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We introduce the largest abdominal CT dataset (termed AbdomenAtlas) of 20,460 three-dimensional CT volumes sourced from 112 hospitals across diverse populations, geographies, and facilities. AbdomenAtlas provides 673K high-quality masks of anatomical structures in the abdominal region annotated by a team of 10 radiologists with the help of AI algorithms. We start by having expert radiologists manually annotate 22 anatomical structures in 5,246 CT volumes. Following this, a semi-automatic annotation procedure is performed for the remaining CT volumes, where radiologists revise the annotations predicted by AI, and in turn, AI improves its predictions by learning from revised annotations. Such a large-scale, detailed-annotated, and multi-center dataset is needed for two reasons. Firstly, AbdomenAtlas provides important resources for AI development at scale, branded as large pre-trained models, which can alleviate the annotation workload of expert radiologists to transfer to broader clinical applications. Secondly, AbdomenAtlas establishes a large-scale benchmark for evaluating AI algorithms -- the more data we use to test the algorithms, the better we can guarantee reliable performance in complex clinical scenarios. An ISBI & MICCAI challenge named BodyMaps: Towards 3D Atlas of Human Body was launched using a subset of our AbdomenAtlas, aiming to stimulate AI innovation and to benchmark segmentation accuracy, inference efficiency, and domain generalizability. We hope our AbdomenAtlas can set the stage for larger-scale clinical trials and offer exceptional opportunities to practitioners in the medical imaging community. Codes, models, and datasets are available at https://www.zongweiz.com/dataset, Comment: Published in Medical Image Analysis

As massive medical data become available with an increasing number of scans, expanding classes, and varying sources, prevalent training paradigms -- where AI is trained with multiple passes over fixed, finite datasets -- face significant challenges. First, training AI all at once on such massive data is impractical as new scans/sources/classes continuously arrive. Second, training AI continuously on new scans/sources/classes can lead to catastrophic forgetting, where AI forgets old data as it learns new data, and vice versa. To address these two challenges, we propose an online learning method that enables training AI from massive medical data. Instead of repeatedly training AI on randomly selected data samples, our method identifies the most significant samples for the current AI model based on their data uniqueness and prediction uncertainty, then trains the AI on these selective data samples. Compared with prevalent training paradigms, our method not only improves data efficiency by enabling training on continual data streams, but also mitigates catastrophic forgetting by selectively training AI on significant data samples that might otherwise be forgotten, outperforming by 15% in Dice score for multi-organ and tumor segmentation. The code is available at https://github.com/MrGiovanni/OnlineLearning, Comment: Accepted to MICCAI 2024

An increasing number of public datasets have shown a transformative impact on automated medical segmentation. However, these datasets are often with varying label quality, ranging from manual expert annotations to AI-generated pseudo-annotations. There is no systematic, reliable, and automatic quality control (QC). To fill in this bridge, we introduce a regression model, Quality Sentinel, to estimate label quality compared with manual annotations in medical segmentation datasets. This regression model was trained on over 4 million image-label pairs created by us. Each pair presents a varying but quantified label quality based on manual annotations, which enable us to predict the label quality of any image-label pairs in the inference. Our Quality Sentinel can predict the label quality of 142 body structures. The predicted label quality quantified by Dice Similarity Coefficient (DSC) shares a strong correlation with ground truth quality, with a positive correlation coefficient (r=0.902). Quality Sentinel has found multiple impactful use cases. (I) We evaluated label quality in publicly available datasets, where quality highly varies across different datasets. Our analysis also uncovers that male and younger subjects exhibit significantly higher quality. (II) We identified and corrected poorly annotated labels, achieving 1/3 reduction in annotation costs with optimal budgeting on TotalSegmentator. (III) We enhanced AI training efficiency and performance by focusing on high-quality pseudo labels, resulting in a 33%--88% performance boost over entropy-based methods, with a cost of 31% time and 4.5% memory. The data and model are released., Comment: 13 pages, 6 figures, 3 tables

