Xin Yang

Haoran Dou, Ning Bi, Luyi Han et al.

Deep learning-based deformable registration methods have been widely investigated in diverse medical applications. Learning-based deformable registration relies on weighted objective functions trading off registration accuracy and smoothness of the deformation field. Therefore, they inevitably require tuning the hyperparameter for optimal registration performance. Tuning the hyperparameters is highly computationally expensive and introduces undesired dependencies on domain knowledge. In this study, we construct a registration model based on the gradient surgery mechanism, named GSMorph, to achieve a hyperparameter-free balance on multiple losses. In GSMorph, we reformulate the optimization procedure by projecting the gradient of similarity loss orthogonally to the plane associated with the smoothness constraint, rather than additionally introducing a hyperparameter to balance these two competing terms. Furthermore, our method is model-agnostic and can be merged into any deep registration network without introducing extra parameters or slowing down inference. In this study, We compared our method with state-of-the-art (SOTA) deformable registration approaches over two publicly available cardiac MRI datasets. GSMorph proves superior to five SOTA learning-based registration models and two conventional registration techniques, SyN and Demons, on both registration accuracy and smoothness.

Yuhao Huang, Xin Yang, Xiaoqiong Huang et al.

Deep classifiers may encounter significant performance degradation when processing unseen testing data from varying centers, vendors, and protocols. Ensuring the robustness of deep models against these domain shifts is crucial for their widespread clinical application. In this study, we propose a novel approach called Fourier Test-time Adaptation (FTTA), which employs a dual-adaptation design to integrate input and model tuning, thereby jointly improving the model robustness. The main idea of FTTA is to build a reliable multi-level consistency measurement of paired inputs for achieving self-correction of prediction. Our contribution is two-fold. First, we encourage consistency in global features and local attention maps between the two transformed images of the same input. Here, the transformation refers to Fourier-based input adaptation, which can transfer one unseen image into source style to reduce the domain gap. Furthermore, we leverage style-interpolated images to enhance the global and local features with learnable parameters, which can smooth the consistency measurement and accelerate convergence. Second, we introduce a regularization technique that utilizes style interpolation consistency in the frequency space to encourage self-consistency in the logit space of the model output. This regularization provides strong self-supervised signals for robustness enhancement. FTTA was extensively validated on three large classification datasets with different modalities and organs. Experimental results show that FTTA is general and outperforms other strong state-of-the-art methods.

Xinrui Zhou, Yuhao Huang, Wufeng Xue et al.

Localization of the narrowest position of the vessel and corresponding vessel and remnant vessel delineation in carotid ultrasound (US) are essential for carotid stenosis grading (CSG) in clinical practice. However, the pipeline is time-consuming and tough due to the ambiguous boundaries of plaque and temporal variation. To automatize this procedure, a large number of manual delineations are usually required, which is not only laborious but also not reliable given the annotation difficulty. In this study, we present the first video classification framework for automatic CSG. Our contribution is three-fold. First, to avoid the requirement of laborious and unreliable annotation, we propose a novel and effective video classification network for weakly-supervised CSG. Second, to ease the model training, we adopt an inflation strategy for the network, where pre-trained 2D convolution weights can be adapted into the 3D counterpart in our network for an effective warm start. Third, to enhance the feature discrimination of the video, we propose a novel attention-guided multi-dimension fusion (AMDF) transformer encoder to model and integrate global dependencies within and across spatial and temporal dimensions, where two lightweight cross-dimensional attention mechanisms are designed. Our approach is extensively validated on a large clinically collected carotid US video dataset, demonstrating state-of-the-art performance compared with strong competitors.

Zhiwei Wang, Junlin Xian, Kangyi Liu et al.

Mammogram image is important for breast cancer screening, and typically obtained in a dual-view form, i.e., cranio-caudal (CC) and mediolateral oblique (MLO), to provide complementary information. However, previous methods mostly learn features from the two views independently, which violates the clinical knowledge and ignores the importance of dual-view correlation. In this paper, we propose a dual-view correlation hybrid attention network (DCHA-Net) for robust holistic mammogram classification. Specifically, DCHA-Net is carefully designed to extract and reinvent deep features for the two views, and meanwhile to maximize the underlying correlations between them. A hybrid attention module, consisting of local relation and non-local attention blocks, is proposed to alleviate the spatial misalignment of the paired views in the correlation maximization. A dual-view correlation loss is introduced to maximize the feature similarity between corresponding strip-like regions with equal distance to the chest wall, motivated by the fact that their features represent the same breast tissues, and thus should be highly-correlated. Experimental results on two public datasets, i.e., INbreast and CBIS-DDSM, demonstrate that DCHA-Net can well preserve and maximize feature correlations across views, and thus outperforms the state-of-the-arts for classifying a whole mammogram as malignant or not.

Yuhao Huang, Xin Yang, Han Zhou et al.

The Segment Anything Model (SAM) can achieve satisfactory segmentation performance under high-quality box prompts. However, SAM's robustness is compromised by the decline in box quality, limiting its practicality in clinical reality. In this study, we propose a novel Robust Box prompt based SAM (\textbf{RoBox-SAM}) to ensure SAM's segmentation performance under prompts with different qualities. Our contribution is three-fold. First, we propose a prompt refinement module to implicitly perceive the potential targets, and output the offsets to directly transform the low-quality box prompt into a high-quality one. We then provide an online iterative strategy for further prompt refinement. Second, we introduce a prompt enhancement module to automatically generate point prompts to assist the box-promptable segmentation effectively. Last, we build a self-information extractor to encode the prior information from the input image. These features can optimize the image embeddings and attention calculation, thus, the robustness of SAM can be further enhanced. Extensive experiments on the large medical segmentation dataset including 99,299 images, 5 modalities, and 25 organs/targets validated the efficacy of our proposed RoBox-SAM.

