0.066 and 0.716 $\pm$ 0.125 on the respective datasets, with an average performance of up to 0.804 $\pm$ 0.15.

Weiping Lin, Shen Liu, Runchen Zhu et al.

Pathology foundation models (PFMs), as large-scale pre-trained models tailored for computational pathology, have significantly advanced a wide range of applications. Their ability to leverage prior knowledge from massive datasets has streamlined the development of intelligent pathology models. However, we identify several critical and interrelated ethical risks that remain underexplored, yet must be addressed to enable the safe translation of PFMs from lab to clinic. These include the potential leakage of patient-sensitive attributes, disparities in model performance across demographic and institutional subgroups, and the reliance on diagnosis-irrelevant features that undermine clinical reliability. In this study, we pioneer the quantitative analysis for ethical risks in PFMs, including privacy leakage, clinical reliability, and group fairness. Specifically, we propose an evaluation framework that systematically measures key dimensions of ethical concern: the degree to which patient-sensitive attributes can be inferred from model representations, the extent of performance disparities across demographic and institutional subgroups, and the influence of diagnostically irrelevant features on model decisions. We further investigate the underlying causes of these ethical risks in PFMs and empirically validate our findings. Then we offer insights into potential directions for mitigating such risks, aiming to inform the development of more ethically robust PFMs. This work provides the first quantitative and systematic evaluation of ethical risks in PFMs. Our findings highlight the urgent need for ethical safeguards in PFMs and offer actionable insights for building more trustworthy and clinically robust PFMs. To facilitate future research and deployment, we will release the assessment framework as an online toolkit to support the development, auditing, and deployment of ethically robust PFMs.

Hong Liu, Dong Wei, Qian Dai et al.

Most existing federated learning (FL) methods for medical image analysis only considered intramodal heterogeneity, limiting their applicability to multimodal imaging applications. In practice, some FL participants may possess only a subset of the complete imaging modalities, posing intermodal heterogeneity as a challenge to effectively training a global model on all participants' data. Meanwhile, each participant expects a personalized model tailored to its local data characteristics in FL. This work proposes a new FL framework with federated modality-specific encoders and partially personalized multimodal fusion decoders (FedMEPD) to address the two concurrent issues. Specifically, FedMEPD employs an exclusive encoder for each modality to account for the intermodal heterogeneity. While these encoders are fully federated, the decoders are partially personalized to meet individual needs -- using the discrepancy between global and local parameter updates to dynamically determine which decoder filters are personalized. Implementation-wise, a server with full-modal data employs a fusion decoder to fuse representations from all modality-specific encoders, thus bridging the modalities to optimize the encoders via backpropagation. Moreover, multiple anchors are extracted from the fused multimodal representations and distributed to the clients in addition to the model parameters. Conversely, the clients with incomplete modalities calibrate their missing-modal representations toward the global full-modal anchors via scaled dot-product cross-attention, making up for the information loss due to absent modalities. FedMEPD is validated on the BraTS 2018 and 2020 multimodal brain tumor segmentation benchmarks. Results show that it outperforms various up-to-date methods for multimodal and personalized FL, and its novel designs are effective.

Haoyue Song, Jiacheng Wang, Liansheng Wang

Federated Learning (FL) has gained attention for addressing data scarcity and privacy concerns. While parallel FL algorithms like FedAvg exhibit remarkable performance, they face challenges in scenarios with diverse network speeds and concerns about centralized control, especially in multi-institutional collaborations like the medical domain. Serial FL presents an alternative solution, circumventing these challenges by transferring model updates serially between devices in a cyclical manner. Nevertheless, it is deemed inferior to parallel FL in that (1) its performance shows undesirable fluctuations, and (2) it converges to a lower plateau, particularly when dealing with non-IID data. The observed phenomenon is attributed to catastrophic forgetting due to knowledge loss from previous sites. In this paper, to overcome fluctuation and low efficiency in the iterative learning and forgetting process, we introduce cyclical weight consolidation (CWC), a straightforward yet potent approach specifically tailored for serial FL. CWC employs a consolidation matrix to regulate local optimization. This matrix tracks the significance of each parameter on the overall federation throughout the entire training trajectory, preventing abrupt changes in significant weights. During revisitation, to maintain adaptability, old memory undergoes decay to incorporate new information. Our comprehensive evaluations demonstrate that in various non-IID settings, CWC mitigates the fluctuation behavior of the original serial FL approach and enhances the converged performance consistently and significantly. The improved performance is either comparable to or better than the parallel vanilla.

