Ipek Oguz

Han Liu, Hao Li, Xing Yao et al.

Medical image segmentation is a critical task in medical image analysis. In recent years, deep learning based approaches have shown exceptional performance when trained on a fully-annotated dataset. However, data annotation is often a significant bottleneck, especially for 3D medical images. Active learning (AL) is a promising solution for efficient annotation but requires an initial set of labeled samples to start active selection. When the entire data pool is unlabeled, how do we select the samples to annotate as our initial set? This is also known as the cold-start AL, which permits only one chance to request annotations from experts without access to previously annotated data. Cold-start AL is highly relevant in many practical scenarios but has been under-explored, especially for 3D medical segmentation tasks requiring substantial annotation effort. In this paper, we present a benchmark named COLosSAL by evaluating six cold-start AL strategies on five 3D medical image segmentation tasks from the public Medical Segmentation Decathlon collection. We perform a thorough performance analysis and explore important open questions for cold-start AL, such as the impact of budget on different strategies. Our results show that cold-start AL is still an unsolved problem for 3D segmentation tasks but some important trends have been observed. The code repository, data partitions, and baseline results for the complete benchmark are publicly available at https://github.com/MedICL-VU/COLosSAL.

Han Liu, Yubo Fan, Hao Li et al.

Multiple Sclerosis (MS) is a chronic neuroinflammatory disease and multi-modality MRIs are routinely used to monitor MS lesions. Many automatic MS lesion segmentation models have been developed and have reached human-level performance. However, most established methods assume the MRI modalities used during training are also available during testing, which is not guaranteed in clinical practice. Previously, a training strategy termed Modality Dropout (ModDrop) has been applied to MS lesion segmentation to achieve the state-of-the-art performance with missing modality. In this paper, we present a novel method dubbed ModDrop++ to train a unified network adaptive to an arbitrary number of input MRI sequences. ModDrop++ upgrades the main idea of ModDrop in two key ways. First, we devise a plug-and-play dynamic head and adopt a filter scaling strategy to improve the expressiveness of the network. Second, we design a co-training strategy to leverage the intra-subject relation between full modality and missing modality. Specifically, the intra-subject co-training strategy aims to guide the dynamic head to generate similar feature representations between the full- and missing-modality data from the same subject. We use two public MS datasets to show the superiority of ModDrop++. Source code and trained models are available at https://github.com/han-liu/ModDropPlusPlus.

Hao Li, Han Liu, Dewei Hu et al.

To address prevalent issues in medical imaging, such as data acquisition challenges and label availability, transfer learning from natural to medical image domains serves as a viable strategy to produce reliable segmentation results. However, several existing barriers between domains need to be broken down, including addressing contrast discrepancies, managing anatomical variability, and adapting 2D pretrained models for 3D segmentation tasks. In this paper, we propose ProMISe,a prompt-driven 3D medical image segmentation model using only a single point prompt to leverage knowledge from a pretrained 2D image foundation model. In particular, we use the pretrained vision transformer from the Segment Anything Model (SAM) and integrate lightweight adapters to extract depth-related (3D) spatial context without updating the pretrained weights. For robust results, a hybrid network with complementary encoders is designed, and a boundary-aware loss is proposed to achieve precise boundaries. We evaluate our model on two public datasets for colon and pancreas tumor segmentations, respectively. Compared to the state-of-the-art segmentation methods with and without prompt engineering, our proposed method achieves superior performance. The code is publicly available at https://github.com/MedICL-VU/ProMISe.

Han Liu, Yubo Fan, Zhoubing Xu et al.

Unsupervised cross-modality domain adaptation is a challenging task in medical image analysis, and it becomes more challenging when source and target domain data are collected from multiple institutions. In this paper, we present our solution to tackle the multi-institutional unsupervised domain adaptation for the crossMoDA 2023 challenge. First, we perform unpaired image translation to translate the source domain images to the target domain, where we design a dynamic network to generate synthetic target domain images with controllable, site-specific styles. Afterwards, we train a segmentation model using the synthetic images and further reduce the domain gap by self-training. Our solution achieved the 1st place during both the validation and testing phases of the challenge. The code repository is publicly available at https://github.com/MedICL-VU/crossmoda2023.

Hao Li, Han Liu, Dewei Hu et al.

Interactive segmentation model leverages prompts from users to produce robust segmentation. This advancement is facilitated by prompt engineering, where interactive prompts serve as strong priors during test-time. However, this is an inherently subjective and hard-to-reproduce process. The variability in user expertise and inherently ambiguous boundaries in medical images can lead to inconsistent prompt selections, potentially affecting segmentation accuracy. This issue has not yet been extensively explored for medical imaging. In this paper, we assess the test-time variability for interactive medical image segmentation with diverse point prompts. For a given target region, the point is classified into three sub-regions: boundary, margin, and center. Our goal is to identify a straightforward and efficient approach for optimal prompt selection during test-time based on three considerations: (1) benefits of additional prompts, (2) effects of prompt placement, and (3) strategies for optimal prompt selection. We conduct extensive experiments on the public Medical Segmentation Decathlon dataset for challenging colon tumor segmentation task. We suggest an optimal strategy for prompt selection during test-time, supported by comprehensive results. The code is publicly available at https://github.com/MedICL-VU/variability

Jiacheng Wang, Hao Li, Dewei Hu et al.

High-resolution Optical Coherence Tomography (OCT) images are crucial for ophthalmology studies but are limited by their relatively narrow field of view (FoV). Image mosaicking is a technique for aligning multiple overlapping images to obtain a larger FoV. Current mosaicking pipelines often struggle with substantial noise and considerable displacement between the input sub-fields. In this paper, we propose a versatile pipeline for stitching multi-view OCT/OCTA \textit{en face} projection images. Our method combines the strengths of learning-based feature matching and robust pixel-based registration to align multiple images effectively. Furthermore, we advance the application of a trained foundational model, Segment Anything Model (SAM), to validate mosaicking results in an unsupervised manner. The efficacy of our pipeline is validated using an in-house dataset and a large public dataset, where our method shows superior performance in terms of both accuracy and computational efficiency. We also made our evaluation tool for image mosaicking and the corresponding pipeline publicly available at \url{https://github.com/MedICL-VU/OCT-mosaicking}.

