Avinash Kori

Ainkaran Santhirasekaram, Avinash Kori, Mathias Winkler et al.

The reliability of segmentation models in the medical domain depends on the model's robustness to perturbations in the input space. Robustness is a particular challenge in medical imaging exhibiting various sources of image noise, corruptions, and domain shifts. Obtaining robustness is often attempted via simulating heterogeneous environments, either heuristically in the form of data augmentation or by learning to generate specific perturbations in an adversarial manner. We propose and justify that learning a discrete representation in a low dimensional embedding space improves robustness of a segmentation model. This is achieved with a dictionary learning method called vector quantisation. We use a set of experiments designed to analyse robustness in both the latent and output space under domain shift and noise perturbations in the input space. We adapt the popular UNet architecture, inserting a quantisation block in the bottleneck. We demonstrate improved segmentation accuracy and better robustness on three segmentation tasks. Code is available at \url{https://github.com/AinkaranSanthi/Vector-Quantisation-for-Robust-Segmentation}

Avinash Kori, Ben Glocker, Francesca Toni

Most of the current explainability techniques focus on capturing the importance of features in input space. However, given the complexity of models and data-generating processes, the resulting explanations are far from being `complete', in that they lack an indication of feature interactions and visualization of their `effect'. In this work, we propose a novel twin-surrogate explainability framework to explain the decisions made by any CNN-based image classifier (irrespective of the architecture). For this, we first disentangle latent features from the classifier, followed by aligning these features to observed/human-defined `context' features. These aligned features form semantically meaningful concepts that are used for extracting a causal graph depicting the `perceived' data-generating process, describing the inter- and intra-feature interactions between unobserved latent features and observed `context' features. This causal graph serves as a global model from which local explanations of different forms can be extracted. Specifically, we provide a generator to visualize the `effect' of interactions among features in latent space and draw feature importance therefrom as local explanations. Our framework utilizes adversarial knowledge distillation to faithfully learn a representation from the classifiers' latent space and use it for extracting visual explanations. We use the styleGAN-v2 architecture with an additional regularization term to enforce disentanglement and alignment. We demonstrate and evaluate explanations obtained with our framework on Morpho-MNIST and on the FFHQ human faces dataset. Our framework is available at \url{https://github.com/koriavinash1/GLANCE-Explanations}.

Ainkaran Santhirasekaram, Avinash Kori, Andrea Rockall et al.

Explanations for \emph{black-box} models help us understand model decisions as well as provide information on model biases and inconsistencies. Most of the current explainability techniques provide a single level of explanation, often in terms of feature importance scores or feature attention maps in input space. Our focus is on explaining deep discriminative models at \emph{multiple levels of abstraction}, from fine-grained to fully abstract explanations. We achieve this by using the natural properties of \emph{hyperbolic geometry} to more efficiently model a hierarchy of symbolic features and generate \emph{hierarchical symbolic rules} as part of our explanations. Specifically, for any given deep discriminative model, we distill the underpinning knowledge by discretisation of the continuous latent space using vector quantisation to form symbols, followed by a \emph{hyperbolic reasoning block} to induce an \emph{abstraction tree}. We traverse the tree to extract explanations in terms of symbolic rules and its corresponding visual semantics. We demonstrate the effectiveness of our method on the MNIST and AFHQ high-resolution animal faces dataset. Our framework is available at \url{https://github.com/koriavinash1/SymbolicInterpretability}.

Avinash Kori, Francesco Locatello, Fabio De Sousa Ribeiro et al.

The extraction of modular object-centric representations for downstream tasks is an emerging area of research. Learning grounded representations of objects that are guaranteed to be stable and invariant promises robust performance across different tasks and environments. Slot Attention (SA) learns object-centric representations by assigning objects to \textit{slots}, but presupposes a \textit{single} distribution from which all slots are randomly initialised. This results in an inability to learn \textit{specialized} slots which bind to specific object types and remain invariant to identity-preserving changes in object appearance. To address this, we present \emph{\textsc{Co}nditional \textsc{S}lot \textsc{A}ttention} (\textsc{CoSA}) using a novel concept of \emph{Grounded Slot Dictionary} (GSD) inspired by vector quantization. Our proposed GSD comprises (i) canonical object-level property vectors and (ii) parametric Gaussian distributions, which define a prior over the slots. We demonstrate the benefits of our method in multiple downstream tasks such as scene generation, composition, and task adaptation, whilst remaining competitive with SA in popular object discovery benchmarks.

