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Recently, the Segment Anything Model (SAM) has demonstrated promising segmentation capabilities in a variety of downstream segmentation tasks. However in the context of universal medical image segmentation there exists a notable performance discrepancy when directly applying SAM due to the domain gap between natural and 2D/3D medical data. In this work, we propose a dual-branch adapted SAM framework, named DB-SAM, that strives to effectively bridge this domain gap. Our dual-branch adapted SAM contains two branches in parallel: a ViT branch and a convolution branch. The ViT branch incorporates a learnable channel attention block after each frozen attention block, which captures domain-specific local features. On the other hand, the convolution branch employs a light-weight convolutional block to extract domain-specific shallow features from the input medical image. To perform cross-branch feature fusion, we design a bilateral cross-attention block and a ViT convolution fusion block, which dynamically combine diverse information of two branches for mask decoder. Extensive experiments on large-scale medical image dataset with various 3D and 2D medical segmentation tasks reveal the merits of our proposed contributions. On 21 3D medical image segmentation tasks, our proposed DB-SAM achieves an absolute gain of 8.8%, compared to a recent medical SAM adapter in the literature. The code and model are available at https://github.com/AlfredQin/DB-SAM., Comment: Accepted by MICCAI 2024 Oral

Ultra-Wide-Field Scanning Laser Ophthalmoscopy (UWF-SLO) images capture high-resolution views of the retina with typically 200 spanning degrees. Accurate segmentation of vessels in UWF-SLO images is essential for detecting and diagnosing fundus disease. Recent studies have revealed that the selective State Space Model (SSM) in Mamba performs well in modeling long-range dependencies, which is crucial for capturing the continuity of elongated vessel structures. Inspired by this, we propose the first Serpentine Mamba (Serp-Mamba) network to address this challenging task. Specifically, we recognize the intricate, varied, and delicate nature of the tubular structure of vessels. Furthermore, the high-resolution of UWF-SLO images exacerbates the imbalance between the vessel and background categories. Based on the above observations, we first devise a Serpentine Interwoven Adaptive (SIA) scan mechanism, which scans UWF-SLO images along curved vessel structures in a snake-like crawling manner. This approach, consistent with vascular texture transformations, ensures the effective and continuous capture of curved vascular structure features. Second, we propose an Ambiguity-Driven Dual Recalibration (ADDR) module to address the category imbalance problem intensified by high-resolution images. Our ADDR module delineates pixels by two learnable thresholds and refines ambiguous pixels through a dual-driven strategy, thereby accurately distinguishing vessels and background regions. Experiment results on three datasets demonstrate the superior performance of our Serp-Mamba on high-resolution vessel segmentation. We also conduct a series of ablation studies to verify the impact of our designs. Our code shall be released upon publication of this work.

The Medical Segment Anything Model (MedSAM) has shown remarkable performance in medical image segmentation, drawing significant attention in the field. However, its sensitivity to varying prompt types and locations poses challenges. This paper addresses these challenges by focusing on the development of reliable prompts that enhance MedSAM's accuracy. We introduce MedSAM-U, an uncertainty-guided framework designed to automatically refine multi-prompt inputs for more reliable and precise medical image segmentation. Specifically, we first train a Multi-Prompt Adapter integrated with MedSAM, creating MPA-MedSAM, to adapt to diverse multi-prompt inputs. We then employ uncertainty-guided multi-prompt to effectively estimate the uncertainties associated with the prompts and their initial segmentation results. In particular, a novel uncertainty-guided prompts adaptation technique is then applied automatically to derive reliable prompts and their corresponding segmentation outcomes. We validate MedSAM-U using datasets from multiple modalities to train a universal image segmentation model. Compared to MedSAM, experimental results on five distinct modal datasets demonstrate that the proposed MedSAM-U achieves an average performance improvement of 1.7\% to 20.5\% across uncertainty-guided prompts., Comment: 10 pages, 4 figures

Model intellectual property (IP) protection has attracted growing attention as science and technology advancements stem from human intellectual labor and computational expenses. Ensuring IP safety for trainers and owners is of utmost importance, particularly in domains where ownership verification and applicability authorization are required. A notable approach to safeguarding model IP involves proactively preventing the use of well-trained models of authorized domains from unauthorized domains. In this paper, we introduce a novel Compact Un-transferable Pyramid Isolation Domain (CUPI-Domain) which serves as a barrier against illegal transfers from authorized to unauthorized domains. Drawing inspiration from human transitive inference and learning abilities, the CUPI-Domain is designed to obstruct cross-domain transfers by emphasizing the distinctive style features of the authorized domain. This emphasis leads to failure in recognizing irrelevant private style features on unauthorized domains. To this end, we propose novel CUPI-Domain generators, which select features from both authorized and CUPI-Domain as anchors. Then, we fuse the style features and semantic features of these anchors to generate labeled and style-rich CUPI-Domain. Additionally, we design external Domain-Information Memory Banks (DIMB) for storing and updating labeled pyramid features to obtain stable domain class features and domain class-wise style features. Based on the proposed whole method, the novel style and discriminative loss functions are designed to effectively enhance the distinction in style and discriminative features between authorized and unauthorized domains, respectively. Moreover, we provide two solutions for utilizing CUPI-Domain based on whether the unauthorized domain is known: target-specified CUPI-Domain and target-free CUPI-Domain.

Early detection of dementia, such as Alzheimer's disease (AD) or mild cognitive impairment (MCI), is essential to enable timely intervention and potential treatment. Accurate detection of AD/MCI is challenging due to the high complexity, cost, and often invasive nature of current diagnostic techniques, which limit their suitability for large-scale population screening. Given the shared embryological origins and physiological characteristics of the retina and brain, retinal imaging is emerging as a potentially rapid and cost-effective alternative for the identification of individuals with or at high risk of AD. In this paper, we present a novel PolarNet+ that uses retinal optical coherence tomography angiography (OCTA) to discriminate early-onset AD (EOAD) and MCI subjects from controls. Our method first maps OCTA images from Cartesian coordinates to polar coordinates, allowing approximate sub-region calculation to implement the clinician-friendly early treatment of diabetic retinopathy study (ETDRS) grid analysis. We then introduce a multi-view module to serialize and analyze the images along three dimensions for comprehensive, clinically useful information extraction. Finally, we abstract the sequence embedding into a graph, transforming the detection task into a general graph classification problem. A regional relationship module is applied after the multi-view module to excavate the relationship between the sub-regions. Such regional relationship analyses validate known eye-brain links and reveal new discriminative patterns.

