Letícia Rittner

Karim Lekadir, Aasa Feragen, Abdul Joseph Fofanah et al. · eth-zurich

Despite major advances in artificial intelligence (AI) for medicine and healthcare, the deployment and adoption of AI technologies remain limited in real-world clinical practice. In recent years, concerns have been raised about the technical, clinical, ethical and legal risks associated with medical AI. To increase real world adoption, it is essential that medical AI tools are trusted and accepted by patients, clinicians, health organisations and authorities. This work describes the FUTURE-AI guideline as the first international consensus framework for guiding the development and deployment of trustworthy AI tools in healthcare. The FUTURE-AI consortium was founded in 2021 and currently comprises 118 inter-disciplinary experts from 51 countries representing all continents, including AI scientists, clinicians, ethicists, and social scientists. Over a two-year period, the consortium defined guiding principles and best practices for trustworthy AI through an iterative process comprising an in-depth literature review, a modified Delphi survey, and online consensus meetings. The FUTURE-AI framework was established based on 6 guiding principles for trustworthy AI in healthcare, i.e. Fairness, Universality, Traceability, Usability, Robustness and Explainability. Through consensus, a set of 28 best practices were defined, addressing technical, clinical, legal and socio-ethical dimensions. The recommendations cover the entire lifecycle of medical AI, from design, development and validation to regulation, deployment, and monitoring. FUTURE-AI is a risk-informed, assumption-free guideline which provides a structured approach for constructing medical AI tools that will be trusted, deployed and adopted in real-world practice. Researchers are encouraged to take the recommendations into account in proof-of-concept stages to facilitate future translation towards clinical practice of medical AI.

Diedre Carmo, Leticia Rittner, Roberto Lotufo

Airway segmentation in computed tomography images can be used to analyze pulmonary diseases, however, manual segmentation is labor intensive and relies on expert knowledge. This manuscript details our contribution to MICCAI's 2022 Airway Tree Modelling challenge, a competition of fully automated methods for airway segmentation. We employed a previously developed deep learning architecture based on a modified EfficientDet (MEDSeg), training from scratch for binary airway segmentation using the provided annotations. Our method achieved 90.72 Dice in internal validation, 95.52 Dice on external validation, and 93.49 Dice in the final test phase, while not being specifically designed or tuned for airway segmentation. Open source code and a pip package for predictions with our model and trained weights are in https://github.com/MICLab-Unicamp/medseg.

Diedre Carmo, Gustavo Pinheiro, Lívia Rodrigues et al.

Medical image segmentation is an increasingly popular area of research in medical imaging processing and analysis. However, many researchers who are new to the field struggle with basic concepts. This tutorial paper aims to provide an overview of the fundamental concepts of medical imaging, with a focus on Magnetic Resonance and Computerized Tomography. We will also discuss deep learning algorithms, tools, and frameworks used for segmentation tasks, and suggest best practices for method development and image analysis. Our tutorial includes sample tasks using public data, and accompanying code is available on GitHub (https://github.com/MICLab-Unicamp/Medical-ImagingTutorial). By sharing our insights gained from years of experience in the field and learning from relevant literature, we hope to assist researchers in overcoming the initial challenges they may encounter in this exciting and important area of research.

Diedre S. Carmo, Rosarie A. Tudas, Alejandro P. Comellas et al.

Automated segmentation of lung abnormalities in computed tomography is an important step for diagnosing and characterizing lung disease. In this work, we improve upon a previous method and propose S-MEDSeg, a deep learning based approach for accurate segmentation of lung lesions in chest CT images. S-MEDSeg combines a pre-trained EfficientNet backbone, bidirectional feature pyramid network, and modern network advancements to achieve improved segmentation performance. A comprehensive ablation study was performed to evaluate the contribution of the proposed network modifications. The results demonstrate modifications introduced in S-MEDSeg significantly improves segmentation performance compared to the baseline approach. The proposed method is applied to an independent dataset of long COVID inpatients to study the effect of post-acute infection vaccination on extent of lung findings. Open-source code, graphical user interface and pip package are available at https://github.com/MICLab-Unicamp/medseg.

