Fausto Milletari

Fausto Milletari, Johann Frei, Seyed-Ahmad Ahmadi

Deep learning has been recently applied to a multitude of computer vision and medical image analysis problems. Although recent research efforts have improved the state of the art, most of the methods cannot be easily accessed, compared or used by either researchers or the general public. Researchers often publish their code and trained models on the internet, but this does not always enable these approaches to be easily used or integrated in stand-alone applications and existing workflows. In this paper we propose a framework which allows easy deployment and access of deep learning methods for segmentation through a cloud-based architecture. Our approach comprises three parts: a server, which wraps trained deep learning models and their pre- and post-processing data pipelines and makes them available on the cloud; a client which interfaces with the server to obtain predictions on user data; a service registry that informs clients about available prediction endpoints that are available in the cloud. These three parts constitute the open-source TOMAAT framework.

Eric Zimmermann, Neil Tenenholtz, James Hall et al.

Self-supervised learning (SSL) has emerged as a key technique for training networks that can generalize well to diverse tasks without task-specific supervision. This property makes SSL desirable for computational pathology, the study of digitized images of tissues, as there are many target applications and often limited labeled training samples. However, SSL algorithms and models have been primarily developed in the field of natural images and whether their performance can be improved by adaptation to particular domains remains an open question. In this work, we present an investigation of modifications to SSL for pathology data, specifically focusing on the DINOv2 algorithm. We propose alternative augmentations, regularization functions, and position encodings motivated by the characteristics of pathology images. We evaluate the impact of these changes on several benchmarks to demonstrate the value of tailored approaches.

Dong Yang, Holger Roth, Ziyue Xu et al.

Deep neural network (DNN) based approaches have been widely investigated and deployed in medical image analysis. For example, fully convolutional neural networks (FCN) achieve the state-of-the-art performance in several applications of 2D/3D medical image segmentation. Even the baseline neural network models (U-Net, V-Net, etc.) have been proven to be very effective and efficient when the training process is set up properly. Nevertheless, to fully exploit the potentials of neural networks, we propose an automated searching approach for the optimal training strategy with reinforcement learning. The proposed approach can be utilized for tuning hyper-parameters, and selecting necessary data augmentation with certain probabilities. The proposed approach is validated on several tasks of 3D medical image segmentation. The performance of the baseline model is boosted after searching, and it can achieve comparable accuracy to other manually-tuned state-of-the-art segmentation approaches.

Nicola Rieke, Jonny Hancox, Wenqi Li et al.

Data-driven Machine Learning has emerged as a promising approach for building accurate and robust statistical models from medical data, which is collected in huge volumes by modern healthcare systems. Existing medical data is not fully exploited by ML primarily because it sits in data silos and privacy concerns restrict access to this data. However, without access to sufficient data, ML will be prevented from reaching its full potential and, ultimately, from making the transition from research to clinical practice. This paper considers key factors contributing to this issue, explores how Federated Learning (FL) may provide a solution for the future of digital health and highlights the challenges and considerations that need to be addressed.

Wentao Zhu, Andriy Myronenko, Ziyue Xu et al.

Registration is a fundamental task in medical image analysis which can be applied to several tasks including image segmentation, intra-operative tracking, multi-modal image alignment, and motion analysis. Popular registration tools such as ANTs and NiftyReg optimize an objective function for each pair of images from scratch which is time-consuming for large images with complicated deformation. Facilitated by the rapid progress of deep learning, learning-based approaches such as VoxelMorph have been emerging for image registration. These approaches can achieve competitive performance in a fraction of a second on advanced GPUs. In this work, we construct a neural registration framework, called NeurReg, with a hybrid loss of displacement fields and data similarity, which substantially improves the current state-of-the-art of registrations. Within the framework, we simulate various transformations by a registration simulator which generates fixed image and displacement field ground truth for training. Furthermore, we design three segmentation frameworks based on the proposed registration framework: 1) atlas-based segmentation, 2) joint learning of both segmentation and registration tasks, and 3) multi-task learning with atlas-based segmentation as an intermediate feature. Extensive experimental results validate the effectiveness of the proposed NeurReg framework based on various metrics: the endpoint error (EPE) of the predicted displacement field, mean square error (MSE), normalized local cross-correlation (NLCC), mutual information (MI), Dice coefficient, uncertainty estimation, and the interpretability of the segmentation. The proposed NeurReg improves registration accuracy with fast inference speed, which can greatly accelerate related medical image analysis tasks.