Diabetic retinopathy (DR) is a complication of diabetes and usually takes decades to reach sight-threatening levels. Accurate and robust detection of DR severity is critical for the timely management and treatment of diabetes. However, most current DR grading methods suffer from insufficient robustness to data variability (\textit{e.g.} colour fundus images), posing a significant difficulty for accurate and robust grading. In this work, we propose a novel DR grading framework CLIP-DR based on three observations: 1) Recent pre-trained visual language models, such as CLIP, showcase a notable capacity for generalisation across various downstream tasks, serving as effective baseline models. 2) The grading of image-text pairs for DR often adheres to a discernible natural sequence, yet most existing DR grading methods have primarily overlooked this aspect. 3) A long-tailed distribution among DR severity levels complicates the grading process. This work proposes a novel ranking-aware prompting strategy to help the CLIP model exploit the ordinal information. Specifically, we sequentially design learnable prompts between neighbouring text-image pairs in two different ranking directions. Additionally, we introduce a Similarity Matrix Smooth module into the structure of CLIP to balance the class distribution. Finally, we perform extensive comparisons with several state-of-the-art methods on the GDRBench benchmark, demonstrating our CLIP-DR's robustness and superior performance. The implementation code is available \footnote{\url{https://github.com/Qinkaiyu/CLIP-DR}, Comment: Accepted by MICCAI 2024

Large Vision-Language Models (LVLMs) have shown significant potential in assisting medical diagnosis by leveraging extensive biomedical datasets. However, the advancement of medical image understanding and reasoning critically depends on building high-quality visual instruction data, which is costly and labor-intensive to obtain, particularly in the medical domain. To mitigate this data-starving issue, we introduce Self-Training Large Language and Vision Assistant for Medicine (STLLaVA-Med). The proposed method is designed to train a policy model (an LVLM) capable of auto-generating medical visual instruction data to improve data efficiency, guided through Direct Preference Optimization (DPO). Specifically, a more powerful and larger LVLM (e.g., GPT-4o) is involved as a biomedical expert to oversee the DPO fine-tuning process on the auto-generated data, encouraging the policy model to align efficiently with human preferences. We validate the efficacy and data efficiency of STLLaVA-Med across three major medical Visual Question Answering (VQA) benchmarks, demonstrating competitive zero-shot performance with the utilization of only 9% of the medical data., Comment: EMNLP 2024 Main conference

With the rapid development of depth sensor, more and more RGB-D videos could be obtained. Identifying the foreground in RGB-D videos is a fundamental and important task. However, the existing salient object detection (SOD) works only focus on either static RGB-D images or RGB videos, ignoring the collaborating of RGB-D and video information. In this paper, we first collect a new annotated RGB-D video SOD (ViDSOD-100) dataset, which contains 100 videos within a total of 9,362 frames, acquired from diverse natural scenes. All the frames in each video are manually annotated to a high-quality saliency annotation. Moreover, we propose a new baseline model, named attentive triple-fusion network (ATF-Net), for RGB-D video salient object detection. Our method aggregates the appearance information from an input RGB image, spatio-temporal information from an estimated motion map, and the geometry information from the depth map by devising three modality-specific branches and a multi-modality integration branch. The modality-specific branches extract the representation of different inputs, while the multi-modality integration branch combines the multi-level modality-specific features by introducing the encoder feature aggregation (MEA) modules and decoder feature aggregation (MDA) modules. The experimental findings conducted on both our newly introduced ViDSOD-100 dataset and the well-established DAVSOD dataset highlight the superior performance of the proposed ATF-Net. This performance enhancement is demonstrated both quantitatively and qualitatively, surpassing the capabilities of current state-of-the-art techniques across various domains, including RGB-D saliency detection, video saliency detection, and video object segmentation. Our data and our code are available at github.com/jhl-Det/RGBD_Video_SOD.

Inability to express the confidence level and detect unseen classes has limited the clinical implementation of artificial intelligence in the real-world. We developed a foundation model with uncertainty estimation (FMUE) to detect 11 retinal conditions on optical coherence tomography (OCT). In the internal test set, FMUE achieved a higher F1 score of 96.76% than two state-of-the-art algorithms, RETFound and UIOS, and got further improvement with thresholding strategy to 98.44%. In the external test sets obtained from other OCT devices, FMUE achieved an accuracy of 88.75% and 92.73% before and after thresholding. Our model is superior to two ophthalmologists with a higher F1 score (95.17% vs. 61.93% &71.72%). Besides, our model correctly predicts high uncertainty scores for samples with ambiguous features, of non-target-category diseases, or with low-quality to prompt manual checks and prevent misdiagnosis. FMUE provides a trustworthy method for automatic retinal anomalies detection in the real-world clinical open set environment., Comment: All codes are available at https://github.com/yuanyuanpeng0129/FMUE

Previous foundation models for retinal images were pre-trained with limited disease categories and knowledge base. Here we introduce RetiZero, a vision-language foundation model that leverages knowledge from over 400 fundus diseases. To RetiZero's pre-training, we compiled 341,896 fundus images paired with text descriptions, sourced from public datasets, ophthalmic literature, and online resources, encompassing a diverse range of diseases across multiple ethnicities and countries. RetiZero exhibits superior performance in several downstream tasks, including zero-shot disease recognition, image-to-image retrieval, and internal- and cross-domain disease identification. In zero-shot scenarios, RetiZero achieves Top5 accuracy scores of 0.8430 for 15 fundus diseases and 0.7561 for 52 fundus diseases. For image retrieval, it achieves Top5 scores of 0.9500 and 0.8860 for the same disease sets, respectively. Clinical evaluations show that RetiZero's Top3 zero-shot performance surpasses the average of 19 ophthalmologists from Singapore, China and the United States. Furthermore, RetiZero significantly enhances clinicians' accuracy in diagnosing fundus disease. These findings underscore the value of integrating the RetiZero foundation model into clinical settings, where a variety of fundus diseases are encountered.