The advancement of artificial intelligence (AI) for organ segmentation and tumor detection is propelled by the growing availability of computed tomography (CT) datasets with detailed, per-voxel annotations. However, these AI models often struggle with flexibility for partially annotated datasets and extensibility for new classes due to limitations in the one-hot encoding, architectural design, and learning scheme. To overcome these limitations, we propose a universal, extensible framework enabling a single model, termed Universal Model, to deal with multiple public datasets and adapt to new classes (e.g., organs/tumors). Firstly, we introduce a novel language-driven parameter generator that leverages language embeddings from large language models, enriching semantic encoding compared with one-hot encoding. Secondly, the conventional output layers are replaced with lightweight, class-specific heads, allowing Universal Model to simultaneously segment 25 organs and six types of tumors and ease the addition of new classes. We train our Universal Model on 3,410 CT volumes assembled from 14 publicly available datasets and then test it on 6,173 CT volumes from four external datasets. Universal Model achieves first place on six CT tasks in the Medical Segmentation Decathlon (MSD) public leaderboard and leading performance on the Beyond The Cranial Vault (BTCV) dataset. In summary, Universal Model exhibits remarkable computational efficiency (6x faster than other dataset-specific models), demonstrates strong generalization across different hospitals, transfers well to numerous downstream tasks, and more importantly, facilitates the extensibility to new classes while alleviating the catastrophic forgetting of previously learned classes. Codes, models, and datasets are available at https://github.com/ljwztc/CLIP-Driven-Universal-Model, Comment: Accepted to Medical Image Analysis

Radiography imaging protocols focus on particular body regions, therefore producing images of great similarity and yielding recurrent anatomical structures across patients. Exploiting this structured information could potentially ease the detection of anomalies from radiography images. To this end, we propose a Simple Space-Aware Memory Matrix for In-painting and Detecting anomalies from radiography images (abbreviated as SimSID). We formulate anomaly detection as an image reconstruction task, consisting of a space-aware memory matrix and an in-painting block in the feature space. During the training, SimSID can taxonomize the ingrained anatomical structures into recurrent visual patterns, and in the inference, it can identify anomalies (unseen/modified visual patterns) from the test image. Our SimSID surpasses the state of the arts in unsupervised anomaly detection by +8.0%, +5.0%, and +9.9% AUC scores on ZhangLab, COVIDx, and CheXpert benchmark datasets, respectively. Code: https://github.com/MrGiovanni/SimSID, Comment: IEEE Transactions on Pattern Analysis and Machine Intelligence (TPAMI). arXiv admin note: substantial text overlap with arXiv:2111.13495

AI for cancer detection encounters the bottleneck of data scarcity, annotation difficulty, and low prevalence of early tumors. Tumor synthesis seeks to create artificial tumors in medical images, which can greatly diversify the data and annotations for AI training. However, current tumor synthesis approaches are not applicable across different organs due to their need for specific expertise and design. This paper establishes a set of generic rules to simulate tumor development. Each cell (pixel) is initially assigned a state between zero and ten to represent the tumor population, and a tumor can be developed based on three rules to describe the process of growth, invasion, and death. We apply these three generic rules to simulate tumor development--from pixel to cancer--using cellular automata. We then integrate the tumor state into the original computed tomography (CT) images to generate synthetic tumors across different organs. This tumor synthesis approach allows for sampling tumors at multiple stages and analyzing tumor-organ interaction. Clinically, a reader study involving three expert radiologists reveals that the synthetic tumors and their developing trajectories are convincingly realistic. Technically, we analyze and simulate tumor development at various stages using 9,262 raw, unlabeled CT images sourced from 68 hospitals worldwide. The performance in segmenting tumors in the liver, pancreas, and kidneys exceeds prevailing literature benchmarks, underlining the immense potential of tumor synthesis, especially for earlier cancer detection. The code and models are available at https://github.com/MrGiovanni/Pixel2Cancer, Comment: Early accepted to MICCAI 2024

