Wilson Silva

Valentina Corbetta, Regina Beets-Tan, Wilson Silva

Multi-centre colonoscopy images from various medical centres exhibit distinct complicating factors and overlays that impact the image content, contingent on the specific acquisition centre. Existing Deep Segmentation networks struggle to achieve adequate generalizability in such data sets, and the currently available data augmentation methods do not effectively address these sources of data variability. As a solution, we introduce an innovative data augmentation approach centred on interpretability saliency maps, aimed at enhancing the generalizability of Deep Learning models within the realm of multi-centre colonoscopy image segmentation. The proposed augmentation technique demonstrates increased robustness across different segmentation models and domains. Thorough testing on a publicly available multi-centre dataset for polyp detection demonstrates the effectiveness and versatility of our approach, which is observed both in quantitative and qualitative results. The code is publicly available at: https://github.com/nki-radiology/interpretability_augmentation

Pedro C. Neto, Tiago Gonçalves, João Ribeiro Pinto et al.

As two sides of the same coin, causality and explainable artificial intelligence (xAI) were initially proposed and developed with different goals. However, the latter can only be complete when seen through the lens of the causality framework. As such, we propose a novel causality-inspired framework for xAI that creates an environment for the development of xAI approaches. To show its applicability, biometrics was used as case study. For this, we have analysed 81 research papers on a myriad of biometric modalities and different tasks. We have categorised each of these methods according to our novel xAI Ladder and discussed the future directions of the field.

Wilson Silva, Maria Carvalho, Carlos Mavioso et al.

Treatments for breast cancer have continued to evolve and improve in recent years, resulting in a substantial increase in survival rates, with approximately 80\% of patients having a 10-year survival period. Given the serious impact that breast cancer treatments can have on a patient's body image, consequently affecting her self-confidence and sexual and intimate relationships, it is paramount to ensure that women receive the treatment that optimizes both survival and aesthetic outcomes. Currently, there is no gold standard for evaluating the aesthetic outcome of breast cancer treatment. In addition, there is no standard way to show patients the potential outcome of surgery. The presentation of similar cases from the past would be extremely important to manage women's expectations of the possible outcome. In this work, we propose a deep neural network to perform the aesthetic evaluation. As a proof-of-concept, we focus on a binary aesthetic evaluation. Besides its use for classification, this deep neural network can also be used to find the most similar past cases by searching for nearest neighbours in the highly semantic space before classification. We performed the experiments on a dataset consisting of 143 photos of women after conservative treatment for breast cancer. The results for accuracy and balanced accuracy showed the superior performance of our proposed model compared to the state of the art in aesthetic evaluation of breast cancer treatments. In addition, the model showed a good ability to retrieve similar previous cases, with the retrieved cases having the same or adjacent class (in the 4-class setting) and having similar types of asymmetry. Finally, a qualitative interpretability assessment was also performed to analyse the robustness and trustworthiness of the model.

Philip Schutte, Valentina Corbetta, Regina Beets-Tan et al.

Federated Learning (FL) in Deep Learning (DL)-automated medical image segmentation helps preserving privacy by enabling collaborative model training without sharing patient data. However, FL faces challenges with data heterogeneity among institutions, leading to suboptimal global models. Integrating Disentangled Representation Learning (DRL) in FL can enhance robustness by separating data into distinct representations. Existing DRL methods assume heterogeneity lies solely in style features, overlooking content-based variability like lesion size and shape. We propose FedGS, a novel FL aggregation method, to improve segmentation performance on small, under-represented targets while maintaining overall efficacy. FedGS demonstrates superior performance over FedAvg, particularly for small lesions, across PolypGen and LiTS datasets. The code and pre-trained checkpoints are available at the following link: https://github.com/Trustworthy-AI-UU-NKI/Federated-Learning-Disentanglement

Aniek Eijpe, Valentina Corbetta, Kalina Chupetlovska et al.

Cross-modal medical image segmentation presents a significant challenge, as different imaging modalities produce images with varying resolutions, contrasts, and appearances of anatomical structures. We introduce compositionality as an inductive bias in a cross-modal segmentation network to improve segmentation performance and interpretability while reducing complexity. The proposed network is an end-to-end cross-modal segmentation framework that enforces compositionality on the learned representations using learnable von Mises-Fisher kernels. These kernels facilitate content-style disentanglement in the learned representations, resulting in compositional content representations that are inherently interpretable and effectively disentangle different anatomical structures. The experimental results demonstrate enhanced segmentation performance and reduced computational costs on multiple medical datasets. Additionally, we demonstrate the interpretability of the learned compositional features. Code and checkpoints will be publicly available at: https://github.com/Trustworthy-AI-UU-NKI/Cross-Modal-Segmentation.

Laura Latorre, Liliana Petrychenko, Regina Beets-Tan et al.

We explore deep generative models to generate case-based explanations in a medical federated learning setting. Explaining AI model decisions through case-based interpretability is paramount to increasing trust and allowing widespread adoption of AI in clinical practice. However, medical AI training paradigms are shifting towards federated learning settings in order to comply with data protection regulations. In a federated scenario, past data is inaccessible to the current user. Thus, we use a deep generative model to generate synthetic examples that protect privacy and explain decisions. Our proof-of-concept focuses on pleural effusion diagnosis and uses publicly available Chest X-ray data.