Yaofei Duan, Yuhao Huang, Xin Yang et al.

Deep learning-based diagnostic models often suffer performance drops due to distribution shifts between training (source) and test (target) domains. Collecting and labeling sufficient target domain data for model retraining represents an optimal solution, yet is limited by time and scarce resources. Active learning (AL) offers an efficient approach to reduce annotation costs while maintaining performance, but struggles to handle the challenge posed by distribution variations across different datasets. In this study, we propose a novel unsupervised Active learning framework for Domain Adaptation, named ADAptation, which efficiently selects informative samples from multi-domain data pools under limited annotation budget. As a fundamental step, our method first utilizes the distribution homogenization capabilities of diffusion models to bridge cross-dataset gaps by translating target images into source-domain style. We then introduce two key innovations: (a) a hypersphere-constrained contrastive learning network for compact feature clustering, and (b) a dual-scoring mechanism that quantifies and balances sample uncertainty and representativeness. Extensive experiments on four breast ultrasound datasets (three public and one in-house/multi-center) across five common deep classifiers demonstrate that our method surpasses existing strong AL-based competitors, validating its effectiveness and generalization for clinical domain adaptation. The code is available at the anonymized link: https://github.com/miccai25-966/ADAptation.

Jian Wang, Xin Yang, Xiaohong Jia et al.

Thyroid nodule classification and segmentation in ultrasound images are crucial for computer-aided diagnosis; however, they face limitations owing to insufficient labeled data. In this study, we proposed a multi-view contrastive self-supervised method to improve thyroid nodule classification and segmentation performance with limited manual labels. Our method aligns the transverse and longitudinal views of the same nodule, thereby enabling the model to focus more on the nodule area. We designed an adaptive loss function that eliminates the limitations of the paired data. Additionally, we adopted a two-stage pre-training to exploit the pre-training on ImageNet and thyroid ultrasound images. Extensive experiments were conducted on a large-scale dataset collected from multiple centers. The results showed that the proposed method significantly improves nodule classification and segmentation performance with limited manual labels and outperforms state-of-the-art self-supervised methods. The two-stage pre-training also significantly exceeded ImageNet pre-training.

Xuxin Cheng, Ke Zeng, Zhiquan Cao et al.

Enhancing customer experience is essential for business success, particularly as service demands grow in scale and complexity. Generative artificial intelligence and Large Language Models (LLMs) have empowered intelligent interaction systems to deliver efficient, personalized, and 24/7 support. In practice, intelligent interaction systems encounter several challenges: (1) Constructing high-quality data for cold-start training is difficult, hindering self-evolution and raising labor costs. (2) Multi-turn dialogue performance remains suboptimal due to inadequate intent understanding, rule compliance, and solution extraction. (3) Frequent evolution of business rules affects system operability and transferability, constraining low-cost expansion and adaptability. (4) Reliance on a single LLM is insufficient in complex scenarios, where the absence of multi-agent frameworks and effective collaboration undermines process completeness and service quality. (5) The open-domain nature of multi-turn dialogues, lacking unified golden answers, hampers quantitative evaluation and continuous optimization. To address these challenges, we introduce WOWService, an intelligent interaction system tailored for industrial applications. With the integration of LLMs and multi-agent architectures, WOWService enables autonomous task management and collaborative problem-solving. Specifically, WOWService focuses on core modules including data construction, general capability enhancement, business scenario adaptation, multi-agent coordination, and automated evaluation. Currently, WOWService is deployed on the Meituan App, achieving significant gains in key metrics, e.g., User Satisfaction Metric 1 (USM 1) -27.53% and User Satisfaction Metric 2 (USM 2) +25.51%, demonstrating its effectiveness in capturing user needs and advancing personalized service.

Qi Li, Shaheer U. Saeed, Yuliang Huang et al.

Trackerless freehand ultrasound reconstruction aims to reconstruct 3D volumes from sequences of 2D ultrasound images without relying on external tracking systems. By eliminating the need for optical or electromagnetic trackers, this approach offers a low-cost, portable, and widely deployable alternative to more expensive volumetric ultrasound imaging systems, particularly valuable in resource-constrained clinical settings. However, predicting long-distance transformations and handling complex probe trajectories remain challenging. The TUS-REC2024 Challenge establishes the first benchmark for trackerless 3D freehand ultrasound reconstruction by providing a large publicly available dataset, along with a baseline model and a rigorous evaluation framework. By the submission deadline, the Challenge had attracted 43 registered teams, of which 6 teams submitted 21 valid dockerized solutions. The submitted methods span a wide range of approaches, including the state space model, the recurrent model, the registration-driven volume refinement, the attention mechanism, and the physics-informed model. This paper provides a comprehensive background introduction and literature review in the field, presents an overview of the challenge design and dataset, and offers a comparative analysis of submitted methods across multiple evaluation metrics. These analyses highlight both the progress and the current limitations of state-of-the-art approaches in this domain and provide insights for future research directions. All data and code are publicly available to facilitate ongoing development and reproducibility. As a live and evolving benchmark, it is designed to be continuously iterated and improved. The Challenge was held at MICCAI 2024 and is organised again at MICCAI 2025, reflecting its sustained commitment to advancing this field.

Chaoyu Chen, Xin Yang, Yuhao Huang et al.