X-ray is widely applied for transmission imaging due to its stronger penetration than natural light. When rendering novel view X-ray projections, existing methods mainly based on NeRF suffer from long training time and slow inference speed. In this paper, we propose a 3D Gaussian splatting-based framework, namely X-Gaussian, for X-ray novel view synthesis. Firstly, we redesign a radiative Gaussian point cloud model inspired by the isotropic nature of X-ray imaging. Our model excludes the influence of view direction when learning to predict the radiation intensity of 3D points. Based on this model, we develop a Differentiable Radiative Rasterization (DRR) with CUDA implementation. Secondly, we customize an Angle-pose Cuboid Uniform Initialization (ACUI) strategy that directly uses the parameters of the X-ray scanner to compute the camera information and then uniformly samples point positions within a cuboid enclosing the scanned object. Experiments show that our X-Gaussian outperforms state-of-the-art methods by 6.5 dB while enjoying less than 15% training time and over 73x inference speed. The application on sparse-view CT reconstruction also reveals the practical values of our method. Code is publicly available at https://github.com/caiyuanhao1998/X-Gaussian . A video demo of the training process visualization is at https://www.youtube.com/watch?v=gDVf_Ngeghg ., Comment: ECCV 2024; The first 3D Gaussian Splatting-based method for X-ray 3D reconstruction

Tumor synthesis enables the creation of artificial tumors in medical images, facilitating the training of AI models for tumor detection and segmentation. However, success in tumor synthesis hinges on creating visually realistic tumors that are generalizable across multiple organs and, furthermore, the resulting AI models being capable of detecting real tumors in images sourced from different domains (e.g., hospitals). This paper made a progressive stride toward generalizable tumor synthesis by leveraging a critical observation: early-stage tumors (< 2cm) tend to have similar imaging characteristics in computed tomography (CT), whether they originate in the liver, pancreas, or kidneys. We have ascertained that generative AI models, e.g., Diffusion Models, can create realistic tumors generalized to a range of organs even when trained on a limited number of tumor examples from only one organ. Moreover, we have shown that AI models trained on these synthetic tumors can be generalized to detect and segment real tumors from CT volumes, encompassing a broad spectrum of patient demographics, imaging protocols, and healthcare facilities., Comment: The IEEE / CVF Computer Vision and Pattern Recognition Conference (CVPR 2024)

Interactive segmentation, an integration of AI algorithms and human expertise, premises to improve the accuracy and efficiency of curating large-scale, detailed-annotated datasets in healthcare. Human experts revise the annotations predicted by AI, and in turn, AI improves its predictions by learning from these revised annotations. This interactive process continues to enhance the quality of annotations until no major revision is needed from experts. The key challenge is how to leverage AI predicted and expert revised annotations to iteratively improve the AI. Two problems arise: (1) The risk of catastrophic forgetting--the AI tends to forget the previously learned classes if it is only retrained using the expert revised classes. (2) Computational inefficiency when retraining the AI using both AI predicted and expert revised annotations; moreover, given the dominant AI predicted annotations in the dataset, the contribution of newly revised annotations--often account for a very small fraction--to the AI training remains marginal. This paper proposes Continual Tuning to address the problems from two perspectives: network design and data reuse. Firstly, we design a shared network for all classes followed by class-specific networks dedicated to individual classes. To mitigate forgetting, we freeze the shared network for previously learned classes and only update the class-specific network for revised classes. Secondly, we reuse a small fraction of data with previous annotations to avoid over-computing. The selection of such data relies on the importance estimate of each data. The importance score is computed by combining the uncertainty and consistency of AI predictions. Our experiments demonstrate that Continual Tuning achieves a speed 16x greater than repeatedly training AI from scratch without compromising the performance., Comment: IEEE International Symposium on Biomedical Imaging (ISBI)

This report introduces a new family of multimodal models, Gemini, that exhibit remarkable capabilities across image, audio, video, and text understanding. The Gemini family consists of Ultra, Pro, and Nano sizes, suitable for applications ranging from complex reasoning tasks to on-device memory-constrained use-cases. Evaluation on a broad range of benchmarks shows that our most-capable Gemini Ultra model advances the state of the art in 30 of 32 of these benchmarks - notably being the first model to achieve human-expert performance on the well-studied exam benchmark MMLU, and improving the state of the art in every one of the 20 multimodal benchmarks we examined. We believe that the new capabilities of the Gemini family in cross-modal reasoning and language understanding will enable a wide variety of use cases. We discuss our approach toward post-training and deploying Gemini models responsibly to users through services including Gemini, Gemini Advanced, Google AI Studio, and Cloud Vertex AI.

