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Limited by expensive pixel-level labels, polyp segmentation models are plagued by data shortage and suffer from impaired generalization. In contrast, polyp bounding box annotations are much cheaper and more accessible. Thus, to reduce labeling cost, we propose to learn a weakly supervised polyp segmentation model (i.e., WeakPolyp) completely based on bounding box annotations. However, coarse bounding boxes contain too much noise. To avoid interference, we introduce the mask-to-box (M2B) transformation. By supervising the outer box mask of the prediction instead of the prediction itself, M2B greatly mitigates the mismatch between the coarse label and the precise prediction. But, M2B only provides sparse supervision, leading to non-unique predictions. Therefore, we further propose a scale consistency (SC) loss for dense supervision. By explicitly aligning predictions across the same image at different scales, the SC loss largely reduces the variation of predictions. Note that our WeakPolyp is a plug-and-play model, which can be easily ported to other appealing backbones. Besides, the proposed modules are only used during training, bringing no computation cost to inference. Extensive experiments demonstrate the effectiveness of our proposed WeakPolyp, which surprisingly achieves a comparable performance with a fully supervised model, requiring no mask annotations at all., accepted by MICCAI 2023, codes are available at https://github.com/weijun88/WeakPolyp

The pelvis, the lower part of the trunk, supports and balances the trunk. Landmark detection from a pelvic X-ray (PXR) facilitates downstream analysis and computer-assisted diagnosis and treatment of pelvic diseases. Although PXRs have the advantages of low radiation and reduced cost compared to computed tomography (CT) images, their 2D pelvis-tissue superposition of 3D structures confuses clinical decision-making. In this paper, we propose a PELvis Extraction (PELE) module that utilizes 3D prior anatomical knowledge in CT to guide and well isolate the pelvis from PXRs, thereby eliminating the influence of soft tissue. We conduct an extensive evaluation based on two public datasets and one private dataset, totaling 850 PXRs. The experimental results show that the proposed PELE module significantly improves the accuracy of PXRs landmark detection and achieves state-of-the-art performances in several benchmark metrics, thus better serving downstream tasks., will revise it and resubmit it again later

Multi-modal medical images provide complementary soft-tissue characteristics that aid in the screening and diagnosis of diseases. However, limited scanning time, image corruption and various imaging protocols often result in incomplete multi-modal images, thus limiting the usage of multi-modal data for clinical purposes. To address this issue, in this paper, we propose a novel unified multi-modal image synthesis method for missing modality imputation. Our method overall takes a generative adversarial architecture, which aims to synthesize missing modalities from any combination of available ones with a single model. To this end, we specifically design a Commonality- and Discrepancy-Sensitive Encoder for the generator to exploit both modality-invariant and specific information contained in input modalities. The incorporation of both types of information facilitates the generation of images with consistent anatomy and realistic details of the desired distribution. Besides, we propose a Dynamic Feature Unification Module to integrate information from a varying number of available modalities, which enables the network to be robust to random missing modalities. The module performs both hard integration and soft integration, ensuring the effectiveness of feature combination while avoiding information loss. Verified on two public multi-modal magnetic resonance datasets, the proposed method is effective in handling various synthesis tasks and shows superior performance compared to previous methods., 10 pages, 9 figures

Low-count PET is an efficient way to reduce radiation exposure and acquisition time, but the reconstructed images often suffer from low signal-to-noise ratio (SNR), thus affecting diagnosis and other downstream tasks. Recent advances in deep learning have shown great potential in improving low-count PET image quality, but acquiring a large, centralized, and diverse dataset from multiple institutions for training a robust model is difficult due to privacy and security concerns of patient data. Moreover, low-count PET data at different institutions may have different data distribution, thus requiring personalized models. While previous federated learning (FL) algorithms enable multi-institution collaborative training without the need of aggregating local data, addressing the large domain shift in the application of multi-institutional low-count PET denoising remains a challenge and is still highly under-explored. In this work, we propose FedFTN, a personalized federated learning strategy that addresses these challenges. FedFTN uses a local deep feature transformation network (FTN) to modulate the feature outputs of a globally shared denoising network, enabling personalized low-count PET denoising for each institution. During the federated learning process, only the denoising network's weights are communicated and aggregated, while the FTN remains at the local institutions for feature transformation. We evaluated our method using a large-scale dataset of multi-institutional low-count PET imaging data from three medical centers located across three continents, and showed that FedFTN provides high-quality low-count PET images, outperforming previous baseline FL reconstruction methods across all low-count levels at all three institutions.

Airway segmentation, especially bronchioles segmentation, is an important but challenging task because distal bronchus are sparsely distributed and of a fine scale. Existing neural networks usually exploit sparse topology to learn the connectivity of bronchioles and inefficient shallow features to capture such high-frequency information, leading to the breakage or missed detection of individual thin branches. To address these problems, we contribute a new bronchial segmentation method based on Group Deep Dense Supervision (GDDS) that emphasizes fine-scale bronchioles segmentation in a simple-but-effective manner. First, Deep Dense Supervision (DDS) is proposed by constructing local dense topology skillfully and implementing dense topological learning on a specific shallow feature layer. GDDS further empowers the shallow features with better perception ability to detect bronchioles, even the ones that are not easily discernible to the naked eye. Extensive experiments on the BAS benchmark dataset have shown that our method promotes the network to have a high sensitivity in capturing fine-scale branches and outperforms state-of-the-art methods by a large margin (+12.8 % in BD and +8.8 % in TD) while only introducing a small number of extra parameters., Submitted to MICCAI2023

Targeted diagnosis and treatment plans for patients with coronary artery disease vary according to atherosclerotic plaque component. Coronary CT angiography (CCTA) is widely used for artery imaging and determining the stenosis degree. However, the limited spatial resolution and susceptibility to artifacts fail CCTA in obtaining lumen morphological characteristics and plaque composition. It can be settled by invasive optical coherence tomography (OCT) without much trouble for physicians, but bringing higher costs and potential risks to patients. Therefore, it is clinically critical to introduce annotations of plaque tissue and lumen characteristics from OCT to paired CCTA scans, denoted as \textbf{the O2CTA problem} in this paper. We propose a method to handle the O2CTA problem. CCTA scans are first reconstructed into multi-planar reformatted (MPR) images, which agree with OCT images in term of semantic contents. The artery segment in OCT, which is manually labelled, is then spatially aligned with the entire artery in MPR images via the proposed alignment strategy. Finally, a classification model involving a 3D CNN and a Transformer, is learned to extract local features and capture dependence along arteries. Experiments on 55 paired OCT and CCTA we curate demonstrate that it is feasible to classify the CCTA based on the OCT labels, with an accuracy of 86.2%, while the manual readings of OCT and CCTA vary significantly, with a Kappa coefficient of 0.113. We will make our source codes, models, data, and results publicly available to benefit the research community.