Jiacheng Wang, Hao Li, Dewei Hu et al.

We propose a novel framework for retinal feature point alignment, designed for learning cross-modality features to enhance matching and registration across multi-modality retinal images. Our model draws on the success of previous learning-based feature detection and description methods. To better leverage unlabeled data and constrain the model to reproduce relevant keypoints, we integrate a keypoint-based segmentation task. It is trained in a self-supervised manner by enforcing segmentation consistency between different augmentations of the same image. By incorporating a keypoint augmented self-supervised layer, we achieve robust feature extraction across modalities. Extensive evaluation on two public datasets and one in-house dataset demonstrates significant improvements in performance for modality-agnostic retinal feature alignment. Our code and model weights are publicly available at \url{https://github.com/MedICL-VU/RetinaIPA}.

Hao Li, Han Liu, Dewei Hu et al.

Convolutional Neural Networks (CNNs) have exhibited strong performance in medical image segmentation tasks by capturing high-level (local) information, such as edges and textures. However, due to the limited field of view of convolution kernel, it is hard for CNNs to fully represent global information. Recently, transformers have shown good performance for medical image segmentation due to their ability to better model long-range dependencies. Nevertheless, transformers struggle to capture high-level spatial features as effectively as CNNs. A good segmentation model should learn a better representation from local and global features to be both precise and semantically accurate. In our previous work, we proposed CATS, which is a U-shaped segmentation network augmented with transformer encoder. In this work, we further extend this model and propose CATS v2 with hybrid encoders. Specifically, hybrid encoders consist of a CNN-based encoder path paralleled to a transformer path with a shifted window, which better leverage both local and global information to produce robust 3D medical image segmentation. We fuse the information from the convolutional encoder and the transformer at the skip connections of different resolutions to form the final segmentation. The proposed method is evaluated on three public challenge datasets: Beyond the Cranial Vault (BTCV), Cross-Modality Domain Adaptation (CrossMoDA) and task 5 of Medical Segmentation Decathlon (MSD-5), to segment abdominal organs, vestibular schwannoma (VS) and prostate, respectively. Compared with the state-of-the-art methods, our approach demonstrates superior performance in terms of higher Dice scores. Our code is publicly available at https://github.com/MedICL-VU/CATS.

Hao Li, Baris Oguz, Gabriel Arenas et al.

Placenta volume measurement from 3D ultrasound images is critical for predicting pregnancy outcomes, and manual annotation is the gold standard. However, such manual annotation is expensive and time-consuming. Automated segmentation algorithms can often successfully segment the placenta, but these methods may not consistently produce robust segmentations suitable for practical use. Recently, inspired by the Segment Anything Model (SAM), deep learning-based interactive segmentation models have been widely applied in the medical imaging domain. These models produce a segmentation from visual prompts provided to indicate the target region, which may offer a feasible solution for practical use. However, none of these models are specifically designed for interactively segmenting 3D ultrasound images, which remain challenging due to the inherent noise of this modality. In this paper, we evaluate publicly available state-of-the-art 3D interactive segmentation models in contrast to a human-in-the-loop approach for the placenta segmentation task. The Dice score, normalized surface Dice, averaged symmetric surface distance, and 95-percent Hausdorff distance are used as evaluation metrics. We consider a Dice score of 0.95 a successful segmentation. Our results indicate that the human-in-the-loop segmentation model reaches this standard. Moreover, we assess the efficiency of the human-in-the-loop model as a function of the amount of prompts. Our results demonstrate that the human-in-the-loop model is both effective and efficient for interactive placenta segmentation. The code is available at \url{https://github.com/MedICL-VU/PRISM-placenta}.

Han Liu, Yubo Fan, Hao Li et al.

Image-level domain alignment is the de facto approach for unsupervised domain adaptation, where unpaired image translation is used to minimize the domain gap. Prior studies mainly focus on the domain shift between the source and target domains, whereas the intra-domain variability remains under-explored. To address the latter, an effective strategy is to diversify the styles of the synthetic target domain data during image translation. However, previous methods typically require intra-domain variations to be pre-specified for style synthesis, which may be impractical. In this paper, we propose an exemplar-based style synthesis method named IntraStyler, which can capture diverse intra-domain styles without any prior knowledge. Specifically, IntraStyler uses an exemplar image to guide the style synthesis such that the output style matches the exemplar style. To extract the style-only features, we introduce a style encoder to learn styles discriminatively based on contrastive learning. We evaluate the proposed method on the largest public dataset for cross-modality domain adaptation, CrossMoDA 2023. Our experiments show the efficacy of our method in controllable style synthesis and the benefits of diverse synthetic data for downstream segmentation. Code is available at https://github.com/han-liu/IntraStyler.

Hao Li, Daiwei Lu, Xing Yao et al.

In this paper, we present Endo-SemiS, a semi-supervised segmentation framework for providing reliable segmentation of endoscopic video frames with limited annotation. EndoSemiS uses 4 strategies to improve performance by effectively utilizing all available data, particularly unlabeled data: (1) Cross-supervision between two individual networks that supervise each other; (2) Uncertainty-guided pseudo-labels from unlabeled data, which are generated by selecting high-confidence regions to improve their quality; (3) Joint pseudolabel supervision, which aggregates reliable pixels from the pseudo-labels of both networks to provide accurate supervision for unlabeled data; and (4) Mutual learning, where both networks learn from each other at the feature and image levels, reducing variance and guiding them toward a consistent solution. Additionally, a separate corrective network that utilizes spatiotemporal information from endoscopy video to improve segmentation performance. Endo-SemiS is evaluated on two clinical applications: kidney stone laser lithotomy from ureteroscopy and polyp screening from colonoscopy. Compared to state-of-the-art segmentation methods, Endo-SemiS substantially achieves superior results on both datasets with limited labeled data. The code is publicly available at https://github.com/MedICL-VU/Endo-SemiS

Hao Li, Daiwei Lu, Jesse d'Almeida et al.