X-ray, known for its ability to reveal internal structures of objects, is expected to provide richer information for 3D reconstruction than visible light. Yet, existing neural radiance fields (NeRF) algorithms overlook this important nature of X-ray, leading to their limitations in capturing structural contents of imaged objects. In this paper, we propose a framework, Structure-Aware X-ray Neural Radiodensity Fields (SAX-NeRF), for sparse-view X-ray 3D reconstruction. Firstly, we design a Line Segment-based Transformer (Lineformer) as the backbone of SAX-NeRF. Linefomer captures internal structures of objects in 3D space by modeling the dependencies within each line segment of an X-ray. Secondly, we present a Masked Local-Global (MLG) ray sampling strategy to extract contextual and geometric information in 2D projection. Plus, we collect a larger-scale dataset X3D covering wider X-ray applications. Experiments on X3D show that SAX-NeRF surpasses previous NeRF-based methods by 12.56 and 2.49 dB on novel view synthesis and CT reconstruction. Code, models, and data are released at https://github.com/caiyuanhao1998/SAX-NeRF, Comment: CVPR 2024; The first Transformer-based method for X-ray and CT 3D reconstruction

This study leverages synthetic data as a validation set to reduce overfitting and ease the selection of the best model in AI development. While synthetic data have been used for augmenting the training set, we find that synthetic data can also significantly diversify the validation set, offering marked advantages in domains like healthcare, where data are typically limited, sensitive, and from out-domain sources (i.e., hospitals). In this study, we illustrate the effectiveness of synthetic data for early cancer detection in computed tomography (CT) volumes, where synthetic tumors are generated and superimposed onto healthy organs, thereby creating an extensive dataset for rigorous validation. Using synthetic data as validation can improve AI robustness in both in-domain and out-domain test sets. Furthermore, we establish a new continual learning framework that continuously trains AI models on a stream of out-domain data with synthetic tumors. The AI model trained and validated in dynamically expanding synthetic data can consistently outperform models trained and validated exclusively on real-world data. Specifically, the DSC score for liver tumor segmentation improves from 26.7% (95% CI: 22.6%-30.9%) to 34.5% (30.8%-38.2%) when evaluated on an in-domain dataset and from 31.1% (26.0%-36.2%) to 35.4% (32.1%-38.7%) on an out-domain dataset. Importantly, the performance gain is particularly significant in identifying very tiny liver tumors (radius < 5mm) in CT volumes, with Sensitivity improving from 33.1% to 55.4% on an in-domain dataset and 33.9% to 52.3% on an out-domain dataset, justifying the efficacy in early detection of cancer. The application of synthetic data, from both training and validation perspectives, underlines a promising avenue to enhance AI robustness when dealing with data from varying domains.

Creating large-scale and well-annotated datasets to train AI algorithms is crucial for automated tumor detection and localization. However, with limited resources, it is challenging to determine the best type of annotations when annotating massive amounts of unlabeled data. To address this issue, we focus on polyps in colonoscopy videos and pancreatic tumors in abdominal CT scans; both applications require significant effort and time for pixel-wise annotation due to the high dimensional nature of the data, involving either temporary or spatial dimensions. In this paper, we develop a new annotation strategy, termed Drag&Drop, which simplifies the annotation process to drag and drop. This annotation strategy is more efficient, particularly for temporal and volumetric imaging, than other types of weak annotations, such as per-pixel, bounding boxes, scribbles, ellipses, and points. Furthermore, to exploit our Drag&Drop annotations, we develop a novel weakly supervised learning method based on the watershed algorithm. Experimental results show that our method achieves better detection and localization performance than alternative weak annotations and, more importantly, achieves similar performance to that trained on detailed per-pixel annotations. Interestingly, we find that, with limited resources, allocating weak annotations from a diverse patient population can foster models more robust to unseen images than allocating per-pixel annotations for a small set of images. In summary, this research proposes an efficient annotation strategy for tumor detection and localization that is less accurate than per-pixel annotations but useful for creating large-scale datasets for screening tumors in various medical modalities., Comment: Published in Machine Intelligence Research