Self-paced curriculum learning (SCL) has demonstrated its great potential in computer vision, natural language processing, etc. During training, it implements easy-to-hard sampling based on online estimation of data difficulty. Most SCL methods commonly adopt a loss-based strategy of estimating data difficulty and deweighting the `hard' samples in the early training stage. While achieving success in a variety of applications, SCL stills confront two challenges in a medical image analysis task, such as universal lesion detection, featuring insufficient and highly class-imbalanced data: (i) the loss-based difficulty measurer is inaccurate; ii) the hard samples are under-utilized from a deweighting mechanism. To overcome these challenges, in this paper we propose a novel mixed-order self-paced curriculum learning (Mo-SCL) method. We integrate both uncertainty and loss to better estimate difficulty online and mix both hard and easy samples in the same mini-batch to appropriately alleviate the problem of under-utilization of hard samples. We provide a theoretical investigation of our method in the context of stochastic gradient descent optimization and extensive experiments based on the DeepLesion benchmark dataset for universal lesion detection (ULD). When applied to two state-of-the-art ULD methods, the proposed mixed-order SCL method can provide a free boost to lesion detection accuracy without extra special network designs., 11 pages, 3 figures

Objective and Impact Statement: Accurate organ segmentation is critical for many clinical applications at different clinical sites, which may have their specific application requirements that concern different organs. Introduction: However, learning high-quality, site-specific organ segmentation models is challenging as it often needs on-site curation of a large number of annotated images. Security concerns further complicate the matter. Methods: The paper aims to tackle these challenges via a two-phase aggregation-then-adaptation approach. The first phase of federated aggregation learns a single multi-organ segmentation model by leveraging the strength of 'bigger data', which are formed by (i) aggregating together datasets from multiple sites that with different organ labels to provide partial supervision, and (ii) conducting partially supervised learning without data breach. The second phase of site adaptation is to transfer the federated multi-organ segmentation model to site-specific organ segmentation models, one model per site, in order to further improve the performance of each site's organ segmentation task. Furthermore, improved marginal loss and exclusion loss functions are used to avoid 'knowledge conflict' problem in a partially supervision mechanism. Results and Conclusion: Extensive experiments on five organ segmentation datasets demonstrate the effectiveness of our multi-site approach, significantly outperforming the site-per-se learned models and achieving the performance comparable to the centrally learned models.

Emerging neural reconstruction techniques based on tomography (e.g., NeRF, NeAT, and NeRP) have started showing unique capabilities in medical imaging. In this work, we present a novel Polychromatic neural representation (Polyner) to tackle the challenging problem of CT imaging when metallic implants exist within the human body. The artifacts arise from the drastic variation of metal's attenuation coefficients at various energy levels of the X-ray spectrum, leading to a nonlinear metal effect in CT measurements. Reconstructing CT images from metal-affected measurements hence poses a complicated nonlinear inverse problem where empirical models adopted in previous metal artifact reduction (MAR) approaches lead to signal loss and strongly aliased reconstructions. Polyner instead models the MAR problem from a nonlinear inverse problem perspective. Specifically, we first derive a polychromatic forward model to accurately simulate the nonlinear CT acquisition process. Then, we incorporate our forward model into the implicit neural representation to accomplish reconstruction. Lastly, we adopt a regularizer to preserve the physical properties of the CT images across different energy levels while effectively constraining the solution space. Our Polyner is an unsupervised method and does not require any external training data. Experimenting with multiple datasets shows that our Polyner achieves comparable or better performance than supervised methods on in-domain datasets while demonstrating significant performance improvements on out-of-domain datasets. To the best of our knowledge, our Polyner is the first unsupervised MAR method that outperforms its supervised counterparts., Comment: 19 pages

The augmentation parameters matter to few-shot semantic segmentation since they directly affect the training outcome by feeding the networks with varying perturbated samples. However, searching optimal augmentation parameters for few-shot segmentation models without annotations is a challenge that current methods fail to address. In this paper, we first propose a framework to determine the ``optimal'' parameters without human annotations by solving a distribution-matching problem between the intra-instance and intra-class similarity distribution, with the intra-instance similarity describing the similarity between the original sample of a particular anatomy and its augmented ones and the intra-class similarity representing the similarity between the selected sample and the others in the same class. Extensive experiments demonstrate the superiority of our optimized augmentation in boosting few-shot segmentation models. We greatly improve the top competing method by 1.27\% and 1.11\% on Abd-MRI and Abd-CT datasets, respectively, and even achieve a significant improvement for SSL-ALP on the left kidney by 3.39\% on the Abd-CT dataset.

Undersampled MRI reconstruction is crucial for accelerating clinical scanning procedures. Recent deep learning methods for MRI reconstruction adopt CNN or ViT as backbone, which lack in utilizing the complementary properties of CNN and ViT. In this paper, we propose DuDoRNeXt, whose backbone hybridizes CNN and ViT in an domain-specific, intra-stage way. Besides our hybrid vertical layout design, we introduce domain-specific modules for dual-domain reconstruction, namely image-domain parallel local detail enhancement and k-space global initialization. We evaluate different conventions of MRI reconstruction including image-domain, k-space-domain, and dual-domain reconstruction with a reference protocol on the IXI dataset and an in-house multi-contrast dataset. DuDoRNeXt achieves significant improvements over competing deep learning methods.

Self-supervised learning is well known for its remarkable performance in representation learning and various downstream computer vision tasks. Recently, Positive-pair-Only Contrastive Learning (POCL) has achieved reliable performance without the need to construct positive-negative training sets. It reduces memory requirements by lessening the dependency on the batch size. The POCL method typically uses a single loss function to extract the distortion invariant representation (DIR) which describes the proximity of positive-pair representations affected by different distortions. This loss function implicitly enables the model to filter out or ignore the distortion variant representation (DVR) affected by different distortions. However, existing POCL methods do not explicitly enforce the disentanglement and exploitation of the actually valuable DVR. In addition, these POCL methods have been observed to be sensitive to augmentation strategies. To address these limitations, we propose a novel POCL framework named Distortion-Disentangled Contrastive Learning (DDCL) and a Distortion-Disentangled Loss (DDL). Our approach is the first to explicitly disentangle and exploit the DVR inside the model and feature stream to improve the overall representation utilization efficiency, robustness and representation ability. Experiments carried out demonstrate the superiority of our framework to Barlow Twins and Simsiam in terms of convergence, representation quality, and robustness on several benchmark datasets.