Avinash Kori, Ben Glocker, Francesca Toni

An effective way to obtain different perspectives on any given topic is by conducting a debate, where participants argue for and against the topic. Here, we propose a novel debate framework for understanding and explaining a continuous image classifier's reasoning for making a particular prediction by modeling it as a multiplayer sequential zero-sum debate game. The contrastive nature of our framework encourages players to learn to put forward diverse arguments during the debates, picking up the reasoning trails missed by their opponents and highlighting any uncertainties in the classifier. Specifically, in our proposed setup, players propose arguments, drawn from the classifier's discretized latent knowledge, to support or oppose the classifier's decision. The resulting Visual Debates collect supporting and opposing features from the discretized latent space of the classifier, serving as explanations for the internal reasoning of the classifier towards its predictions. We demonstrate and evaluate (a practical realization of) our Visual Debates on the geometric SHAPE and MNIST datasets and on the high-resolution animal faces (AFHQ) dataset, along standard evaluation metrics for explanations (i.e. faithfulness and completeness) and novel, bespoke metrics for visual debates as explanations (consensus and split ratio).

Avinash Kori, Pedro Sanchez, Konstantinos Vilouras et al.

Unsupervised representation learning with variational inference relies heavily on independence assumptions over latent variables. Causal representation learning (CRL), however, argues that factors of variation in a dataset are, in fact, causally related. Allowing latent variables to be correlated, as a consequence of causal relationships, is more realistic and generalisable. So far, provably identifiable methods rely on: auxiliary information, weak labels, and interventional or even counterfactual data. Inspired by causal discovery with functional causal models, we propose a fully unsupervised representation learning method that considers a data generation process with a latent additive noise model (ANM). We encourage the latent space to follow a causal ordering via loss function based on the Hessian of the latent distribution.

Avinash Kori, Antonio Rago, Francesca Toni

Deep learning models are powerful image classifiers but their opacity hinders their trustworthiness. Explanation methods for capturing the reasoning process within these classifiers faithfully and in a clear manner are scarce, due to their sheer complexity and size. We provide a solution for this problem by defining a novel method for explaining the outputs of image classifiers with debates between two agents, each arguing for a particular class. We obtain these debates as concrete instances of Free Argumentative eXchanges (FAXs), a novel argumentation-based multi-agent framework allowing agents to internalise opinions by other agents differently than originally stated. We define two metrics (consensus and persuasion rate) to assess the usefulness of FAXs as argumentative explanations for image classifiers. We then conduct a number of empirical experiments showing that FAXs perform well along these metrics as well as being more faithful to the image classifiers than conventional, non-argumentative explanation methods. All our implementations can be found at https://github.com/koriavinash1/FAX.

Fabio De Sousa Ribeiro, Omar Todd, Charles Jones et al.

We introduce the Flow Stochastic Segmentation Network (Flow-SSN), a generative segmentation model family featuring discrete-time autoregressive and modern continuous-time flow variants. We prove fundamental limitations of the low-rank parameterisation of previous methods and show that Flow-SSNs can estimate arbitrarily high-rank pixel-wise covariances without assuming the rank or storing the distributional parameters. Flow-SSNs are also more efficient to sample from than standard diffusion-based segmentation models, thanks to most of the model capacity being allocated to learning the base distribution of the flow, constituting an expressive prior. We apply Flow-SSNs to challenging medical imaging benchmarks and achieve state-of-the-art results. Code available: https://github.com/biomedia-mira/flow-ssn.

Avinash Kori, Parth Natekar, Ganapathy Krishnamurthi et al.

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

Mahendra Khened, Avinash Kori, Haran Rajkumar et al.

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

Rajat Rasal, Avinash Kori, Fabio De Sousa Ribeiro et al.

Counterfactual image generation presents significant challenges, including preserving identity, maintaining perceptual quality, and ensuring faithfulness to an underlying causal model. While existing auto-encoding frameworks admit semantic latent spaces which can be manipulated for causal control, they struggle with scalability and fidelity. Advancements in diffusion models present opportunities for improving counterfactual image editing, having demonstrated state-of-the-art visual quality, human-aligned perception and representation learning capabilities. Here, we present a suite of diffusion-based causal mechanisms, introducing the notions of spatial, semantic and dynamic abduction. We propose a general framework that integrates semantic representations into diffusion models through the lens of Pearlian causality to edit images via a counterfactual reasoning process. To our knowledge, this is the first work to consider high-level semantic identity preservation for diffusion counterfactuals and to demonstrate how semantic control enables principled trade-offs between faithful causal control and identity preservation.

Anish Dhir, Ruby Sedgwick, Avinash Kori et al.

Current causal discovery approaches require restrictive model assumptions in the absence of interventional data to ensure structure identifiability. These assumptions often do not hold in real-world applications leading to a loss of guarantees and poor performance in practice. Recent work has shown that, in the bivariate case, Bayesian model selection can greatly improve performance by exchanging restrictive modelling for more flexible assumptions, at the cost of a small probability of making an error. Our work shows that this approach is useful in the important multivariate case as well. We propose a scalable algorithm leveraging a continuous relaxation of the discrete model selection problem. Specifically, we employ the Causal Gaussian Process Conditional Density Estimator (CGP-CDE) as a Bayesian non-parametric model, using its hyperparameters to construct an adjacency matrix. This matrix is then optimised using the marginal likelihood and an acyclicity regulariser, giving the maximum a posteriori causal graph. We demonstrate the competitiveness of our approach, showing it is advantageous to perform multivariate causal discovery without infeasible assumptions using Bayesian model selection.