Monocular depth estimation (MDE) is a critical task to guide autonomous medical robots. However, obtaining absolute (metric) depth from an endoscopy camera in surgical scenes is difficult, which limits supervised learning of depth on real endoscopic images. Current image-level unsupervised domain adaptation methods translate synthetic images with known depth maps into the style of real endoscopic frames and train depth networks using these translated images with their corresponding depth maps. However a domain gap often remains between real and translated synthetic images. In this paper, we present a latent feature alignment method to improve absolute depth estimation by reducing this domain gap in the context of endoscopic videos of the central airway. Our methods are agnostic to the image translation process and focus on the depth estimation itself. Specifically, the depth network takes translated synthetic and real endoscopic frames as input and learns latent domain-invariant features via adversarial learning and directional feature consistency. The evaluation is conducted on endoscopic videos of central airway phantoms with manually aligned absolute depth maps. Compared to state-of-the-art MDE methods, our approach achieves superior performance on both absolute and relative depth metrics, and consistently improves results across various backbones and pretrained weights. Our code is available at https://github.com/MedICL-VU/MDE.

Hao Li, Baris Oguz, Gabriel Arenas et al.

Placenta volume measured from 3D ultrasound (3DUS) images is an important tool for tracking the growth trajectory and is associated with pregnancy outcomes. Manual segmentation is the gold standard, but it is time-consuming and subjective. Although fully automated deep learning algorithms perform well, they do not always yield high-quality results for each case. Interactive segmentation models could address this issue. However, there is limited work on interactive segmentation models for the placenta. Despite their segmentation accuracy, these methods may not be feasible for clinical use as they require relatively large computational power which may be especially prohibitive in low-resource environments, or on mobile devices. In this paper, we propose a lightweight interactive segmentation model aiming for clinical use to interactively segment the placenta from 3DUS images in real-time. The proposed model adopts the segmentation from our fully automated model for initialization and is designed in a human-in-the-loop manner to achieve iterative improvements. The Dice score and normalized surface Dice are used as evaluation metrics. The results show that our model can achieve superior performance in segmentation compared to state-of-the-art models while using significantly fewer parameters. Additionally, the proposed model is much faster for inference and robust to poor initial masks. The code is available at https://github.com/MedICL-VU/PRISM-placenta.

Han Liu, Yubo Fan, Ipek Oguz et al.

Automatic segmentation of vestibular schwannoma (VS) and cochlea from magnetic resonance imaging can facilitate VS treatment planning. Unsupervised segmentation methods have shown promising results without requiring the time-consuming and laborious manual labeling process. In this paper, we present an approach for VS and cochlea segmentation in an unsupervised domain adaptation setting. Specifically, we first develop a cross-site cross-modality unpaired image translation strategy to enrich the diversity of the synthesized data. Then, we devise a rule-based offline augmentation technique to further minimize the domain gap. Lastly, we adopt a self-configuring segmentation framework empowered by self-training to obtain the final results. On the CrossMoDA 2022 validation leaderboard, our method has achieved competitive VS and cochlea segmentation performance with mean Dice scores of 0.8178 $\pm$ 0.0803 and 0.8433 $\pm$ 0.0293, respectively.

Han Liu, Zhoubing Xu, Riqiang Gao et al.

Deep learning models have demonstrated remarkable success in multi-organ segmentation but typically require large-scale datasets with all organs of interest annotated. However, medical image datasets are often low in sample size and only partially labeled, i.e., only a subset of organs are annotated. Therefore, it is crucial to investigate how to learn a unified model on the available partially labeled datasets to leverage their synergistic potential. In this paper, we systematically investigate the partial-label segmentation problem with theoretical and empirical analyses on the prior techniques. We revisit the problem from a perspective of partial label supervision signals and identify two signals derived from ground truth and one from pseudo labels. We propose a novel two-stage framework termed COSST, which effectively and efficiently integrates comprehensive supervision signals with self-training. Concretely, we first train an initial unified model using two ground truth-based signals and then iteratively incorporate the pseudo label signal to the initial model using self-training. To mitigate performance degradation caused by unreliable pseudo labels, we assess the reliability of pseudo labels via outlier detection in latent space and exclude the most unreliable pseudo labels from each self-training iteration. Extensive experiments are conducted on one public and three private partial-label segmentation tasks over 12 CT datasets. Experimental results show that our proposed COSST achieves significant improvement over the baseline method, i.e., individual networks trained on each partially labeled dataset. Compared to the state-of-the-art partial-label segmentation methods, COSST demonstrates consistent superior performance on various segmentation tasks and with different training data sizes.

Hao Li, Han Liu, Heinrich von Busch et al.

Our hypothesis is that UDA using diffusion-weighted images, generated with a unified model, offers a promising and reliable strategy for enhancing the performance of supervised learning models in multi-site prostate lesion detection, especially when various b-values are present. This retrospective study included data from 5,150 patients (14,191 samples) collected across nine different imaging centers. A novel UDA method using a unified generative model was developed for multi-site PCa detection. This method translates diffusion-weighted imaging (DWI) acquisitions, including apparent diffusion coefficient (ADC) and individual DW images acquired using various b-values, to align with the style of images acquired using b-values recommended by Prostate Imaging Reporting and Data System (PI-RADS) guidelines. The generated ADC and DW images replace the original images for PCa detection. An independent set of 1,692 test cases (2,393 samples) was used for evaluation. The area under the receiver operating characteristic curve (AUC) was used as the primary metric, and statistical analysis was performed via bootstrapping. For all test cases, the AUC values for baseline SL and UDA methods were 0.73 and 0.79 (p<.001), respectively, for PI-RADS>=3, and 0.77 and 0.80 (p<.001) for PI-RADS>=4 PCa lesions. In the 361 test cases under the most unfavorable image acquisition setting, the AUC values for baseline SL and UDA were 0.49 and 0.76 (p<.001) for PI-RADS>=3, and 0.50 and 0.77 (p<.001) for PI-RADS>=4 PCa lesions. The results indicate the proposed UDA with generated images improved the performance of SL methods in multi-site PCa lesion detection across datasets with various b values, especially for images acquired with significant deviations from the PI-RADS recommended DWI protocol (e.g. with an extremely high b-value).

Hao Li, Dewei Hu, Han Liu et al.