One-shot medical landmark detection gains much attention and achieves great success for its label-efficient training process. However, existing one-shot learning methods are highly specialized in a single domain and suffer domain preference heavily in the situation of multi-domain unlabeled data. Moreover, one-shot learning is not robust that it faces performance drop when annotating a sub-optimal image. To tackle these issues, we resort to developing a domain-adaptive one-shot landmark detection framework for handling multi-domain medical images, named Universal One-shot Detection (UOD). UOD consists of two stages and two corresponding universal models which are designed as combinations of domain-specific modules and domain-shared modules. In the first stage, a domain-adaptive convolution model is self-supervised learned to generate pseudo landmark labels. In the second stage, we design a domain-adaptive transformer to eliminate domain preference and build the global context for multi-domain data. Even though only one annotated sample from each domain is available for training, the domain-shared modules help UOD aggregate all one-shot samples to detect more robust and accurate landmarks. We investigated both qualitatively and quantitatively the proposed UOD on three widely-used public X-ray datasets in different anatomical domains (i.e., head, hand, chest) and obtained state-of-the-art performances in each domain. The code is available at https://github.com/heqin-zhu/UOD_universal_oneshot_detection., Comment: Eealy accepted by MICCAI 2023. 11pages, 4 figures, 2 tables. arXiv admin note: text overlap with arXiv:2203.06433

Radiologists have different training and clinical experiences, which may result in various segmentation annotations for lung nodules, causing segmentation uncertainty. Conventional methods usually select a single annotation as the learning target or try to learn a latent space of various annotations, but these approaches waste the valuable information of consensus or disagreements ingrained in the multiple annotations. In this paper, we propose an Uncertainty-Aware Attention Mechanism (UAAM) that utilizes consensus and disagreements among multiple annotations to facilitate better segmentation. To achieve this, we introduce the Multi-Confidence Mask (MCM), which is a combination of a Low-Confidence (LC) Mask and a High-Confidence (HC) Mask. The LC mask indicates regions with a low segmentation confidence, which may cause different segmentation options among radiologists. Following UAAM, we further design an Uncertainty-Guide Segmentation Network (UGS-Net), which contains three modules: a Feature Extracting Module that captures a general feature of a lung nodule, an Uncertainty-Aware Module that produces three features for the annotations' union, intersection, and annotation set, and an Intersection-Union Constraining Module that uses distances between the three features to balance the predictions of final segmentation, LC mask, and HC mask. To fully demonstrate the performance of our method, we propose a Complex Nodule Validation on LIDC-IDRI, which tests UGS-Net's segmentation performance on lung nodules that are difficult to segment using U-Net. Experimental results demonstrate that our method can significantly improve the segmentation performance on nodules with poor segmentation by U-Net., Comment: 10 pages, 10 figures. We have reported a preliminary version of this work in MICCAI 2022

Domain shift and label scarcity heavily limit deep learning applications to various medical image analysis tasks. Unsupervised domain adaptation (UDA) techniques have recently achieved promising cross-modality medical image segmentation by transferring knowledge from a label-rich source domain to an unlabeled target domain. However, it is also difficult to collect annotations from the source domain in many clinical applications, rendering most prior works suboptimal with the label-scarce source domain, particularly for few-shot scenarios, where only a few source labels are accessible. To achieve efficient few-shot cross-modality segmentation, we propose a novel transformation-consistent meta-hallucination framework, meta-hallucinator, with the goal of learning to diversify data distributions and generate useful examples for enhancing cross-modality performance. In our framework, hallucination and segmentation models are jointly trained with the gradient-based meta-learning strategy to synthesize examples that lead to good segmentation performance on the target domain. To further facilitate data hallucination and cross-domain knowledge transfer, we develop a self-ensembling model with a hallucination-consistent property. Our meta-hallucinator can seamlessly collaborate with the meta-segmenter for learning to hallucinate with mutual benefits from a combined view of meta-learning and self-ensembling learning. Extensive studies on MM-WHS 2017 dataset for cross-modality cardiac segmentation demonstrate that our method performs favorably against various approaches by a lot in the few-shot UDA scenario., Comment: Accepted by MICCAI 2022 (top 13% paper; early accept)

Deep neural networks have been widely studied for predicting a medical condition, such as total knee replacement (TKR). It has shown that data of different modalities, such as imaging data, clinical variables and demographic information, provide complementary information and thus can improve the prediction accuracy together. However, the data sources of various modalities may not always be of high quality, and each modality may have only partial information of medical condition. Thus, predictions from different modalities can be opposite, and the final prediction may fail in the presence of such a conflict. Therefore, it is important to consider the reliability of each source data and the prediction output when making a final decision. In this paper, we propose an evidence-aware multi-modal data fusion framework based on the Dempster-Shafer theory (DST). The backbone models contain an image branch, a non-image branch and a fusion branch. For each branch, there is an evidence network that takes the extracted features as input and outputs an evidence score, which is designed to represent the reliability of the output from the current branch. The output probabilities along with the evidence scores from multiple branches are combined with the Dempster's combination rule to make a final prediction. Experimental results on the public OA initiative (OAI) dataset for the TKR prediction task show the superiority of the proposed fusion strategy on various backbone models.

Deep learning is becoming increasingly ubiquitous in medical research and applications while involving sensitive information and even critical diagnosis decisions. Researchers observe a significant performance disparity among subgroups with different demographic attributes, which is called model unfairness, and put lots of effort into carefully designing elegant architectures to address unfairness, which poses heavy training burden, brings poor generalization, and reveals the trade-off between model performance and fairness. To tackle these issues, we propose FairAdaBN by making batch normalization adaptive to sensitive attribute. This simple but effective design can be adopted to several classification backbones that are originally unaware of fairness. Additionally, we derive a novel loss function that restrains statistical parity between subgroups on mini-batches, encouraging the model to converge with considerable fairness. In order to evaluate the trade-off between model performance and fairness, we propose a new metric, named Fairness-Accuracy Trade-off Efficiency (FATE), to compute normalized fairness improvement over accuracy drop. Experiments on two dermatological datasets show that our proposed method outperforms other methods on fairness criteria and FATE., Comment: Accepted by MICCAI 2023

Autonomous robotic surgery has advanced significantly based on analysis of visual and temporal cues in surgical workflow, but relational cues from domain knowledge remain under investigation. Complex relations in surgical annotations can be divided into intra- and inter-relations, both valuable to autonomous systems to comprehend surgical workflows. Intra- and inter-relations describe the relevance of various categories within a particular annotation type and the relevance of different annotation types, respectively. This paper aims to systematically investigate the importance of relational cues in surgery. First, we contribute the RLLS12M dataset, a large-scale collection of robotic left lateral sectionectomy (RLLS), by curating 50 videos of 50 patients operated by 5 surgeons and annotating a hierarchical workflow, which consists of 3 inter- and 6 intra-relations, 6 steps, 15 tasks, and 38 activities represented as the triplet of 11 instruments, 8 actions, and 16 objects, totaling 2,113,510 video frames and 12,681,060 annotation entities. Correspondingly, we propose a multi-relation purification hybrid network (MURPHY), which aptly incorporates novel relation modules to augment the feature representation by purifying relational features using the intra- and inter-relations embodied in annotations. The intra-relation module leverages a R-GCN to implant visual features in different graph relations, which are aggregated using a targeted relation purification with affinity information measuring label consistency and feature similarity. The inter-relation module is motivated by attention mechanisms to regularize the influence of relational features based on the hierarchy of annotation types from the domain knowledge. Extensive experimental results on the curated RLLS dataset confirm the effectiveness of our approach, demonstrating that relations matter in surgical workflow analysis.

