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Intraoperative ultrasound (iUS) imaging has the potential to improve surgical outcomes in brain surgery. However, its interpretation is challenging, even for expert neurosurgeons. In this work, we designed the first patient-specific framework that performs brain tumor segmentation in trackerless iUS. To disambiguate ultrasound imaging and adapt to the neurosurgeon's surgical objective, a patient-specific real-time network is trained using synthetic ultrasound data generated by simulating virtual iUS sweep acquisitions in pre-operative MR data. Extensive experiments performed in real ultrasound data demonstrate the effectiveness of the proposed approach, allowing for adapting to the surgeon's definition of surgical targets and outperforming non-patient-specific models, neurosurgeon experts, and high-end tracking systems. Our code is available at: \url{https://github.com/ReubenDo/MHVAE-Seg}., Comment: Early accept at MICCAI 2024 - code available at: https://github.com/ReubenDo/MHVAE-Seg

We introduce MHVAE, a deep hierarchical variational auto-encoder (VAE) that synthesizes missing images from various modalities. Extending multi-modal VAEs with a hierarchical latent structure, we introduce a probabilistic formulation for fusing multi-modal images in a common latent representation while having the flexibility to handle incomplete image sets as input. Moreover, adversarial learning is employed to generate sharper images. Extensive experiments are performed on the challenging problem of joint intra-operative ultrasound (iUS) and Magnetic Resonance (MR) synthesis. Our model outperformed multi-modal VAEs, conditional GANs, and the current state-of-the-art unified method (ResViT) for synthesizing missing images, demonstrating the advantage of using a hierarchical latent representation and a principled probabilistic fusion operation. Our code is publicly available \url{https://github.com/ReubenDo/MHVAE}., Comment: Accepted at MICCAI 2023

Self-supervised representation learning on image-text data facilitates crucial medical applications, such as image classification, visual grounding, and cross-modal retrieval. One common approach involves contrasting semantically similar (positive) and dissimilar (negative) pairs of data points. Drawing negative samples uniformly from the training data set introduces false negatives, i.e., samples that are treated as dissimilar but belong to the same class. In healthcare data, the underlying class distribution is nonuniform, implying that false negatives occur at a highly variable rate. To improve the quality of learned representations, we develop a novel approach that corrects for false negatives. Our method can be viewed as a variant of debiased contrastive learning that uses estimated sample-specific class probabilities. We provide theoretical analysis of the objective function and demonstrate the proposed approach on both image and paired image-text data sets. Our experiments illustrate empirical advantages of sample-specific debiasing., Comment: Machine Learning for Healthcare Conference 2023

Lung ultrasound (LUS) is an important imaging modality used by emergency physicians to assess pulmonary congestion at the patient bedside. B-line artifacts in LUS videos are key findings associated with pulmonary congestion. Not only can the interpretation of LUS be challenging for novice operators, but visual quantification of B-lines remains subject to observer variability. In this work, we investigate the strengths and weaknesses of multiple deep learning approaches for automated B-line detection and localization in LUS videos. We curate and publish, BEDLUS, a new ultrasound dataset comprising 1,419 videos from 113 patients with a total of 15,755 expert-annotated B-lines. Based on this dataset, we present a benchmark of established deep learning methods applied to the task of B-line detection. To pave the way for interpretable quantification of B-lines, we propose a novel "single-point" approach to B-line localization using only the point of origin. Our results show that (a) the area under the receiver operating characteristic curve ranges from 0.864 to 0.955 for the benchmarked detection methods, (b) within this range, the best performance is achieved by models that leverage multiple successive frames as input, and (c) the proposed single-point approach for B-line localization reaches an F1-score of 0.65, performing on par with the inter-observer agreement. The dataset and developed methods can facilitate further biomedical research on automated interpretation of lung ultrasound with the potential to expand the clinical utility., Comment: 10 pages, 4 figures

Image-text multimodal representation learning aligns data across modalities and enables important medical applications, e.g., image classification, visual grounding, and cross-modal retrieval. In this work, we establish a connection between multimodal representation learning and multiple instance learning. Based on this connection, we propose a generic framework for constructing permutation-invariant score functions with many existing multimodal representation learning approaches as special cases. Furthermore, we use the framework to derive a novel contrastive learning approach and demonstrate that our method achieves state-of-the-art results in several downstream tasks.

