Ganapathy Krishnamurthi

Akansh Maurya, Kunal Dashrath Patil, Rohan Padhy et al.

In this work, we present our proposed method to segment the pulmonary arteries from the CT scans using Swin UNETR and U-Net-based deep neural network architecture. Six models, three models based on Swin UNETR, and three models based on 3D U-net with residual units were ensemble using a weighted average to make the final segmentation masks. Our team achieved a multi-level dice score of 84.36 percent through this method. The code of our work is available on the following link: https://github.com/akansh12/parse2022. This work is part of the MICCAI PARSE 2022 challenge.

Vikas Dwivedi, Balaji Srinivasan, Ganapathy Krishnamurthi

Effective training of deep image segmentation models is challenging due to the need for abundant, high-quality annotations. Generating annotations is laborious and time-consuming for human experts, especially in medical image segmentation. To facilitate image annotation, we introduce Physics Informed Contour Selection (PICS) - an interpretable, physics-informed algorithm for rapid image segmentation without relying on labeled data. PICS draws inspiration from physics-informed neural networks (PINNs) and an active contour model called snake. It is fast and computationally lightweight because it employs cubic splines instead of a deep neural network as a basis function. Its training parameters are physically interpretable because they directly represent control knots of the segmentation curve. Traditional snakes involve minimization of the edge-based loss functionals by deriving the Euler-Lagrange equation followed by its numerical solution. However, PICS directly minimizes the loss functional, bypassing the Euler Lagrange equations. It is the first snake variant to minimize a region-based loss function instead of traditional edge-based loss functions. PICS uniquely models the three-dimensional (3D) segmentation process with an unsteady partial differential equation (PDE), which allows accelerated segmentation via transfer learning. To demonstrate its effectiveness, we apply PICS for 3D segmentation of the left ventricle on a publicly available cardiac dataset. While doing so, we also introduce a new convexity-preserving loss term that encodes the shape information of the left ventricle to enhance PICS's segmentation quality. Overall, PICS presents several novelties in network architecture, transfer learning, and physics-inspired losses for image segmentation, thereby showing promising outcomes and potential for further refinement.

Mathumetha Palani, Kavya Puthumana, Ayantika Das et al.

The advent of handheld fundus imaging devices has made ophthalmologic diagnosis and disease screening more accessible, efficient, and cost-effective. However, images captured from these setups often suffer from artifacts such as flash reflections, exposure variations, and motion-induced blur, which degrade image quality and hinder downstream analysis. While generative models have been effective in image restoration, most depend on paired supervision or predefined artifact structures, making them less adaptable to unstructured degradations commonly observed in handheld fundus images. To address this, we propose an unsupervised diffusion autoencoder that integrates a context encoder with the denoising process to learn semantically meaningful representations for artifact restoration. The model is trained only on high-quality table-top fundus images and infers to restore artifact-affected handheld acquisitions. We validate the restorations through quantitative and qualitative evaluations, and have shown that diagnostic accuracy increases to 81.17% on an unseen dataset and multiple artifact conditions

Rishi Mishra, Smriti, Balaji Srinivasan et al.

Physics-informed extreme learning machines (PIELMs) typically impose boundary and initial conditions through penalty terms, yielding only approximate satisfaction that is sensitive to user-specified weights and can propagate errors into the interior solution. This work introduces Null-Space Projected PIELM (NP-PIELM), achieving exact constraint enforcement through algebraic projection in coefficient space. The method exploits the geometric structure of the admissible coefficient manifold, recognizing that it admits a decomposition through the null space of the boundary operator. By characterizing this manifold via a translation-invariant representation and projecting onto the kernel component, optimization is restricted to constraint-preserving directions, transforming the constrained problem into unconstrained least-squares where boundary conditions are satisfied exactly at discrete collocation points. This eliminates penalty coefficients, dual variables, and problem-specific constructions while preserving single-shot training efficiency. Numerical experiments on elliptic and parabolic problems including complex geometries and mixed boundary conditions validate the framework.

Shrish Shrinath Vaidya, Gowthamaan Palani, Sidharth Ramesh et al.