Recently, deep learning methods have achieved state-of-the-art performance in many medical image segmentation tasks. Many of these are based on convolutional neural networks (CNNs). For such methods, the encoder is the key part for global and local information extraction from input images; the extracted features are then passed to the decoder for predicting the segmentations. In contrast, several recent works show a superior performance with the use of transformers, which can better model long-range spatial dependencies and capture low-level details. However, transformer as sole encoder underperforms for some tasks where it cannot efficiently replace the convolution based encoder. In this paper, we propose a model with double encoders for 3D biomedical image segmentation. Our model is a U-shaped CNN augmented with an independent transformer encoder. We fuse the information from the convolutional encoder and the transformer, and pass it to the decoder to obtain the results. We evaluate our methods on three public datasets from three different challenges: BTCV, MoDA and Decathlon. Compared to the state-of-the-art models with and without transformers on each task, our proposed method obtains higher Dice scores across the board.

Xing Yao, Han Liu, Dewei Hu et al.

The Segment Anything Model (SAM) is a recently developed all-range foundation model for image segmentation. It can use sparse manual prompts such as bounding boxes to generate pixel-level segmentation in natural images but struggles in medical images such as low-contrast, noisy ultrasound images. We propose a refined test-phase prompt augmentation technique designed to improve SAM's performance in medical image segmentation. The method couples multi-box prompt augmentation and an aleatoric uncertainty-based false-negative (FN) and false-positive (FP) correction (FNPC) strategy. We evaluate the method on two ultrasound datasets and show improvement in SAM's performance and robustness to inaccurate prompts, without the necessity for further training or tuning. Moreover, we present the Single-Slice-to-Volume (SS2V) method, enabling 3D pixel-level segmentation using only the bounding box annotation from a single 2D slice. Our results allow efficient use of SAM in even noisy, low-contrast medical images. The source code will be released soon.

Jiacheng Wang, Hao Li, Han Liu et al.

Automated segmentation of multiple sclerosis (MS) lesions from MRI scans is important to quantify disease progression. In recent years, convolutional neural networks (CNNs) have shown top performance for this task when a large amount of labeled data is available. However, the accuracy of CNNs suffers when dealing with few and/or sparsely labeled datasets. A potential solution is to leverage the information available in large public datasets in conjunction with a target dataset which only has limited labeled data. In this paper, we propose a training framework, SSL2 (self-supervised-semi-supervised), for multi-modality MS lesion segmentation with limited supervision. We adopt self-supervised learning to leverage the knowledge from large public 3T datasets to tackle the limitations of a small 7T target dataset. To leverage the information from unlabeled 7T data, we also evaluate state-of-the-art semi-supervised methods for other limited annotation settings, such as small labeled training size and sparse annotations. We use the shifted-window (Swin) transformer1 as our backbone network. The effectiveness of self-supervised and semi-supervised training strategies is evaluated in our in-house 7T MRI dataset. The results indicate that each strategy improves lesion segmentation for both limited training data size and for sparse labeling scenarios. The combined overall framework further improves the performance substantially compared to either of its components alone. Our proposed framework thus provides a promising solution for future data/label-hungry 7T MS studies.

Zachary A Stoebner, Daiwei Lu, Seok Hee Hong et al.

Image segmentation has been increasingly applied in medical settings as recent developments have skyrocketed the potential applications of deep learning. Urology, specifically, is one field of medicine that is primed for the adoption of a real-time image segmentation system with the long-term aim of automating endoscopic stone treatment. In this project, we explored supervised deep learning models to annotate kidney stones in surgical endoscopic video feeds. In this paper, we describe how we built a dataset from the raw videos and how we developed a pipeline to automate as much of the process as possible. For the segmentation task, we adapted and analyzed three baseline deep learning models -- U-Net, U-Net++, and DenseNet -- to predict annotations on the frames of the endoscopic videos with the highest accuracy above 90\%. To show clinical potential for real-time use, we also confirmed that our best trained model can accurately annotate new videos at 30 frames per second. Our results demonstrate that the proposed method justifies continued development and study of image segmentation to annotate ureteroscopic video feeds.

Dewei Hu, Xing Yao, Jiacheng Wang et al.

Among the research efforts to segment the retinal vasculature from fundus images, deep learning models consistently achieve superior performance. However, this data-driven approach is very sensitive to domain shifts. For fundus images, such data distribution changes can easily be caused by variations in illumination conditions as well as the presence of disease-related features such as hemorrhages and drusen. Since the source domain may not include all possible types of pathological cases, a model that can robustly recognize vessels on unseen domains is desirable but remains elusive, despite many proposed segmentation networks of ever-increasing complexity. In this work, we propose a contrastive variational auto-encoder that can filter out irrelevant features and synthesize a latent image, named deep angiogram, representing only the retinal vessels. Then segmentation can be readily accomplished by thresholding the deep angiogram. The generalizability of the synthetic network is improved by the contrastive loss that makes the model less sensitive to variations of image contrast and noisy features. Compared to baseline deep segmentation networks, our model achieves higher segmentation performance via simple thresholding. Our experiments show that the model can generate stable angiograms on different target domains, providing excellent visualization of vessels and a non-invasive, safe alternative to fluorescein angiography.

Britton Jordan, Jordan Thompson, Jesse F. d'Almeida et al.

Monocular depth estimation (MDE) provides a useful tool for robotic perception, but its predictions are often uncertain and inaccurate in challenging environments such as surgical scenes where textureless surfaces, specular reflections, and occlusions are common. To address this, we propose ProbeMDE, a cost-aware active sensing framework that combines RGB images with sparse proprioceptive measurements for MDE. Our approach utilizes an ensemble of MDE models to predict dense depth maps conditioned on both RGB images and on a sparse set of known depth measurements obtained via proprioception, where the robot has touched the environment in a known configuration. We quantify predictive uncertainty via the ensemble's variance and measure the gradient of the uncertainty with respect to candidate measurement locations. To prevent mode collapse while selecting maximally informative locations to propriocept (touch), we leverage Stein Variational Gradient Descent (SVGD) over this gradient map. We validate our method in both simulated and physical experiments on central airway obstruction surgical phantoms. Our results demonstrate that our approach outperforms baseline methods across standard depth estimation metrics, achieving higher accuracy while minimizing the number of required proprioceptive measurements. Project page: https://brittonjordan.github.io/probe_mde/

