Yan-Jie Zhou

Feng Zhou, Yanjie Zhou, Longjie Wang et al.

Traditional one-shot medical image segmentation (MIS) methods use registration networks to propagate labels from a reference atlas or rely on comprehensive sampling strategies to generate synthetic labeled data for training. However, these methods often struggle with registration errors and low-quality synthetic images, leading to poor performance and generalization. To overcome this, we introduce a novel one-shot MIS framework based on knowledge distillation, which allows the network to directly 'see' real images through a distillation process guided by image reconstruction. It focuses on anatomical structures in a single labeled image and a few unlabeled ones. A registration-based data augmentation network creates realistic, labeled samples, while a feature distillation module helps the student network learn segmentation from these samples, guided by the teacher network. During inference, the streamlined student network accurately segments new images. Evaluations on three public datasets (OASIS for T1 brain MRI, BCV for abdomen CT, and VerSe for vertebrae CT) show superior segmentation performance and generalization across different medical image datasets and modalities compared to leading methods. Our code is available at https://github.com/NoviceFodder/OS-MedSeg.

Bizhe Bai, Yan-Jie Zhou, Yujian Hu et al.

Pulmonary embolism (PE) is a life-threatening condition where rapid and accurate diagnosis is imperative yet difficult due to predominantly atypical symptomatology. Computed tomography pulmonary angiography (CTPA) is acknowledged as the gold standard imaging tool in clinics, yet it can be contraindicated for emergency department (ED) patients and represents an onerous procedure, thus necessitating PE identification through non-contrast CT (NCT) scans. In this work, we explore the feasibility of applying a deep-learning approach to NCT scans for PE identification. We propose a novel Cross-Phase Mutual learNing framework (CPMN) that fosters knowledge transfer from CTPA to NCT, while concurrently conducting embolism segmentation and abnormality classification in a multi-task manner. The proposed CPMN leverages the Inter-Feature Alignment (IFA) strategy that enhances spatial contiguity and mutual learning between the dual-pathway network, while the Intra-Feature Discrepancy (IFD) strategy can facilitate precise segmentation of PE against complex backgrounds for single-pathway networks. For a comprehensive assessment of the proposed approach, a large-scale dual-phase dataset containing 334 PE patients and 1,105 normal subjects has been established. Experimental results demonstrate that CPMN achieves the leading identification performance, which is 95.4\% and 99.6\% in patient-level sensitivity and specificity on NCT scans, indicating the potential of our approach as an economical, accessible, and precise tool for PE identification in clinical practice.

Tony C. W. Mok, Zi Li, Yunhao Bai et al.

Establishing dense anatomical correspondence across distinct imaging modalities is a foundational yet challenging procedure for numerous medical image analysis studies and image-guided radiotherapy. Existing multi-modality image registration algorithms rely on statistical-based similarity measures or local structural image representations. However, the former is sensitive to locally varying noise, while the latter is not discriminative enough to cope with complex anatomical structures in multimodal scans, causing ambiguity in determining the anatomical correspondence across scans with different modalities. In this paper, we propose a modality-agnostic structural representation learning method, which leverages Deep Neighbourhood Self-similarity (DNS) and anatomy-aware contrastive learning to learn discriminative and contrast-invariance deep structural image representations (DSIR) without the need for anatomical delineations or pre-aligned training images. We evaluate our method on multiphase CT, abdomen MR-CT, and brain MR T1w-T2w registration. Comprehensive results demonstrate that our method is superior to the conventional local structural representation and statistical-based similarity measures in terms of discriminability and accuracy.

Zi Li, Ying Chen, Zeli Chen et al.

In the radiation therapy of nasopharyngeal carcinoma (NPC), clinicians typically delineate the gross tumor volume (GTV) using non-contrast planning computed tomography to ensure accurate radiation dose delivery. However, the low contrast between tumors and adjacent normal tissues necessitates that radiation oncologists manually delineate the tumors, often relying on diagnostic MRI for guidance. % In this study, we propose a novel approach to directly segment NPC gross tumors on non-contrast planning CT images, circumventing potential registration errors when aligning MRI or MRI-derived tumor masks to planning CT. To address the low contrast issues between tumors and adjacent normal structures in planning CT, we introduce a 3D Semantic Asymmetry Tumor segmentation (SATs) method. Specifically, we posit that a healthy nasopharyngeal region is characteristically bilaterally symmetric, whereas the emergence of nasopharyngeal carcinoma disrupts this symmetry. Then, we propose a Siamese contrastive learning segmentation framework that minimizes the voxel-wise distance between original and flipped areas without tumor and encourages a larger distance between original and flipped areas with tumor. Thus, our approach enhances the sensitivity of features to semantic asymmetries. % Extensive experiments demonstrate that the proposed SATs achieves the leading NPC GTV segmentation performance in both internal and external testing, \emph{e.g.}, with at least 2\% absolute Dice score improvement and 12\% average distance error reduction when compared to other state-of-the-art methods in the external testing.