Tian Xia, Fabio De Sousa Ribeiro, Rajat R Rasal et al.

Counterfactual generation aims to simulate realistic hypothetical outcomes under causal interventions. Diffusion models have emerged as a powerful tool for this task, combining DDIM inversion with conditional generation and classifier-free guidance (CFG). In this work, we identify a key limitation of CFG for counterfactual generation: it prescribes a global guidance scale for all attributes, leading to significant spurious changes in inferred counterfactuals. To mitigate this, we propose Decoupled Classifier-Free Guidance (DCFG), a flexible and model-agnostic guidance technique that enables attribute-wise control following a causal graph. DCFG is implemented via a simple attribute-split embedding strategy that disentangles semantic inputs, enabling selective guidance on user-defined attribute groups.

Abdul Rahman Jacob, Avinash Kori, Emanuele De Angelis et al.

Over the last decade, as we rely more on deep learning technologies to make critical decisions, concerns regarding their safety, reliability and interpretability have emerged. We introduce a novel Neural Argumentative Learning (NAL) architecture that integrates Assumption-Based Argumentation (ABA) with deep learning for image analysis. Our architecture consists of neural and symbolic components. The former segments and encodes images into facts using object-centric learning, while the latter applies ABA learning to develop ABA frameworks enabling predictions with images. Experiments on synthetic data show that the NAL architecture can be competitive with a state-of-the-art alternative.

Devin Thomas, Junqi Jiang, Avinash Kori et al.

In Formula One, teams compete to develop their cars and achieve the highest possible finishing position in each race. During a race, however, teams are unable to alter the car, so they must improve their cars' finishing positions via race strategy, i.e. optimising their selection of which tyre compounds to put on the car and when to do so. In this work, we introduce a reinforcement learning model, RSRL (Race Strategy Reinforcement Learning), to control race strategies in simulations, offering a faster alternative to the industry standard of hard-coded and Monte Carlo-based race strategies. Controlling cars with a pace equating to an expected finishing position of P5.5 (where P1 represents first place and P20 is last place), RSRL achieves an average finishing position of P5.33 on our test race, the 2023 Bahrain Grand Prix, outperforming the best baseline of P5.63. We then demonstrate, in a generalisability study, how performance for one track or multiple tracks can be prioritised via training. Further, we supplement model predictions with feature importance, decision tree-based surrogate models, and decision tree counterfactuals towards improving user trust in the model. Finally, we provide illustrations which exemplify our approach in real-world situations, drawing parallels between simulations and reality.

Gabriel de Olim Gaul, Adam Gould, Avinash Kori et al.

We introduce Slot Attention Argumentation for Case-Based Reasoning (SAA-CBR), a novel neuro-symbolic pipeline for image classification that integrates object-centric learning via a neural Slot Attention (SA) component with symbolic reasoning conducted by Abstract Argumentation for Case-Based Reasoning (AA-CBR). We explore novel integrations of AA-CBR with the neural component, including feature combination strategies, casebase reduction via representative samples, novel count-based partial orders, a One-Vs-Rest strategy for extending AA-CBR to multi-class classification, and an application of Supported AA-CBR, a bipolar variant of AA-CBR. We demonstrate that SAA-CBR is an effective classifier on the CLEVR-Hans datasets, showing competitive performance against baseline models.

Benjamin Teoh, Ben Glocker, Francesca Toni et al.

A central challenge in explainable AI, particularly in the visual domain, is producing explanations grounded in human-understandable concepts. To tackle this, we introduce OCEAN (Object-Centric Explananda via Agent Negotiation), a novel, inherently interpretable framework built on object-centric representations and a transparent multi-agent reasoning process. The game-theoretic reasoning process drives agents to agree on coherent and discriminative evidence, resulting in a faithful and interpretable decision-making process. We train OCEAN end-to-end and benchmark it against standard visual classifiers and popular posthoc explanation tools like GradCAM and LIME across two diagnostic multi-object datasets. Our results demonstrate competitive performance with respect to state-of-the-art black-box models with a faithful reasoning process, which was reflected by our user study, where participants consistently rated OCEAN's explanations as more intuitive and trustworthy.

Rajat Rasal, Avinash Kori, Ben Glocker

Identifiable causal representation learning seeks to uncover the true causal relationships underlying a data generation process. In medical imaging, this presents opportunities to improve the generalisability and robustness of task-specific latent features. This work introduces the concept of grouping observations to learn identifiable representations for disease classification in chest X-rays via an end-to-end framework. Our experiments demonstrate that these causal representations improve generalisability and robustness across multiple classification tasks when grouping is used to enforce invariance w.r.t race, sex, and imaging views.