Federated Learning (FL) has evolved as a powerful tool for collaborative model training across multiple entities, ensuring data privacy in sensitive sectors such as healthcare and finance. However, the introduction of the Right to Be Forgotten (RTBF) poses new challenges, necessitating federated unlearning to delete data without full model retraining. Traditional FL unlearning methods, not originally designed with domain specificity in mind, inadequately address the complexities of multi-domain scenarios, often affecting the accuracy of models in non-targeted domains or leading to uniform forgetting across all domains. Our work presents the first comprehensive empirical study on Federated Domain Unlearning, analyzing the characteristics and challenges of current techniques in multi-domain contexts. We uncover that these methods falter, particularly because they neglect the nuanced influences of domain-specific data, which can lead to significant performance degradation and inaccurate model behavior. Our findings reveal that unlearning disproportionately affects the model's deeper layers, erasing critical representational subspaces acquired during earlier training phases. In response, we propose novel evaluation methodologies tailored for Federated Domain Unlearning, aiming to accurately assess and verify domain-specific data erasure without compromising the model's overall integrity and performance. This investigation not only highlights the urgent need for domain-centric unlearning strategies in FL but also sets a new precedent for evaluating and implementing these techniques effectively., Comment: 16 pages, 12 figures

Deep learning models are widely recognized for their effectiveness in identifying medical image findings in disease classification. However, their limitations become apparent in the dynamic and ever-changing clinical environment, characterized by the continuous influx of newly annotated medical data from diverse sources. In this context, the need for continual learning becomes particularly paramount, not only to adapt to evolving medical scenarios but also to ensure the privacy of healthcare data. In our research, we emphasize the utilization of a network comprising expert classifiers, where a new expert classifier is added each time a new task is introduced. We present CTP, a task-id predictor that utilizes confidence scores, leveraging the probability distribution (logits) of the classifier to accurately determine the task-id at inference time. Logits are adjusted to ensure that classifiers yield a high-entropy distribution for data associated with tasks other than their own. By defining a noise region in the distribution and computing confidence scores, CTP achieves superior performance when compared to other relevant continual learning methods. Additionally, the performance of CTP can be further improved by providing it with a continuum of data at the time of inference.

Multi-modal ophthalmic image classification plays a key role in diagnosing eye diseases, as it integrates information from different sources to complement their respective performances. However, recent improvements have mainly focused on accuracy, often neglecting the importance of confidence and robustness in predictions for diverse modalities. In this study, we propose a novel multi-modality evidential fusion pipeline for eye disease screening. It provides a measure of confidence for each modality and elegantly integrates the multi-modality information using a multi-distribution fusion perspective. Specifically, our method first utilizes normal inverse gamma prior distributions over pre-trained models to learn both aleatoric and epistemic uncertainty for uni-modality. Then, the normal inverse gamma distribution is analyzed as the Student's t distribution. Furthermore, within a confidence-aware fusion framework, we propose a mixture of Student's t distributions to effectively integrate different modalities, imparting the model with heavy-tailed properties and enhancing its robustness and reliability. More importantly, the confidence-aware multi-modality ranking regularization term induces the model to more reasonably rank the noisy single-modal and fused-modal confidence, leading to improved reliability and accuracy. Experimental results on both public and internal datasets demonstrate that our model excels in robustness, particularly in challenging scenarios involving Gaussian noise and modality missing conditions. Moreover, our model exhibits strong generalization capabilities to out-of-distribution data, underscoring its potential as a promising solution for multimodal eye disease screening., Comment: 27 pages, 7 figures, 9 tables

Limited labeled data hinder the application of deep learning in medical domain. In clinical practice, there are sufficient unlabeled data that are not effectively used, and semi-supervised learning (SSL) is a promising way for leveraging these unlabeled data. However, existing SSL methods ignore frequency domain and region-level information and it is important for lesion regions located at low frequencies and with significant scale changes. In this paper, we introduce two consistency regularization strategies for semi-supervised medical image segmentation, including frequency domain consistency (FDC) to assist the feature learning in frequency domain and multi-granularity region similarity consistency (MRSC) to perform multi-scale region-level local context information feature learning. With the help of the proposed FDC and MRSC, we can leverage the powerful feature representation capability of them in an effective and efficient way. We perform comprehensive experiments on two datasets, and the results show that our method achieves large performance gains and exceeds other state-of-the-art methods., Comment: MICCAI 2024 Early Accept

Optical coherence tomography (OCT) image analysis plays an important role in the field of ophthalmology. Current successful analysis models rely on available large datasets, which can be challenging to be obtained for certain tasks. The use of deep generative models to create realistic data emerges as a promising approach. However, due to limitations in hardware resources, it is still difficulty to synthesize high-resolution OCT volumes. In this paper, we introduce a cascaded amortized latent diffusion model (CA-LDM) that can synthesis high-resolution OCT volumes in a memory-efficient way. First, we propose non-holistic autoencoders to efficiently build a bidirectional mapping between high-resolution volume space and low-resolution latent space. In tandem with autoencoders, we propose cascaded diffusion processes to synthesize high-resolution OCT volumes with a global-to-local refinement process, amortizing the memory and computational demands. Experiments on a public high-resolution OCT dataset show that our synthetic data have realistic high-resolution and global features, surpassing the capabilities of existing methods. Moreover, performance gains on two down-stream fine-grained segmentation tasks demonstrate the benefit of the proposed method in training deep learning models for medical imaging tasks. The code is public available at: https://github.com/nicetomeetu21/CA-LDM., Comment: Provisionally accepted for medical image computing and computer-assisted intervention (MICCAI) 2024

Source-Free Unsupervised Domain Adaptation (SFUDA) has recently become a focus in the medical image domain adaptation, as it only utilizes the source model and does not require annotated target data. However, current SFUDA approaches cannot tackle the complex segmentation task across different MRI sequences, such as the vestibular schwannoma segmentation. To address this problem, we proposed Reliable Source Approximation (RSA), which can generate source-like and structure-preserved images from the target domain for updating model parameters and adapting domain shifts. Specifically, RSA deploys a conditional diffusion model to generate multiple source-like images under the guidance of varying edges of one target image. An uncertainty estimation module is then introduced to predict and refine reliable pseudo labels of generated images, and the prediction consistency is developed to select the most reliable generations. Subsequently, all reliable generated images and their pseudo labels are utilized to update the model. Our RSA is validated on vestibular schwannoma segmentation across multi-modality MRI. The experimental results demonstrate that RSA consistently improves domain adaptation performance over other state-of-the-art SFUDA methods. Code is available at https://github.com/zenghy96/Reliable-Source-Approximation., Comment: Early accepted by MICCAI 2024

Recent advancements in pre-trained large foundation models (LFM) have yielded significant breakthroughs across various domains, including natural language processing and computer vision. These models have been particularly impactful in the domain of medical diagnostic tasks. With abundant unlabeled data, an LFM has been developed for fundus images using the Vision Transformer (VIT) and a self-supervised learning framework. This LFM has shown promising performance in fundus disease diagnosis across multiple datasets. On the other hand, deep learning models have long been challenged by dataset quality issues, such as image quality and dataset bias. To investigate the influence of data quality on LFM, we conducted explorations in two fundus diagnosis tasks using datasets of varying quality. Specifically, we explored the following questions: Is LFM more robust to image quality? Is LFM affected by dataset bias? Can fine-tuning techniques alleviate these effects? Our investigation found that LFM exhibits greater resilience to dataset quality issues, including image quality and dataset bias, compared to typical convolutional networks. Furthermore, we discovered that overall fine-tuning is an effective adapter for LFM to mitigate the impact of dataset quality issues., Comment: 10 pages, 6 figures