Minfeng Xu, Chen-Chen Fan, Yan-Jie Zhou et al.

Cardiovascular diseases (CVD) remain a leading health concern and contribute significantly to global mortality rates. While clinical advancements have led to a decline in CVD mortality, accurately identifying individuals who could benefit from preventive interventions remains an unsolved challenge in preventive cardiology. Current CVD risk prediction models, recommended by guidelines, are based on limited traditional risk factors or use CT imaging to acquire quantitative biomarkers, and still have limitations in predictive accuracy and applicability. On the other hand, end-to-end trained CVD risk prediction methods leveraging deep learning on CT images often fail to provide transparent and explainable decision grounds for assisting physicians. In this work, we proposed a novel joint representation that integrates discrete quantitative biomarkers and continuous deep features extracted from chest CT scans. Our approach initiated with a deep CVD risk classification model by capturing comprehensive continuous deep learning features while jointly obtaining currently clinical-established quantitative biomarkers via segmentation models. In the feature joint representation stage, we use an instance-wise feature-gated mechanism to align the continuous and discrete features, followed by a soft instance-wise feature interaction mechanism fostering independent and effective feature interaction for the final CVD risk prediction. Our method substantially improves CVD risk predictive performance and offers individual contribution analysis of each biomarker, which is important in assisting physicians' decision-making processes. We validated our method on a public chest low-dose CT dataset and a private external chest standard-dose CT patient cohort of 17,207 CT volumes from 6,393 unique subjects, and demonstrated superior predictive performance, achieving AUCs of 0.875 and 0.843, respectively.

Yujian Hu, Yilang Xiang, Yan-Jie Zhou et al.

The accurate and timely diagnosis of acute aortic syndromes (AAS) in patients presenting with acute chest pain remains a clinical challenge. Aortic CT angiography (CTA) is the imaging protocol of choice in patients with suspected AAS. However, due to economic and workflow constraints in China, the majority of suspected patients initially undergo non-contrast CT as the initial imaging testing, and CTA is reserved for those at higher risk. In this work, we present an artificial intelligence-based warning system, iAorta, using non-contrast CT for AAS identification in China, which demonstrates remarkably high accuracy and provides clinicians with interpretable warnings. iAorta was evaluated through a comprehensive step-wise study. In the multi-center retrospective study (n = 20,750), iAorta achieved a mean area under the receiver operating curve (AUC) of 0.958 (95% CI 0.950-0.967). In the large-scale real-world study (n = 137,525), iAorta demonstrated consistently high performance across various non-contrast CT protocols, achieving a sensitivity of 0.913-0.942 and a specificity of 0.991-0.993. In the prospective comparative study (n = 13,846), iAorta demonstrated the capability to significantly shorten the time to correct diagnostic pathway. For the prospective pilot deployment that we conducted, iAorta correctly identified 21 out of 22 patients with AAS among 15,584 consecutive patients presenting with acute chest pain and under non-contrast CT protocol in the emergency department (ED) and enabled the average diagnostic time of these 21 AAS positive patients to be 102.1 (75-133) mins. Last, the iAorta can help avoid delayed or missed diagnosis of AAS in settings where non-contrast CT remains the unavoidable the initial or only imaging test in resource-constrained regions and in patients who cannot or did not receive intravenous contrast.

Chen-Chen Fan, Haiqun Xie, Liang Peng et al.