The deployment of Large Language Models (LLMs) for structuring clinical data is critically hindered by their tendency to hallucinate facts and their inability to follow domain-specific rules. To address this, we introduce MedPAO, a novel agentic framework that ensures accuracy and verifiable reasoning by grounding its operation in established clinical protocols such as the ABCDEF protocol for CXR analysis. MedPAO decomposes the report structuring task into a transparent process managed by a Plan-Act-Observe (PAO) loop and specialized tools. This protocol-driven method provides a verifiable alternative to opaque, monolithic models. The efficacy of our approach is demonstrated through rigorous evaluation: MedPAO achieves an F1-score of 0.96 on the critical sub-task of concept categorization. Notably, expert radiologists and clinicians rated the final structured outputs with an average score of 4.52 out of 5, indicating a level of reliability that surpasses baseline approaches relying solely on LLM-based foundation models. The code is available at: https://github.com/MiRL-IITM/medpao-agent

Avinash Kori, Parth Natekar, Ganapathy Krishnamurthi et al.

The black-box nature of deep learning models prevents them from being completely trusted in domains like biomedicine. Most explainability techniques do not capture the concept-based reasoning that human beings follow. In this work, we attempt to understand the behavior of trained models that perform image processing tasks in the medical domain by building a graphical representation of the concepts they learn. Extracting such a graphical representation of the model's behavior on an abstract, higher conceptual level would unravel the learnings of these models and would help us to evaluate the steps taken by the model for predictions. We show the application of our proposed implementation on two biomedical problems - brain tumor segmentation and fundus image classification. We provide an alternative graphical representation of the model by formulating a concept level graph as discussed above, which makes the problem of intervention to find active inference trails more tractable. Understanding these trails would provide an understanding of the hierarchy of the decision-making process followed by the model. [As well as overall nature of model]. Our framework is available at https://github.com/koriavinash1/BioExp

Mahendra Khened, Avinash Kori, Haran Rajkumar et al.

Histopathology tissue analysis is considered the gold standard in cancer diagnosis and prognosis. Given the large size of these images and the increase in the number of potential cancer cases, an automated solution as an aid to histopathologists is highly desirable. In the recent past, deep learning-based techniques have provided state of the art results in a wide variety of image analysis tasks, including analysis of digitized slides. However, the size of images and variability in histopathology tasks makes it a challenge to develop an integrated framework for histopathology image analysis. We propose a deep learning-based framework for histopathology tissue analysis. We demonstrate the generalizability of our framework, including training and inference, on several open-source datasets, which include CAMELYON (breast cancer metastases), DigestPath (colon cancer), and PAIP (liver cancer) datasets. We discuss multiple types of uncertainties pertaining to data and model, namely aleatoric and epistemic, respectively. Simultaneously, we demonstrate our model generalization across different data distribution by evaluating some samples on TCGA data. On CAMELYON16 test data (n=139) for the task of lesion detection, the FROC score achieved was 0.86 and in the CAMELYON17 test-data (n=500) for the task of pN-staging the Cohen's kappa score achieved was 0.9090 (third in the open leaderboard). On DigestPath test data (n=212) for the task of tumor segmentation, a Dice score of 0.782 was achieved (fourth in the challenge). On PAIP test data (n=40) for the task of viable tumor segmentation, a Jaccard Index of 0.75 (third in the challenge) was achieved, and for viable tumor burden, a score of 0.633 was achieved (second in the challenge). Our entire framework and related documentation are freely available at GitHub and PyPi.

Kunal Dasharath Patil, Gowthamaan Palani, Ganapathy Krishnamurthi

The Segment Anything Model (SAM) has set a new standard in interactive image segmentation, offering robust performance across various tasks. However, its significant computational requirements limit its deployment in real-time or resource-constrained environments. To address these challenges, we propose a novel knowledge distillation approach, KD SAM, which incorporates both encoder and decoder optimization through a combination of Mean Squared Error (MSE) and Perceptual Loss. This dual-loss framework captures structural and semantic features, enabling the student model to maintain high segmentation accuracy while reducing computational complexity. Based on the model evaluation on datasets, including Kvasir-SEG, ISIC 2017, Fetal Head Ultrasound, and Breast Ultrasound, we demonstrate that KD SAM achieves comparable or superior performance to the baseline models, with significantly fewer parameters. KD SAM effectively balances segmentation accuracy and computational efficiency, making it well-suited for real-time medical image segmentation applications in resource-constrained environments.

Vikas Kumar Anand, Sanjeev Grampurohit, Pranav Aurangabadkar et al.