Current fundus image analysis models are predominantly built for specific tasks relying on individual datasets. The learning process is usually based on data-driven paradigm without prior knowledge, resulting in poor transferability and generalizability. To address this issue, we propose MM-Retinal, a multi-modal dataset that encompasses high-quality image-text pairs collected from professional fundus diagram books. Moreover, enabled by MM-Retinal, we present a novel Knowledge-enhanced foundational pretraining model which incorporates Fundus Image-Text expertise, called KeepFIT. It is designed with image similarity-guided text revision and mixed training strategy to infuse expert knowledge. Our proposed fundus foundation model achieves state-of-the-art performance across six unseen downstream tasks and holds excellent generalization ability in zero-shot and few-shot scenarios. MM-Retinal and KeepFIT are available at https://github.com/lxirich/MM-Retinal., Comment: Early Accepted by The International Conference on Medical Image Computing and Computer Assisted Intervention(MICCAI)2024

Automated radiology reporting holds immense clinical potential in alleviating the burdensome workload of radiologists and mitigating diagnostic bias. Recently, retrieval-based report generation methods have garnered increasing attention due to their inherent advantages in terms of the quality and consistency of generated reports. However, due to the long-tail distribution of the training data, these models tend to learn frequently occurring sentences and topics, overlooking the rare topics. Regrettably, in many cases, the descriptions of rare topics often indicate critical findings that should be mentioned in the report. To address this problem, we introduce a Topicwise Separable Sentence Retrieval (Teaser) for medical report generation. To ensure comprehensive learning of both common and rare topics, we categorize queries into common and rare types to learn differentiated topics, and then propose Topic Contrastive Loss to effectively align topics and queries in the latent space. Moreover, we integrate an Abstractor module following the extraction of visual features, which aids the topic decoder in gaining a deeper understanding of the visual observational intent. Experiments on the MIMIC-CXR and IU X-ray datasets demonstrate that Teaser surpasses state-of-the-art models, while also validating its capability to effectively represent rare topics and establish more dependable correspondences between queries and topics.

Deep learning models often encounter challenges in making accurate inferences when there are domain shifts between the source and target data. This issue is particularly pronounced in clinical settings due to the scarcity of annotated data resulting from the professional and private nature of medical data. Despite the existence of decent solutions, many of them are hindered in clinical settings due to limitations in data collection and computational complexity. To tackle domain shifts in data-scarce medical scenarios, we propose a Random frequency filtering enabled Single-source Domain Generalization algorithm (RaffeSDG), which promises robust out-of-domain inference with segmentation models trained on a single-source domain. A filter-based data augmentation strategy is first proposed to promote domain variability within a single-source domain by introducing variations in frequency space and blending homologous samples. Then Gaussian filter-based structural saliency is also leveraged to learn robust representations across augmented samples, further facilitating the training of generalizable segmentation models. To validate the effectiveness of RaffeSDG, we conducted extensive experiments involving out-of-domain inference on segmentation tasks for three human tissues imaged by four diverse modalities. Through thorough investigations and comparisons, compelling evidence was observed in these experiments, demonstrating the potential and generalizability of RaffeSDG. The code is available at https://github.com/liamheng/Non-IID_Medical_Image_Segmentation.

The performance of Federated Learning (FL) hinges on the effectiveness of utilizing knowledge from distributed datasets. Traditional FL methods adopt an aggregate-then-adapt framework, where clients update local models based on a global model aggregated by the server from the previous training round. This process can cause client drift, especially with significant cross-client data heterogeneity, impacting model performance and convergence of the FL algorithm. To address these challenges, we introduce FedAF, a novel aggregation-free FL algorithm. In this framework, clients collaboratively learn condensed data by leveraging peer knowledge, the server subsequently trains the global model using the condensed data and soft labels received from the clients. FedAF inherently avoids the issue of client drift, enhances the quality of condensed data amid notable data heterogeneity, and improves the global model performance. Extensive numerical studies on several popular benchmark datasets show FedAF surpasses various state-of-the-art FL algorithms in handling label-skew and feature-skew data heterogeneity, leading to superior global model accuracy and faster convergence., Comment: Accepted to CVPR 2024

Multimodal fusion focuses on integrating information from multiple modalities with the goal of more accurate prediction, which has achieved remarkable progress in a wide range of scenarios, including autonomous driving and medical diagnosis. However, the reliability of multimodal fusion remains largely unexplored especially under low-quality data settings. This paper surveys the common challenges and recent advances of multimodal fusion in the wild and presents them in a comprehensive taxonomy. From a data-centric view, we identify four main challenges that are faced by multimodal fusion on low-quality data, namely (1) noisy multimodal data that are contaminated with heterogeneous noises, (2) incomplete multimodal data that some modalities are missing, (3) imbalanced multimodal data that the qualities or properties of different modalities are significantly different and (4) quality-varying multimodal data that the quality of each modality dynamically changes with respect to different samples. This new taxonomy will enable researchers to understand the state of the field and identify several potential directions. We also provide discussion for the open problems in this field together with interesting future research directions., Comment: Feel free to comment on our manuscript: qingyangzhang@tju$.$edu$.$cn

Medical Report Grounding is pivotal in identifying the most relevant regions in medical images based on a given phrase query, a critical aspect in medical image analysis and radiological diagnosis. However, prevailing visual grounding approaches necessitate the manual extraction of key phrases from medical reports, imposing substantial burdens on both system efficiency and physicians. In this paper, we introduce a novel framework, Medical Report Grounding (MedRG), an end-to-end solution for utilizing a multi-modal Large Language Model to predict key phrase by incorporating a unique token, BOX, into the vocabulary to serve as an embedding for unlocking detection capabilities. Subsequently, the vision encoder-decoder jointly decodes the hidden embedding and the input medical image, generating the corresponding grounding box. The experimental results validate the effectiveness of MedRG, surpassing the performance of the existing state-of-the-art medical phrase grounding methods. This study represents a pioneering exploration of the medical report grounding task, marking the first-ever endeavor in this domain., Comment: 12 pages, 4 figures

