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Heatmap-based anatomical landmark detection is still facing two unresolved challenges: 1) inability to accurately evaluate the distribution of heatmap; 2) inability to effectively exploit global spatial structure information. To address the computational inability challenge, we propose a novel position-aware and sample-aware central loss. Specifically, our central loss can absorb position information, enabling accurate evaluation of the heatmap distribution. More advanced is that our central loss is sample-aware, which can adaptively distinguish easy and hard samples and make the model more focused on hard samples while solving the challenge of extreme imbalance between landmarks and non-landmarks. To address the challenge of ignoring structure information, a Coordinated Transformer, called CoorTransformer, is proposed, which establishes long-range dependencies under the guidance of landmark coordination information, making the attention more focused on the sparse landmarks while taking advantage of global spatial structure. Furthermore, CoorTransformer can speed up convergence, effectively avoiding the defect that Transformers have difficulty converging in sparse representation learning. Using the advanced CoorTransformer and central loss, we propose a generalized detection model that can handle various scenarios, inherently exploiting the underlying relationship between landmarks and incorporating rich structural knowledge around the target landmarks. We analyzed and evaluated CoorTransformer and central loss on three challenging landmark detection tasks. The experimental results show that our CoorTransformer outperforms state-of-the-art methods, and the central loss significantly improves the performance of the model with p-values< 0.05.

The human annotations are imperfect, especially when produced by junior practitioners. Multi-expert consensus is usually regarded as golden standard, while this annotation protocol is too expensive to implement in many real-world projects. In this study, we propose a method to refine human annotation, named Neural Annotation Refinement (NeAR). It is based on a learnable implicit function, which decodes a latent vector into represented shape. By integrating the appearance as an input of implicit functions, the appearance-aware NeAR fixes the annotation artefacts. Our method is demonstrated on the application of adrenal gland analysis. We first show that the NeAR can repair distorted golden standards on a public adrenal gland segmentation dataset. Besides, we develop a new Adrenal gLand ANalysis (ALAN) dataset with the proposed NeAR, where each case consists of a 3D shape of adrenal gland and its diagnosis label (normal vs. abnormal) assigned by experts. We show that models trained on the shapes repaired by the NeAR can diagnose adrenal glands better than the original ones. The ALAN dataset will be open-source, with 1,584 shapes for adrenal gland diagnosis, which serves as a new benchmark for medical shape analysis. Code and dataset are available at https://github.com/M3DV/NeAR., Comment: MICCAI 2022