Neuroimaging-based prediction of neurocognitive measures is valuable for studying how the brain's structure relates to cognitive function. However, the accuracy of prediction using popular linear regression models is relatively low. We propose a novel deep regression method, namely TractoSCR, that allows full supervision for contrastive learning in regression tasks using diffusion MRI tractography. TractoSCR performs supervised contrastive learning by using the absolute difference between continuous regression labels (i.e. neurocognitive scores) to determine positive and negative pairs. We apply TractoSCR to analyze a large-scale dataset including multi-site harmonized diffusion MRI and neurocognitive data from 8735 participants in the Adolescent Brain Cognitive Development (ABCD) Study. We extract white matter microstructural measures using a fine parcellation of white matter tractography into fiber clusters. Using these measures, we predict three scores related to domains of higher-order cognition (general cognitive ability, executive function, and learning/memory). To identify important fiber clusters for prediction of these neurocognitive scores, we propose a permutation feature importance method for high-dimensional data. We find that TractoSCR improves the accuracy of neurocognitive score prediction compared to other state-of-the-art methods. We find that the most predictive fiber clusters are predominantly located within the superficial white matter and projection tracts, particularly the superficial frontal white matter and striato-frontal connections. Overall, our results demonstrate the utility of contrastive representation learning methods for regression, and in particular for improving neuroimaging-based prediction of higher-order cognitive abilities., Comment: 28 pages, 4 figures

In recent years, learning-based image registration methods have gradually moved away from direct supervision with target warps to instead use self-supervision, with excellent results in several registration benchmarks. These approaches utilize a loss function that penalizes the intensity differences between the fixed and moving images, along with a suitable regularizer on the deformation. In this paper, we argue that the relative failure of supervised registration approaches can in part be blamed on the use of regular U-Nets, which are jointly tasked with feature extraction, feature matching, and estimation of deformation. We introduce one simple but crucial modification to the U-Net that disentangles feature extraction and matching from deformation prediction, allowing the U-Net to warp the features, across levels, as the deformation field is evolved. With this modification, direct supervision using target warps begins to outperform self-supervision approaches that require segmentations, presenting new directions for registration when images do not have segmentations. We hope that our findings in this preliminary workshop paper will re-ignite research interest in supervised image registration techniques. Our code is publicly available from https://github.com/balbasty/superwarp.

We demonstrate an object tracking method for 3D images with fixed computational cost and state-of-the-art performance. Previous methods predicted transformation parameters from convolutional layers. We instead propose an architecture that does not include either flattening of convolutional features or fully connected layers, but instead relies on equivariant filters to preserve transformations between inputs and outputs (e.g. rot./trans. of inputs rotate/translate outputs). The transformation is then derived in closed form from the outputs of the filters. This method is useful for applications requiring low latency, such as real-time tracking. We demonstrate our model on synthetically augmented adult brain MRI, as well as fetal brain MRI, which is the intended use-case., Comment: MICCAI 2021 Early Accept

We propose and demonstrate a representation learning approach by maximizing the mutual information between local features of images and text. The goal of this approach is to learn useful image representations by taking advantage of the rich information contained in the free text that describes the findings in the image. Our method trains image and text encoders by encouraging the resulting representations to exhibit high local mutual information. We make use of recent advances in mutual information estimation with neural network discriminators. We argue that the sum of local mutual information is typically a lower bound on the global mutual information. Our experimental results in the downstream image classification tasks demonstrate the advantages of using local features for image-text representation learning., Comment: In Proceedings of International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI), 2021