Instrument-tissue interaction detection task, which helps understand surgical activities, is vital for constructing computer-assisted surgery systems but with many challenges. Firstly, most models represent instrument-tissue interaction in a coarse-grained way which only focuses on classification and lacks the ability to automatically detect instruments and tissues. Secondly, existing works do not fully consider relations between intra- and inter-frame of instruments and tissues. In the paper, we propose to represent instrument-tissue interaction as quintuple and present an Instrument-Tissue Interaction Detection Network (ITIDNet) to detect the quintuple for surgery videos understanding. Specifically, we propose a Snippet Consecutive Feature (SCF) Layer to enhance features by modeling relationships of proposals in the current frame using global context information in the video snippet. We also propose a Spatial Corresponding Attention (SCA) Layer to incorporate features of proposals between adjacent frames through spatial encoding. To reason relationships between instruments and tissues, a Temporal Graph (TG) Layer is proposed with intra-frame connections to exploit relationships between instruments and tissues in the same frame and inter-frame connections to model the temporal information for the same instance. For evaluation, we build a cataract surgery video (PhacoQ) dataset and a cholecystectomy surgery video (CholecQ) dataset. Experimental results demonstrate the promising performance of our model, which outperforms other state-of-the-art models on both datasets.

Imposing key anatomical features, such as the number of organs, their shapes and relative positions, is crucial for building a robust multi-organ segmentation model. Current attempts to incorporate anatomical features include broadening the effective receptive field (ERF) size with data-intensive modules, or introducing anatomical constraints that scales poorly to multi-organ segmentation. We introduce a novel architecture called the Anatomy-Informed Cascaded Segmentation Network (AIC-Net). AIC-Net incorporates a learnable input termed "Anatomical Prior", which can be adapted to patient-specific anatomy using a differentiable spatial deformation. The deformed prior later guides decoder layers towards more anatomy-informed predictions. We repeat this process at a local patch level to enhance the representation of intricate objects, resulting in a cascaded network structure. AIC-Net is a general method that enhances any existing segmentation models to be more anatomy-aware. We have validated the performance of AIC-Net, with various backbones, on two multi-organ segmentation tasks: abdominal organs and vertebrae. For each respective task, our benchmarks demonstrate improved dice score and Hausdorff distance.

Handheld ultrasound devices face usage limitations due to user inexperience and cannot benefit from supervised deep learning without extensive expert annotations. Moreover, the models trained on standard ultrasound device data are constrained by training data distribution and perform poorly when directly applied to handheld device data. In this study, we propose the Training-free Image Style Alignment (TISA) framework to align the style of handheld device data to those of standard devices. The proposed TISA can directly infer handheld device images without extra training and is suited for clinical applications. We show that TISA performs better and more stably in medical detection and segmentation tasks for handheld device data. We further validate TISA as the clinical model for automatic measurements of spinal curvature and carotid intima-media thickness. The automatic measurements agree well with manual measurements made by human experts and the measurement errors remain within clinically acceptable ranges. We demonstrate the potential for TISA to facilitate automatic diagnosis on handheld ultrasound devices and expedite their eventual widespread use.

Medical video segmentation gains increasing attention in clinical practice due to the redundant dynamic references in video frames. However, traditional convolutional neural networks have a limited receptive field and transformer-based networks are mediocre in constructing long-term dependency from the perspective of computational complexity. This bottleneck poses a significant challenge when processing longer sequences in medical video analysis tasks using available devices with limited memory. Recently, state space models (SSMs), famous by Mamba, have exhibited impressive achievements in efficient long sequence modeling, which develops deep neural networks by expanding the receptive field on many vision tasks significantly. Unfortunately, vanilla SSMs failed to simultaneously capture causal temporal cues and preserve non-casual spatial information. To this end, this paper presents a Video Vision Mamba-based framework, dubbed as Vivim, for medical video segmentation tasks. Our Vivim can effectively compress the long-term spatiotemporal representation into sequences at varying scales with our designed Temporal Mamba Block. We also introduce an improved boundary-aware affine constraint across frames to enhance the discriminative ability of Vivim on ambiguous lesions. Extensive experiments on thyroid segmentation, breast lesion segmentation in ultrasound videos, and polyp segmentation in colonoscopy videos demonstrate the effectiveness and efficiency of our Vivim, superior to existing methods. The code is available at: https://github.com/scott-yjyang/Vivim. The dataset will be released once accepted.

Medical image segmentation plays a crucial role in computer-aided diagnosis. However, existing methods heavily rely on fully supervised training, which requires a large amount of labeled data with time-consuming pixel-wise annotations. Moreover, accurately segmenting lesions poses challenges due to variations in shape, size, and location. To address these issues, we propose a novel Dual-scale Enhanced and Cross-generative consistency learning framework for semi-supervised medical image Segmentation (DEC-Seg). First, we propose a Cross-level Feature Aggregation (CFA) module that integrates cross-level adjacent layers to enhance the feature representation ability across different resolutions. To address scale variation, we present a scale-enhanced consistency constraint, which ensures consistency in the segmentation maps generated from the same input image at different scales. This constraint helps handle variations in lesion sizes and improves the robustness of the model. Furthermore, we propose a cross-generative consistency scheme, in which the original and perturbed images can be reconstructed using cross-segmentation maps. This consistency constraint allows us to mine effective feature representations and boost the segmentation performance. To further exploit the scale information, we propose a Dual-scale Complementary Fusion (DCF) module that integrates features from two scale-specific decoders operating at different scales to help produce more accurate segmentation maps. Extensive experimental results on multiple medical segmentation tasks (polyp, skin lesion, and brain glioma) demonstrate the effectiveness of our DEC-Seg against other state-of-the-art semi-supervised segmentation approaches. The implementation code will be released at https://github.com/taozh2017/DECSeg., Comment: 12 pages 10 figures

The morphologies of vessel-like structures, such as blood vessels and nerve fibres, play significant roles in disease diagnosis, e.g., Parkinson's disease. Deep network-based refinement segmentation methods have recently achieved promising vessel-like structure segmentation results. There are still two challenges: (1) existing methods have limitations in rehabilitating subsection ruptures in segmented vessel-like structures; (2) they are often overconfident in predicted segmentation results. To tackle these two challenges, this paper attempts to leverage the potential of spatial interconnection relationships among subsection ruptures from the structure rehabilitation perspective. Based on this, we propose a novel Vessel-like Structure Rehabilitation Network (VSR-Net) to rehabilitate subsection ruptures and improve the model calibration based on coarse vessel-like structure segmentation results. VSR-Net first constructs subsection rupture clusters with Curvilinear Clustering Module (CCM). Then, the well-designed Curvilinear Merging Module (CMM) is applied to rehabilitate the subsection ruptures to obtain the refined vessel-like structures. Extensive experiments on five 2D/3D medical image datasets show that VSR-Net significantly outperforms state-of-the-art (SOTA) refinement segmentation methods with lower calibration error. Additionally, we provide quantitative analysis to explain the morphological difference between the rehabilitation results of VSR-Net and ground truth (GT), which is smaller than SOTA methods and GT, demonstrating that our method better rehabilitates vessel-like structures by restoring subsection ruptures.