Contrastive learning (CL) is a form of self-supervised learning and has been widely used for various tasks. Different from widely studied instance-level contrastive learning, pixel-wise contrastive learning mainly helps with pixel-wise tasks such as medical landmark detection. The counterpart to an instance in instance-level CL is a pixel, along with its neighboring context, in pixel-wise CL. Aiming to build better feature representation, there is a vast literature about designing instance augmentation strategies for instance-level CL; but there is little similar work on pixel augmentation for pixel-wise CL with a pixel granularity. In this paper, we attempt to bridge this gap. We first classify a pixel into three categories, namely low-, medium-, and high-informative, based on the information quantity the pixel contains. Inspired by the ``InfoMin" principle, we then design separate augmentation strategies for each category in terms of augmentation intensity and sampling ratio. Extensive experiments validate that our information-guided pixel augmentation strategy succeeds in encoding more discriminative representations and surpassing other competitive approaches in unsupervised local feature matching. Furthermore, our pretrained model improves the performance of both one-shot and fully supervised models. To the best of our knowledge, we are the first to propose a pixel augmentation method with a pixel granularity for enhancing unsupervised pixel-wise contrastive learning.

Machine learning-enabled medical imaging analysis has become a vital part of the current automatic diagnosis system. However, machine learning models have been shown to demonstrate a systematic bias towards certain subgroups of people, e.g., giving a worse predictive performance to old females. It is harmful and dangerous in such a sensitive area and therefore researchers have been working on developing bias mitigation algorithms to address the fairness issue in the general machine learning field. However, given the specific characteristics of medical imaging, fairness in medical image analysis (MedIA) requires additional efforts. Hence, in this survey, we give a comprehensive review of the current progress of fairness study and that in MedIA. Specifically, we first discuss the definitions of fairness and analyze the source of bias in medical imaging. Then, we discuss current research on fairness for MedIA and present a collection of public medical imaging datasets that can be used for evaluating fairness in MedIA. Furthermore, we conduct extensive experiments to evaluate the fairness of several different tasks for medical imaging, including classification, object detection, and landmark detection. Finally, we discuss the challenges and potential future directions in developing fair MedIA., 21 pages, 11 figures

Fluoroscopy is an imaging technique that uses X-ray to obtain a real-time 2D video of the interior of a 3D object, helping surgeons to observe pathological structures and tissue functions especially during intervention. However, it suffers from heavy noise that mainly arises from the clinical use of a low dose X-ray, thereby necessitating the technology of fluoroscopy denoising. Such denoising is challenged by the relative motion between the object being imaged and the X-ray imaging system. We tackle this challenge by proposing a self-supervised, three-stage framework that exploits the domain knowledge of fluoroscopy imaging. (i) Stabilize: we first construct a dynamic panorama based on optical flow calculation to stabilize the non-stationary background induced by the motion of the X-ray detector. (ii) Decompose: we then propose a novel mask-based Robust Principle Component Analysis (RPCA) decomposition method to separate a video with detector motion into a low-rank background and a sparse foreground. Such a decomposition accommodates the reading habit of experts. (iii) Denoise: we finally denoise the background and foreground separately by a self-supervised learning strategy and fuse the denoised parts into the final output via a bilateral, spatiotemporal filter. To assess the effectiveness of our work, we curate a dedicated fluoroscopy dataset of 27 videos (1,568 frames) and corresponding ground truth. Our experiments demonstrate that it achieves significant improvements in terms of denoising and enhancement effects when compared with standard approaches. Finally, expert rating confirms this efficacy., 11 pages, 18 figures

While medical images such as computed tomography (CT) are stored in DICOM format in hospital PACS, it is still quite routine in many countries to print a film as a transferable medium for the purposes of self-storage and secondary consultation. Also, with the ubiquitousness of mobile phone cameras, it is quite common to take pictures of CT films, which unfortunately suffer from geometric deformation and illumination variation. In this work, we study the problem of recovering a CT film, which marks \textbf{the first attempt} in the literature, to the best of our knowledge. We start with building a large-scale head CT film database CTFilm20K, consisting of approximately 20,000 pictures, using the widely used computer graphics software Blender. We also record all accompanying information related to the geometric deformation (such as 3D coordinate, depth, normal, and UV maps) and illumination variation (such as albedo map). Then we propose a deep framework called \textbf{F}ilm \textbf{I}mage \textbf{Re}covery \textbf{Net}work (\textbf{FIReNet}) to tackle geometric deformation and illumination variation using the multiple maps extracted from the CT films to collaboratively guide the recovery process. Finally, we convert the dewarped images to DICOM files with our cascade model for further analysis such as radiomics feature extraction. Extensive experiments demonstrate the superiority of our approach over the previous approaches. We plan to open source the simulated images and deep models for promoting the research on CT film image analysis.

Digital chest tomosynthesis (DCT) is a technique to produce sectional 3D images of a human chest for pulmonary disease screening, with 2D X-ray projections taken within an extremely limited range of angles. However, under the limited angle scenario, DCT contains strong artifacts caused by the presence of ribs, jamming the imaging quality of the lung area. Recently, great progress has been achieved for rib suppression in a single X-ray image, to reveal a clearer lung texture. We firstly extend the rib suppression problem to the 3D case at the software level. We propose a $\textbf{T}$omosynthesis $\textbf{RI}$b Su$\textbf{P}$pression and $\textbf{L}$ung $\textbf{E}$nhancement $\textbf{Net}$work (TRIPLE-Net) to model the 3D rib component and provide a rib-free DCT. TRIPLE-Net takes the advantages from both 2D and 3D domains, which model the ribs in DCT with the exact FBP procedure and 3D depth information, respectively. The experiments on simulated datasets and clinical data have shown the effectiveness of TRIPLE-Net to preserve lung details as well as improve the imaging quality of pulmonary diseases. Finally, an expert user study confirms our findings.