Fetal pose estimation in 3D ultrasound (US) involves identifying a set of associated fetal anatomical landmarks. Its primary objective is to provide comprehensive information about the fetus through landmark connections, thus benefiting various critical applications, such as biometric measurements, plane localization, and fetal movement monitoring. However, accurately estimating the 3D fetal pose in US volume has several challenges, including poor image quality, limited GPU memory for tackling high dimensional data, symmetrical or ambiguous anatomical structures, and considerable variations in fetal poses. In this study, we propose a novel 3D fetal pose estimation framework (called FetusMapV2) to overcome the above challenges. Our contribution is three-fold. First, we propose a heuristic scheme that explores the complementary network structure-unconstrained and activation-unreserved GPU memory management approaches, which can enlarge the input image resolution for better results under limited GPU memory. Second, we design a novel Pair Loss to mitigate confusion caused by symmetrical and similar anatomical structures. It separates the hidden classification task from the landmark localization task and thus progressively eases model learning. Last, we propose a shape priors-based self-supervised learning by selecting the relatively stable landmarks to refine the pose online. Extensive experiments and diverse applications on a large-scale fetal US dataset including 1000 volumes with 22 landmarks per volume demonstrate that our method outperforms other strong competitors.

Shuangchi He, Zehui Lin, Xin Yang et al.

Standard plane recognition plays an important role in prenatal ultrasound (US) screening. Automatically recognizing the standard plane along with the corresponding anatomical structures in US image can not only facilitate US image interpretation but also improve diagnostic efficiency. In this study, we build a novel multi-label learning (MLL) scheme to identify multiple standard planes and corresponding anatomical structures of fetus simultaneously. Our contribution is three-fold. First, we represent the class correlation by word embeddings to capture the fine-grained semantic and latent statistical concurrency. Second, we equip the MLL with a graph convolutional network to explore the inner and outer relationship among categories. Third, we propose a novel cluster relabel-based contrastive learning algorithm to encourage the divergence among ambiguous classes. Extensive validation was performed on our large in-house dataset. Our approach reports the highest accuracy as 90.25% for standard planes labeling, 85.59% for planes and structures labeling and mAP as 94.63%. The proposed MLL scheme provides a novel perspective for standard plane recognition and can be easily extended to other medical image classification tasks.

Yuhao Huang, Xin Yang, Yuxin Zou et al.

Nodule segmentation from breast ultrasound images is challenging yet essential for the diagnosis. Weakly-supervised segmentation (WSS) can help reduce time-consuming and cumbersome manual annotation. Unlike existing weakly-supervised approaches, in this study, we propose a novel and general WSS framework called Flip Learning, which only needs the box annotation. Specifically, the target in the label box will be erased gradually to flip the classification tag, and the erased region will be considered as the segmentation result finally. Our contribution is three-fold. First, our proposed approach erases on superpixel level using a Multi-agent Reinforcement Learning framework to exploit the prior boundary knowledge and accelerate the learning process. Second, we design two rewards: classification score and intensity distribution reward, to avoid under- and over-segmentation, respectively. Third, we adopt a coarse-to-fine learning strategy to reduce the residual errors and improve the segmentation performance. Extensively validated on a large dataset, our proposed approach achieves competitive performance and shows great potential to narrow the gap between fully-supervised and weakly-supervised learning.

Mingyuan Luo, Xin Yang, Xiaoqiong Huang et al.

3D ultrasound (US) is widely used for its rich diagnostic information. However, it is criticized for its limited field of view. 3D freehand US reconstruction is promising in addressing the problem by providing broad range and freeform scan. The existing deep learning based methods only focus on the basic cases of skill sequences, and the model relies on the training data heavily. The sequences in real clinical practice are a mix of diverse skills and have complex scanning paths. Besides, deep models should adapt themselves to the testing cases with prior knowledge for better robustness, rather than only fit to the training cases. In this paper, we propose a novel approach to sensorless freehand 3D US reconstruction considering the complex skill sequences. Our contribution is three-fold. First, we advance a novel online learning framework by designing a differentiable reconstruction algorithm. It realizes an end-to-end optimization from section sequences to the reconstructed volume. Second, a self-supervised learning method is developed to explore the context information that reconstructed by the testing data itself, promoting the perception of the model. Third, inspired by the effectiveness of shape prior, we also introduce adversarial training to strengthen the learning of anatomical shape prior in the reconstructed volume. By mining the context and structural cues of the testing data, our online learning methods can drive the model to handle complex skill sequences. Experimental results on developmental dysplasia of the hip US and fetal US datasets show that, our proposed method can outperform the start-of-the-art methods regarding the shift errors and path similarities.

Xindi Hu, Limin Wang, Xin Yang et al.

The ultrasound (US) screening of the infant hip is vital for the early diagnosis of developmental dysplasia of the hip (DDH). The US diagnosis of DDH refers to measuring alpha and beta angles that quantify hip joint development. These two angles are calculated from key anatomical landmarks and structures of the hip. However, this measurement process is not trivial for sonographers and usually requires a thorough understanding of complex anatomical structures. In this study, we propose a multi-task framework to learn the relationships among landmarks and structures jointly and automatically evaluate DDH. Our multi-task networks are equipped with three novel modules. Firstly, we adopt Mask R-CNN as the basic framework to detect and segment key anatomical structures and add one landmark detection branch to form a new multi-task framework. Secondly, we propose a novel shape similarity loss to refine the incomplete anatomical structure prediction robustly and accurately. Thirdly, we further incorporate the landmark-structure consistent prior to ensure the consistency of the bony rim estimated from the segmented structure and the detected landmark. In our experiments, 1,231 US images of the infant hip from 632 patients are collected, of which 247 images from 126 patients are tested. The average errors in alpha and beta angles are 2.221 degrees and 2.899 degrees. About 93% and 85% estimates of alpha and beta angles have errors less than 5 degrees, respectively. Experimental results demonstrate that the proposed method can accurately and robustly realize the automatic evaluation of DDH, showing great potential for clinical application.