Image synthesis approaches, e.g., generative adversarial networks, have been popular as a form of data augmentation in medical image analysis tasks. It is primarily beneficial to overcome the shortage of publicly accessible data and associated quality annotations. However, the current techniques often lack control over the detailed contents in generated images, e.g., the type of disease patterns, the location of lesions, and attributes of the diagnosis. In this work, we adapt the latest advance in the generative model, i.e., the diffusion model, with the added control flow using lesion-specific visual and textual prompts for generating dermatoscopic images. We further demonstrate the advantage of our diffusion model-based framework over the classical generation models in both the image quality and boosting the segmentation performance on skin lesions. It can achieve a 9% increase in the SSIM image quality measure and an over 5% increase in Dice coefficients over the prior arts., Comment: 10 pages, 4 figures

Prior to the deep learning era, shape was commonly used to describe the objects. Nowadays, state-of-the-art (SOTA) algorithms in medical imaging are predominantly diverging from computer vision, where voxel grids, meshes, point clouds, and implicit surface models are used. This is seen from numerous shape-related publications in premier vision conferences as well as the growing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models). For the medical domain, we present a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D models of surgical instrument, called MedShapeNet, created to facilitate the translation of data-driven vision algorithms to medical applications and to adapt SOTA vision algorithms to medical problems. As a unique feature, we directly model the majority of shapes on the imaging data of real patients. As of today, MedShapeNet includes 23 dataset with more than 100,000 shapes that are paired with annotations (ground truth). Our data is freely accessible via a web interface and a Python application programming interface (API) and can be used for discriminative, reconstructive, and variational benchmarks as well as various applications in virtual, augmented, or mixed reality, and 3D printing. Exemplary, we present use cases in the fields of classification of brain tumors, facial and skull reconstructions, multi-class anatomy completion, education, and 3D printing. In future, we will extend the data and improve the interfaces. The project pages are: https://medshapenet.ikim.nrw/ and https://github.com/Jianningli/medshapenet-feedback, Comment: 16 pages

Early detection and localization of pancreatic cancer can increase the 5-year survival rate for patients from 8.5% to 20%. Artificial intelligence (AI) can potentially assist radiologists in detecting pancreatic tumors at an early stage. Training AI models require a vast number of annotated examples, but the availability of CT scans obtaining early-stage tumors is constrained. This is because early-stage tumors may not cause any symptoms, which can delay detection, and the tumors are relatively small and may be almost invisible to human eyes on CT scans. To address this issue, we develop a tumor synthesis method that can synthesize enormous examples of small pancreatic tumors in the healthy pancreas without the need for manual annotation. Our experiments demonstrate that the overall detection rate of pancreatic tumors, measured by Sensitivity and Specificity, achieved by AI trained on synthetic tumors is comparable to that of real tumors. More importantly, our method shows a much higher detection rate for small tumors. We further investigate the per-voxel segmentation performance of pancreatic tumors if AI is trained on a combination of CT scans with synthetic tumors and CT scans with annotated large tumors at an advanced stage. Finally, we show that synthetic tumors improve AI generalizability in tumor detection and localization when processing CT scans from different hospitals. Overall, our proposed tumor synthesis method has immense potential to improve the early detection of pancreatic cancer, leading to better patient outcomes., Comment: Big Task Small Data, 1001-AI, MICCAI Workshop, 2023

The ability to dynamically extend a model to new data and classes is critical for multiple organ and tumor segmentation. However, due to privacy regulations, accessing previous data and annotations can be problematic in the medical domain. This poses a significant barrier to preserving the high segmentation accuracy of the old classes when learning from new classes because of the catastrophic forgetting problem. In this paper, we first empirically demonstrate that simply using high-quality pseudo labels can fairly mitigate this problem in the setting of organ segmentation. Furthermore, we put forward an innovative architecture designed specifically for continuous organ and tumor segmentation, which incurs minimal computational overhead. Our proposed design involves replacing the conventional output layer with a suite of lightweight, class-specific heads, thereby offering the flexibility to accommodate newly emerging classes. These heads enable independent predictions for newly introduced and previously learned classes, effectively minimizing the impact of new classes on old ones during the course of continual learning. We further propose incorporating Contrastive Language-Image Pretraining (CLIP) embeddings into the organ-specific heads. These embeddings encapsulate the semantic information of each class, informed by extensive image-text co-training. The proposed method is evaluated on both in-house and public abdominal CT datasets under organ and tumor segmentation tasks. Empirical results suggest that the proposed design improves the segmentation performance of a baseline neural network on newly-introduced and previously-learned classes along the learning trajectory., Comment: MICCAI-2023