There exists a large number of datasets for organ segmentation, which are partially annotated and sequentially constructed. A typical dataset is constructed at a certain time by curating medical images and annotating the organs of interest. In other words, new datasets with annotations of new organ categories are built over time. To unleash the potential behind these partially labeled, sequentially-constructed datasets, we propose to incrementally learn a multi-organ segmentation model. In each incremental learning (IL) stage, we lose the access to previous data and annotations, whose knowledge is assumingly captured by the current model, and gain the access to a new dataset with annotations of new organ categories, from which we learn to update the organ segmentation model to include the new organs. While IL is notorious for its `catastrophic forgetting' weakness in the context of natural image analysis, we experimentally discover that such a weakness mostly disappears for CT multi-organ segmentation. To further stabilize the model performance across the IL stages, we introduce a light memory module and some loss functions to restrain the representation of different categories in feature space, aggregating feature representation of the same class and separating feature representation of different classes. Extensive experiments on five open-sourced datasets are conducted to illustrate the effectiveness of our method., arXiv admin note: text overlap with arXiv:2103.04526

Artificial Intelligence (AI) is having a tremendous impact across most areas of science. Applications of AI in healthcare have the potential to improve our ability to detect, diagnose, prognose, and intervene on human disease. For AI models to be used clinically, they need to be made safe, reproducible and robust, and the underlying software framework must be aware of the particularities (e.g. geometry, physiology, physics) of medical data being processed. This work introduces MONAI, a freely available, community-supported, and consortium-led PyTorch-based framework for deep learning in healthcare. MONAI extends PyTorch to support medical data, with a particular focus on imaging, and provide purpose-specific AI model architectures, transformations and utilities that streamline the development and deployment of medical AI models. MONAI follows best practices for software-development, providing an easy-to-use, robust, well-documented, and well-tested software framework. MONAI preserves the simple, additive, and compositional approach of its underlying PyTorch libraries. MONAI is being used by and receiving contributions from research, clinical and industrial teams from around the world, who are pursuing applications spanning nearly every aspect of healthcare., Comment: www.monai.io

Magnetic Resonance (MR) image reconstruction from under-sampled acquisition promises faster scanning time. To this end, current State-of-The-Art (SoTA) approaches leverage deep neural networks and supervised training to learn a recovery model. While these approaches achieve impressive performances, the learned model can be fragile on unseen degradation, e.g. when given a different acceleration factor. These methods are also generally deterministic and provide a single solution to an ill-posed problem; as such, it can be difficult for practitioners to understand the reliability of the reconstruction. We introduce DiffuseRecon, a novel diffusion model-based MR reconstruction method. DiffuseRecon guides the generation process based on the observed signals and a pre-trained diffusion model, and does not require additional training on specific acceleration factors. DiffuseRecon is stochastic in nature and generates results from a distribution of fully-sampled MR images; as such, it allows us to explicitly visualize different potential reconstruction solutions. Lastly, DiffuseRecon proposes an accelerated, coarse-to-fine Monte-Carlo sampling scheme to approximate the most likely reconstruction candidate. The proposed DiffuseRecon achieves SoTA performances reconstructing from raw acquisition signals in fastMRI and SKM-TEA. Code will be open-sourced at www.github.com/cpeng93/DiffuseRecon.

Magnetic resonance (MR) images exhibit various contrasts and appearances based on factors such as different acquisition protocols, views, manufacturers, scanning parameters, etc. This generally accessible appearance-related side information affects deep learning-based undersampled magnetic resonance imaging (MRI) reconstruction frameworks, but has been overlooked in the majority of current works. In this paper, we investigate the use of such side information as normalisation parameters in a convolutional neural network (CNN) to improve undersampled MRI reconstruction. Specifically, a Side Information-Guided Normalisation (SIGN) module, containing only few layers, is proposed to efficiently encode the side information and output the normalisation parameters. We examine the effectiveness of such a module on two popular reconstruction architectures, D5C5 and OUCR. The experimental results on both brain and knee images under various acceleration rates demonstrate that the proposed method improves on its corresponding baseline architectures with a significant margin.

Accurate anatomical landmark detection plays an increasingly vital role in medical image analysis. Although existing methods achieve satisfying performance, they are mostly based on CNN and specialized for a single domain say associated with a particular anatomical region. In this work, we propose a universal model for multi-domain landmark detection by taking advantage of transformer for modeling long dependencies and develop a domain-adaptive transformer model, named as DATR, which is trained on multiple mixed datasets from different anatomies and capable of detecting landmarks of any image from those anatomies. The proposed DATR exhibits three primary features: (i) It is the first universal model which introduces transformer as an encoder for multi-anatomy landmark detection; (ii) We design a domain-adaptive transformer for anatomy-aware landmark detection, which can be effectively extended to any other transformer network; (iii) Following previous studies, we employ a light-weighted guidance network, which encourages the transformer network to detect more accurate landmarks. We carry out experiments on three widely used X-ray datasets for landmark detection, which have 1,588 images and 62 landmarks in total, including three different anatomies (head, hand, and chest). Experimental results demonstrate that our proposed DATR achieves state-of-the-art performances by most metrics and behaves much better than any previous convolution-based models. The code will be released publicly., Comment: 8 pages, 2 figures, 4 tables

Contrastive learning and self-supervised techniques have gained prevalence in computer vision for the past few years. It is essential for medical image analysis, which is often notorious for its lack of annotations. Most existing self-supervised methods applied in natural imaging tasks focus on designing proxy tasks for unlabeled data. For example, contrastive learning is often based on the fact that an image and its transformed version share the same identity. However, pixel annotations contain much valuable information for medical image segmentation, which is largely ignored in contrastive learning. In this work, we propose a novel pre-training framework called Mixed Contrastive Learning (MixCL) that leverages both image identities and pixel labels for better modeling by maintaining identity consistency, label consistency, and reconstruction consistency together. Consequently, thus pre-trained model has more robust representations that characterize medical images. Extensive experiments demonstrate the effectiveness of the proposed method, improving the baseline by 5.28% and 14.12% in Dice coefficient when 5% labeled data of Spleen and 15% of BTVC are used in fine-tuning, respectively.

Fast screening and diagnosis are critical in COVID-19 patient treatment. In addition to the gold standard RT-PCR, radiological imaging like X-ray and CT also works as an important means in patient screening and follow-up. However, due to the excessive number of patients, writing reports becomes a heavy burden for radiologists. To reduce the workload of radiologists, we propose DeltaNet to generate medical reports automatically. Different from typical image captioning approaches that generate reports with an encoder and a decoder, DeltaNet applies a conditional generation process. In particular, given a medical image, DeltaNet employs three steps to generate a report: 1) first retrieving related medical reports, i.e., the historical reports from the same or similar patients; 2) then comparing retrieved images and current image to find the differences; 3) finally generating a new report to accommodate identified differences based on the conditional report. We evaluate DeltaNet on a COVID-19 dataset, where DeltaNet outperforms state-of-the-art approaches. Besides COVID-19, the proposed DeltaNet can be applied to other diseases as well. We validate its generalization capabilities on the public IU-Xray and MIMIC-CXR datasets for chest-related diseases. Code is available at \url{https://github.com/LX-doctorAI1/DeltaNet}.