Hong Liu, Dong Wei, Qiong Peng et al.

Computed Tomography Report Generation (CTRG) aims to automate the clinical radiology reporting process, thereby reducing the workload of report writing and facilitating patient care. While deep learning approaches have achieved remarkable advances in X-ray report generation, their effectiveness may be limited in CTRG due to larger data volumes of CT images and more intricate details required to describe them. This work introduces a novel two-stage (structure- and report-learning) framework tailored for CTRG featuring effective structure-wise image-text contrasting. In the first stage, a set of learnable structure-specific visual queries observe corresponding structures in a CT image. The resulting observation tokens are contrasted with structure-specific textual features extracted from the accompanying radiology report with a structure-wise image-text contrastive loss. In addition, text-text similarity-based soft pseudo targets are proposed to mitigate the impact of false negatives, i.e., semantically identical image structures and texts from non-paired images and reports. Thus, the model learns structure-level semantic correspondences between CT images and reports. Further, a dynamic, diversity-enhanced negative queue is proposed to guide the network in learning to discriminate various abnormalities. In the second stage, the visual structure queries are frozen and used to select the critical image patch embeddings depicting each anatomical structure, minimizing distractions from irrelevant areas while reducing memory consumption. Also, a text decoder is added and trained for report generation.Our extensive experiments on two public datasets demonstrate that our framework establishes new state-of-the-art performance for CTRG in clinical efficiency, and its components are effective.

Zenan Lin, Wei Li, Jintao Chen et al.

Nuclei instance segmentation in pathological images is crucial for downstream tasks such as tumor microenvironment analysis. However, the high cost and scarcity of annotated data limit the applicability of fully supervised methods, while existing semi-supervised methods fail to adequately regularize consistency at the instance level, lack leverage of the inherent prior knowledge of pathological structures, and are prone to introducing noisy pseudo-labels during training. In this paper, we propose an Instance-Aware Robust Consistency Regularization Network (IRCR-Net) for accurate instance-level nuclei segmentation. Specifically, we introduce the Matching-Driven Instance-Aware Consistency (MIAC) and Prior-Driven Instance-Aware Consistency (PIAC) mechanisms to refine the nuclei instance segmentation result of the teacher and student subnetwork, particularly for densely distributed and overlapping nuclei. We incorporate morphological prior knowledge of nuclei in pathological images and utilize these priors to assess the quality of pseudo-labels generated from unlabeled data. Low-quality pseudo-labels are discarded, while high-quality predictions are enhanced to reduce pseudo-label noise and benefit the network's robust training. Experimental results demonstrate that the proposed method significantly enhances semi-supervised nuclei instance segmentation performance across multiple public datasets compared to existing approaches, even surpassing fully supervised methods in some scenarios.