Xin Yang, Haoran Dou, Ruobing Huang et al.

Accurate standard plane (SP) localization is the fundamental step for prenatal ultrasound (US) diagnosis. Typically, dozens of US SPs are collected to determine the clinical diagnosis. 2D US has to perform scanning for each SP, which is time-consuming and operator-dependent. While 3D US containing multiple SPs in one shot has the inherent advantages of less user-dependency and more efficiency. Automatically locating SP in 3D US is very challenging due to the huge search space and large fetal posture variations. Our previous study proposed a deep reinforcement learning (RL) framework with an alignment module and active termination to localize SPs in 3D US automatically. However, termination of agent search in RL is important and affects the practical deployment. In this study, we enhance our previous RL framework with a newly designed adaptive dynamic termination to enable an early stop for the agent searching, saving at most 67% inference time, thus boosting the accuracy and efficiency of the RL framework at the same time. Besides, we validate the effectiveness and generalizability of our algorithm extensively on our in-house multi-organ datasets containing 433 fetal brain volumes, 519 fetal abdomen volumes, and 683 uterus volumes. Our approach achieves localization error of 2.52mm/10.26 degrees, 2.48mm/10.39 degrees, 2.02mm/10.48 degrees, 2.00mm/14.57 degrees, 2.61mm/9.71 degrees, 3.09mm/9.58 degrees, 1.49mm/7.54 degrees for the transcerebellar, transventricular, transthalamic planes in fetal brain, abdominal plane in fetal abdomen, and mid-sagittal, transverse and coronal planes in uterus, respectively. Experimental results show that our method is general and has the potential to improve the efficiency and standardization of US scanning.

Shujun Wang, Lequan Yu, Kang Li et al.

Deep convolutional neural networks have significantly boosted the performance of fundus image segmentation when test datasets have the same distribution as the training datasets. However, in clinical practice, medical images often exhibit variations in appearance for various reasons, e.g., different scanner vendors and image quality. These distribution discrepancies could lead the deep networks to over-fit on the training datasets and lack generalization ability on the unseen test datasets. To alleviate this issue, we present a novel Domain-oriented Feature Embedding (DoFE) framework to improve the generalization ability of CNNs on unseen target domains by exploring the knowledge from multiple source domains. Our DoFE framework dynamically enriches the image features with additional domain prior knowledge learned from multi-source domains to make the semantic features more discriminative. Specifically, we introduce a Domain Knowledge Pool to learn and memorize the prior information extracted from multi-source domains. Then the original image features are augmented with domain-oriented aggregated features, which are induced from the knowledge pool based on the similarity between the input image and multi-source domain images. We further design a novel domain code prediction branch to infer this similarity and employ an attention-guided mechanism to dynamically combine the aggregated features with the semantic features. We comprehensively evaluate our DoFE framework on two fundus image segmentation tasks, including the optic cup and disc segmentation and vessel segmentation. Our DoFE framework generates satisfying segmentation results on unseen datasets and surpasses other domain generalization and network regularization methods.

Xiaoqiong Huang, Zejian Chen, Xin Yang et al.

Deep models often suffer from severe performance drop due to the appearance shift in the real clinical setting. Most of the existing learning-based methods rely on images from multiple sites/vendors or even corresponding labels. However, collecting enough unknown data to robustly model segmentation cannot always hold since the complex appearance shift caused by imaging factors in daily application. In this paper, we propose a novel style-invariant method for cardiac image segmentation. Based on the zero-shot style transfer to remove appearance shift and test-time augmentation to explore diverse underlying anatomy, our proposed method is effective in combating the appearance shift. Our contribution is three-fold. First, inspired by the spirit of universal style transfer, we develop a zero-shot stylization for content images to generate stylized images that appearance similarity to the style images. Second, we build up a robust cardiac segmentation model based on the U-Net structure. Our framework mainly consists of two networks during testing: the ST network for removing appearance shift and the segmentation network. Third, we investigate test-time augmentation to explore transformed versions of the stylized image for prediction and the results are merged. Notably, our proposed framework is fully test-time adaptation. Experiment results demonstrate that our methods are promising and generic for generalizing deep segmentation models.

Junxiong Yu, Chaoyu Chen, Xin Yang et al.

Automated breast ultrasound (ABUS) is a new and promising imaging modality for breast cancer detection and diagnosis, which could provide intuitive 3D information and coronal plane information with great diagnostic value. However, manually screening and diagnosing tumors from ABUS images is very time-consuming and overlooks of abnormalities may happen. In this study, we propose a novel two-stage 3D detection network for locating suspected lesion areas and further classifying lesions as benign or malignant tumors. Specifically, we propose a 3D detection network rather than frequently-used segmentation network to locate lesions in ABUS images, thus our network can make full use of the spatial context information in ABUS images. A novel similarity loss is designed to effectively distinguish lesions from background. Then a classification network is employed to identify the located lesions as benign or malignant. An IoU-balanced classification loss is adopted to improve the correlation between classification and localization task. The efficacy of our network is verified from a collected dataset of 418 patients with 145 benign tumors and 273 malignant tumors. Experiments show our network attains a sensitivity of 97.66% with 1.23 false positives (FPs), and has an area under the curve(AUC) value of 0.8720.