Accurate polyp segmentation is of great importance for colorectal cancer diagnosis and treatment. However, due to the high cost of producing accurate mask annotations, existing polyp segmentation methods suffer from severe data shortage and impaired model generalization. Reversely, coarse polyp bounding box annotations are more accessible. Thus, in this paper, we propose a boosted BoxPolyp model to make full use of both accurate mask and extra coarse box annotations. In practice, box annotations are applied to alleviate the over-fitting issue of previous polyp segmentation models, which generate fine-grained polyp area through the iterative boosted segmentation model. To achieve this goal, a fusion filter sampling (FFS) module is firstly proposed to generate pixel-wise pseudo labels from box annotations with less noise, leading to significant performance improvements. Besides, considering the appearance consistency of the same polyp, an image consistency (IC) loss is designed. Such IC loss explicitly narrows the distance between features extracted by two different networks, which improves the robustness of the model. Note that our BoxPolyp is a plug-and-play model, which can be merged into any appealing backbone. Quantitative and qualitative experimental results on five challenging benchmarks confirm that our proposed model outperforms previous state-of-the-art methods by a large margin., Comment: Accepted by MICCAI2022, Codes Available

Robotic-assisted surgery allows surgeons to conduct precise surgical operations with stereo vision and flexible motor control. However, the lack of 3D spatial perception limits situational awareness during procedures and hinders mastering surgical skills in the narrow abdominal space. Depth estimation, as a representative perception task, is typically defined as an image reconstruction problem. In this work, we show that depth estimation can be reformed from a 3D surface perspective. We propose a loss function for depth estimation that integrates the surface-aware constraints, leading to a faster and better convergence with the valid information from spatial information. In addition, camera parameters are incorporated into the training pipeline to increase the control and transparency of the depth estimation. We also integrate a specularity removal module to recover more buried image information. Quantitative experimental results on endoscopic datasets and user studies with medical professionals demonstrate the effectiveness of our method.

Automated salient object detection (SOD) plays an increasingly crucial role in many computer vision applications. By reformulating the depth information as supervision rather than as input, depth-supervised convolutional neural networks (CNN) have achieved promising results on both RGB and RGB-D SOD scenarios with the merits of no requirements for extra depth networks and depth inputs in the inference stage. This paper, for the first time, seeks to expand the applicability of depth supervision to the Transformer architecture. Specifically, we develop a Depth-supervised Fusion TRansformer (DFTR), to further improve the accuracy of both RGB and RGB-D SOD. The proposed DFTR involves three primary features: 1) DFTR, to the best of our knowledge, is the first pure Transformer-based model for depth-supervised SOD; 2) A multi-scale feature aggregation (MFA) module is proposed to fully exploit the multi-scale features encoded by the Swin Transformer in a coarse-to-fine manner; 3) To enable bidirectional information flow across different streams of features, a novel multi-stage feature fusion (MFF) module is further integrated into our DFTR with the emphasis on salient regions at different network learning stages. We extensively evaluate the proposed DFTR on ten benchmarking datasets. Experimental results show that our DFTR consistently outperforms the existing state-of-the-art methods for both RGB and RGB-D SOD tasks. The code and model will be made publicly available., Comment: 15 pages, 5 figures, 4 tables

In the paper, we present an approach for learning a single model that universally segments 33 anatomical structures, including vertebrae, pelvic bones, and abdominal organs. Our model building has to address the following challenges. Firstly, while it is ideal to learn such a model from a large-scale, fully-annotated dataset, it is practically hard to curate such a dataset. Thus, we resort to learn from a union of multiple datasets, with each dataset containing the images that are partially labeled. Secondly, along the line of partial labelling, we contribute an open-source, large-scale vertebra segmentation dataset for the benefit of spine analysis community, CTSpine1K, boasting over 1,000 3D volumes and over 11K annotated vertebrae. Thirdly, in a 3D medical image segmentation task, due to the limitation of GPU memory, we always train a model using cropped patches as inputs instead a whole 3D volume, which limits the amount of contextual information to be learned. To this, we propose a cross-patch transformer module to fuse more information in adjacent patches, which enlarges the aggregated receptive field for improved segmentation performance. This is especially important for segmenting, say, the elongated spine. Based on 7 partially labeled datasets that collectively contain about 2,800 3D volumes, we successfully learn such a universal model. Finally, we evaluate the universal model on multiple open-source datasets, proving that our model has a good generalization performance and can potentially serve as a solid foundation for downstream tasks.

Universal Lesion Detection (ULD) in computed tomography plays an essential role in computer-aided diagnosis. Promising ULD results have been reported by multi-slice-input detection approaches which model 3D context from multiple adjacent CT slices, but such methods still experience difficulty in obtaining a global representation among different slices and within each individual slice since they only use convolution-based fusion operations. In this paper, we propose a novel Slice Attention Transformer (SATr) block which can be easily plugged into convolution-based ULD backbones to form hybrid network structures. Such newly formed hybrid backbones can better model long-distance feature dependency via the cascaded self-attention modules in the Transformer block while still holding a strong power of modeling local features with the convolutional operations in the original backbone. Experiments with five state-of-the-art methods show that the proposed SATr block can provide an almost free boost to lesion detection accuracy without extra hyperparameters or special network designs., Comment: 11 pages, 3 figures

Medical image super-resolution (SR) is an active research area that has many potential applications, including reducing scan time, bettering visual understanding, increasing robustness in downstream tasks, etc. However, applying deep-learning-based SR approaches for clinical applications often encounters issues of domain inconsistency, as the test data may be acquired by different machines or on different organs. In this work, we present a novel algorithm called domain adaptable volumetric super-resolution (DA-VSR) to better bridge the domain inconsistency gap. DA-VSR uses a unified feature extraction backbone and a series of network heads to improve image quality over different planes. Furthermore, DA-VSR leverages the in-plane and through-plane resolution differences on the test data to achieve a self-learned domain adaptation. As such, DA-VSR combines the advantages of a strong feature generator learned through supervised training and the ability to tune to the idiosyncrasies of the test volumes through unsupervised learning. Through experiments, we demonstrate that DA-VSR significantly improves super-resolution quality across numerous datasets of different domains, thereby taking a further step toward real clinical applications., Comment: MICCAI2021

Contrastive learning based methods such as cascade comparing to detect (CC2D) have shown great potential for one-shot medical landmark detection. However, the important cue of relative distance between landmarks is ignored in CC2D. In this paper, we upgrade CC2D to version II by incorporating a simple-yet-effective relative distance bias in the training stage, which is theoretically proved to encourage the encoder to project the relatively distant landmarks to the embeddings with low similarities. As consequence, CC2Dv2 is less possible to detect a wrong point far from the correct landmark. Furthermore, we present an open-source, landmark-labeled dataset for the measurement of biomechanical parameters of the lower extremity to alleviate the burden of orthopedic surgeons. The effectiveness of CC2Dv2 is evaluated on the public dataset from the ISBI 2015 Grand-Challenge of cephalometric radiographs and our new dataset, which greatly outperforms the state-of-the-art one-shot landmark detection approaches.