Huaying Li, Liansheng Wang, Yinran Chen

High-sensitivity clutter filtering is a fundamental step in ultrasound microvascular imaging. Singular value decomposition (SVD) and robust principal component analysis (rPCA) are the main clutter filtering strategies. However, both strategies are limited in feature modeling and tissue-blood flow separation for high-quality microvascular imaging. Recently, deep learning-based clutter filtering has shown potential in more thoroughly separating tissue and blood flow signals. However, the existing supervised filters face the challenges of interpretability and lack of in-vitro and in-vivo ground truths. While the interpretability issue can be addressed by algorithm deep unfolding, the training ground truth remains unsolved. To this end, this paper proposes an unsupervised unfolded rPCA (U2-rPCA) method that preserves mathematical interpretability and is insusceptible to learning labels. Specifically, U2-rPCA is unfolded from an iteratively reweighted least squares (IRLS) rPCA baseline with intrinsic low-rank and sparse regularization. A sparse-enhancement unit is added to the network to strengthen its capability to capture the sparse micro-flow signals. U2-rPCA is like an adaptive filter that is trained with part of the image sequence and then used for the following frames. Experimental validations on a in-silico dataset and public in-vivo datasets demonstrated the outperformance of U2-rPCA when compared with the SVD-based method, the rPCA baseline, and another deep learning-based filter. Particularly, the proposed method improved the contrastto-noise ratio (CNR) of the power Doppler image by 2 dB to 10 dB when compared with other methods. Furthermore, the effectiveness of the building modules of U2-rPCA was validated through ablation studies.

Hangbei Cheng, Xiaorong Dong, Xueyu Liu et al.

Accurate lesion segmentation in histopathology images is essential for diagnostic interpretation and quantitative analysis, yet it remains challenging due to the limited availability of costly pixel-level annotations. To address this, we propose FMaMIL, a novel two-stage framework for weakly supervised lesion segmentation based solely on image-level labels. In the first stage, a lightweight Mamba-based encoder is introduced to capture long-range dependencies across image patches under the MIL paradigm. To enhance spatial sensitivity and structural awareness, we design a learnable frequency-domain encoding module that supplements spatial-domain features with spectrum-based information. CAMs generated in this stage are used to guide segmentation training. In the second stage, we refine the initial pseudo labels via a CAM-guided soft-label supervision and a self-correction mechanism, enabling robust training even under label noise. Extensive experiments on both public and private histopathology datasets demonstrate that FMaMIL outperforms state-of-the-art weakly supervised methods without relying on pixel-level annotations, validating its effectiveness and potential for digital pathology applications.

Xinyi Tan, Jiacheng Wang, Liansheng Wang

Employing self-supervised learning (SSL) methodologies assumes par-amount significance in handling unlabeled polyp datasets when building deep learning-based automatic polyp segmentation models. However, the intricate privacy dynamics surrounding medical data often preclude seamless data sharing among disparate medical centers. Federated learning (FL) emerges as a formidable solution to this privacy conundrum, yet within the realm of FL, optimizing model generalization stands as a pressing imperative. Robust generalization capabilities are imperative to ensure the model's efficacy across diverse geographical domains post-training on localized client datasets. In this paper, a Federated self-supervised Domain Generalization method is proposed to enhance the generalization capacity of federated and Label-efficient intestinal polyp segmentation, named LFDG. Based on a classical SSL method, DropPos, LFDG proposes an adversarial learning-based data augmentation method (SSADA) to enhance the data diversity. LFDG further proposes a relaxation module based on Source-reconstruction and Augmentation-masking (SRAM) to maintain stability in feature learning. We have validated LFDG on polyp images from six medical centers. The performance of our method achieves 3.80% and 3.92% better than the baseline and other recent FL methods and SSL methods, respectively.

Jinghan Sun, Dong Wei, Zhe Xu et al.