We utilize 3-D fully convolutional neural networks (CNN) to segment gliomas and its constituents from multimodal Magnetic Resonance Images (MRI). The architecture uses dense connectivity patterns to reduce the number of weights and residual connections and is initialized with weights obtained from training this model with BraTS 2018 dataset. Hard mining is done during training to train for the difficult cases of segmentation tasks by increasing the dice similarity coefficient (DSC) threshold to choose the hard cases as epoch increases. On the BraTS2020 validation data (n = 125), this architecture achieved a tumor core, whole tumor, and active tumor dice of 0.744, 0.876, 0.714,respectively. On the test dataset, we get an increment in DSC of tumor core and active tumor by approximately 7%. In terms of DSC, our network performances on the BraTS 2020 test data are 0.775, 0.815, and 0.85 for enhancing tumor, tumor core, and whole tumor, respectively. Overall survival of a subject is determined using conventional machine learning from rediomics features obtained using a generated segmentation mask. Our approach has achieved 0.448 and 0.452 as the accuracy on the validation and test dataset.

Manik Sharma, Ganapathy Krishnamurthi

The cost of some drugs and medical treatments has risen in recent years that many patients are having to go without. A classification project could make researchers more efficient. One of the more surprising reasons behind the cost is how long it takes to bring new treatments to market. Despite improvements in technology and science, research and development continues to lag. In fact, finding new treatment takes, on average, more than 10 years and costs hundreds of millions of dollars. In turn, greatly decreasing the cost of treatments can make ensure these treatments get to patients faster. This work aims at solving a part of this problem by creating a cellular image classification model which can decipher the genetic perturbations in cell (occurring naturally or artificially). Another interesting question addressed is what makes the deep-learning model decide in a particular fashion, which can further help in demystifying the mechanism of action of certain perturbations and paves a way towards the explainability of the deep-learning model. We show the results of Grad-CAM visualizations and make a case for the significance of certain features over others. Further we discuss how these significant features are pivotal in extracting useful diagnostic information from the deep-learning model.

Vismay Agrawal, Avinash Kori, Vikas Kumar Anand et al.

Magnetic Resonance (MR) Imaging and Computed Tomography (CT) are the primary diagnostic imaging modalities quite frequently used for surgical planning and analysis. A general problem with medical imaging is that the acquisition process is quite expensive and time-consuming. Deep learning techniques like generative adversarial networks (GANs) can help us to leverage the possibility of an image to image translation between multiple imaging modalities, which in turn helps in saving time and cost. These techniques will help to conduct surgical planning under CT with the feedback of MRI information. While previous studies have shown paired and unpaired image synthesis from MR to CT, image synthesis from CT to MR still remains a challenge, since it involves the addition of extra tissue information. In this manuscript, we have implemented two different variations of Generative Adversarial Networks exploiting the cycling consistency and structural similarity between both CT and MR image modalities on a pelvis dataset, thus facilitating a bidirectional exchange of content and style between these image modalities. The proposed GANs translate the input medical images by different mechanisms, and hence generated images not only appears realistic but also performs well across various comparison metrics, and these images have also been cross verified with a radiologist. The radiologist verification has shown that slight variations in generated MR and CT images may not be exactly the same as their true counterpart but it can be used for medical purposes.

Max Allan, Satoshi Kondo, Sebastian Bodenstedt et al.

In 2015 we began a sub-challenge at the EndoVis workshop at MICCAI in Munich using endoscope images of ex-vivo tissue with automatically generated annotations from robot forward kinematics and instrument CAD models. However, the limited background variation and simple motion rendered the dataset uninformative in learning about which techniques would be suitable for segmentation in real surgery. In 2017, at the same workshop in Quebec we introduced the robotic instrument segmentation dataset with 10 teams participating in the challenge to perform binary, articulating parts and type segmentation of da Vinci instruments. This challenge included realistic instrument motion and more complex porcine tissue as background and was widely addressed with modifications on U-Nets and other popular CNN architectures. In 2018 we added to the complexity by introducing a set of anatomical objects and medical devices to the segmented classes. To avoid over-complicating the challenge, we continued with porcine data which is dramatically simpler than human tissue due to the lack of fatty tissue occluding many organs.

