Zahra Bashir

Manxi Lin, Zahra Bashir, Martin Grønnebæk Tolsgaard et al.

Curvilinear structure segmentation is important in medical imaging, quantifying structures such as vessels, airways, neurons, or organ boundaries in 2D slices. Segmentation via pixel-wise classification often fails to capture the small and low-contrast curvilinear structures. Prior topological information is typically used to address this problem, often at an expensive computational cost, and sometimes requiring prior knowledge of the expected topology. We present DTU-Net, a data-driven approach to topology-preserving curvilinear structure segmentation. DTU-Net consists of two sequential, lightweight U-Nets, dedicated to texture and topology, respectively. While the texture net makes a coarse prediction using image texture information, the topology net learns topological information from the coarse prediction by employing a triplet loss trained to recognize false and missed splits in the structure. We conduct experiments on a challenging multi-class ultrasound scan segmentation dataset as well as a well-known retinal imaging dataset. Results show that our model outperforms existing approaches in both pixel-wise segmentation accuracy and topological continuity, with no need for prior topological knowledge.

Kamil Mikolaj, Manxi Lin, Zahra Bashir et al.

Confounding information in the form of text or markings embedded in medical images can severely affect the training of diagnostic deep learning algorithms. However, data collected for clinical purposes often have such markings embedded in them. In dermatology, known examples include drawings or rulers that are overrepresented in images of malignant lesions. In this paper, we encounter text and calipers placed on the images found in national databases containing fetal screening ultrasound scans, which correlate with standard planes to be predicted. In order to utilize the vast amounts of data available in these databases, we develop and validate a series of methods for minimizing the confounding effects of embedded text and calipers on deep learning algorithms designed for ultrasound, using standard plane classification as a test case.

Manxi Lin, Aasa Feragen, Kamil Mikolaj et al.

The quality of fetal ultrasound screening scans directly influences the precision of biometric measurements. However, acquiring high-quality scans is labor-intensive and highly relies on the operator's skills. Considering the low contrastiveness and imaging artifacts that widely exist in ultrasound, even a dedicated deep-learning model can be vulnerable to learning from confounding information in the image. In this paper, we propose a holistic and explainable method for fetal ultrasound quality assessment, where we design a hierarchical concept bottleneck model by introducing human-readable ``concepts" into the task and imitating the sequential expert decision-making process. This hierarchical information flow forces the model to learn concepts from semantically meaningful areas: The model first passes through a layer of visual, segmentation-based concepts, and next a second layer of property concepts directly associated with the decision-making task. We consider the quality assessment to be in a more challenging but more realistic setting, with fine-grained image recognition. Experiments show that our model outperforms equivalent concept-free models on an in-house dataset, and shows better generalizability on two public benchmarks, one from Spain and one from Africa, without any fine-tuning.

Chun Kit Wong, Manxi Lin, Alberto Raheli et al.

Examination of the umbilical artery with Doppler ultrasonography is performed to investigate blood supply to the fetus through the umbilical cord, which is vital for the monitoring of fetal health. Such examination involves several steps that must be performed correctly: identifying suitable sites on the umbilical artery for the measurement, acquiring the blood flow curve in the form of a Doppler spectrum, and ensuring compliance to a set of quality standards. These steps rely heavily on the operator's skill, and the shortage of experienced sonographers has thus created a demand for machine assistance. In this work, we propose an automatic system to fill the gap. By using a modified Faster R-CNN network, we obtain an algorithm that can suggest locations suitable for Doppler measurement. Meanwhile, we have also developed a method for assessment of the Doppler spectrum's quality. The proposed system is validated on 657 images from a national ultrasound screening database, with results demonstrating its potential as a guidance system.

Manxi Lin, Nina Weng, Kamil Mikolaj et al.

Shortcut learning is a phenomenon where machine learning models prioritize learning simple, potentially misleading cues from data that do not generalize well beyond the training set. While existing research primarily investigates this in the realm of image classification, this study extends the exploration of shortcut learning into medical image segmentation. We demonstrate that clinical annotations such as calipers, and the combination of zero-padded convolutions and center-cropped training sets in the dataset can inadvertently serve as shortcuts, impacting segmentation accuracy. We identify and evaluate the shortcut learning on two different but common medical image segmentation tasks. In addition, we suggest strategies to mitigate the influence of shortcut learning and improve the generalizability of the segmentation models. By uncovering the presence and implications of shortcuts in medical image segmentation, we provide insights and methodologies for evaluating and overcoming this pervasive challenge and call for attention in the community for shortcuts in segmentation. Our code is public at https://github.com/nina-weng/shortcut_skinseg .

Zahra Bashir, Michael Bowling, Levi H. S. Lelis

Although the synthesis of programs encoding policies often carries the promise of interpretability, systematic evaluations were never performed to assess the interpretability of these policies, likely because of the complexity of such an evaluation. In this paper, we introduce a novel metric that uses large-language models (LLM) to assess the interpretability of programmatic policies. For our metric, an LLM is given both a program and a description of its associated programming language. The LLM then formulates a natural language explanation of the program. This explanation is subsequently fed into a second LLM, which tries to reconstruct the program from the natural-language explanation. Our metric then measures the behavioral similarity between the reconstructed program and the original. We validate our approach with synthesized and human-crafted programmatic policies for playing a real-time strategy game, comparing the interpretability scores of these programmatic policies to obfuscated versions of the same programs. Our LLM-based interpretability score consistently ranks less interpretable programs lower and more interpretable ones higher. These findings suggest that our metric could serve as a reliable and inexpensive tool for evaluating the interpretability of programmatic policies.

Paraskevas Pegios, Manxi Lin, Nina Weng et al.

Obstetric ultrasound image quality is crucial for accurate diagnosis and monitoring of fetal health. However, acquiring high-quality standard planes is difficult, influenced by the sonographer's expertise and factors like the maternal BMI or fetus dynamics. In this work, we explore diffusion-based counterfactual explainable AI to generate realistic, high-quality standard planes from low-quality non-standard ones. Through quantitative and qualitative evaluation, we demonstrate the effectiveness of our approach in generating plausible counterfactuals of increased quality. This shows future promise for enhancing training of clinicians by providing visual feedback and potentially improving standard plane quality and acquisition for downstream diagnosis and monitoring.

Manxi Lin, Jakob Ambsdorf, Emilie Pi Fogtmann Sejer et al.

We introduce the notion of semantic image quality for applications where image quality relies on semantic requirements. Working in fetal ultrasound, where ranking is challenging and annotations are noisy, we design a robust coarse-to-fine model that ranks images based on their semantic image quality and endow our predicted rankings with an uncertainty estimate. To annotate rankings on training data, we design an efficient ranking annotation scheme based on the merge sort algorithm. Finally, we compare our ranking algorithm to a number of state-of-the-art ranking algorithms on a challenging fetal ultrasound quality assessment task, showing the superior performance of our method on the majority of rank correlation metrics.

Chun Kit Wong, Mary Ngo, Manxi Lin et al.

Despite the rapid development of AI models in medical image analysis, their validation in real-world clinical settings remains limited. To address this, we introduce a generic framework designed for deploying image-based AI models in such settings. Using this framework, we deployed a trained model for fetal ultrasound standard plane detection, and evaluated it in real-time sessions with both novice and expert users. Feedback from these sessions revealed that while the model offers potential benefits to medical practitioners, the need for navigational guidance was identified as a key area for improvement. These findings underscore the importance of early deployment of AI models in real-world settings, leading to insights that can guide the refinement of the model and system based on actual user feedback.