Annotating medical images, particularly for organ segmentation, is laborious and time-consuming. For example, annotating an abdominal organ requires an estimated rate of 30-60 minutes per CT volume based on the expertise of an annotator and the size, visibility, and complexity of the organ. Therefore, publicly available datasets for multi-organ segmentation are often limited in data size and organ diversity. This paper proposes an active learning method to expedite the annotation process for organ segmentation and creates the largest multi-organ dataset (by far) with the spleen, liver, kidneys, stomach, gallbladder, pancreas, aorta, and IVC annotated in 8,448 CT volumes, equating to 3.2 million slices. The conventional annotation methods would take an experienced annotator up to 1,600 weeks (or roughly 30.8 years) to complete this task. In contrast, our annotation method has accomplished this task in three weeks (based on an 8-hour workday, five days a week) while maintaining a similar or even better annotation quality. This achievement is attributed to three unique properties of our method: (1) label bias reduction using multiple pre-trained segmentation models, (2) effective error detection in the model predictions, and (3) attention guidance for annotators to make corrections on the most salient errors. Furthermore, we summarize the taxonomy of common errors made by AI algorithms and annotators. This allows for continuous revision of both AI and annotations and significantly reduces the annotation costs required to create large-scale datasets for a wider variety of medical imaging tasks., Comment: Conference on Neural Information Processing Systems (NeurIPS 2023)

In response to innovations in machine learning (ML) models, production workloads changed radically and rapidly. TPU v4 is the fifth Google domain specific architecture (DSA) and its third supercomputer for such ML models. Optical circuit switches (OCSes) dynamically reconfigure its interconnect topology to improve scale, availability, utilization, modularity, deployment, security, power, and performance; users can pick a twisted 3D torus topology if desired. Much cheaper, lower power, and faster than Infiniband, OCSes and underlying optical components are <5% of system cost and <3% of system power. Each TPU v4 includes SparseCores, dataflow processors that accelerate models that rely on embeddings by 5x-7x yet use only 5% of die area and power. Deployed since 2020, TPU v4 outperforms TPU v3 by 2.1x and improves performance/Watt by 2.7x. The TPU v4 supercomputer is 4x larger at 4096 chips and thus ~10x faster overall, which along with OCS flexibility helps large language models. For similar sized systems, it is ~4.3x-4.5x faster than the Graphcore IPU Bow and is 1.2x-1.7x faster and uses 1.3x-1.9x less power than the Nvidia A100. TPU v4s inside the energy-optimized warehouse scale computers of Google Cloud use ~3x less energy and produce ~20x less CO2e than contemporary DSAs in a typical on-premise data center., Comment: 15 pages; 16 figures; to be published at ISCA 2023 (the International Symposium on Computer Architecture)

We demonstrate that AI models can accurately segment liver tumors without the need for manual annotation by using synthetic tumors in CT scans. Our synthetic tumors have two intriguing advantages: (I) realistic in shape and texture, which even medical professionals can confuse with real tumors; (II) effective for training AI models, which can perform liver tumor segmentation similarly to the model trained on real tumors -- this result is exciting because no existing work, using synthetic tumors only, has thus far reached a similar or even close performance to real tumors. This result also implies that manual efforts for annotating tumors voxel by voxel (which took years to create) can be significantly reduced in the future. Moreover, our synthetic tumors can automatically generate many examples of small (or even tiny) synthetic tumors and have the potential to improve the success rate of detecting small liver tumors, which is critical for detecting the early stages of cancer. In addition to enriching the training data, our synthesizing strategy also enables us to rigorously assess the AI robustness., Comment: CVPR 2023