Parth Natekar, Avinash Kori, Ganapathy Krishnamurthi

The accurate automatic segmentation of gliomas and its intra-tumoral structures is important not only for treatment planning but also for follow-up evaluations. Several methods based on 2D and 3D Deep Neural Networks (DNN) have been developed to segment brain tumors and to classify different categories of tumors from different MRI modalities. However, these networks are often black-box models and do not provide any evidence regarding the process they take to perform this task. Increasing transparency and interpretability of such deep learning techniques are necessary for the complete integration of such methods into medical practice. In this paper, we explore various techniques to explain the functional organization of brain tumor segmentation models and to extract visualizations of internal concepts to understand how these networks achieve highly accurate tumor segmentations. We use the BraTS 2018 dataset to train three different networks with standard architectures and outline similarities and differences in the process that these networks take to segment brain tumors. We show that brain tumor segmentation networks learn certain human-understandable disentangled concepts on a filter level. We also show that they take a top-down or hierarchical approach to localizing the different parts of the tumor. We then extract visualizations of some internal feature maps and also provide a measure of uncertainty with regards to the outputs of the models to give additional qualitative evidence about the predictions of these networks. We believe that the emergence of such human-understandable organization and concepts might aid in the acceptance and integration of such methods in medical diagnosis.

Patrick Bilic, Patrick Christ, Hongwei Bran Li et al.

In this work, we report the set-up and results of the Liver Tumor Segmentation Benchmark (LiTS), which was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI) 2017 and the International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2017 and 2018. The image dataset is diverse and contains primary and secondary tumors with varied sizes and appearances with various lesion-to-background levels (hyper-/hypo-dense), created in collaboration with seven hospitals and research institutions. Seventy-five submitted liver and liver tumor segmentation algorithms were trained on a set of 131 computed tomography (CT) volumes and were tested on 70 unseen test images acquired from different patients. We found that not a single algorithm performed best for both liver and liver tumors in the three events. The best liver segmentation algorithm achieved a Dice score of 0.963, whereas, for tumor segmentation, the best algorithms achieved Dices scores of 0.674 (ISBI 2017), 0.702 (MICCAI 2017), and 0.739 (MICCAI 2018). Retrospectively, we performed additional analysis on liver tumor detection and revealed that not all top-performing segmentation algorithms worked well for tumor detection. The best liver tumor detection method achieved a lesion-wise recall of 0.458 (ISBI 2017), 0.515 (MICCAI 2017), and 0.554 (MICCAI 2018), indicating the need for further research. LiTS remains an active benchmark and resource for research, e.g., contributing the liver-related segmentation tasks in \url{http://medicaldecathlon.com/}. In addition, both data and online evaluation are accessible via \url{www.lits-challenge.com}.

Spyridon Bakas, Mauricio Reyes, Andras Jakab et al.

Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that underwent gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset.

Vismay Agrawal, Avinash Kori, Varghese Alex et al.

In this manuscript, we present a robust method for glaucoma screening from fundus images using an ensemble of convolutional neural networks (CNNs). The pipeline comprises of first segmenting the optic disk and optic cup from the fundus image, then extracting a patch centered around the optic disk and subsequently feeding to the classification network to differentiate the image as diseased or healthy. In the segmentation network, apart from the image, we make use of spatial co-ordinate (X \& Y) space so as to learn the structure of interest better. The classification network is composed of a DenseNet201 and a ResNet18 which were pre-trained on a large cohort of natural images. On the REFUGE validation data (n=400), the segmentation network achieved a dice score of 0.88 and 0.64 for optic disc and optic cup respectively. For the tasking differentiating images affected with glaucoma from healthy images, the area under the ROC curve was observed to be 0.85.

Mahendra Khened, Varghese Alex Kollerathu, Ganapathy Krishnamurthi

Deep fully convolutional neural network (FCN) based architectures have shown great potential in medical image segmentation. However, such architectures usually have millions of parameters and inadequate number of training samples leading to over-fitting and poor generalization. In this paper, we present a novel highly parameter and memory efficient FCN based architecture for medical image analysis. We propose a novel up-sampling path which incorporates long skip and short-cut connections to overcome the feature map explosion in FCN like architectures. In order to processes the input images at multiple scales and view points simultaneously, we propose to incorporate Inception module's parallel structures. We also propose a novel dual loss function whose weighting scheme allows to combine advantages of cross-entropy and dice loss. We have validated our proposed network architecture on two publicly available datasets, namely: (i) Automated Cardiac Disease Diagnosis Challenge (ACDC-2017), (ii) Left Ventricular Segmentation Challenge (LV-2011). Our approach in ACDC-2017 challenge stands second place for segmentation and first place in automated cardiac disease diagnosis tasks with an accuracy of 100%. In the LV-2011 challenge our approach attained 0.74 Jaccard index, which is so far the highest published result in fully automated algorithms. From the segmentation we extracted clinically relevant cardiac parameters and hand-crafted features which reflected the clinical diagnostic analysis to train an ensemble system for cardiac disease classification. Our approach combined both cardiac segmentation and disease diagnosis into a fully automated framework which is computational efficient and hence has the potential to be incorporated in computer-aided diagnosis (CAD) tools for clinical application.