Jiacheng Wang, Kathleen E. Larson, Ipek Oguz

Accuracy validation of cortical thickness measurement is a difficult problem due to the lack of ground truth data. To address this need, many methods have been developed to synthetically induce gray matter (GM) atrophy in an MRI via deformable registration, creating a set of images with known changes in cortical thickness. However, these methods often cause blurring in atrophied regions, and cannot simulate realistic atrophy within deep sulci where cerebrospinal fluid (CSF) is obscured or absent. In this paper, we present a solution using a self-supervised inpainting model to generate CSF in these regions and create images with more plausible GM/CSF boundaries. Specifically, we introduce a novel, 3D GAN model that incorporates patch-based dropout training, edge map priors, and sinusoidal positional encoding, all of which are established methods previously limited to 2D domains. We show that our framework significantly improves the quality of the resulting synthetic images and is adaptable to unseen data with fine-tuning. We also demonstrate that our resulting dataset can be employed for accuracy validation of cortical segmentation and thickness measurement.

Hanchen David Wang, Diego Manzanas Lopez, Preston K. Robinette et al.

As deep neural networks are deployed in safety-critical domains such as autonomous driving and medical diagnosis, stakeholders need explanations that are interpretable but also trustworthy with formal guarantees. Existing XAI methods fall short: heuristic attribution techniques (e.g., LIME, Integrated Gradients) highlight influential features but offer no mathematical guarantees about decision boundaries, while formal methods verify robustness yet remain untargeted, analyzing the nearest boundary regardless of whether it represents a critical risk. In safety-critical systems, not all misclassifications carry equal consequences; confusing a "Stop" sign for a "60 kph" sign is far more dangerous than confusing it with a "No Passing" sign. We introduce ViTaX (Verified and Targeted Explanations), a formal XAI framework that generates targeted semifactual explanations with mathematical guarantees. For a given input (class y) and a user-specified critical alternative (class t), ViTaX: (1) identifies the minimal feature subset most sensitive to the y->t transition, and (2) applies formal reachability analysis to guarantee that perturbing these features by epsilon cannot flip the classification to t. We formalize this through Targeted epsilon-Robustness, certifying whether a feature subset remains robust under perturbation toward a specific target class. ViTaX is the first method to provide formally guaranteed explanations of a model's resilience against user-identified alternatives. Evaluations on MNIST, GTSRB, EMNIST, and TaxiNet demonstrate over 30% fidelity improvement with minimal explanation cardinality.

Dewei Hu, Hao Li, Han Liu et al.

Due to the absence of a single standardized imaging protocol, domain shift between data acquired from different sites is an inherent property of medical images and has become a major obstacle for large-scale deployment of learning-based algorithms. For retinal vessel images, domain shift usually presents as the variation of intensity, contrast and resolution, while the basic tubular shape of vessels remains unaffected. Thus, taking advantage of such domain-invariant morphological features can greatly improve the generalizability of deep models. In this study, we propose a method named VesselMorph which generalizes the 2D retinal vessel segmentation task by synthesizing a shape-aware representation. Inspired by the traditional Frangi filter and the diffusion tensor imaging literature, we introduce a Hessian-based bipolar tensor field to depict the morphology of the vessels so that the shape information is taken into account. We map the intensity image and the tensor field to a latent space for feature extraction. Then we fuse the two latent representations via a weight-balancing trick and feed the result to a segmentation network. We evaluate on six public datasets of fundus and OCT angiography images from diverse patient populations. VesselMorph achieves superior generalization performance compared with competing methods in different domain shift scenarios.

Hao Li, Han Liu, Dewei Hu et al.

In this paper, we present PRISM, a Promptable and Robust Interactive Segmentation Model, aiming for precise segmentation of 3D medical images. PRISM accepts various visual inputs, including points, boxes, and scribbles as sparse prompts, as well as masks as dense prompts. Specifically, PRISM is designed with four principles to achieve robustness: (1) Iterative learning. The model produces segmentations by using visual prompts from previous iterations to achieve progressive improvement. (2) Confidence learning. PRISM employs multiple segmentation heads per input image, each generating a continuous map and a confidence score to optimize predictions. (3) Corrective learning. Following each segmentation iteration, PRISM employs a shallow corrective refinement network to reassign mislabeled voxels. (4) Hybrid design. PRISM integrates hybrid encoders to better capture both the local and global information. Comprehensive validation of PRISM is conducted using four public datasets for tumor segmentation in the colon, pancreas, liver, and kidney, highlighting challenges caused by anatomical variations and ambiguous boundaries in accurate tumor identification. Compared to state-of-the-art methods, both with and without prompt engineering, PRISM significantly improves performance, achieving results that are close to human levels. The code is publicly available at https://github.com/MedICL-VU/PRISM.

Nick DiSanto, Ehsan Khodapanah Aghdam, Han Liu et al.

Handheld Optical Coherence Tomography Angiography (OCTA) enables noninvasive retinal imaging in uncooperative or pediatric subjects, but is highly susceptible to motion artifacts that severely degrade volumetric image quality. Sudden motion during 3D acquisition can lead to unsampled retinal regions across entire B-scans (cross-sectional slices), resulting in blank bands in en face projections. We propose VAMOS-OCTA, a deep learning framework for inpainting motion-corrupted B-scans using vessel-aware multi-axis supervision. We employ a 2.5D U-Net architecture that takes a stack of neighboring B-scans as input to reconstruct a corrupted center B-scan, guided by a novel Vessel-Aware Multi-Axis Orthogonal Supervision (VAMOS) loss. This loss combines vessel-weighted intensity reconstruction with axial and lateral projection consistency, encouraging vascular continuity in native B-scans and across orthogonal planes. Unlike prior work that focuses primarily on restoring the en face MIP, VAMOS-OCTA jointly enhances both cross-sectional B-scan sharpness and volumetric projection accuracy, even under severe motion corruptions. We trained our model on both synthetic and real-world corrupted volumes and evaluated its performance using both perceptual quality and pixel-wise accuracy metrics. VAMOS-OCTA consistently outperforms prior methods, producing reconstructions with sharp capillaries, restored vessel continuity, and clean en face projections. These results demonstrate that multi-axis supervision offers a powerful constraint for restoring motion-degraded 3D OCTA data. Our source code is available at https://github.com/MedICL-VU/VAMOS-OCTA.

