Jakob Dexl

Katharina Jeblick, Balthasar Schachtner, Jakob Dexl et al.

The release of ChatGPT, a language model capable of generating text that appears human-like and authentic, has gained significant attention beyond the research community. We expect that the convincing performance of ChatGPT incentivizes users to apply it to a variety of downstream tasks, including prompting the model to simplify their own medical reports. To investigate this phenomenon, we conducted an exploratory case study. In a questionnaire, we asked 15 radiologists to assess the quality of radiology reports simplified by ChatGPT. Most radiologists agreed that the simplified reports were factually correct, complete, and not potentially harmful to the patient. Nevertheless, instances of incorrect statements, missed key medical findings, and potentially harmful passages were reported. While further studies are needed, the initial insights of this study indicate a great potential in using large language models like ChatGPT to improve patient-centered care in radiology and other medical domains.

Marc Aubreville, Nikolas Stathonikos, Christof A. Bertram et al.

The density of mitotic figures within tumor tissue is known to be highly correlated with tumor proliferation and thus is an important marker in tumor grading. Recognition of mitotic figures by pathologists is known to be subject to a strong inter-rater bias, which limits the prognostic value. State-of-the-art deep learning methods can support the expert in this assessment but are known to strongly deteriorate when applied in a different clinical environment than was used for training. One decisive component in the underlying domain shift has been identified as the variability caused by using different whole slide scanners. The goal of the MICCAI MIDOG 2021 challenge has been to propose and evaluate methods that counter this domain shift and derive scanner-agnostic mitosis detection algorithms. The challenge used a training set of 200 cases, split across four scanning systems. As a test set, an additional 100 cases split across four scanning systems, including two previously unseen scanners, were given. The best approaches performed on an expert level, with the winning algorithm yielding an F_1 score of 0.748 (CI95: 0.704-0.781). In this paper, we evaluate and compare the approaches that were submitted to the challenge and identify methodological factors contributing to better performance.

Jakob Dexl, Katharina Jeblick, Andreas Mittermeier et al.

We report the design and results of the third autoPET challenge (MICCAI 2024), which benchmarked automated lesion segmentation in whole-body PET/CT under a compositional generalization setting. Training data comprised 1,014 [18F]-FDG PET/CT studies from the University Hospital Tübingen and 597 [18F]/[68Ga]-PSMA PET/CT studies from the LMU University Hospital Munich, constituting the largest publicly available annotated PSMA PET/CT dataset to date. The held-out test set of 200 studies covered four tracer-center combinations, two of which represented unseen compositional pairings. A complementary data-centric award category isolated the contribution of data handling strategies by restricting participants to a fixed baseline model. Seventeen teams submitted 27 algorithms, predominantly nnU-Net-based 3D networks with PET/CT channel concatenation. The top-ranked algorithm achieved a mean DSC of 0.66, FNV of 3.18 mL, and FPV of 2.78 mL across all four test conditions, improving DSC by 8% and reducing the false-negative volume by 5 mL relative to the provided baseline. Ranking was stable across bootstrap resampling and alternative ranking schemes for the top tier. Beyond the benchmark, we provide an in-depth analysis of segmentation performance at the patient and lesion level. Three main conclusions can be drawn: (1) in-domain multitracer PET/CT segmentation is sufficient and probably approaching reader agreement; (2) compositional generalization to unseen tracer-center combinations remains an open problem mainly driven by systematic volume overestimation; (3) heterogeneity and case difficulty drive performance variation substantially more than the choice of algorithm among top-ranked teams.

Tobias Weber, Jakob Dexl, David Rügamer et al.

We address the computational barrier of deploying advanced deep learning segmentation models in clinical settings by studying the efficacy of network compression through tensor decomposition. We propose a post-training Tucker factorization that enables the decomposition of pre-existing models to reduce computational requirements without impeding segmentation accuracy. We applied Tucker decomposition to the convolutional kernels of the TotalSegmentator (TS) model, an nnU-Net model trained on a comprehensive dataset for automatic segmentation of 117 anatomical structures. Our approach reduced the floating-point operations (FLOPs) and memory required during inference, offering an adjustable trade-off between computational efficiency and segmentation quality. This study utilized the publicly available TS dataset, employing various downsampling factors to explore the relationship between model size, inference speed, and segmentation performance. The application of Tucker decomposition to the TS model substantially reduced the model parameters and FLOPs across various compression rates, with limited loss in segmentation accuracy. We removed up to 88% of the model's parameters with no significant performance changes in the majority of classes after fine-tuning. Practical benefits varied across different graphics processing unit (GPU) architectures, with more distinct speed-ups on less powerful hardware. Post-hoc network compression via Tucker decomposition presents a viable strategy for reducing the computational demand of medical image segmentation models without substantially sacrificing accuracy. This approach enables the broader adoption of advanced deep learning technologies in clinical practice, offering a way to navigate the constraints of hardware capabilities.

Jakob Dexl, Michaela Benz, Volker Bruns et al.

Mitotic figure detection is a challenging task in digital pathology that has a direct impact on therapeutic decisions. While automated methods often achieve acceptable results under laboratory conditions, they frequently fail in the clinical deployment phase. This problem can be mainly attributed to a phenomenon called domain shift. An important source of a domain shift is introduced by different microscopes and their camera systems, which noticeably change the color representation of digitized images. In this method description we present our submitted algorithm for the Mitosis Domain Generalization Challenge, which employs a RetinaNet trained with strong data augmentation and achieves an F1 score of 0.7138 on the preliminary test set.

Frauke Wilm, Michaela Benz, Volker Bruns et al.

Automatic outlining of different tissue types in digitized histological specimen provides a basis for follow-up analyses and can potentially guide subsequent medical decisions. The immense size of whole-slide-images (WSI), however, poses a challenge in terms of computation time. In this regard, the analysis of non-overlapping patches outperforms pixelwise segmentation approaches, but still leaves room for optimization. Furthermore, the division into patches, regardless of the biological structures they contain, is a drawback due to the loss of local dependencies. We propose to subdivide the WSI into coherent regions prior to classification by grouping visually similar adjacent pixels into superpixels. Afterwards, only a random subset of patches per superpixel is classified and patch labels are combined into a superpixel label. We propose a metric for identifying superpixels with an uncertain classification and evaluate two medical applications, namely tumor area and invasive margin estimation and tumor composition analysis. The algorithm has been developed on 159 hand-annotated WSIs of colon resections and its performance is compared to an analysis without prior segmentation. The algorithm shows an average speed-up of 41% and an increase in accuracy from 93.8% to 95.7%. By assigning a rejection label to uncertain superpixels, we further increase the accuracy by 0.4%. Whilst tumor area estimation shows high concordance to the annotated area, the analysis of tumor composition highlights limitations of our approach. By combining superpixel segmentation and patch classification, we designed a fast and accurate framework for whole-slide cartography that is AI-model agnostic and provides the basis for various medical endpoints.