An increasing number of public datasets have shown a marked impact on automated organ segmentation and tumor detection. However, due to the small size and partially labeled problem of each dataset, as well as a limited investigation of diverse types of tumors, the resulting models are often limited to segmenting specific organs/tumors and ignore the semantics of anatomical structures, nor can they be extended to novel domains. To address these issues, we propose the CLIP-Driven Universal Model, which incorporates text embedding learned from Contrastive Language-Image Pre-training (CLIP) to segmentation models. This CLIP-based label encoding captures anatomical relationships, enabling the model to learn a structured feature embedding and segment 25 organs and 6 types of tumors. The proposed model is developed from an assembly of 14 datasets, using a total of 3,410 CT scans for training and then evaluated on 6,162 external CT scans from 3 additional datasets. We rank first on the Medical Segmentation Decathlon (MSD) public leaderboard and achieve state-of-the-art results on Beyond The Cranial Vault (BTCV). Additionally, the Universal Model is computationally more efficient (6x faster) compared with dataset-specific models, generalized better to CT scans from varying sites, and shows stronger transfer learning performance on novel tasks., Comment: ICCV-2023; Rank first in Medical Segmentation Decathlon (MSD) Competition

We develop a novel strategy to generate synthetic tumors. Unlike existing works, the tumors generated by our strategy have two intriguing advantages: (1) realistic in shape and texture, which even medical professionals can confuse with real tumors; (2) effective for AI model training, which can perform liver tumor segmentation similarly to a model trained on real tumors - this result is unprecedented because no existing work, using synthetic tumors only, has thus far reached a similar or even close performance to the model trained on real tumors. This result also implies that manual efforts for developing per-voxel annotation of tumors (which took years to create) can be considerably reduced for training AI models in the future. Moreover, our synthetic tumors have the potential to improve the success rate of small tumor detection by automatically generating enormous examples of small (or tiny) synthetic tumors., Comment: NeurIPS Workshop on Medical Imaging Meets NeurIPS, 2022

Vision Transformer (ViT) has become one of the most popular neural architectures due to its great scalability, computational efficiency, and compelling performance in many vision tasks. However, ViT has shown inferior performance to Convolutional Neural Network (CNN) on medical tasks due to its data-hungry nature and the lack of annotated medical data. In this paper, we pre-train ViTs on 266,340 chest X-rays using Masked Autoencoders (MAE) which reconstruct missing pixels from a small part of each image. For comparison, CNNs are also pre-trained on the same 266,340 X-rays using advanced self-supervised methods (e.g., MoCo v2). The results show that our pre-trained ViT performs comparably (sometimes better) to the state-of-the-art CNN (DenseNet-121) for multi-label thorax disease classification. This performance is attributed to the strong recipes extracted from our empirical studies for pre-training and fine-tuning ViT. The pre-training recipe signifies that medical reconstruction requires a much smaller proportion of an image (10% vs. 25%) and a more moderate random resized crop range (0.5~1.0 vs. 0.2~1.0) compared with natural imaging. Furthermore, we remark that in-domain transfer learning is preferred whenever possible. The fine-tuning recipe discloses that layer-wise LR decay, RandAug magnitude, and DropPath rate are significant factors to consider. We hope that this study can direct future research on the application of Transformers to a larger variety of medical imaging tasks., Comment: IEEE/CVF Winter Conference on Applications of Computer Vision (WACV 2023)

Active learning promises to improve annotation efficiency by iteratively selecting the most important data to be annotated first. However, we uncover a striking contradiction to this promise: active learning fails to select data as efficiently as random selection at the first few choices. We identify this as the cold start problem in vision active learning, caused by a biased and outlier initial query. This paper seeks to address the cold start problem by exploiting the three advantages of contrastive learning: (1) no annotation is required; (2) label diversity is ensured by pseudo-labels to mitigate bias; (3) typical data is determined by contrastive features to reduce outliers. Experiments are conducted on CIFAR-10-LT and three medical imaging datasets (i.e. Colon Pathology, Abdominal CT, and Blood Cell Microscope). Our initial query not only significantly outperforms existing active querying strategies but also surpasses random selection by a large margin. We foresee our solution to the cold start problem as a simple yet strong baseline to choose the initial query for vision active learning. Code is available: https://github.com/c-liangyu/CSVAL