Jiacheng Wang, Hao Li, Xing Yao et al.

Quantitative magnetization transfer (qMT) imaging provides myelin-sensitive biomarkers, such as the pool size ratio (PSR), which is valuable for multiple sclerosis (MS) assessment. However, qMT requires specialized 20-30 minute scans. We propose DEMIST to synthesize PSR maps from standard T1w and FLAIR images using a 3D latent diffusion model with three complementary conditioning mechanisms. Our approach has two stages: first, we train separate autoencoders for PSR and anatomical images to learn aligned latent representations. Second, we train a conditional diffusion model in this latent space on top of a frozen diffusion foundation backbone. Conditioning is decoupled into: (i) \textbf{semantic} tokens via cross-attention, (ii) \textbf{spatial} per-scale residual hints via a 3D ControlNet branch, and (iii) \textbf{adaptive} LoRA-modulated attention. We include edge-aware loss terms to preserve lesion boundaries and alignment losses to maintain quantitative consistency, while keeping the number of trainable parameters low and retaining the inductive bias of the pretrained model. We evaluate on 163 scans from 99 subjects using 5-fold cross-validation. Our method outperforms VAE, GAN and diffusion baselines on multiple metrics, producing sharper boundaries and better quantitative agreement with ground truth. Our code is publicly available at https://github.com/MedICL-VU/MS-Synthesis-3DcLDM.

Navid Hashemi, Samuel Sasaki, Diego Manzanas Lopez et al.

Semantic segmentation networks (SSNs) are central to safety-critical applications such as medical imaging and autonomous driving, where robustness under uncertainty is essential. However, existing probabilistic verification methods often fail to scale with the complexity and dimensionality of modern segmentation tasks, producing guarantees that are overly conservative and of limited practical value. We propose a probabilistic verification framework that is architecture-agnostic and scalable to high-dimensional input-output spaces. Our approach employs conformal inference (CI), enhanced by a novel technique that we call the \textbf{clipping block}, to provide provable guarantees while mitigating the excessive conservatism of prior methods. Experiments on large-scale segmentation models across CamVid, OCTA-500, Lung Segmentation, and Cityscapes demonstrate that our framework delivers reliable safety guarantees while substantially reducing conservatism compared to state-of-the-art approaches on segmentation tasks. We also provide a public GitHub repository (https://github.com/Navidhashemicodes/SSN_Reach_CLP_Surrogate) for this approach, to support reproducibility.

Han Liu, Hao Li, Jiacheng Wang et al.

Fluorescence labeling is the standard approach to reveal cellular structures and other subcellular constituents for microscopy images. However, this invasive procedure may perturb or even kill the cells and the procedure itself is highly time-consuming and complex. Recently, in silico labeling has emerged as a promising alternative, aiming to use machine learning models to directly predict the fluorescently labeled images from label-free microscopy. In this paper, we propose a deep learning-based in silico labeling method for the Light My Cells challenge. Built upon pix2pix, our proposed method can be trained using the partially labeled datasets with an adaptive loss. Moreover, we explore the effectiveness of several training strategies to handle different input modalities, such as training them together or separately. The results show that our method achieves promising performance for in silico labeling. Our code is available at https://github.com/MedICL-VU/LightMyCells.

Dewei Hu, Hao Li, Han Liu et al.

Deep models suffer from limited generalization capability to unseen domains, which has severely hindered their clinical applicability. Specifically for the retinal vessel segmentation task, although the model is supposed to learn the anatomy of the target, it can be distracted by confounding factors like intensity and contrast. We propose Meta learning on Anatomy-consistent Pseudo-modalities (MAP), a method that improves model generalizability by learning structural features. We first leverage a feature extraction network to generate three distinct pseudo-modalities that share the vessel structure of the original image. Next, we use the episodic learning paradigm by selecting one of the pseudo-modalities as the meta-train dataset, and perform meta-testing on a continuous augmented image space generated through Dirichlet mixup of the remaining pseudo-modalities. Further, we introduce two loss functions that facilitate the model's focus on shape information by clustering the latent vectors obtained from images featuring identical vasculature. We evaluate our model on seven public datasets of various retinal imaging modalities and we conclude that MAP has substantially better generalizability. Our code is publically available at https://github.com/DeweiHu/MAP.

Ayberk Acar, Mariana Smith, Lidia Al-Zogbi et al.

Surgical automation requires precise guidance and understanding of the scene. Current methods in the literature rely on bulky depth cameras to create maps of the anatomy, however this does not translate well to space-limited clinical applications. Monocular cameras are small and allow minimally invasive surgeries in tight spaces but additional processing is required to generate 3D scene understanding. We propose a 3D mapping pipeline that uses only RGB images to create segmented point clouds of the target anatomy. To ensure the most precise reconstruction, we compare different structure from motion algorithms' performance on mapping the central airway obstructions, and test the pipeline on a downstream task of tumor resection. In several metrics, including post-procedure tissue model evaluation, our pipeline performs comparably to RGB-D cameras and, in some cases, even surpasses their performance. These promising results demonstrate that automation guidance can be achieved in minimally invasive procedures with monocular cameras. This study is a step toward the complete autonomy of surgical robots.

Ayberk Acar, Fangjie Li, Hao Li et al.

Central airway obstruction (CAO) is a life-threatening condition with increasing incidence, caused by tumors in and outside of the airway. Traditional treatment methods such as bronchoscopy and electrocautery can be used to remove the tumor completely; however, these methods carry a high risk of complications. Recent advances allow robotic interventions with lesser risk. The combination of robot interventions with scene understanding and mapping also opens up the possibilities for automation. We present a novel pipeline that enables real-time, semantically informed 3D reconstructions of the central airway using monocular endoscopic video. Our approach combines DROID-SLAM with a segmentation model trained to identify obstructive tissues. The SLAM module reconstructs the 3D geometry of the airway in real time, while the segmentation masks guide the annotation of obstruction regions within the reconstructed point cloud. To validate our pipeline, we evaluate the reconstruction quality using ex vivo models. Qualitative and quantitative results show high similarity between ground truth CT scans and the 3D reconstructions (0.62 mm Chamfer distance). By integrating segmentation directly into the SLAM workflow, our system produces annotated 3D maps that highlight clinically relevant regions in real time. High-speed capabilities of the pipeline allows quicker reconstructions compared to previous work, reflecting the surgical scene more accurately. To the best of our knowledge, this is the first work to integrate semantic segmentation with real-time monocular SLAM for endoscopic CAO scenarios. Our framework is modular and can generalize to other anatomies or procedures with minimal changes, offering a promising step toward autonomous robotic interventions.