Valentina Corbetta, Floris Six Dijkstra, Regina Beets-Tan et al.

Deep learning models in medical imaging often achieve strong in-distribution performance but struggle to generalise under distribution shifts, frequently relying on spurious correlations instead of clinically meaningful features. We introduce LCRReg, a novel regularisation approach that leverages Latent Concept Representations (LCRs) (e.g., Concept Activation Vectors (CAVs)) to guide models toward semantically grounded representations. LCRReg requires no concept labels in the main training set and instead uses a small auxiliary dataset to synthesise high-quality, disentangled concept examples. We extract LCRs for predefined relevant features, and incorporate a regularisation term that guides a Convolutional Neural Network (CNN) to activate within latent subspaces associated with those concepts. We evaluate LCRReg across synthetic and real-world medical tasks. On a controlled toy dataset, it significantly improves robustness to injected spurious correlations and remains effective even in multi-concept and multiclass settings. On the diabetic retinopathy binary classification task, LCRReg enhances performance under both synthetic spurious perturbations and out-of-distribution (OOD) generalisation. Compared to baselines, including multitask learning, linear probing, and post-hoc concept-based models, LCRReg offers a lightweight, architecture-agnostic strategy for improving model robustness without requiring dense concept supervision. Code is available at the following link: https://github.com/Trustworthy-AI-UU-NKI/lcr\_regularization

Aniek Eijpe, Soufyan Lakbir, Melis Erdal Cesur et al.

To improve the prediction of cancer survival using whole-slide images and transcriptomics data, it is crucial to capture both modality-shared and modality-specific information. However, multimodal frameworks often entangle these representations, limiting interpretability and potentially suppressing discriminative features. To address this, we propose Disentangled and Interpretable Multimodal Attention Fusion (DIMAF), a multimodal framework that separates the intra- and inter-modal interactions within an attention-based fusion mechanism to learn distinct modality-specific and modality-shared representations. We introduce a loss based on Distance Correlation to promote disentanglement between these representations and integrate Shapley additive explanations to assess their relative contributions to survival prediction. We evaluate DIMAF on four public cancer survival datasets, achieving a relative average improvement of 1.85% in performance and 23.7% in disentanglement compared to current state-of-the-art multimodal models. Beyond improved performance, our interpretable framework enables a deeper exploration of the underlying interactions between and within modalities in cancer biology.

Miriam Cobo, David Corral Fontecha, Wilson Silva et al.

Artificial intelligence in medical imaging has seen unprecedented growth in the last years, due to rapid advances in deep learning and computing resources. Applications cover the full range of existing medical imaging modalities, with unique characteristics driven by the physics of each technique. Yet, artificial intelligence professionals entering the field, and even experienced developers, often lack a comprehensive understanding of the physical principles underlying medical image acquisition, which hinders their ability to fully leverage its potential. The integration of physics knowledge into artificial intelligence algorithms enhances their trustworthiness and robustness in medical imaging, especially in scenarios with limited data availability. In this work, we review the fundamentals of physics in medical images and their impact on the latest advances in artificial intelligence, particularly, in generative models and reconstruction algorithms. Finally, we explore the integration of physics knowledge into physics-inspired machine learning models, which leverage physics-based constraints to enhance the learning of medical imaging features.

Carla Monteiro, Valentina Corbetta, Regina Beets-Tan et al.

Automatic polyp segmentation is crucial for improving the clinical identification of colorectal cancer (CRC). While Deep Learning (DL) techniques have been extensively researched for this problem, current methods frequently struggle with generalization, particularly in data-constrained or challenging settings. Moreover, many existing polyp segmentation methods rely on complex, task-specific architectures. To address these limitations, we present a framework that leverages the intrinsic robustness of DINO self-attention "key" features for robust segmentation. Unlike traditional methods that extract tokens from the deepest layers of the Vision Transformer (ViT), our approach leverages the key features of the self-attention module with a simple convolutional decoder to predict polyp masks, resulting in enhanced performance and better generalizability. We validate our approach using a multi-center dataset under two rigorous protocols: Domain Generalization (DG) and Extreme Single Domain Generalization (ESDG). Our results, supported by a comprehensive statistical analysis, demonstrate that this pipeline achieves state-of-the-art (SOTA) performance, significantly enhancing generalization, particularly in data-scarce and challenging scenarios. While avoiding a polyp-specific architecture, we surpass well-established models like nnU-Net and UM-Net. Additionally, we provide a systematic benchmark of the DINO framework's evolution, quantifying the specific impact of architectural advancements on downstream polyp segmentation performance.

H. Montenegro, W. Silva, J. S. Cardoso

The use of Deep Learning in the medical field is hindered by the lack of interpretability. Case-based interpretability strategies can provide intuitive explanations for deep learning models' decisions, thus, enhancing trust. However, the resulting explanations threaten patient privacy, motivating the development of privacy-preserving methods compatible with the specifics of medical data. In this work, we analyze existing privacy-preserving methods and their respective capacity to anonymize medical data while preserving disease-related semantic features. We find that the PPRL-VGAN deep learning method was the best at preserving the disease-related semantic features while guaranteeing a high level of privacy among the compared state-of-the-art methods. Nevertheless, we emphasize the need to improve privacy-preserving methods for medical imaging, as we identified relevant drawbacks in all existing privacy-preserving approaches.