Medical imaging provides many valuable clues involving anatomical structure and pathological characteristics. However, image degradation is a common issue in clinical practice, which can adversely impact the observation and diagnosis by physicians and algorithms. Although extensive enhancement models have been developed, these models require a well pre-training before deployment, while failing to take advantage of the potential value of inference data after deployment. In this paper, we raise an algorithm for source-free unsupervised domain adaptive medical image enhancement (SAME), which adapts and optimizes enhancement models using test data in the inference phase. A structure-preserving enhancement network is first constructed to learn a robust source model from synthesized training data. Then a teacher-student model is initialized with the source model and conducts source-free unsupervised domain adaptation (SFUDA) by knowledge distillation with the test data. Additionally, a pseudo-label picker is developed to boost the knowledge distillation of enhancement tasks. Experiments were implemented on ten datasets from three medical image modalities to validate the advantage of the proposed algorithm, and setting analysis and ablation studies were also carried out to interpret the effectiveness of SAME. The remarkable enhancement performance and benefits for downstream tasks demonstrate the potential and generalizability of SAME. The code is available at https://github.com/liamheng/Annotation-free-Medical-Image-Enhancement., Comment: 14 pages, 9 figures, in IEEE Transactions on Medical Imaging

Early detection and assessment of polyps play a crucial role in the prevention and treatment of colorectal cancer (CRC). Polyp segmentation provides an effective solution to assist clinicians in accurately locating and segmenting polyp regions. In the past, people often relied on manually extracted lower-level features such as color, texture, and shape, which often had issues capturing global context and lacked robustness to complex scenarios. With the advent of deep learning, more and more outstanding medical image segmentation algorithms based on deep learning networks have emerged, making significant progress in this field. This paper provides a comprehensive review of polyp segmentation algorithms. We first review some traditional algorithms based on manually extracted features and deep segmentation algorithms, then detail benchmark datasets related to the topic. Specifically, we carry out a comprehensive evaluation of recent deep learning models and results based on polyp sizes, considering the pain points of research topics and differences in network structures. Finally, we discuss the challenges of polyp segmentation and future trends in this field. The models, benchmark datasets, and source code links we collected are all published at https://github.com/taozh2017/Awesome-Polyp-Segmentation., Comment: 17 pages, 7 figures

Polyp segmentation plays a vital role in accurately locating polyps at an early stage, which holds significant clinical importance for the prevention of colorectal cancer. Various polyp segmentation methods have been developed using fully-supervised deep learning techniques. However, pixel-wise annotation for polyp images by physicians during the diagnosis is both time-consuming and expensive. Moreover, visual foundation models such as the Segment Anything Model (SAM) have shown remarkable performance. Nevertheless, directly applying SAM to medical segmentation may not produce satisfactory results due to the inherent absence of medical knowledge. In this paper, we propose a novel SAM-guided Collaborative Learning Network (SAM-CLNet) for scribble-supervised polyp segmentation, enabling a collaborative learning process between our segmentation network and SAM to boost the model performance. Specifically, we first propose a Cross-level Enhancement and Aggregation Network (CEA-Net) for weakly-supervised polyp segmentation. Within CEA-Net, we propose a Cross-level Enhancement Module (CEM) that integrates the adjacent features to enhance the representation capabilities of different resolution features. Additionally, a Feature Aggregation Module (FAM) is employed to capture richer features across multiple levels. Moreover, we present a box-augmentation strategy that combines the segmentation maps generated by CEA-Net with scribble annotations to create more precise prompts. These prompts are then fed into SAM, generating segmentation SAM-guided masks, which can provide additional supervision to train CEA-Net effectively. Furthermore, we present an Image-level Filtering Mechanism to filter out unreliable SAM-guided masks. Extensive experimental results show that our SAM-CLNet outperforms state-of-the-art weakly-supervised segmentation methods., Comment: 10 pages, 7 figures

Recently, research on denoising diffusion models has expanded its application to the field of image restoration. Traditional diffusion-based image restoration methods utilize degraded images as conditional input to effectively guide the reverse generation process, without modifying the original denoising diffusion process. However, since the degraded images already include low-frequency information, starting from Gaussian white noise will result in increased sampling steps. We propose Resfusion, a general framework that incorporates the residual term into the diffusion forward process, starting the reverse process directly from the noisy degraded images. The form of our inference process is consistent with the DDPM. We introduced a weighted residual noise, named resnoise, as the prediction target and explicitly provide the quantitative relationship between the residual term and the noise term in resnoise. By leveraging a smooth equivalence transformation, Resfusion determine the optimal acceleration step and maintains the integrity of existing noise schedules, unifying the training and inference processes. The experimental results demonstrate that Resfusion exhibits competitive performance on ISTD dataset, LOL dataset and Raindrop dataset with only five sampling steps. Furthermore, Resfusion can be easily applied to image generation and emerges with strong versatility. Our code and model are available at https://github.com/nkicsl/Resfusion., Comment: NeurIPS 2024

Diffusion probabilistic models (DPMs) which employ explicit likelihood characterization and a gradual sampling process to synthesize data, have gained increasing research interest. Despite their huge computational burdens due to the large number of steps involved during sampling, DPMs are widely appreciated in various medical imaging tasks for their high-quality and diversity of generation. Magnetic resonance imaging (MRI) is an important medical imaging modality with excellent soft tissue contrast and superb spatial resolution, which possesses unique opportunities for DPMs. Although there is a recent surge of studies exploring DPMs in MRI, a survey paper of DPMs specifically designed for MRI applications is still lacking. This review article aims to help researchers in the MRI community to grasp the advances of DPMs in different applications. We first introduce the theory of two dominant kinds of DPMs, categorized according to whether the diffusion time step is discrete or continuous, and then provide a comprehensive review of emerging DPMs in MRI, including reconstruction, image generation, image translation, segmentation, anomaly detection, and further research topics. Finally, we discuss the general limitations as well as limitations specific to the MRI tasks of DPMs and point out potential areas that are worth further exploration.