Gabriel Dias, Rodrigo Pommot Berto, Mateus Oliveira et al.

Purpose: To investigate the use of a Vision Transformer (ViT) to reconstruct/denoise GABA-edited magnetic resonance spectroscopy (MRS) from a quarter of the typically acquired number of transients using spectrograms. Theory and Methods: A quarter of the typically acquired number of transients collected in GABA-edited MRS scans are pre-processed and converted to a spectrogram image representation using the Short-Time Fourier Transform (STFT). The image representation of the data allows the adaptation of a pre-trained ViT for reconstructing GABA-edited MRS spectra (Spectro-ViT). The Spectro-ViT is fine-tuned and then tested using \textit{in vivo} GABA-edited MRS data. The Spectro-ViT performance is compared against other models in the literature using spectral quality metrics and estimated metabolite concentration values. Results: The Spectro-ViT model significantly outperformed all other models in four out of five quantitative metrics (mean squared error, shape score, GABA+/water fit error, and full width at half maximum). The metabolite concentrations estimated (GABA+/water, GABA+/Cr, and Glx/water) were consistent with the metabolite concentrations estimated using typical GABA-edited MRS scans reconstructed with the full amount of typically collected transients. Conclusion: The proposed Spectro-ViT model achieved state-of-the-art results in reconstructing GABA-edited MRS, and the results indicate these scans could be up to four times faster.

Mateus Oliveira da Silva, Caio Pinheiro Santana, Diedre Santos do Carmo et al.

Identifying and characterizing brain fiber bundles can help to understand many diseases and conditions. An important step in this process is the estimation of fiber orientations using Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI). However, obtaining robust orientation estimates demands high-resolution data, leading to lengthy acquisitions that are not always clinically available. In this work, we explore the use of automated angular super resolution from faster acquisitions to overcome this challenge. Using the publicly available Human Connectome Project (HCP) DW-MRI data, we trained a transformer-based deep learning architecture to achieve angular super resolution in fiber orientation distribution (FOD). Our patch-based methodology, FOD-Swin-Net, is able to bring a single-shell reconstruction driven from 32 directions to be comparable to a multi-shell 288 direction FOD reconstruction, greatly reducing the number of required directions on initial acquisition. Evaluations of the reconstructed FOD with Angular Correlation Coefficient and qualitative visualizations reveal superior performance than the state-of-the-art in HCP testing data. Open source code for reproducibility is available at https://github.com/MICLab-Unicamp/FOD-Swin-Net.

Diedre S. Carmo, Jean A. Ribeiro, Alejandro P. Comellas et al.

The COVID-19 pandemic response highlighted the potential of deep learning methods in facilitating the diagnosis, prognosis and understanding of lung diseases through automated segmentation of pulmonary structures and lesions in chest computed tomography (CT). Automated separation of lung lesion into ground-glass opacity (GGO) and consolidation is hindered due to the labor-intensive and subjective nature of this task, resulting in scarce availability of ground truth for supervised learning. To tackle this problem, we propose MEDPSeg. MEDPSeg learns from heterogeneous chest CT targets through hierarchical polymorphic multitask learning (HPML). HPML explores the hierarchical nature of GGO and consolidation, lung lesions, and the lungs, with further benefits achieved through multitasking airway and pulmonary artery segmentation. Over 6000 volumetric CT scans from different partially labeled sources were used for training and testing. Experiments show PML enabling new state-of-the-art performance for GGO and consolidation segmentation tasks. In addition, MEDPSeg simultaneously performs segmentation of the lung parenchyma, airways, pulmonary artery, and lung lesions, all in a single forward prediction, with performance comparable to state-of-the-art methods specialized in each of those targets. Finally, we provide an open-source implementation with a graphical user interface at https://github.com/MICLab-Unicamp/medpseg.

Livia Rodrigues, Martina Bocchetta, Oula Puonti et al.