Yuhao Huang, Xin Yang, Rui Li et al.

3D ultrasound (US) is widely used due to its rich diagnostic information, portability and low cost. Automated standard plane (SP) localization in US volume not only improves efficiency and reduces user-dependence, but also boosts 3D US interpretation. In this study, we propose a novel Multi-Agent Reinforcement Learning (MARL) framework to localize multiple uterine SPs in 3D US simultaneously. Our contribution is two-fold. First, we equip the MARL with a one-shot neural architecture search (NAS) module to obtain the optimal agent for each plane. Specifically, Gradient-based search using Differentiable Architecture Sampler (GDAS) is employed to accelerate and stabilize the training process. Second, we propose a novel collaborative strategy to strengthen agents' communication. Our strategy uses recurrent neural network (RNN) to learn the spatial relationship among SPs effectively. Extensively validated on a large dataset, our approach achieves the accuracy of 7.05 degree/2.21mm, 8.62 degree/2.36mm and 5.93 degree/0.89mm for the mid-sagittal, transverse and coronal plane localization, respectively. The proposed MARL framework can significantly increase the plane localization accuracy and reduce the computational cost and model size.

Xin Yang, Xu Wang, Yi Wang et al.

Background and Objective: Biometric measurements of fetal head are important indicators for maternal and fetal health monitoring during pregnancy. 3D ultrasound (US) has unique advantages over 2D scan in covering the whole fetal head and may promote the diagnoses. However, automatically segmenting the whole fetal head in US volumes still pends as an emerging and unsolved problem. The challenges that automated solutions need to tackle include the poor image quality, boundary ambiguity, long-span occlusion, and the appearance variability across different fetal poses and gestational ages. In this paper, we propose the first fully-automated solution to segment the whole fetal head in US volumes. Methods: The segmentation task is firstly formulated as an end-to-end volumetric mapping under an encoder-decoder deep architecture. We then combine the segmentor with a proposed hybrid attention scheme (HAS) to select discriminative features and suppress the non-informative volumetric features in a composite and hierarchical way. With little computation overhead, HAS proves to be effective in addressing boundary ambiguity and deficiency. To enhance the spatial consistency in segmentation, we further organize multiple segmentors in a cascaded fashion to refine the results by revisiting context in the prediction of predecessors. Results: Validated on a large dataset collected from 100 healthy volunteers, our method presents superior segmentation performance (DSC (Dice Similarity Coefficient), 96.05%), remarkable agreements with experts. With another 156 volumes collected from 52 volunteers, we ahieve high reproducibilities (mean standard deviation 11.524 mL) against scan variations. Conclusion: This is the first investigation about whole fetal head segmentation in 3D US. Our method is promising to be a feasible solution in assisting the volumetric US-based prenatal studies.

Haoran Dou, Davood Karimi, Caitlin K. Rollins et al.

Fetal cortical plate segmentation is essential in quantitative analysis of fetal brain maturation and cortical folding. Manual segmentation of the cortical plate, or manual refinement of automatic segmentations is tedious and time-consuming. Automatic segmentation of the cortical plate, on the other hand, is challenged by the relatively low resolution of the reconstructed fetal brain MRI scans compared to the thin structure of the cortical plate, partial voluming, and the wide range of variations in the morphology of the cortical plate as the brain matures during gestation. To reduce the burden of manual refinement of segmentations, we have developed a new and powerful deep learning segmentation method. Our method exploits new deep attentive modules with mixed kernel convolutions within a fully convolutional neural network architecture that utilizes deep supervision and residual connections. We evaluated our method quantitatively based on several performance measures and expert evaluations. Results show that our method outperforms several state-of-the-art deep models for segmentation, as well as a state-of-the-art multi-atlas segmentation technique. We achieved average Dice similarity coefficient of 0.87, average Hausdorff distance of 0.96 mm, and average symmetric surface difference of 0.28 mm on reconstructed fetal brain MRI scans of fetuses scanned in the gestational age range of 16 to 39 weeks. With a computation time of less than 1 minute per fetal brain, our method can facilitate and accelerate large-scale studies on normal and altered fetal brain cortical maturation and folding.

Zhaohan Xiong, Qing Xia, Zhiqiang Hu et al.

Segmentation of cardiac images, particularly late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) widely used for visualizing diseased cardiac structures, is a crucial first step for clinical diagnosis and treatment. However, direct segmentation of LGE-MRIs is challenging due to its attenuated contrast. Since most clinical studies have relied on manual and labor-intensive approaches, automatic methods are of high interest, particularly optimized machine learning approaches. To address this, we organized the "2018 Left Atrium Segmentation Challenge" using 154 3D LGE-MRIs, currently the world's largest cardiac LGE-MRI dataset, and associated labels of the left atrium segmented by three medical experts, ultimately attracting the participation of 27 international teams. In this paper, extensive analysis of the submitted algorithms using technical and biological metrics was performed by undergoing subgroup analysis and conducting hyper-parameter analysis, offering an overall picture of the major design choices of convolutional neural networks (CNNs) and practical considerations for achieving state-of-the-art left atrium segmentation. Results show the top method achieved a dice score of 93.2% and a mean surface to a surface distance of 0.7 mm, significantly outperforming prior state-of-the-art. Particularly, our analysis demonstrated that double, sequentially used CNNs, in which a first CNN is used for automatic region-of-interest localization and a subsequent CNN is used for refined regional segmentation, achieved far superior results than traditional methods and pipelines containing single CNNs. This large-scale benchmarking study makes a significant step towards much-improved segmentation methods for cardiac LGE-MRIs, and will serve as an important benchmark for evaluating and comparing the future works in the field.