It is a long-standing challenge to reconstruct Cone Beam Computed Tomography (CBCT) of the lung under respiratory motion. This work takes a step further to address a challenging setting in reconstructing a multi-phase}4D lung image from just a single}3D CBCT acquisition. To this end, we introduce REpiratory-GAted Synthesis of views, or REGAS. REGAS proposes a self-supervised method to synthesize the undersampled tomographic views and mitigate aliasing artifacts in reconstructed images. This method allows a much better estimation of between-phase Deformation Vector Fields (DVFs), which are used to enhance reconstruction quality from direct observations without synthesis. To address the large memory cost of deep neural networks on high resolution 4D data, REGAS introduces a novel Ray Path Transformation (RPT) that allows for distributed, differentiable forward projections. REGAS require no additional measurements like prior scans, air-flow volume, or breathing velocity. Our extensive experiments show that REGAS significantly outperforms comparable methods in quantitative metrics and visual quality.

Computed tomography (CT) is a widely-used imaging technology that assists clinical decision-making with high-quality human body representations. To reduce the radiation dose posed by CT, sparse-view and limited-angle CT are developed with preserved image quality. However, these methods are still stuck with a fixed or uniform sampling strategy, which inhibits the possibility of acquiring a better image with an even reduced dose. In this paper, we explore this possibility via learning an active sampling policy that optimizes the sampling positions for patient-specific, high-quality reconstruction. To this end, we design an \textit{intelligent agent} for active recommendation of sampling positions based on on-the-fly reconstruction with obtained sinograms in a progressive fashion. With such a design, we achieve better performances on the NIH-AAPM dataset over popular uniform sampling, especially when the number of views is small. Finally, such a design also enables RoI-aware reconstruction with improved reconstruction quality within regions of interest (RoI's) that are clinically important. Experiments on the VerSe dataset demonstrate this ability of our sampling policy, which is difficult to achieve based on uniform sampling.

While Computed Tomography (CT) reconstruction from X-ray sinograms is necessary for clinical diagnosis, iodine radiation in the imaging process induces irreversible injury, thereby driving researchers to study sparse-view CT reconstruction, that is, recovering a high-quality CT image from a sparse set of sinogram views. Iterative models are proposed to alleviate the appeared artifacts in sparse-view CT images, but the computation cost is too expensive. Then deep-learning-based methods have gained prevalence due to the excellent performances and lower computation. However, these methods ignore the mismatch between the CNN's \textbf{local} feature extraction capability and the sinogram's \textbf{global} characteristics. To overcome the problem, we propose \textbf{Du}al-\textbf{Do}main \textbf{Trans}former (\textbf{DuDoTrans}) to simultaneously restore informative sinograms via the long-range dependency modeling capability of Transformer and reconstruct CT image with both the enhanced and raw sinograms. With such a novel design, reconstruction performance on the NIH-AAPM dataset and COVID-19 dataset experimentally confirms the effectiveness and generalizability of DuDoTrans with fewer involved parameters. Extensive experiments also demonstrate its robustness with different noise-level scenarios for sparse-view CT reconstruction. The code and models are publicly available at https://github.com/DuDoTrans/CODE

Accurate polyp segmentation is of great importance for colorectal cancer diagnosis. However, even with a powerful deep neural network, there still exists three big challenges that impede the development of polyp segmentation. (i) Samples collected under different conditions show inconsistent colors, causing the feature distribution gap and overfitting issue; (ii) Due to repeated feature downsampling, small polyps are easily degraded; (iii) Foreground and background pixels are imbalanced, leading to a biased training. To address the above issues, we propose the Shallow Attention Network (SANet) for polyp segmentation. Specifically, to eliminate the effects of color, we design the color exchange operation to decouple the image contents and colors, and force the model to focus more on the target shape and structure. Furthermore, to enhance the segmentation quality of small polyps, we propose the shallow attention module to filter out the background noise of shallow features. Thanks to the high resolution of shallow features, small polyps can be preserved correctly. In addition, to ease the severe pixel imbalance for small polyps, we propose a probability correction strategy (PCS) during the inference phase. Note that even though PCS is not involved in the training phase, it can still work well on a biased model and consistently improve the segmentation performance. Quantitative and qualitative experimental results on five challenging benchmarks confirm that our proposed SANet outperforms previous state-of-the-art methods by a large margin and achieves a speed about 72FPS., Accepted by MICCAI2021

Spine-related diseases have high morbidity and cause a huge burden of social cost. Spine imaging is an essential tool for noninvasively visualizing and assessing spinal pathology. Segmenting vertebrae in computed tomography (CT) images is the basis of quantitative medical image analysis for clinical diagnosis and surgery planning of spine diseases. Current publicly available annotated datasets on spinal vertebrae are small in size. Due to the lack of a large-scale annotated spine image dataset, the mainstream deep learning-based segmentation methods, which are data-driven, are heavily restricted. In this paper, we introduce a large-scale spine CT dataset, called CTSpine1K, curated from multiple sources for vertebra segmentation, which contains 1,005 CT volumes with over 11,100 labeled vertebrae belonging to different spinal conditions. Based on this dataset, we conduct several spinal vertebrae segmentation experiments to set the first benchmark. We believe that this large-scale dataset will facilitate further research in many spine-related image analysis tasks, including but not limited to vertebrae segmentation, labeling, 3D spine reconstruction from biplanar radiographs, image super-resolution, and enhancement.

Segmentation of pathological images is essential for accurate disease diagnosis. The quality of manual labels plays a critical role in segmentation accuracy; yet, in practice, the labels between pathologists could be inconsistent, thus confusing the training process. In this work, we propose a novel label re-weighting framework to account for the reliability of different experts' labels on each pixel according to its surrounding features. We further devise a new attention heatmap, which takes roughness as prior knowledge to guide the model to focus on important regions. Our approach is evaluated on the public Gleason 2019 datasets. The results show that our approach effectively improves the model's robustness against noisy labels and outperforms state-of-the-art approaches.