Anatomical abnormality detection and report generation of chest X-ray (CXR) are two essential tasks in clinical practice. The former aims at localizing and characterizing cardiopulmonary radiological findings in CXRs, while the latter summarizes the findings in a detailed report for further diagnosis and treatment. Existing methods often focused on either task separately, ignoring their correlation. This work proposes a co-evolutionary abnormality detection and report generation (CoE-DG) framework. The framework utilizes both fully labeled (with bounding box annotations and clinical reports) and weakly labeled (with reports only) data to achieve mutual promotion between the abnormality detection and report generation tasks. Specifically, we introduce a bi-directional information interaction strategy with generator-guided information propagation (GIP) and detector-guided information propagation (DIP). For semi-supervised abnormality detection, GIP takes the informative feature extracted by the generator as an auxiliary input to the detector and uses the generator's prediction to refine the detector's pseudo labels. We further propose an intra-image-modal self-adaptive non-maximum suppression module (SA-NMS). This module dynamically rectifies pseudo detection labels generated by the teacher detection model with high-confidence predictions by the student.Inversely, for report generation, DIP takes the abnormalities' categories and locations predicted by the detector as input and guidance for the generator to improve the generated reports.

Jiacheng Wang, Yueming Jin, Shuntian Cai et al.

We propose a novel shape-aware relation network for accurate and real-time landmark detection in endoscopic submucosal dissection (ESD) surgery. This task is of great clinical significance but extremely challenging due to bleeding, lighting reflection, and motion blur in the complicated surgical environment. Compared with existing solutions, which either neglect geometric relationships among targeting objects or capture the relationships by using complicated aggregation schemes, the proposed network is capable of achieving satisfactory accuracy while maintaining real-time performance by taking full advantage of the spatial relations among landmarks. We first devise an algorithm to automatically generate relation keypoint heatmaps, which are able to intuitively represent the prior knowledge of spatial relations among landmarks without using any extra manual annotation efforts. We then develop two complementary regularization schemes to progressively incorporate the prior knowledge into the training process. While one scheme introduces pixel-level regularization by multi-task learning, the other integrates global-level regularization by harnessing a newly designed grouped consistency evaluator, which adds relation constraints to the proposed network in an adversarial manner. Both schemes are beneficial to the model in training, and can be readily unloaded in inference to achieve real-time detection. We establish a large in-house dataset of ESD surgery for esophageal cancer to validate the effectiveness of our proposed method. Extensive experimental results demonstrate that our approach outperforms state-of-the-art methods in terms of accuracy and efficiency, achieving better detection results faster. Promising results on two downstream applications further corroborate the great potential of our method in ESD clinical practice.

Hong-Yu Zhou, Xiaoyu Chen, Yinghao Zhang et al.

Pre-training lays the foundation for recent successes in radiograph analysis supported by deep learning. It learns transferable image representations by conducting large-scale fully-supervised or self-supervised learning on a source domain. However, supervised pre-training requires a complex and labor intensive two-stage human-assisted annotation process while self-supervised learning cannot compete with the supervised paradigm. To tackle these issues, we propose a cross-supervised methodology named REviewing FreE-text Reports for Supervision (REFERS), which acquires free supervision signals from original radiology reports accompanying the radiographs. The proposed approach employs a vision transformer and is designed to learn joint representations from multiple views within every patient study. REFERS outperforms its transfer learning and self-supervised learning counterparts on 4 well-known X-ray datasets under extremely limited supervision. Moreover, REFERS even surpasses methods based on a source domain of radiographs with human-assisted structured labels. Thus REFERS has the potential to replace canonical pre-training methodologies.

Jinghan Sun, Dong Wei, Kai Ma et al.

Rare diseases are characterized by low prevalence and are often chronically debilitating or life-threatening. Imaging-based classification of rare diseases is challenging due to the severe shortage in training examples. Few-shot learning (FSL) methods tackle this challenge by extracting generalizable prior knowledge from a large base dataset of common diseases and normal controls, and transferring the knowledge to rare diseases. Yet, most existing methods require the base dataset to be labeled and do not make full use of the precious examples of the rare diseases. To this end, we propose in this work a novel hybrid approach to rare disease classification, featuring two key novelties targeted at the above drawbacks. First, we adopt the unsupervised representation learning (URL) based on self-supervising contrastive loss, whereby to eliminate the overhead in labeling the base dataset. Second, we integrate the URL with pseudo-label supervised classification for effective self-distillation of the knowledge about the rare diseases, composing a hybrid approach taking advantages of both unsupervised and (pseudo-) supervised learning on the base dataset. Experimental results on classification of rare skin lesions show that our hybrid approach substantially outperforms existing FSL methods (including those using fully supervised base dataset) for rare disease classification via effective integration of the URL and pseudo-label driven self-distillation, thus establishing a new state of the art.