Chaoyu Chen, Xin Yang, Ruobing Huang et al.

3D ultrasound (US) can facilitate detailed prenatal examinations for fetal growth monitoring. To analyze a 3D US volume, it is fundamental to identify anatomical landmarks of the evaluated organs accurately. Typical deep learning methods usually regress the coordinates directly or involve heatmap-matching. However, these methods struggle to deal with volumes with large sizes and the highly-varying positions and orientations of fetuses. In this work, we exploit an object detection framework to detect landmarks in 3D fetal facial US volumes. By regressing multiple parameters of the landmark-centered bounding box (B-box) with a strict criteria, the proposed model is able to pinpoint the exact location of the targeted landmarks. Specifically, the model uses a 3D region proposal network (RPN) to generate 3D candidate regions, followed by several 3D classification branches to select the best candidate. It also adopts an IoU-balance loss to improve communications between branches that benefits the learning process. Furthermore, it leverages a distance-based graph prior to regularize the training and helps to reduce false positive predictions. The performance of the proposed framework is evaluated on a 3D US dataset to detect five key fetal facial landmarks. Results showed the proposed method outperforms some of the state-of-the-art methods in efficacy and efficiency.

Yingyu Liang, Zhao Song, Mengdi Wang et al.

Suppose we are given a large matrix $A=(a_{i,j})$ that cannot be stored in memory but is in a disk or is presented in a data stream. However, we need to compute a matrix decomposition of the entry-wisely transformed matrix, $f(A):=(f(a_{i,j}))$ for some function $f$. Is it possible to do it in a space efficient way? Many machine learning applications indeed need to deal with such large transformed matrices, for example word embedding method in NLP needs to work with the pointwise mutual information (PMI) matrix, while the entrywise transformation makes it difficult to apply known linear algebraic tools. Existing approaches for this problem either need to store the whole matrix and perform the entry-wise transformation afterwards, which is space consuming or infeasible, or need to redesign the learning method, which is application specific and requires substantial remodeling. In this paper, we first propose a space-efficient sketching algorithm for computing the product of a given small matrix with the transformed matrix. It works for a general family of transformations with provable small error bounds and thus can be used as a primitive in downstream learning tasks. We then apply this primitive to a concrete application: low-rank approximation. We show that our approach obtains small error and is efficient in both space and time. We complement our theoretical results with experiments on synthetic and real data.

Zhendong Liu, Xin Yang, Rui Gao et al.

Deep Neural Networks (DNNs) suffer from the performance degradation when image appearance shift occurs, especially in ultrasound (US) image segmentation. In this paper, we propose a novel and intuitive framework to remove the appearance shift, and hence improve the generalization ability of DNNs. Our work has three highlights. First, we follow the spirit of universal style transfer to remove appearance shifts, which was not explored before for US images. Without sacrificing image structure details, it enables the arbitrary style-content transfer. Second, accelerated with Adaptive Instance Normalization block, our framework achieved real-time speed required in the clinical US scanning. Third, an efficient and effective style image selection strategy is proposed to ensure the target-style US image and testing content US image properly match each other. Experiments on two large US datasets demonstrate that our methods are superior to state-of-the-art methods on making DNNs robust against various appearance shifts.

Xin Yang, Wenlong Shi, Haoran Dou et al.

The 3D ultrasound (US) entrance inspires a multitude of automated prenatal examinations. However, studies about the structuralized description of the whole fetus in 3D US are still rare. In this paper, we propose to estimate the 3D pose of fetus in US volumes to facilitate its quantitative analyses in global and local scales. Given the great challenges in 3D US, including the high volume dimension, poor image quality, symmetric ambiguity in anatomical structures and large variations of fetal pose, our contribution is three-fold. (i) This is the first work about 3D pose estimation of fetus in the literature. We aim to extract the skeleton of whole fetus and assign different segments/joints with correct torso/limb labels. (ii) We propose a self-supervised learning (SSL) framework to finetune the deep network to form visually plausible pose predictions. Specifically, we leverage the landmark-based registration to effectively encode case-adaptive anatomical priors and generate evolving label proxy for supervision. (iii) To enable our 3D network perceive better contextual cues with higher resolution input under limited computing resource, we further adopt the gradient check-pointing (GCP) strategy to save GPU memory and improve the prediction. Extensively validated on a large 3D US dataset, our method tackles varying fetal poses and achieves promising results. 3D pose estimation of fetus has potentials in serving as a map to provide navigation for many advanced studies.

Haoran Dou, Xin Yang, Jikuan Qian et al.

Standard plane localization is crucial for ultrasound (US) diagnosis. In prenatal US, dozens of standard planes are manually acquired with a 2D probe. It is time-consuming and operator-dependent. In comparison, 3D US containing multiple standard planes in one shot has the inherent advantages of less user-dependency and more efficiency. However, manual plane localization in US volume is challenging due to the huge search space and large fetal posture variation. In this study, we propose a novel reinforcement learning (RL) framework to automatically localize fetal brain standard planes in 3D US. Our contribution is two-fold. First, we equip the RL framework with a landmark-aware alignment module to provide warm start and strong spatial bounds for the agent actions, thus ensuring its effectiveness. Second, instead of passively and empirically terminating the agent inference, we propose a recurrent neural network based strategy for active termination of the agent's interaction procedure. This improves both the accuracy and efficiency of the localization system. Extensively validated on our in-house large dataset, our approach achieves the accuracy of 3.4mm/9.6° and 2.7mm/9.1° for the transcerebellar and transthalamic plane localization, respectively. Ourproposed RL framework is general and has the potential to improve the efficiency and standardization of US scanning.