Deep neural networks have been extensively studied for undersampled MRI reconstruction. While achieving state-of-the-art performance, they are trained and deployed specifically for one anatomy with limited generalization ability to another anatomy. Rather than building multiple models, a universal model that reconstructs images across different anatomies is highly desirable for efficient deployment and better generalization. Simply mixing images from multiple anatomies for training a single network does not lead to an ideal universal model due to the statistical shift among datasets of various anatomies, the need to retrain from scratch on all datasets with the addition of a new dataset, and the difficulty in dealing with imbalanced sampling when the new dataset is further of a smaller size. In this paper, for the first time, we propose a framework to learn a universal deep neural network for undersampled MRI reconstruction. Specifically, anatomy-specific instance normalization is proposed to compensate for statistical shift and allow easy generalization to new datasets. Moreover, the universal model is trained by distilling knowledge from available independent models to further exploit representations across anatomies. Experimental results show the proposed universal model can reconstruct both brain and knee images with high image quality. Also, it is easy to adapt the trained model to new datasets of smaller size, i.e., abdomen, cardiac and prostate, with little effort and superior performance.

Detecting anatomical landmarks in medical images plays an essential role in understanding the anatomy and planning automated processing. In recent years, a variety of deep neural network methods have been developed to detect landmarks automatically. However, all of those methods are unary in the sense that a highly specialized network is trained for a single task say associated with a particular anatomical region. In this work, for the first time, we investigate the idea of "You Only Learn Once (YOLO)" and develop a universal anatomical landmark detection model to realize multiple landmark detection tasks with end-to-end training based on mixed datasets. The model consists of a local network and a global network: The local network is built upon the idea of universal U-Net to learn multi-domain local features and the global network is a parallelly-duplicated sequential of dilated convolutions that extract global features to further disambiguate the landmark locations. It is worth mentioning that the new model design requires much fewer parameters than models with standard convolutions to train. We evaluate our YOLO model on three X-ray datasets of 1,588 images on the head, hand, and chest, collectively contributing 62 landmarks. The experimental results show that our proposed universal model behaves largely better than any previous models trained on multiple datasets. It even beats the performance of the model that is trained separately for every single dataset. The code is available at https://github.com/MIRACLE-Center/YOLO_Universal_Anatomical_Landmark_Detection, Accepted for MICCAI 2021, 11 pages, 2 figures, 2 tables

Recently, both supervised and unsupervised deep learning methods have been widely applied on the CT metal artifact reduction (MAR) task. Supervised methods such as Dual Domain Network (Du-DoNet) work well on simulation data; however, their performance on clinical data is limited due to domain gap. Unsupervised methods are more generalized, but do not eliminate artifacts completely through the sole processing on the image domain. To combine the advantages of both MAR methods, we propose an unpaired dual-domain network (U-DuDoNet) trained using unpaired data. Unlike the artifact disentanglement network (ADN) that utilizes multiple encoders and decoders for disentangling content from artifact, our U-DuDoNet directly models the artifact generation process through additions in both sinogram and image domains, which is theoretically justified by an additive property associated with metal artifact. Our design includes a self-learned sinogram prior net, which provides guidance for restoring the information in the sinogram domain, and cyclic constraints for artifact reduction and addition on unpaired data. Extensive experiments on simulation data and clinical images demonstrate that our novel framework outperforms the state-of-the-art unpaired approaches., 11 pages, 4 figures

The success of deep learning methods relies on the availability of a large number of datasets with annotations; however, curating such datasets is burdensome, especially for medical images. To relieve such a burden for a landmark detection task, we explore the feasibility of using only a single annotated image and propose a novel framework named Cascade Comparing to Detect (CC2D) for one-shot landmark detection. CC2D consists of two stages: 1) Self-supervised learning (CC2D-SSL) and 2) Training with pseudo-labels (CC2D-TPL). CC2D-SSL captures the consistent anatomical information in a coarse-to-fine fashion by comparing the cascade feature representations and generates predictions on the training set. CC2D-TPL further improves the performance by training a new landmark detector with those predictions. The effectiveness of CC2D is evaluated on a widely-used public dataset of cephalometric landmark detection, which achieves a competitive detection accuracy of 81.01\% within 4.0mm, comparable to the state-of-the-art fully-supervised methods using a lot more than one training image.

Pseudo-normality synthesis, which computationally generates a pseudo-normal image from an abnormal one (e.g., with lesions), is critical in many perspectives, from lesion detection, data augmentation to clinical surgery suggestion. However, it is challenging to generate high-quality pseudo-normal images in the absence of the lesion information. Thus, expensive lesion segmentation data have been introduced to provide lesion information for the generative models and improve the quality of the synthetic images. In this paper, we aim to alleviate the need of a large amount of lesion segmentation data when generating pseudo-normal images. We propose a Semi-supervised Medical Image generative LEarning network (SMILE) which not only utilizes limited medical images with segmentation masks, but also leverages massive medical images without segmentation masks to generate realistic pseudo-normal images. Extensive experiments show that our model outperforms the best state-of-the-art model by up to 6% for data augmentation task and 3% in generating high-quality images. Moreover, the proposed semi-supervised learning achieves comparable medical image synthesis quality with supervised learning model, using only 50 of segmentation data.

Universal Lesion Detection (ULD) in computed tomography plays an essential role in computer-aided diagnosis. Promising ULD results have been reported by coarse-to-fine two-stage detection approaches, but such two-stage ULD methods still suffer from issues like imbalance of positive v.s. negative anchors during object proposal and insufficient supervision problem during localization regression and classification of the region of interest (RoI) proposals. While leveraging pseudo segmentation masks such as bounding map (BM) can reduce the above issues to some degree, it is still an open problem to effectively handle the diverse lesion shapes and sizes in ULD. In this paper, we propose a BM-based conditional training for two-stage ULD, which can (i) reduce positive vs. negative anchor imbalance via BM-based conditioning (BMC) mechanism for anchor sampling instead of traditional IoU-based rule; and (ii) adaptively compute size-adaptive BM (ABM) from lesion bounding box, which is used for improving lesion localization accuracy via ABMsupervised segmentation. Experiments with four state-of-the-art methods show that the proposed approach can bring an almost free detection accuracy improvement without requiring expensive lesion mask annotations.

Deep reinforcement learning (DRL) augments the reinforcement learning framework, which learns a sequence of actions that maximizes the expected reward, with the representative power of deep neural networks. Recent works have demonstrated the great potential of DRL in medicine and healthcare. This paper presents a literature review of DRL in medical imaging. We start with a comprehensive tutorial of DRL, including the latest model-free and model-based algorithms. We then cover existing DRL applications for medical imaging, which are roughly divided into three main categories: (I) parametric medical image analysis tasks including landmark detection, object/lesion detection, registration, and view plane localization; (ii) solving optimization tasks including hyperparameter tuning, selecting augmentation strategies, and neural architecture search; and (iii) miscellaneous applications including surgical gesture segmentation, personalized mobile health intervention, and computational model personalization. The paper concludes with discussions of future perspectives., 39 pages, 20 figures