Avinash Kori, Ganapathy Krishnamurthi, Balaji Srinivasan

In this paper we propose the use of image pixel position coordinate system to improve image classification accuracy in various applications. Specifically, we hypothesize that the use of pixel coordinates will lead to (a) Resolution invariant performance. Here, by resolution we mean the spacing between the pixels rather than the size of the image matrix. (b) Overall improvement in classification accuracy in comparison with network models trained without local pixel coordinates. This is due to position coordinates enabling the network to learn relationship between parts of objects, mimicking the human vision system. We demonstrate our hypothesis using empirical results and intuitive explanations of the feature maps learnt by deep neural networks. Specifically, our approach showed improvements in MNIST digit classification and beats state of the results on the SVHN database. We also show that the performance of our networks is unaffected despite training the same using blurred images of the MNIST database and predicting on the high resolution database.

Krishna Chaitanya Kaluva, Mahendra Khened, Avinash Kori et al.

In this paper we propose a fully automatic 2-stage cascaded approach for segmentation of liver and its tumors in CT (Computed Tomography) images using densely connected fully convolutional neural network (DenseNet). We independently train liver and tumor segmentation models and cascade them for a combined segmentation of the liver and its tumor. The first stage involves segmentation of liver and the second stage uses the first stage's segmentation results for localization of liver and henceforth tumor segmentations inside liver region. The liver model was trained on the down-sampled axial slices $(256 \times 256)$, whereas for the tumor model no down-sampling of slices was done, but instead it was trained on the CT axial slices windowed at three different Hounsfield (HU) levels. On the test set our model achieved a global dice score of 0.923 and 0.625 on liver and tumor respectively. The computed tumor burden had an rmse of 0.044.

Varghese Alex, Mohammed Safwan, Ganapathy Krishnamurthi

In this paper, we use a fully convolutional neural network (FCNN) for the segmentation of gliomas from Magnetic Resonance Images (MRI). A fully automatic, voxel based classification was achieved by training a 23 layer deep FCNN on 2-D slices extracted from patient volumes. The network was trained on slices extracted from 130 patients and validated on 50 patients. For the task of survival prediction, texture and shape based features were extracted from T1 post contrast volume to train an XGBoost regressor. On BraTS 2017 validation set, the proposed scheme achieved a mean whole tumor, tumor core and active dice score of 0.83, 0.69 and 0.69 respectively and an accuracy of 52% for the overall survival prediction.

Varghese Alex, Kiran Vaidhya, Subramaniam Thirunavukkarasu et al.

The work presented explores the use of denoising autoencoders (DAE) for brain lesion detection, segmentation and false positive reduction. Stacked denoising autoencoders (SDAE) were pre-trained using a large number of unlabeled patient volumes and fine tuned with patches drawn from a limited number of patients (n=20, 40, 65). The results show negligible loss in performance even when SDAE was fine tuned using 20 patients. Low grade glioma (LGG) segmentation was achieved using a transfer learning approach wherein a network pre-trained with High Grade Glioma (HGG) data was fine tuned using LGG image patches. The weakly supervised SDAE (for HGG) and transfer learning based LGG network were also shown to generalize well and provide good segmentation on unseen BraTS 2013 & BraTS 2015 test data. An unique contribution includes a single layer DAE, referred to as novelty detector(ND). ND was trained to accurately reconstruct non-lesion patches using a mean squared error loss function. The reconstruction error maps of test data were used to identify regions containing lesions. The error maps were shown to assign unique error distributions to various constituents of the glioma, enabling localization. The ND learns the non-lesion brain accurately as it was also shown to provide good segmentation performance on ischemic brain lesions in images from a different database.