Jiacheng Wang, Lan Wei, Liansheng Wang et al.

Skin lesion segmentation from dermoscopy images is of great importance for improving the quantitative analysis of skin cancer. However, the automatic segmentation of melanoma is a very challenging task owing to the large variation of melanoma and ambiguous boundaries of lesion areas. While convolutional neutral networks (CNNs) have achieved remarkable progress in this task, most of existing solutions are still incapable of effectively capturing global dependencies to counteract the inductive bias caused by limited receptive fields. Recently, transformers have been proposed as a promising tool for global context modeling by employing a powerful global attention mechanism, but one of their main shortcomings when applied to segmentation tasks is that they cannot effectively extract sufficient local details to tackle ambiguous boundaries. We propose a novel boundary-aware transformer (BAT) to comprehensively address the challenges of automatic skin lesion segmentation. Specifically, we integrate a new boundary-wise attention gate (BAG) into transformers to enable the whole network to not only effectively model global long-range dependencies via transformers but also, simultaneously, capture more local details by making full use of boundary-wise prior knowledge. Particularly, the auxiliary supervision of BAG is capable of assisting transformers to learn position embedding as it provides much spatial information. We conducted extensive experiments to evaluate the proposed BAT and experiments corroborate its effectiveness, consistently outperforming state-of-the-art methods in two famous datasets.

Jiacheng Wang, Yueming Jin, Liansheng Wang et al.

Performing a real-time and accurate instrument segmentation from videos is of great significance for improving the performance of robotic-assisted surgery. We identify two important clues for surgical instrument perception, including local temporal dependency from adjacent frames and global semantic correlation in long-range duration. However, most existing works perform segmentation purely using visual cues in a single frame. Optical flow is just used to model the motion between only two frames and brings heavy computational cost. We propose a novel dual-memory network (DMNet) to wisely relate both global and local spatio-temporal knowledge to augment the current features, boosting the segmentation performance and retaining the real-time prediction capability. We propose, on the one hand, an efficient local memory by taking the complementary advantages of convolutional LSTM and non-local mechanisms towards the relating reception field. On the other hand, we develop an active global memory to gather the global semantic correlation in long temporal range to current one, in which we gather the most informative frames derived from model uncertainty and frame similarity. We have extensively validated our method on two public benchmark surgical video datasets. Experimental results demonstrate that our method largely outperforms the state-of-the-art works on segmentation accuracy while maintaining a real-time speed.

Hong-Yu Zhou, Jiansen Guo, Yinghao Zhang et al.

Transformer, the model of choice for natural language processing, has drawn scant attention from the medical imaging community. Given the ability to exploit long-term dependencies, transformers are promising to help atypical convolutional neural networks to overcome their inherent shortcomings of spatial inductive bias. However, most of recently proposed transformer-based segmentation approaches simply treated transformers as assisted modules to help encode global context into convolutional representations. To address this issue, we introduce nnFormer, a 3D transformer for volumetric medical image segmentation. nnFormer not only exploits the combination of interleaved convolution and self-attention operations, but also introduces local and global volume-based self-attention mechanism to learn volume representations. Moreover, nnFormer proposes to use skip attention to replace the traditional concatenation/summation operations in skip connections in U-Net like architecture. Experiments show that nnFormer significantly outperforms previous transformer-based counterparts by large margins on three public datasets. Compared to nnUNet, nnFormer produces significantly lower HD95 and comparable DSC results. Furthermore, we show that nnFormer and nnUNet are highly complementary to each other in model ensembling.