Holger Roth, Ling Zhang, Dong Yang et al.

Annotation of medical images has been a major bottleneck for the development of accurate and robust machine learning models. Annotation is costly and time-consuming and typically requires expert knowledge, especially in the medical domain. Here, we propose to use minimal user interaction in the form of extreme point clicks in order to train a segmentation model that can, in turn, be used to speed up the annotation of medical images. We use extreme points in each dimension of a 3D medical image to constrain an initial segmentation based on the random walker algorithm. This segmentation is then used as a weak supervisory signal to train a fully convolutional network that can segment the organ of interest based on the provided user clicks. We show that the network's predictions can be refined through several iterations of training and prediction using the same weakly annotated data. Ultimately, our method has the potential to speed up the generation process of new training datasets for the development of new machine learning and deep learning-based models for, but not exclusively, medical image analysis.

Ziyue Xu, Xiaosong Wang, Hoo-Chang Shin et al.

Radiogenomic map linking image features and gene expression profiles is useful for noninvasively identifying molecular properties of a particular type of disease. Conventionally, such map is produced in three separate steps: 1) gene-clustering to "metagenes", 2) image feature extraction, and 3) statistical correlation between metagenes and image features. Each step is independently performed and relies on arbitrary measurements. In this work, we investigate the potential of an end-to-end method fusing gene data with image features to generate synthetic image and learn radiogenomic map simultaneously. To achieve this goal, we develop a generative adversarial network (GAN) conditioned on both background images and gene expression profiles, synthesizing the corresponding image. Image and gene features are fused at different scales to ensure the realism and quality of the synthesized image. We tested our method on non-small cell lung cancer (NSCLC) dataset. Results demonstrate that the proposed method produces realistic synthetic images, and provides a promising way to find gene-image relationship in a holistic end-to-end manner.

Tomas Sakinis, Fausto Milletari, Holger Roth et al.

Image segmentation plays an essential role in medicine for both diagnostic and interventional tasks. Segmentation approaches are either manual, semi-automated or fully-automated. Manual segmentation offers full control over the quality of the results, but is tedious, time consuming and prone to operator bias. Fully automated methods require no human effort, but often deliver sub-optimal results without providing users with the means to make corrections. Semi-automated approaches keep users in control of the results by providing means for interaction, but the main challenge is to offer a good trade-off between precision and required interaction. In this paper we present a deep learning (DL) based semi-automated segmentation approach that aims to be a "smart" interactive tool for region of interest delineation in medical images. We demonstrate its use for segmenting multiple organs on computed tomography (CT) of the abdomen. Our approach solves some of the most pressing clinical challenges: (i) it requires only one to a few user clicks to deliver excellent 2D segmentations in a fast and reliable fashion; (ii) it can generalize to previously unseen structures and "corner cases"; (iii) it delivers results that can be corrected quickly in a smart and intuitive way up to an arbitrary degree of precision chosen by the user and (iv) ensures high accuracy. We present our approach and compare it to other techniques and previous work to show the advantages brought by our method.

Fausto Milletari, Vighnesh Birodkar, Michal Sofka

Point of care ultrasound (POCUS) consists in the use of ultrasound imaging in critical or emergency situations to support clinical decisions by healthcare professionals and first responders. In this setting it is essential to be able to provide means to obtain diagnostic data to potentially inexperienced users who did not receive an extensive medical training. Interpretation and acquisition of ultrasound images is not trivial. First, the user needs to find a suitable sound window which can be used to get a clear image, and then he needs to correctly interpret it to perform a diagnosis. Although many recent approaches focus on developing smart ultrasound devices that add interpretation capabilities to existing systems, our goal in this paper is to present a reinforcement learning (RL) strategy which is capable to guide novice users to the correct sonic window and enable them to obtain clinically relevant pictures of the anatomy of interest. We apply our approach to cardiac images acquired from the parasternal long axis (PLAx) view of the left ventricle of the heart.

Fausto Milletari, Nicola Rieke, Maximilian Baust et al.

