Anton S. Becker

Gabriele Campanella, David Ho, Ida Häggström et al.

Lung cancer is the leading cause of cancer death worldwide, with lung adenocarcinoma being the most prevalent form of lung cancer. EGFR positive lung adenocarcinomas have been shown to have high response rates to TKI therapy, underlying the essential nature of molecular testing for lung cancers. Despite current guidelines consider testing necessary, a large portion of patients are not routinely profiled, resulting in millions of people not receiving the optimal treatment for their lung cancer. Sequencing is the gold standard for molecular testing of EGFR mutations, but it can take several weeks for results to come back, which is not ideal in a time constrained scenario. The development of alternative screening tools capable of detecting EGFR mutations quickly and cheaply while preserving tissue for sequencing could help reduce the amount of sub-optimally treated patients. We propose a multi-modal approach which integrates pathology images and clinical variables to predict EGFR mutational status achieving an AUC of 84% on the largest clinical cohort to date. Such a computational model could be deployed at large at little additional cost. Its clinical application could reduce the number of patients who receive sub-optimal treatments by 53.1% in China, and up to 96.6% in the US.

Krishna Chaitanya, Neerav Karani, Christian F. Baumgartner et al.

Supervised learning-based segmentation methods typically require a large number of annotated training data to generalize well at test time. In medical applications, curating such datasets is not a favourable option because acquiring a large number of annotated samples from experts is time-consuming and expensive. Consequently, numerous methods have been proposed in the literature for learning with limited annotated examples. Unfortunately, the proposed approaches in the literature have not yet yielded significant gains over random data augmentation for image segmentation, where random augmentations themselves do not yield high accuracy. In this work, we propose a novel task-driven data augmentation method for learning with limited labeled data where the synthetic data generator, is optimized for the segmentation task. The generator of the proposed method models intensity and shape variations using two sets of transformations, as additive intensity transformations and deformation fields. Both transformations are optimized using labeled as well as unlabeled examples in a semi-supervised framework. Our experiments on three medical datasets, namely cardic, prostate and pancreas, show that the proposed approach significantly outperforms standard augmentation and semi-supervised approaches for image segmentation in the limited annotation setting. The code is made publicly available at https://github.com/krishnabits001/task$\_$driven$\_$data$\_$augmentation.

Hongwei Bran Li, Fernando Navarro, Ivan Ezhov et al.

Uncertainty in medical image segmentation tasks, especially inter-rater variability, arising from differences in interpretations and annotations by various experts, presents a significant challenge in achieving consistent and reliable image segmentation. This variability not only reflects the inherent complexity and subjective nature of medical image interpretation but also directly impacts the development and evaluation of automated segmentation algorithms. Accurately modeling and quantifying this variability is essential for enhancing the robustness and clinical applicability of these algorithms. We report the set-up and summarize the benchmark results of the Quantification of Uncertainties in Biomedical Image Quantification Challenge (QUBIQ), which was organized in conjunction with International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2020 and 2021. The challenge focuses on the uncertainty quantification of medical image segmentation which considers the omnipresence of inter-rater variability in imaging datasets. The large collection of images with multi-rater annotations features various modalities such as MRI and CT; various organs such as the brain, prostate, kidney, and pancreas; and different image dimensions 2D-vs-3D. A total of 24 teams submitted different solutions to the problem, combining various baseline models, Bayesian neural networks, and ensemble model techniques. The obtained results indicate the importance of the ensemble models, as well as the need for further research to develop efficient 3D methods for uncertainty quantification methods in 3D segmentation tasks.

Christian F. Baumgartner, Kerem C. Tezcan, Krishna Chaitanya et al.