Avinash Kori, Francesca Toni, Ben Glocker

Modular object-centric representations are essential for *human-like reasoning* but are challenging to obtain under spatial ambiguities, *e.g. due to occlusions and view ambiguities*. However, addressing challenges presents both theoretical and practical difficulties. We introduce a novel multi-view probabilistic approach that aggregates view-specific slots to capture *invariant content* information while simultaneously learning disentangled global *viewpoint-level* information. Unlike prior single-view methods, our approach resolves spatial ambiguities, provides theoretical guarantees for identifiability, and requires *no viewpoint annotations*. Extensive experiments on standard benchmarks and novel complex datasets validate our method's robustness and scalability.

Avinash Kori, Francesco Locatello, Ainkaran Santhirasekaram et al.

Learning modular object-centric representations is crucial for systematic generalization. Existing methods show promising object-binding capabilities empirically, but theoretical identifiability guarantees remain relatively underdeveloped. Understanding when object-centric representations can theoretically be identified is crucial for scaling slot-based methods to high-dimensional images with correctness guarantees. To that end, we propose a probabilistic slot-attention algorithm that imposes an aggregate mixture prior over object-centric slot representations, thereby providing slot identifiability guarantees without supervision, up to an equivalence relation. We provide empirical verification of our theoretical identifiability result using both simple 2-dimensional data and high-resolution imaging datasets.

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

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

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

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

Max Allan, Satoshi Kondo, Sebastian Bodenstedt et al.

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

Avinash Kori, Manik Sharma

Regularization methods, specifically those which directly alter weights like $L_1$ and $L_2$, are an integral part of many learning algorithms. Both the regularizers mentioned above are formulated by assuming certain priors in the parameter space and these assumptions, in some cases, induce sparsity in the parameter space. Regularizers help in transferring beliefs one has on the dataset or the parameter space by introducing adequate terms in the loss function. Any kind of formulation represents a specific set of beliefs: $L_1$ regularization conveys that the parameter space should be sparse whereas $L_2$ regularization conveys that the parameter space should be bounded and continuous. These regularizers in turn leverage certain priors to express these inherent beliefs. A better understanding of how the prior affects the behavior of the parameters and how the priors can be updated based on the dataset can contribute greatly in improving the generalization capabilities of a function estimator. In this work, we introduce a weakly informative prior and then further extend it to an informative prior in order to formulate a regularization penalty, which shows better results in terms of inducing sparsity experimentally, when compared to regularizers based only on Gaussian and Laplacian priors. Experimentally, we verify that a regularizer based on an adapted prior improves the generalization capabilities of any network. We illustrate the performance of the proposed method on the MNIST and CIFAR-10 datasets.

Parth Natekar, Avinash Kori, Ganapathy Krishnamurthi

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

Avinash Kori, Ganapathi Krishnamurthi

In this report we present an unsupervised image registration framework, using a pre-trained deep neural network as a feature extractor. We refer this to zero-shot learning, due to nonoverlap between training and testing dataset (none of the network modules in the processing pipeline were trained specifically for the task of medical image registration). Highlights of our technique are: (a) No requirement of a training dataset (b) Keypoints i.e.locations of important features are automatically estimated (c) The number of key points in this model is fixed and can possibly be tuned as a hyperparameter. (d) Uncertaintycalculation of the proposed, transformation estimates (e) Real-time registration of images. Our technique was evaluated on BraTS, ALBERT, and collaborative hospital Brain MRI data. Results suggest that the method proved to be robust for affine transformation models and the results are practically instantaneous, irrespective of the size of the input image

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

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

Spyridon Bakas, Mauricio Reyes, Andras Jakab et al.

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

Vismay Agrawal, Avinash Kori, Varghese Alex et al.

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

Avinash Kori, Sai Saketh Chennamsetty, Mohammed Safwan K. P. et al.

In this manuscript, we automate the procedure of grading of diabetic retinopathy and macular edema from fundus images using an ensemble of convolutional neural networks. The availability of limited amount of labeled data to perform supervised learning was circumvented by using transfer learning approach. The models in the ensemble were pre-trained on a large dataset comprising natural images and were later fine-tuned with the limited data for the task of choice. For an image, the ensemble of classifiers generate multiple predictions, and a max-voting based approach was utilized to attain the final grade of the anomaly in the image. For the task of grading DR, on the test data (n=56), the ensemble achieved an accuracy of 83.9\%, while for the task for grading macular edema the network achieved an accuracy of 95.45% (n=44).

Avinash Kori, Ganapathy Krishnamurthi, Balaji Srinivasan

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

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

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