The hypothalamus is a small structure located in the center of the brain and is involved in significant functions such as sleeping, temperature, and appetite control. Various neurological disorders are also associated with hypothalamic abnormalities. Automated image analysis of this structure from brain MRI is thus highly desirable to study the hypothalamus in vivo. However, most automated segmentation tools currently available focus exclusively on T1w images. In this study, we introduce H-SynEx, a machine learning method for automated segmentation of hypothalamic subregions that generalizes across different MRI sequences and resolutions without retraining. H-synEx was trained with synthetic images built from label maps derived from ultra-high resolution ex vivo MRI scans, which enables finer-grained manual segmentation when compared with 1mm isometric in vivo images. We validated our method using Dice Coefficient (DSC) and Average Hausdorff distance (AVD) across in vivo images from six different datasets with six different MRI sequences (T1, T2, proton density, quantitative T1, fractional anisotrophy, and FLAIR). Statistical analysis compared hypothalamic subregion volumes in controls, Alzheimer's disease (AD), and behavioral variant frontotemporal dementia (bvFTD) subjects using the Area Under the Receiving Operating Characteristic curve (AUROC) and Wilcoxon rank sum test. Our results show that H-SynEx successfully leverages information from ultra-high resolution scans to segment in vivo from different MRI sequences. Our automated segmentation was able to discriminate controls versus Alzheimer's Disease patients on FLAIR images with 5mm spacing. H-SynEx is openly available at https://github.com/liviamarodrigues/hsynex.

Livia Rodrigues, Martina Bocchetta, Oula Puonti et al.

Segmentation of brain structures on magnetic resonance imaging (MRI) is a highly relevant neuroimaging topic, as it is a prerequisite for different analyses such as volumetry or shape analysis. Automated segmentation facilitates the study of brain structures in larger cohorts when compared with manual segmentation, which is time-consuming. However, the development of most automated methods relies on large and manually annotated datasets, which limits the generalizability of these methods. Recently, new techniques using synthetic images have emerged, reducing the need for manual annotation. Here we provide HELM, Hypothalamic ex vivo Label Maps, a dataset composed of label maps built from publicly available ultra-high resolution ex vivo MRI from 10 whole hemispheres, which can be used to develop segmentation methods using synthetic data. The label maps are obtained with a combination of manual labels for the hypothalamic regions and automated segmentations for the rest of the brain, and mirrored to simulate entire brains. We also provide the pre-processed ex vivo scans, as this dataset can support future projects to include other structures after these are manually segmented.

Youssef Beauferris, Jonas Teuwen, Dimitrios Karkalousos et al.

Deep-learning-based brain magnetic resonance imaging (MRI) reconstruction methods have the potential to accelerate the MRI acquisition process. Nevertheless, the scientific community lacks appropriate benchmarks to assess MRI reconstruction quality of high-resolution brain images, and evaluate how these proposed algorithms will behave in the presence of small, but expected data distribution shifts. The Multi-Coil Magnetic Resonance Image (MC-MRI) Reconstruction Challenge provides a benchmark that aims at addressing these issues, using a large dataset of high-resolution, three-dimensional, T1-weighted MRI scans. The challenge has two primary goals: 1) to compare different MRI reconstruction models on this dataset and 2) to assess the generalizability of these models to data acquired with a different number of receiver coils. In this paper, we describe the challenge experimental design, and summarize the results of a set of baseline and state of the art brain MRI reconstruction models. We provide relevant comparative information on the current MRI reconstruction state-of-the-art and highlight the challenges of obtaining generalizable models that are required prior to broader clinical adoption. The MC-MRI benchmark data, evaluation code and current challenge leaderboard are publicly available. They provide an objective performance assessment for future developments in the field of brain MRI reconstruction.

Hugo J. Kuijf, J. Matthijs Biesbroek, Jeroen de Bresser et al.