Segmentation of anatomical structures and pathologies is inherently ambiguous. For instance, structure borders may not be clearly visible or different experts may have different styles of annotating. The majority of current state-of-the-art methods do not account for such ambiguities but rather learn a single mapping from image to segmentation. In this work, we propose a novel method to model the conditional probability distribution of the segmentations given an input image. We derive a hierarchical probabilistic model, in which separate latent variables are responsible for modelling the segmentation at different resolutions. Inference in this model can be efficiently performed using the variational autoencoder framework. We show that our proposed method can be used to generate significantly more realistic and diverse segmentation samples compared to recent related work, both, when trained with annotations from a single or multiple annotators.

Lukas Jendele, Ondrej Skopek, Anton S. Becker et al.

Supervised deep learning relies on the assumption that enough training data is available, which presents a problem for its application to several fields, like medical imaging. On the example of a binary image classification task (breast cancer recognition), we show that pretraining a generative model for meaningful image augmentation helps enhance the performance of the resulting classifier. By augmenting the data, performance on downstream classification tasks could be improved even with a relatively small training set. We show that this "adversarial augmentation" yields promising results compared to classical image augmentation on the example of breast cancer classification.

Krishna Chaitanya, Neerav Karani, Christian Baumgartner et al.

Supervised deep learning methods for segmentation require large amounts of labelled training data, without which they are prone to overfitting, not generalizing well to unseen images. In practice, obtaining a large number of annotations from clinical experts is expensive and time-consuming. One way to address scarcity of annotated examples is data augmentation using random spatial and intensity transformations. Recently, it has been proposed to use generative models to synthesize realistic training examples, complementing the random augmentation. So far, these methods have yielded limited gains over the random augmentation. However, there is potential to improve the approach by (i) explicitly modeling deformation fields (non-affine spatial transformation) and intensity transformations and (ii) leveraging unlabelled data during the generative process. With this motivation, we propose a novel task-driven data augmentation method where to synthesize new training examples, a generative network explicitly models and applies deformation fields and additive intensity masks on existing labelled data, modeling shape and intensity variations, respectively. Crucially, the generative model is optimized to be conducive to the task, in this case segmentation, and constrained to match the distribution of images observed from labelled and unlabelled samples. Furthermore, explicit modeling of deformation fields allow synthesizing segmentation masks and images in exact correspondence by simply applying the generated transformation to an input image and the corresponding annotation. Our experiments on cardiac magnetic resonance images (MRI) showed that, for the task of segmentation in small training data scenarios, the proposed method substantially outperforms conventional augmentation techniques.

Anton S. Becker, Lukas Jendele, Ondrej Skopek et al.

$\textbf{Purpose}$ To train a cycle-consistent generative adversarial network (CycleGAN) on mammographic data to inject or remove features of malignancy, and to determine whether these AI-mediated attacks can be detected by radiologists. $\textbf{Material and Methods}$ From the two publicly available datasets, BCDR and INbreast, we selected images from cancer patients and healthy controls. An internal dataset served as test data, withheld during training. We ran two experiments training CycleGAN on low and higher resolution images ($256 \times 256$ px and $512 \times 408$ px). Three radiologists read the images and rated the likelihood of malignancy on a scale from 1-5 and the likelihood of the image being manipulated. The readout was evaluated by ROC analysis (Area under the ROC curve = AUC). $\textbf{Results}$ At the lower resolution, only one radiologist exhibited markedly lower detection of cancer (AUC=0.85 vs 0.63, p=0.06), while the other two were unaffected (0.67 vs. 0.69 and 0.75 vs. 0.77, p=0.55). Only one radiologist could discriminate between original and modified images slightly better than guessing/chance (0.66, p=0.008). At the higher resolution, all radiologists showed significantly lower detection rate of cancer in the modified images (0.77-0.84 vs. 0.59-0.69, p=0.008), however, they were now able to reliably detect modified images due to better visibility of artifacts (0.92, 0.92 and 0.97). $\textbf{Conclusion}$ A CycleGAN can implicitly learn malignant features and inject or remove them so that a substantial proportion of small mammographic images would consequently be misdiagnosed. At higher resolutions, however, the method is currently limited and has a clear trade-off between manipulation of images and introduction of artifacts.