Huaian Diao, Zhao Song, David P. Woodruff et al.

In the total least squares problem, one is given an $m \times n$ matrix $A$, and an $m \times d$ matrix $B$, and one seeks to "correct" both $A$ and $B$, obtaining matrices $\hat{A}$ and $\hat{B}$, so that there exists an $X$ satisfying the equation $\hat{A}X = \hat{B}$. Typically the problem is overconstrained, meaning that $m \gg \max(n,d)$. The cost of the solution $\hat{A}, \hat{B}$ is given by $\|A-\hat{A}\|_F^2 + \|B - \hat{B}\|_F^2$. We give an algorithm for finding a solution $X$ to the linear system $\hat{A}X=\hat{B}$ for which the cost $\|A-\hat{A}\|_F^2 + \|B-\hat{B}\|_F^2$ is at most a multiplicative $(1+ε)$ factor times the optimal cost, up to an additive error $η$ that may be an arbitrarily small function of $n$. Importantly, our running time is $\tilde{O}( \mathrm{nnz}(A) + \mathrm{nnz}(B) ) + \mathrm{poly}(n/ε) \cdot d$, where for a matrix $C$, $\mathrm{nnz}(C)$ denotes its number of non-zero entries. Importantly, our running time does not directly depend on the large parameter $m$. As total least squares regression is known to be solvable via low rank approximation, a natural approach is to invoke fast algorithms for approximate low rank approximation, obtaining matrices $\hat{A}$ and $\hat{B}$ from this low rank approximation, and then solving for $X$ so that $\hat{A}X = \hat{B}$. However, existing algorithms do not apply since in total least squares the rank of the low rank approximation needs to be $n$, and so the running time of known methods would be at least $mn^2$. In contrast, we are able to achieve a much faster running time for finding $X$ by never explicitly forming the equation $\hat{A} X = \hat{B}$, but instead solving for an $X$ which is a solution to an implicit such equation. Finally, we generalize our algorithm to the total least squares problem with regularization.

Xu Wang, Xin Yang, Haoran Dou et al.

Volumetric ultrasound has great potentials in promoting prenatal examinations. Automated solutions are highly desired to efficiently and effectively analyze the massive volumes. Segmentation and landmark localization are two key techniques in making the quantitative evaluation of prenatal ultrasound volumes available in clinic. However, both tasks are non-trivial when considering the poor image quality, boundary ambiguity and anatomical variations in volumetric ultrasound. In this paper, we propose an effective framework for simultaneous segmentation and landmark localization in prenatal ultrasound volumes. The proposed framework has two branches where informative cues of segmentation and landmark localization can be propagated bidirectionally to benefit both tasks. As landmark localization tends to suffer from false positives, we propose a distance based loss to suppress the noise and thus enhance the localization map and in turn the segmentation. Finally, we further leverage an adversarial module to emphasize the correspondence between segmentation and landmark localization. Extensively validated on a volumetric ultrasound dataset of fetal femur, our proposed framework proves to be a promising solution to facilitate the interpretation of prenatal ultrasound volumes.

Xiahai Zhuang, Lei Li, Christian Payer et al.

Knowledge of whole heart anatomy is a prerequisite for many clinical applications. Whole heart segmentation (WHS), which delineates substructures of the heart, can be very valuable for modeling and analysis of the anatomy and functions of the heart. However, automating this segmentation can be arduous due to the large variation of the heart shape, and different image qualities of the clinical data. To achieve this goal, a set of training data is generally needed for constructing priors or for training. In addition, it is difficult to perform comparisons between different methods, largely due to differences in the datasets and evaluation metrics used. This manuscript presents the methodologies and evaluation results for the WHS algorithms selected from the submissions to the Multi-Modality Whole Heart Segmentation (MM-WHS) challenge, in conjunction with MICCAI 2017. The challenge provides 120 three-dimensional cardiac images covering the whole heart, including 60 CT and 60 MRI volumes, all acquired in clinical environments with manual delineation. Ten algorithms for CT data and eleven algorithms for MRI data, submitted from twelve groups, have been evaluated. The results show that many of the deep learning (DL) based methods achieved high accuracy, even though the number of training datasets was limited. A number of them also reported poor results in the blinded evaluation, probably due to overfitting in their training. The conventional algorithms, mainly based on multi-atlas segmentation, demonstrated robust and stable performance, even though the accuracy is not as good as the best DL method in CT segmentation. The challenge, including the provision of the annotated training data and the blinded evaluation for submitted algorithms on the test data, continues as an ongoing benchmarking resource via its homepage (\url{www.sdspeople.fudan.edu.cn/zhuangxiahai/0/mmwhs/}).

Shujun Wang, Lequan Yu, Xin Yang et al.

Glaucoma is a leading cause of irreversible blindness. Accurate segmentation of the optic disc (OD) and cup (OC) from fundus images is beneficial to glaucoma screening and diagnosis. Recently, convolutional neural networks demonstrate promising progress in joint OD and OC segmentation. However, affected by the domain shift among different datasets, deep networks are severely hindered in generalizing across different scanners and institutions. In this paper, we present a novel patchbased Output Space Adversarial Learning framework (pOSAL) to jointly and robustly segment the OD and OC from different fundus image datasets. We first devise a lightweight and efficient segmentation network as a backbone. Considering the specific morphology of OD and OC, a novel morphology-aware segmentation loss is proposed to guide the network to generate accurate and smooth segmentation. Our pOSAL framework then exploits unsupervised domain adaptation to address the domain shift challenge by encouraging the segmentation in the target domain to be similar to the source ones. Since the whole-segmentationbased adversarial loss is insufficient to drive the network to capture segmentation details, we further design the pOSAL in a patch-based fashion to enable fine-grained discrimination on local segmentation details. We extensively evaluate our pOSAL framework and demonstrate its effectiveness in improving the segmentation performance on three public retinal fundus image datasets, i.e., Drishti-GS, RIM-ONE-r3, and REFUGE. Furthermore, our pOSAL framework achieved the first place in the OD and OC segmentation tasks in MICCAI 2018 Retinal Fundus Glaucoma Challenge.