Recent neural-network-based architectures for image segmentation make extensive usage of feature forwarding mechanisms to integrate information from multiple scales. Although yielding good results, even deeper architectures and alternative methods for feature fusion at different resolutions have been scarcely investigated for medical applications. In this work we propose to implement segmentation via an encoder-decoder architecture which differs from any other previously published method since (i) it employs a very deep architecture based on residual learning and (ii) combines features via a convolutional Long Short Term Memory (LSTM), instead of concatenation or summation. The intuition is that the memory mechanism implemented by LSTMs can better integrate features from different scales through a coarse-to-fine strategy; hence the name Coarse-to-Fine Context Memory (CFCM). We demonstrate the remarkable advantages of this approach on two datasets: the Montgomery county lung segmentation dataset, and the EndoVis 2015 challenge dataset for surgical instrument segmentation.

Gerda Bortsova, Michael Sterr, Lichao Wang et al.

Intestinal enteroendocrine cells secrete hormones that are vital for the regulation of glucose metabolism but their differentiation from intestinal stem cells is not fully understood. Asymmetric stem cell divisions have been linked to intestinal stem cell homeostasis and secretory fate commitment. We monitored cell divisions using 4D live cell imaging of cultured intestinal crypts to characterize division modes by means of measurable features such as orientation or shape. A statistical analysis of these measurements requires annotation of mitosis events, which is currently a tedious and time-consuming task that has to be performed manually. To assist data processing, we developed a learning based method to automatically detect mitosis events. The method contains a dual-phase framework for joint detection of dividing cells (mothers) and their progeny (daughters). In the first phase we detect mother and daughters independently using Hough Forest whilst in the second phase we associate mother and daughters by modelling their joint probability as Conditional Random Field (CRF). The method has been evaluated on 32 movies and has achieved an AUC of 72%, which can be used in conjunction with manual correction and dramatically speed up the processing pipeline.

Wadim Kehl, Fausto Milletari, Federico Tombari et al.

We present a 3D object detection method that uses regressed descriptors of locally-sampled RGB-D patches for 6D vote casting. For regression, we employ a convolutional auto-encoder that has been trained on a large collection of random local patches. During testing, scene patch descriptors are matched against a database of synthetic model view patches and cast 6D object votes which are subsequently filtered to refined hypotheses. We evaluate on three datasets to show that our method generalizes well to previously unseen input data, delivers robust detection results that compete with and surpass the state-of-the-art while being scalable in the number of objects.

Fausto Milletari, Nassir Navab, Seyed-Ahmad Ahmadi

Convolutional Neural Networks (CNNs) have been recently employed to solve problems from both the computer vision and medical image analysis fields. Despite their popularity, most approaches are only able to process 2D images while most medical data used in clinical practice consists of 3D volumes. In this work we propose an approach to 3D image segmentation based on a volumetric, fully convolutional, neural network. Our CNN is trained end-to-end on MRI volumes depicting prostate, and learns to predict segmentation for the whole volume at once. We introduce a novel objective function, that we optimise during training, based on Dice coefficient. In this way we can deal with situations where there is a strong imbalance between the number of foreground and background voxels. To cope with the limited number of annotated volumes available for training, we augment the data applying random non-linear transformations and histogram matching. We show in our experimental evaluation that our approach achieves good performances on challenging test data while requiring only a fraction of the processing time needed by other previous methods.

Fausto Milletari, Seyed-Ahmad Ahmadi, Christine Kroll et al.

In this work we propose a novel approach to perform segmentation by leveraging the abstraction capabilities of convolutional neural networks (CNNs). Our method is based on Hough voting, a strategy that allows for fully automatic localisation and segmentation of the anatomies of interest. This approach does not only use the CNN classification outcomes, but it also implements voting by exploiting the features produced by the deepest portion of the network. We show that this learning-based segmentation method is robust, multi-region, flexible and can be easily adapted to different modalities. In the attempt to show the capabilities and the behaviour of CNNs when they are applied to medical image analysis, we perform a systematic study of the performances of six different network architectures, conceived according to state-of-the-art criteria, in various situations. We evaluate the impact of both different amount of training data and different data dimensionality (2D, 2.5D and 3D) on the final results. We show results on both MRI and transcranial US volumes depicting respectively 26 regions of the basal ganglia and the midbrain.