Quantification of cerebral white matter hyperintensities (WMH) of presumed vascular origin is of key importance in many neurological research studies. Currently, measurements are often still obtained from manual segmentations on brain MR images, which is a laborious procedure. Automatic WMH segmentation methods exist, but a standardized comparison of the performance of such methods is lacking. We organized a scientific challenge, in which developers could evaluate their method on a standardized multi-center/-scanner image dataset, giving an objective comparison: the WMH Segmentation Challenge (https://wmh.isi.uu.nl/). Sixty T1+FLAIR images from three MR scanners were released with manual WMH segmentations for training. A test set of 110 images from five MR scanners was used for evaluation. Segmentation methods had to be containerized and submitted to the challenge organizers. Five evaluation metrics were used to rank the methods: (1) Dice similarity coefficient, (2) modified Hausdorff distance (95th percentile), (3) absolute log-transformed volume difference, (4) sensitivity for detecting individual lesions, and (5) F1-score for individual lesions. Additionally, methods were ranked on their inter-scanner robustness. Twenty participants submitted their method for evaluation. This paper provides a detailed analysis of the results. In brief, there is a cluster of four methods that rank significantly better than the other methods, with one clear winner. The inter-scanner robustness ranking shows that not all methods generalize to unseen scanners. The challenge remains open for future submissions and provides a public platform for method evaluation.

Diedre Carmo, Bruna Silva, Clarissa Yasuda et al.

Hippocampus segmentation plays a key role in diagnosing various brain disorders such as Alzheimer's disease, epilepsy, multiple sclerosis, cancer, depression and others. Nowadays, segmentation is still mainly performed manually by specialists. Segmentation done by experts is considered to be a gold-standard when evaluating automated methods, buts it is a time consuming and arduos task, requiring specialized personnel. In recent years, efforts have been made to achieve reliable automated segmentation. For years the best performing authomatic methods were multi atlas based with around 80-85% Dice coefficient and very time consuming, but machine learning methods are recently rising with promising time and accuracy performance. A method for volumetric hippocampus segmentation is presented, based on the consensus of tri-planar U-Net inspired fully convolutional networks (FCNNs), with some modifications, including residual connections, VGG weight transfers, batch normalization and a patch extraction technique employing data from neighbor patches. A study on the impact of our modifications to the classical U-Net architecture was performed. Our method achieves cutting edge performance in our dataset, with around 96% volumetric Dice accuracy in our test data. In a public validation dataset, HARP, we achieve 87.48% DICE. GPU execution time is in the order of seconds per volume, and source code is publicly available. Also, masks are shown to be similar to other recent state-of-the-art hippocampus segmentation methods in a third dataset, without manual annotations.

Oeslle Lucena, Roberto Souza, Leticia Rittner et al.

Convolutional neural networks (CNN) for medical imaging are constrained by the number of annotated data required in the training stage. Usually, manual annotation is considered to be the "gold standard". However, medical imaging datasets that include expert manual segmentation are scarce as this step is time-consuming, and therefore expensive. Moreover, single-rater manual annotation is most often used in data-driven approaches making the network optimal with respect to only that single expert. In this work, we propose a CNN for brain extraction in magnetic resonance (MR) imaging, that is fully trained with what we refer to as silver standard masks. Our method consists of 1) developing a dataset with "silver standard" masks as input, and implementing both 2) a tri-planar method using parallel 2D U-Net-based CNNs (referred to as CONSNet) and 3) an auto-context implementation of CONSNet. The term CONSNet refers to our integrated approach, i.e., training with silver standard masks and using a 2D U-Net-based architecture. Our results showed that we outperformed (i.e., larger Dice coefficients) the current state-of-the-art SS methods. Our use of silver standard masks reduced the cost of manual annotation, decreased inter-intra-rater variability, and avoided CNN segmentation super-specialization towards one specific manual annotation guideline that can occur when gold standard masks are used. Moreover, the usage of silver standard masks greatly enlarges the volume of input annotated data because we can relatively easily generate labels for unlabeled data. In addition, our method has the advantage that, once trained, it takes only a few seconds to process a typical brain image volume using modern hardware, such as a high-end graphics processing unit. In contrast, many of the other competitive methods have processing times in the order of minutes.