Xin Yang, Na Wang, Yi Wang et al.

Segmenting left atrium in MR volume holds great potentials in promoting the treatment of atrial fibrillation. However, the varying anatomies, artifacts and low contrasts among tissues hinder the advance of both manual and automated solutions. In this paper, we propose a fully-automated framework to segment left atrium in gadolinium-enhanced MR volumes. The region of left atrium is firstly automatically localized by a detection module. Our framework then originates with a customized 3D deep neural network to fully explore the spatial dependency in the region for segmentation. To alleviate the risk of low training efficiency and potential overfitting, we enhance our deep network with the transfer learning and deep supervision strategy. Main contribution of our network design lies in the composite loss function to combat the boundary ambiguity and hard examples. We firstly adopt the Overlap loss to encourage network reduce the overlap between the foreground and background and thus sharpen the predictions on boundary. We then propose a novel Focal Positive loss to guide the learning of voxel-specific threshold and emphasize the foreground to improve classification sensitivity. Further improvement is obtained with an recursive training scheme. With ablation studies, all the introduced modules prove to be effective. The proposed framework achieves an average Dice of 92.24 in segmenting left atrium with pulmonary veins on 20 testing volumes.

Cheng Bian, Xin Yang, Jianqiang Ma et al.

Accurately segmenting left atrium in MR volume can benefit the ablation procedure of atrial fibrillation. Traditional automated solutions often fail in relieving experts from the labor-intensive manual labeling. In this paper, we propose a deep neural network based solution for automated left atrium segmentation in gadolinium-enhanced MR volumes with promising performance. We firstly argue that, for this volumetric segmentation task, networks in 2D fashion can present great superiorities in time efficiency and segmentation accuracy than networks with 3D fashion. Considering the highly varying shape of atrium and the branchy structure of associated pulmonary veins, we propose to adopt a pyramid module to collect semantic cues in feature maps from multiple scales for fine-grained segmentation. Also, to promote our network in classifying the hard examples, we propose an Online Hard Negative Example Mining strategy to identify voxels in slices with low classification certainties and penalize the wrong predictions on them. Finally, we devise a competitive training scheme to further boost the generalization ability of networks. Extensively verified on 20 testing volumes, our proposed framework achieves an average Dice of 92.83% in segmenting the left atria and pulmonary veins.

Lequan Yu, Jie-Zhi Cheng, Qi Dou et al.

Automatic and accurate whole-heart and great vessel segmentation from 3D cardiac magnetic resonance (MR) images plays an important role in the computer-assisted diagnosis and treatment of cardiovascular disease. However, this task is very challenging due to ambiguous cardiac borders and large anatomical variations among different subjects. In this paper, we propose a novel densely-connected volumetric convolutional neural network, referred as DenseVoxNet, to automatically segment the cardiac and vascular structures from 3D cardiac MR images. The DenseVoxNet adopts the 3D fully convolutional architecture for effective volume-to-volume prediction. From the learning perspective, our DenseVoxNet has three compelling advantages. First, it preserves the maximum information flow between layers by a densely-connected mechanism and hence eases the network training. Second, it avoids learning redundant feature maps by encouraging feature reuse and hence requires fewer parameters to achieve high performance, which is essential for medical applications with limited training data. Third, we add auxiliary side paths to strengthen the gradient propagation and stabilize the learning process. We demonstrate the effectiveness of DenseVoxNet by comparing it with the state-of-the-art approaches from HVSMR 2016 challenge in conjunction with MICCAI, and our network achieves the best dice coefficient. We also show that our network can achieve better performance than other 3D ConvNets but with fewer parameters.

Xin Yang, Lequan Yu, Lingyun Wu et al.

Boundary incompleteness raises great challenges to automatic prostate segmentation in ultrasound images. Shape prior can provide strong guidance in estimating the missing boundary, but traditional shape models often suffer from hand-crafted descriptors and local information loss in the fitting procedure. In this paper, we attempt to address those issues with a novel framework. The proposed framework can seamlessly integrate feature extraction and shape prior exploring, and estimate the complete boundary with a sequential manner. Our framework is composed of three key modules. Firstly, we serialize the static 2D prostate ultrasound images into dynamic sequences and then predict prostate shapes by sequentially exploring shape priors. Intuitively, we propose to learn the shape prior with the biologically plausible Recurrent Neural Networks (RNNs). This module is corroborated to be effective in dealing with the boundary incompleteness. Secondly, to alleviate the bias caused by different serialization manners, we propose a multi-view fusion strategy to merge shape predictions obtained from different perspectives. Thirdly, we further implant the RNN core into a multiscale Auto-Context scheme to successively refine the details of the shape prediction map. With extensive validation on challenging prostate ultrasound images, our framework bridges severe boundary incompleteness and achieves the best performance in prostate boundary delineation when compared with several advanced methods. Additionally, our approach is general and can be extended to other medical image segmentation tasks, where boundary incompleteness is one of the main challenges.