The loss function of an unsupervised multimodal image registration framework has two terms, i.e., a metric for similarity measure and regularization. In the deep learning era, researchers proposed many approaches to automatically learn the similarity metric, which has been shown effective in improving registration performance. However, for the regularization term, most existing multimodal registration approaches still use a hand-crafted formula to impose artificial properties on the estimated deformation field. In this work, we propose a unimodal cyclic regularization training pipeline, which learns task-specific prior knowledge from simpler unimodal registration, to constrain the deformation field of multimodal registration. In the experiment of abdominal CT-MR registration, the proposed method yields better results over conventional regularization methods, especially for severely deformed local regions., Comment: 5 pages, 5 figures

Estimating mutual information between continuous random variables is often intractable and extremely challenging for high-dimensional data. Recent progress has leveraged neural networks to optimize variational lower bounds on mutual information. Although showing promise for this difficult problem, the variational methods have been theoretically and empirically proven to have serious statistical limitations: 1) many methods struggle to produce accurate estimates when the underlying mutual information is either low or high; 2) the resulting estimators may suffer from high variance. Our approach is based on training a classifier that provides the probability that a data sample pair is drawn from the joint distribution rather than from the product of its marginal distributions. Moreover, we establish a direct connection between mutual information and the average log odds estimate produced by the classifier on a test set, leading to a simple and accurate estimator of mutual information. We show theoretically that our method and other variational approaches are equivalent when they achieve their optimum, while our method sidesteps the variational bound. Empirical results demonstrate high accuracy of our approach and the advantages of our estimator in the context of representation learning. Our demo is available at https://github.com/RayRuizhiLiao/demi_mi_estimator.

We propose and demonstrate a novel machine learning algorithm that assesses pulmonary edema severity from chest radiographs. While large publicly available datasets of chest radiographs and free-text radiology reports exist, only limited numerical edema severity labels can be extracted from radiology reports. This is a significant challenge in learning such models for image classification. To take advantage of the rich information present in the radiology reports, we develop a neural network model that is trained on both images and free-text to assess pulmonary edema severity from chest radiographs at inference time. Our experimental results suggest that the joint image-text representation learning improves the performance of pulmonary edema assessment compared to a supervised model trained on images only. We also show the use of the text for explaining the image classification by the joint model. To the best of our knowledge, our approach is the first to leverage free-text radiology reports for improving the image model performance in this application. Our code is available at https://github.com/RayRuizhiLiao/joint_chestxray., Comment: The two first authors contributed equally. To be published in the proceedings of MICCAI 2020

We propose and demonstrate machine learning algorithms to assess the severity of pulmonary edema in chest x-ray images of congestive heart failure patients. Accurate assessment of pulmonary edema in heart failure is critical when making treatment and disposition decisions. Our work is grounded in a large-scale clinical dataset of over 300,000 x-ray images with associated radiology reports. While edema severity labels can be extracted unambiguously from a small fraction of the radiology reports, accurate annotation is challenging in most cases. To take advantage of the unlabeled images, we develop a Bayesian model that includes a variational auto-encoder for learning a latent representation from the entire image set trained jointly with a regressor that employs this representation for predicting pulmonary edema severity. Our experimental results suggest that modeling the distribution of images jointly with the limited labels improves the accuracy of pulmonary edema scoring compared to a strictly supervised approach. To the best of our knowledge, this is the first attempt to employ machine learning algorithms to automatically and quantitatively assess the severity of pulmonary edema in chest x-ray images.

We introduce an approach for image segmentation based on sparse correspondences between keypoints in testing and training images. Keypoints represent automatically identified distinctive image locations, where each keypoint correspondence suggests a transformation between images. We use these correspondences to transfer label maps of entire organs from the training images to the test image. The keypoint transfer algorithm includes three steps: (i) keypoint matching, (ii) voting-based keypoint labeling, and (iii) keypoint-based probabilistic transfer of organ segmentations. We report segmentation results for abdominal organs in whole-body CT and MRI, as well as in contrast-enhanced CT and MRI. Our method offers a speed-up of about three orders of magnitude in comparison to common multi-atlas segmentation, while achieving an accuracy that compares favorably. Moreover, keypoint transfer does not require the registration to an atlas or a training phase. Finally, the method allows for the segmentation of scans with highly variable field-of-view., Comment: Accepted for publication at IEEE Transactions on Medical Imaging