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We present a new encoder-decoder Vision Transformer architecture, Patcher, for medical image segmentation. Unlike standard Vision Transformers, it employs Patcher blocks that segment an image into large patches, each of which is further divided into small patches. Transformers are applied to the small patches within a large patch, which constrains the receptive field of each pixel. We intentionally make the large patches overlap to enhance intra-patch communication. The encoder employs a cascade of Patcher blocks with increasing receptive fields to extract features from local to global levels. This design allows Patcher to benefit from both the coarse-to-fine feature extraction common in CNNs and the superior spatial relationship modeling of Transformers. We also propose a new mixture-of-experts (MoE) based decoder, which treats the feature maps from the encoder as experts and selects a suitable set of expert features to predict the label for each pixel. The use of MoE enables better specializations of the expert features and reduces interference between them during inference. Extensive experiments demonstrate that Patcher outperforms state-of-the-art Transformer- and CNN-based approaches significantly on stroke lesion segmentation and polyp segmentation. Code for Patcher is released with publication to facilitate future research., Comment: MICCAI 2022

Additional file 1. Supplementary Figure 1: Characteristics of ex vivo expanded Tregs. Supplementary Figure 2: The presence of Tregs in the frontal cortex following peripheral administration. Supplementary Figure 4: Inflammation gene expressions in the frontal cortex.

Diffusion-weighted (DW) magnetic resonance imaging is essential for the diagnosis and treatment of ischemic stroke. DW images (DWIs) are usually acquired in multi-slice settings where lesion areas in two consecutive 2D slices are highly discontinuous due to large slice thickness and sometimes even slice gaps. Therefore, although DWIs contain rich 3D information, they cannot be treated as regular 3D or 2D images. Instead, DWIs are somewhere in-between (or 2.5D) due to the volumetric nature but inter-slice discontinuities. Thus, it is not ideal to apply most existing segmentation methods as they are designed for either 2D or 3D images. To tackle this problem, we propose a new neural network architecture tailored for segmenting highly-discontinuous 2.5D data such as DWIs. Our network, termed LambdaUNet, extends UNet by replacing convolutional layers with our proposed Lambda+ layers. In particular, Lambda+ layers transform both intra-slice and inter-slice context around a pixel into linear functions, called lambdas, which are then applied to the pixel to produce informative 2.5D features. LambdaUNet is simple yet effective in combining sparse inter-slice information from adjacent slices while also capturing dense contextual features within a single slice. Experiments on a unique clinical dataset demonstrate that LambdaUNet outperforms existing 3D/2D image segmentation methods including recent variants of UNet. Code for LambdaUNet is released with the publication to facilitate future research.

Healthcare organizations have shown growing interest in implementing lean management. Through systematically identifying and eliminating waste, fewer resources are needed while similar or higher quality healthcare can be delivered. However, doing so demands a holistic view of the interrelationships between all sub-processes and their deliverables within a healthcare system. Gaining this view is challenging given the increasingly complex and interconnected nature of modern healthcare processes and its underlying information technology landscape. This paper presents a first step towards a meta-modeling technique to model healthcare processes that captures both the activity as well as outcome perspective. Practitioners can utilize this technique to analyze, design and adapt healthcare processes to optimize the overall system.