Navodini Wijethilake, Reuben Dorent, Marina Ivory et al.

The cross-Modality Domain Adaptation (crossMoDA) challenge series, initiated in 2021 in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI), focuses on unsupervised cross-modality segmentation, learning from contrast-enhanced T1 (ceT1) and transferring to T2 MRI. The task is an extreme example of domain shift chosen to serve as a meaningful and illustrative benchmark. From a clinical application perspective, it aims to automate Vestibular Schwannoma (VS) and cochlea segmentation on T2 scans for more cost-effective VS management. Over time, the challenge objectives have evolved to enhance its clinical relevance. The challenge evolved from using single-institutional data and basic segmentation in 2021 to incorporating multi-institutional data and Koos grading in 2022, and by 2023, it included heterogeneous routine data and sub-segmentation of intra- and extra-meatal tumour components. In this work, we report the findings of the 2022 and 2023 editions and perform a retrospective analysis of the challenge progression over the years. The observations from the successive challenge contributions indicate that the number of outliers decreases with an expanding dataset. This is notable since the diversity of scanning protocols of the datasets concurrently increased. The winning approach of the 2023 edition reduced the number of outliers on the 2021 and 2022 testing data, demonstrating how increased data heterogeneity can enhance segmentation performance even on homogeneous data. However, the cochlea Dice score declined in 2023, likely due to the added complexity from tumour sub-annotations affecting overall segmentation performance. While progress is still needed for clinically acceptable VS segmentation, the plateauing performance suggests that a more challenging cross-modal task may better serve future benchmarking.

Xing Yao, Runxuan Yu, Dewei Hu et al.

Ultrasound (US) image stitching can expand the field-of-view (FOV) by combining multiple US images from varied probe positions. However, registering US images with only partially overlapping anatomical contents is a challenging task. In this work, we introduce SynStitch, a self-supervised framework designed for 2DUS stitching. SynStitch consists of a synthetic stitching pair generation module (SSPGM) and an image stitching module (ISM). SSPGM utilizes a patch-conditioned ControlNet to generate realistic 2DUS stitching pairs with known affine matrix from a single input image. ISM then utilizes this synthetic paired data to learn 2DUS stitching in a supervised manner. Our framework was evaluated against multiple leading methods on a kidney ultrasound dataset, demonstrating superior 2DUS stitching performance through both qualitative and quantitative analyses. The code will be made public upon acceptance of the paper.

Dewei Hu, Yuankai K. Tao, Ipek Oguz

Optical coherence tomography (OCT) is a prevalent non-invasive imaging method which provides high resolution volumetric visualization of retina. However, its inherent defect, the speckle noise, can seriously deteriorate the tissue visibility in OCT. Deep learning based approaches have been widely used for image restoration, but most of these require a noise-free reference image for supervision. In this study, we present a diffusion probabilistic model that is fully unsupervised to learn from noise instead of signal. A diffusion process is defined by adding a sequence of Gaussian noise to self-fused OCT b-scans. Then the reverse process of diffusion, modeled by a Markov chain, provides an adjustable level of denoising. Our experiment results demonstrate that our method can significantly improve the image quality with a simple working pipeline and a small amount of training data.

Reuben Dorent, Aaron Kujawa, Marina Ivory et al.

Domain Adaptation (DA) has recently raised strong interests in the medical imaging community. While a large variety of DA techniques has been proposed for image segmentation, most of these techniques have been validated either on private datasets or on small publicly available datasets. Moreover, these datasets mostly addressed single-class problems. To tackle these limitations, the Cross-Modality Domain Adaptation (crossMoDA) challenge was organised in conjunction with the 24th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2021). CrossMoDA is the first large and multi-class benchmark for unsupervised cross-modality DA. The challenge's goal is to segment two key brain structures involved in the follow-up and treatment planning of vestibular schwannoma (VS): the VS and the cochleas. Currently, the diagnosis and surveillance in patients with VS are performed using contrast-enhanced T1 (ceT1) MRI. However, there is growing interest in using non-contrast sequences such as high-resolution T2 (hrT2) MRI. Therefore, we created an unsupervised cross-modality segmentation benchmark. The training set provides annotated ceT1 (N=105) and unpaired non-annotated hrT2 (N=105). The aim was to automatically perform unilateral VS and bilateral cochlea segmentation on hrT2 as provided in the testing set (N=137). A total of 16 teams submitted their algorithm for the evaluation phase. The level of performance reached by the top-performing teams is strikingly high (best median Dice - VS:88.4%; Cochleas:85.7%) and close to full supervision (median Dice - VS:92.5%; Cochleas:87.7%). All top-performing methods made use of an image-to-image translation approach to transform the source-domain images into pseudo-target-domain images. A segmentation network was then trained using these generated images and the manual annotations provided for the source image.

Hao Li, Dewei Hu, Qibang Zhu et al.

Magnetic resonance images (MRIs) are widely used to quantify vestibular schwannoma and the cochlea. Recently, deep learning methods have shown state-of-the-art performance for segmenting these structures. However, training segmentation models may require manual labels in target domain, which is expensive and time-consuming. To overcome this problem, domain adaptation is an effective way to leverage information from source domain to obtain accurate segmentations without requiring manual labels in target domain. In this paper, we propose an unsupervised learning framework to segment the VS and cochlea. Our framework leverages information from contrast-enhanced T1-weighted (ceT1-w) MRIs and its labels, and produces segmentations for T2-weighted MRIs without any labels in the target domain. We first applied a generator to achieve image-to-image translation. Next, we ensemble outputs from an ensemble of different models to obtain final segmentations. To cope with MRIs from different sites/scanners, we applied various 'online' augmentations during training to better capture the geometric variability and the variability in image appearance and quality. Our method is easy to build and produces promising segmentations, with a mean Dice score of 0.7930 and 0.7432 for VS and cochlea respectively in the validation set.