Optical Coherence Tomography Angiography (OCTA) is a promising tool for detecting Alzheimer's disease (AD) by imaging the retinal microvasculature. Ophthalmologists commonly use region-based analysis, such as the ETDRS grid, to study OCTA image biomarkers and understand the correlation with AD. However, existing studies have used general deep computer vision methods, which present challenges in providing interpretable results and leveraging clinical prior knowledge. To address these challenges, we propose a novel deep-learning framework called Polar-Net. Our approach involves mapping OCTA images from Cartesian coordinates to polar coordinates, which allows for the use of approximate sector convolution and enables the implementation of the ETDRS grid-based regional analysis method commonly used in clinical practice. Furthermore, Polar-Net incorporates clinical prior information of each sector region into the training process, which further enhances its performance. Additionally, our framework adapts to acquire the importance of the corresponding retinal region, which helps researchers and clinicians understand the model's decision-making process in detecting AD and assess its conformity to clinical observations. Through evaluations on private and public datasets, we have demonstrated that Polar-Net outperforms existing state-of-the-art methods and provides more valuable pathological evidence for the association between retinal vascular changes and AD. In addition, we also show that the two innovative modules introduced in our framework have a significant impact on improving overall performance., Comment: Accepted by MICCAI2023

Federated learning (FL) has shown promising potential in safeguarding data privacy in healthcare collaborations. While the term "FL" was originally coined by the engineering community, the statistical field has also explored similar privacy-preserving algorithms. Statistical FL algorithms, however, remain considerably less recognized than their engineering counterparts. Our goal was to bridge the gap by presenting the first comprehensive comparison of FL frameworks from both engineering and statistical domains. We evaluated five FL frameworks using both simulated and real-world data. The results indicate that statistical FL algorithms yield less biased point estimates for model coefficients and offer convenient confidence interval estimations. In contrast, engineering-based methods tend to generate more accurate predictions, sometimes surpassing central pooled and statistical FL models. This study underscores the relative strengths and weaknesses of both types of methods, emphasizing the need for increased awareness and their integration in future FL applications.

Nowadays, billions of people engage in communication and express their opinions on the internet daily. Unfortunately, not all of these expressions are friendly or compliant, making content moderation an indispensable task. A common approach is to use a discriminative model to classify the content, but this method often requires strict data engineering, otherwise it will face unacceptable overfitting. With the successful development of Large Language Models (LLMs) in recent years, LLM-based methods have become a feasible solution for handling tasks in various domains. Thanks to the knowledge of the foundation models, we can develop more robust privately deployed models with limited data via fine-tuning these foundation models. Moreover, as a generative model, it can provide detailed analysis of the review process, enhancing interpretability. In this paper, we introduce how to fine-tune a LLM model that can be privately deployed for content moderation. Specifically, we discuss the differences between discriminative and generative models using content moderation as an example. Additionally, we reveal that incorporating reasoning processes during the fine-tuning of LLMs can effectively alleviate overfitting, even if the model is not allowed to directly output reasoning processes during deployment. We present a complete process, from data collection and construction to model training and overfitting elimination, for fine-tuning LLMs in vertical domain deployments. We report the entire research process and the key findings in this paper, hoping to provide valuable experience for researchers who are fine-tuning privately deployed models in their domain-specific research.

Recognition and localization of surgical detailed actions is an essential component of developing a context-aware decision support system. However, most existing detection algorithms fail to provide high-accuracy action classes even having their locations, as they do not consider the surgery procedure's regularity in the whole video. This limitation hinders their application. Moreover, implementing the predictions in clinical applications seriously needs to convey model confidence to earn entrustment, which is unexplored in surgical action prediction. In this paper, to accurately detect fine-grained actions that happen at every moment, we propose an anchor-context action detection network (ACTNet), including an anchor-context detection (ACD) module and a class conditional diffusion (CCD) module, to answer the following questions: 1) where the actions happen; 2) what actions are; 3) how confidence predictions are. Specifically, the proposed ACD module spatially and temporally highlights the regions interacting with the extracted anchor in surgery video, which outputs action location and its class distribution based on anchor-context interactions. Considering the full distribution of action classes in videos, the CCD module adopts a denoising diffusion-based generative model conditioned on our ACD estimator to further reconstruct accurately the action predictions. Moreover, we utilize the stochastic nature of the diffusion model outputs to access model confidence for each prediction. Our method reports the state-of-the-art performance, with improvements of 4.0% mAP against baseline on the surgical video dataset., Comment: Accepted early by MICCAI2023 (Oral)

Breast lesion segmentation in ultrasound (US) videos is essential for diagnosing and treating axillary lymph node metastasis. However, the lack of a well-established and large-scale ultrasound video dataset with high-quality annotations has posed a persistent challenge for the research community. To overcome this issue, we meticulously curated a US video breast lesion segmentation dataset comprising 572 videos and 34,300 annotated frames, covering a wide range of realistic clinical scenarios. Furthermore, we propose a novel frequency and localization feature aggregation network (FLA-Net) that learns temporal features from the frequency domain and predicts additional lesion location positions to assist with breast lesion segmentation. We also devise a localization-based contrastive loss to reduce the lesion location distance between neighboring video frames within the same video and enlarge the location distances between frames from different ultrasound videos. Our experiments on our annotated dataset and two public video polyp segmentation datasets demonstrate that our proposed FLA-Net achieves state-of-the-art performance in breast lesion segmentation in US videos and video polyp segmentation while significantly reducing time and space complexity. Our model and dataset are available at https://github.com/jhl-Det/FLA-Net., Comment: 10 pages

Although convolutional neural networks (CNNs) have been proposed to remove adverse weather conditions in single images using a single set of pre-trained weights, they fail to restore weather videos due to the absence of temporal information. Furthermore, existing methods for removing adverse weather conditions (e.g., rain, fog, and snow) from videos can only handle one type of adverse weather. In this work, we propose the first framework for restoring videos from all adverse weather conditions by developing a video adverse-weather-component suppression network (ViWS-Net). To achieve this, we first devise a weather-agnostic video transformer encoder with multiple transformer stages. Moreover, we design a long short-term temporal modeling mechanism for weather messenger to early fuse input adjacent video frames and learn weather-specific information. We further introduce a weather discriminator with gradient reversion, to maintain the weather-invariant common information and suppress the weather-specific information in pixel features, by adversarially predicting weather types. Finally, we develop a messenger-driven video transformer decoder to retrieve the residual weather-specific feature, which is spatiotemporally aggregated with hierarchical pixel features and refined to predict the clean target frame of input videos. Experimental results, on benchmark datasets and real-world weather videos, demonstrate that our ViWS-Net outperforms current state-of-the-art methods in terms of restoring videos degraded by any weather condition.