Medical diagnostic robot systems have been paid more and more attention due to its objectivity and accuracy. The diagnosis of mild cognitive impairment (MCI) is considered an effective means to prevent Alzheimer's disease (AD). Doctors diagnose MCI based on various clinical examinations, which are expensive and the diagnosis results rely on the knowledge of doctors. Therefore, it is necessary to develop a robot diagnostic system to eliminate the influence of human factors and obtain a higher accuracy rate. In this paper, we propose a novel Group Feature Domain Adversarial Neural Network (GF-DANN) for amnestic MCI (aMCI) diagnosis, which involves two important modules. A Group Feature Extraction (GFE) module is proposed to reduce individual differences by learning group-level features through adversarial learning. A Dual Branch Domain Adaptation (DBDA) module is carefully designed to reduce the distribution difference between the source and target domain in a domain adaption way. On three types of data set, GF-DANN achieves the best accuracy compared with classic machine learning and deep learning methods. On the DMS data set, GF-DANN has obtained an accuracy rate of 89.47%, and the sensitivity and specificity are 90% and 89%. In addition, by comparing three EEG data collection paradigms, our results demonstrate that the DMS paradigm has the potential to build an aMCI diagnose robot system.

Tobias Ross, Annika Reinke, Peter M. Full et al.

Intraoperative tracking of laparoscopic instruments is often a prerequisite for computer and robotic-assisted interventions. While numerous methods for detecting, segmenting and tracking of medical instruments based on endoscopic video images have been proposed in the literature, key limitations remain to be addressed: Firstly, robustness, that is, the reliable performance of state-of-the-art methods when run on challenging images (e.g. in the presence of blood, smoke or motion artifacts). Secondly, generalization; algorithms trained for a specific intervention in a specific hospital should generalize to other interventions or institutions. In an effort to promote solutions for these limitations, we organized the Robust Medical Instrument Segmentation (ROBUST-MIS) challenge as an international benchmarking competition with a specific focus on the robustness and generalization capabilities of algorithms. For the first time in the field of endoscopic image processing, our challenge included a task on binary segmentation and also addressed multi-instance detection and segmentation. The challenge was based on a surgical data set comprising 10,040 annotated images acquired from a total of 30 surgical procedures from three different types of surgery. The validation of the competing methods for the three tasks (binary segmentation, multi-instance detection and multi-instance segmentation) was performed in three different stages with an increasing domain gap between the training and the test data. The results confirm the initial hypothesis, namely that algorithm performance degrades with an increasing domain gap. While the average detection and segmentation quality of the best-performing algorithms is high, future research should concentrate on detection and segmentation of small, crossing, moving and transparent instrument(s) (parts).

Zhen-Liang Ni, Gui-Bin Bian, Xiao-Hu Zhou et al.

Semantic segmentation of surgical instruments plays a crucial role in robot-assisted surgery. However, accurate segmentation of cataract surgical instruments is still a challenge due to specular reflection and class imbalance issues. In this paper, an attention-guided network is proposed to segment the cataract surgical instrument. A new attention module is designed to learn discriminative features and address the specular reflection issue. It captures global context and encodes semantic dependencies to emphasize key semantic features, boosting the feature representation. This attention module has very few parameters, which helps to save memory. Thus, it can be flexibly plugged into other networks. Besides, a hybrid loss is introduced to train our network for addressing the class imbalance issue, which merges cross entropy and logarithms of Dice loss. A new dataset named Cata7 is constructed to evaluate our network. To the best of our knowledge, this is the first cataract surgical instrument dataset for semantic segmentation. Based on this dataset, RAUNet achieves state-of-the-art performance 97.71% mean Dice and 95.62% mean IOU.

Zhen-Liang Ni, Gui-Bin Bian, Xiao-Liang Xie et al.

Segmentation for tracking surgical instruments plays an important role in robot-assisted surgery. Segmentation of surgical instruments contributes to capturing accurate spatial information for tracking. In this paper, a novel network, Refined Attention Segmentation Network, is proposed to simultaneously segment surgical instruments and identify their categories. The U-shape network which is popular in segmentation is used. Different from previous work, an attention module is adopted to help the network focus on key regions, which can improve the segmentation accuracy. To solve the class imbalance problem, the weighted sum of the cross entropy loss and the logarithm of the Jaccard index is used as loss function. Furthermore, transfer learning is adopted in our network. The encoder is pre-trained on ImageNet. The dataset from the MICCAI EndoVis Challenge 2017 is used to evaluate our network. Based on this dataset, our network achieves state-of-the-art performance 94.65% mean Dice and 90.33% mean IOU.