Dewei Hu, Joseph D. Malone, Yigit Atay et al.

Optical coherence tomography (OCT) is a prevalent imaging technique for retina. However, it is affected by multiplicative speckle noise that can degrade the visibility of essential anatomical structures, including blood vessels and tissue layers. Although averaging repeated B-scan frames can significantly improve the signal-to-noise-ratio (SNR), this requires longer acquisition time, which can introduce motion artifacts and cause discomfort to patients. In this study, we propose a learning-based method that exploits information from the single-frame noisy B-scan and a pseudo-modality that is created with the aid of the self-fusion method. The pseudo-modality provides good SNR for layers that are barely perceptible in the noisy B-scan but can over-smooth fine features such as small vessels. By using a fusion network, desired features from each modality can be combined, and the weight of their contribution is adjustable. Evaluated by intensity-based and structural metrics, the result shows that our method can effectively suppress the speckle noise and enhance the contrast between retina layers while the overall structure and small blood vessels are preserved. Compared to the single modality network, our method improves the structural similarity with low noise B-scan from 0.559 +\- 0.033 to 0.576 +\- 0.031.

Dewei Hu, Can Cui, Hao Li et al.

Optical coherence tomography (OCT) is a non-invasive imaging technique widely used for ophthalmology. It can be extended to OCT angiography (OCT-A), which reveals the retinal vasculature with improved contrast. Recent deep learning algorithms produced promising vascular segmentation results; however, 3D retinal vessel segmentation remains difficult due to the lack of manually annotated training data. We propose a learning-based method that is only supervised by a self-synthesized modality named local intensity fusion (LIF). LIF is a capillary-enhanced volume computed directly from the input OCT-A. We then construct the local intensity fusion encoder (LIFE) to map a given OCT-A volume and its LIF counterpart to a shared latent space. The latent space of LIFE has the same dimensions as the input data and it contains features common to both modalities. By binarizing this latent space, we obtain a volumetric vessel segmentation. Our method is evaluated in a human fovea OCT-A and three zebrafish OCT-A volumes with manual labels. It yields a Dice score of 0.7736 on human data and 0.8594 +/- 0.0275 on zebrafish data, a dramatic improvement over existing unsupervised algorithms.

Huahong Zhang, Ipek Oguz

Lesion segmentation is a core task for quantitative analysis of MRI scans of Multiple Sclerosis patients. The recent success of deep learning techniques in a variety of medical image analysis applications has renewed community interest in this challenging problem and led to a burst of activity for new algorithm development. In this survey, we investigate the supervised CNN-based methods for MS lesion segmentation. We decouple these reviewed works into their algorithmic components and discuss each separately. For methods that provide evaluations on public benchmark datasets, we report comparisons between their results.

Kilian Hett, Hans Johnson, Pierrick Coupé et al.

The improvements in magnetic resonance imaging have led to the development of numerous techniques to better detect structural alterations caused by neurodegenerative diseases. Among these, the patch-based grading framework has been proposed to model local patterns of anatomical changes. This approach is attractive because of its low computational cost and its competitive performance. Other studies have proposed to analyze the deformations of brain structures using tensor-based morphometry, which is a highly interpretable approach. In this work, we propose to combine the advantages of these two approaches by extending the patch-based grading framework with a new tensor-based grading method that enables us to model patterns of local deformation using a log-Euclidean metric. We evaluate our new method in a study of the putamen for the classification of patients with pre-manifest Huntington's disease and healthy controls. Our experiments show a substantial increase in classification accuracy (87.5 $\pm$ 0.5 vs. 81.3 $\pm$ 0.6) compared to the existing patch-based grading methods, and a good complement to putamen volume, which is a primary imaging-based marker for the study of Huntington's disease.

M. Jorge Cardoso, Aasa Feragen, Ben Glocker et al.

This compendium gathers all the accepted extended abstracts from the Second International Conference on Medical Imaging with Deep Learning (MIDL 2019), held in London, UK, 8-10 July 2019. Note that only accepted extended abstracts are listed here, the Proceedings of the MIDL 2019 Full Paper Track are published as Volume 102 of the Proceedings of Machine Learning Research (PMLR) http://proceedings.mlr.press/v102/.

Satyananda Kashyap, Ipek Oguz, Honghai Zhang et al.

We present a fully automated learning-based approach for segmenting knee cartilage in the presence of osteoarthritis (OA). The algorithm employs a hierarchical set of two random forest classifiers. The first is a neighborhood approximation forest, the output probability map of which is utilized as a feature set for the second random forest (RF) classifier. The output probabilities of the hierarchical approach are used as cost functions in a Layered Optimal Graph Segmentation of Multiple Objects and Surfaces (LOGISMOS). In this work, we highlight a novel post-processing interaction called just-enough interaction (JEI) which enables quick and accurate generation of a large set of training examples. Disjoint sets of 15 and 13 subjects were used for training and tested on another disjoint set of 53 knee datasets. All images were acquired using a double echo steady state (DESS) MRI sequence and are from the osteoarthritis initiative (OAI) database. Segmentation performance using the learning-based cost function showed significant reduction in segmentation errors ($p< 0.05$) in comparison with conventional gradient-based cost functions.

Hossam Isack, Olga Veksler, Ipek Oguz et al.

We propose an effective optimization algorithm for a general hierarchical segmentation model with geometric interactions between segments. Any given tree can specify a partial order over object labels defining a hierarchy. It is well-established that segment interactions, such as inclusion/exclusion and margin constraints, make the model significantly more discriminant. However, existing optimization methods do not allow full use of such models. Generic -expansion results in weak local minima, while common binary multi-layered formulations lead to non-submodularity, complex high-order potentials, or polar domain unwrapping and shape biases. In practice, applying these methods to arbitrary trees does not work except for simple cases. Our main contribution is an optimization method for the Hierarchically-structured Interacting Segments (HINTS) model with arbitrary trees. Our Path-Moves algorithm is based on multi-label MRF formulation and can be seen as a combination of well-known a-expansion and Ishikawa techniques. We show state-of-the-art biomedical segmentation for many diverse examples of complex trees.