Detecting breast lesion in videos is crucial for computer-aided diagnosis. Existing video-based breast lesion detection approaches typically perform temporal feature aggregation of deep backbone features based on the self-attention operation. We argue that such a strategy struggles to effectively perform deep feature aggregation and ignores the useful local information. To tackle these issues, we propose a spatial-temporal deformable attention based framework, named STNet. Our STNet introduces a spatial-temporal deformable attention module to perform local spatial-temporal feature fusion. The spatial-temporal deformable attention module enables deep feature aggregation in each stage of both encoder and decoder. To further accelerate the detection speed, we introduce an encoder feature shuffle strategy for multi-frame prediction during inference. In our encoder feature shuffle strategy, we share the backbone and encoder features, and shuffle encoder features for decoder to generate the predictions of multiple frames. The experiments on the public breast lesion ultrasound video dataset show that our STNet obtains a state-of-the-art detection performance, while operating twice as fast inference speed. The code and model are available at https://github.com/AlfredQin/STNet., Comment: Accepted by MICCAI 2023

Fundus photography is prone to suffer from image quality degradation that impacts clinical examination performed by ophthalmologists or intelligent systems. Though enhancement algorithms have been developed to promote fundus observation on degraded images, high data demands and limited applicability hinder their clinical deployment. To circumvent this bottleneck, a generic fundus image enhancement network (GFE-Net) is developed in this study to robustly correct unknown fundus images without supervised or extra data. Levering image frequency information, self-supervised representation learning is conducted to learn robust structure-aware representations from degraded images. Then with a seamless architecture that couples representation learning and image enhancement, GFE-Net can accurately correct fundus images and meanwhile preserve retinal structures. Comprehensive experiments are implemented to demonstrate the effectiveness and advantages of GFE-Net. Compared with state-of-the-art algorithms, GFE-Net achieves superior performance in data dependency, enhancement performance, deployment efficiency, and scale generalizability. Follow-up fundus image analysis is also facilitated by GFE-Net, whose modules are respectively verified to be effective for image enhancement., Comment: Accepted by Medical Image Analysis in Auguest, 2023

In the medical field, federated learning commonly deals with highly imbalanced datasets, including skin lesions and gastrointestinal images. Existing federated methods under highly imbalanced datasets primarily focus on optimizing a global model without incorporating the intra-class variations that can arise in medical imaging due to different populations, findings, and scanners. In this paper, we study the inter-client intra-class variations with publicly available self-supervised auxiliary networks. Specifically, we find that employing a shared auxiliary pre-trained model, like MoCo-V2, locally on every client yields consistent divergence measurements. Based on these findings, we derive a dynamic balanced model aggregation via self-supervised priors (MAS) to guide the global model optimization. Fed-MAS can be utilized with different local learning methods for effective model aggregation toward a highly robust and unbiased global model. Our code is available at \url{https://github.com/xmed-lab/Fed-MAS}.

Limited labeled data makes it hard to train models from scratch in medical domain, and an important paradigm is pre-training and then fine-tuning. Large pre-trained models contain rich representations, which can be adapted to downstream medical tasks. However, existing methods either tune all the parameters or the task-specific layers of the pre-trained models, ignoring the input variations of medical images, and thus they are not efficient or effective. In this work, we aim to study parameter-efficient fine-tuning (PEFT) for medical image analysis, and propose a dynamic visual prompt tuning method, named DVPT. It can extract knowledge beneficial to downstream tasks from large models with a few trainable parameters. Firstly, the frozen features are transformed by an lightweight bottleneck layer to learn the domain-specific distribution of downstream medical tasks, and then a few learnable visual prompts are used as dynamic queries and then conduct cross-attention with the transformed features, attempting to acquire sample-specific knowledge that are suitable for each sample. Finally, the features are projected to original feature dimension and aggregated with the frozen features. This DVPT module can be shared between different Transformer layers, further reducing the trainable parameters. To validate DVPT, we conduct extensive experiments with different pre-trained models on medical classification and segmentation tasks. We find such PEFT method can not only efficiently adapt the pre-trained models to the medical domain, but also brings data efficiency with partial labeled data. For example, with 0.5\% extra trainable parameters, our method not only outperforms state-of-the-art PEFT methods, even surpasses the full fine-tuning by more than 2.20\% Kappa score on medical classification task. It can saves up to 60\% labeled data and 99\% storage cost of ViT-B/16.

The annotation scarcity of medical image segmentation poses challenges in collecting sufficient training data for deep learning models. Specifically, models trained on limited data may not generalize well to other unseen data domains, resulting in a domain shift issue. Consequently, domain generalization (DG) is developed to boost the performance of segmentation models on unseen domains. However, the DG setup requires multiple source domains, which impedes the efficient deployment of segmentation algorithms in clinical scenarios. To address this challenge and improve the segmentation model's generalizability, we propose a novel approach called the Frequency-mixed Single-source Domain Generalization method (FreeSDG). By analyzing the frequency's effect on domain discrepancy, FreeSDG leverages a mixed frequency spectrum to augment the single-source domain. Additionally, self-supervision is constructed in the domain augmentation to learn robust context-aware representations for the segmentation task. Experimental results on five datasets of three modalities demonstrate the effectiveness of the proposed algorithm. FreeSDG outperforms state-of-the-art methods and significantly improves the segmentation model's generalizability. Therefore, FreeSDG provides a promising solution for enhancing the generalization of medical image segmentation models, especially when annotated data is scarce. The code is available at https://github.com/liamheng/Non-IID_Medical_Image_Segmentation.

Frontotemporal Dementia (FTD) diagnosis has been successfully progress using deep learning techniques. However, current FTD identification methods suffer from two limitations. Firstly, they do not exploit the potential of multi-view functional magnetic resonance imaging (fMRI) for classifying FTD. Secondly, they do not consider the reliability of the multi-view FTD diagnosis. To address these limitations, we propose a reliable multi-view impartial decision network (MID-Net) for FTD diagnosis in fMRI. Our MID-Net provides confidence for each view and generates a reliable prediction without any conflict. To achieve this, we employ multiple expert models to extract evidence from the abundant neural network information contained in fMRI images. We then introduce the Dirichlet Distribution to characterize the expert class probability distribution from an evidence level. Additionally, a novel Impartial Decision Maker (IDer) is proposed to combine the different opinions inductively to arrive at an unbiased prediction without additional computation cost. Overall, our MID-Net dynamically integrates the decisions of different experts on FTD disease, especially when dealing with multi-view high-conflict cases. Extensive experiments on a high-quality FTD fMRI dataset demonstrate that our model outperforms previous methods and provides high uncertainty for hard-to-classify examples. We believe that our approach represents a significant step toward the deployment of reliable FTD decision-making under multi-expert conditions. We will release the codes for reproduction after acceptance.