Shape information is a strong and valuable prior in segmenting organs in medical images. However, most current deep learning based segmentation algorithms have not taken shape information into consideration, which can lead to bias towards texture. We aim at modeling shape explicitly and using it to help medical image segmentation. Previous methods proposed Variational Autoencoder (VAE) based models to learn the distribution of shape for a particular organ and used it to automatically evaluate the quality of a segmentation prediction by fitting it into the learned shape distribution. Based on which we aim at incorporating VAE into current segmentation pipelines. Specifically, we propose a new unsupervised domain adaptation pipeline based on a pseudo loss and a VAE reconstruction loss under a teacher-student learning paradigm. Both losses are optimized simultaneously and, in return, boost the segmentation task performance. Extensive experiments on three public Pancreas segmentation datasets as well as two in-house Pancreas segmentation datasets show consistent improvements with at least 2.8 points gain in the Dice score, demonstrating the effectiveness of our method in challenging unsupervised domain adaptation scenarios for medical image segmentation. We hope this work will advance shape analysis and geometric learning in medical imaging., Comment: Accepted to MIDL 2022 (15 pages, 6 figures)

In medical image analysis, transfer learning is a powerful method for deep neural networks (DNNs) to generalize well on limited medical data. Prior efforts have focused on developing pre-training algorithms on domains such as lung ultrasound, chest X-ray, and liver CT to bridge domain gaps. However, we find that model fine-tuning also plays a crucial role in adapting medical knowledge to target tasks. The common fine-tuning method is manually picking transferable layers (e.g., the last few layers) to update, which is labor-expensive. In this work, we propose a meta-learning-based LR tuner, named MetaLR, to make different layers automatically co-adapt to downstream tasks based on their transferabilities across domains. MetaLR learns appropriate LRs for different layers in an online manner, preventing highly transferable layers from forgetting their medical representation abilities and driving less transferable layers to adapt actively to new domains. Extensive experiments on various medical applications show that MetaLR outperforms previous state-of-the-art (SOTA) fine-tuning strategies. Codes are released., Comment: MICCAI 2023

Large language models have been shown to achieve remarkable performance across a variety of natural language tasks using few-shot learning, which drastically reduces the number of task-specific training examples needed to adapt the model to a particular application. To further our understanding of the impact of scale on few-shot learning, we trained a 540-billion parameter, densely activated, Transformer language model, which we call Pathways Language Model PaLM. We trained PaLM on 6144 TPU v4 chips using Pathways, a new ML system which enables highly efficient training across multiple TPU Pods. We demonstrate continued benefits of scaling by achieving state-of-the-art few-shot learning results on hundreds of language understanding and generation benchmarks. On a number of these tasks, PaLM 540B achieves breakthrough performance, outperforming the finetuned state-of-the-art on a suite of multi-step reasoning tasks, and outperforming average human performance on the recently released BIG-bench benchmark. A significant number of BIG-bench tasks showed discontinuous improvements from model scale, meaning that performance steeply increased as we scaled to our largest model. PaLM also has strong capabilities in multilingual tasks and source code generation, which we demonstrate on a wide array of benchmarks. We additionally provide a comprehensive analysis on bias and toxicity, and study the extent of training data memorization with respect to model scale. Finally, we discuss the ethical considerations related to large language models and discuss potential mitigation strategies.

Recently, large pre-trained models have significantly improved the performance of various Natural LanguageProcessing (NLP) tasks but they are expensive to serve due to long serving latency and large memory usage. To compress these models, knowledge distillation has attracted an increasing amount of interest as one of the most effective methods for model compression. However, existing distillation methods have not yet addressed the unique challenges of model serving in datacenters, such as handling fast evolving models, considering serving performance, and optimizing for multiple objectives. To solve these problems, we propose AutoDistill, an end-to-end model distillation framework integrating model architecture exploration and multi-objective optimization for building hardware-efficient NLP pre-trained models. We use Bayesian Optimization to conduct multi-objective Neural Architecture Search for selecting student model architectures. The proposed search comprehensively considers both prediction accuracy and serving latency on target hardware. The experiments on TPUv4i show the finding of seven model architectures with better pre-trained accuracy (up to 3.2% higher) and lower inference latency (up to 1.44x faster) than MobileBERT. By running downstream NLP tasks in the GLUE benchmark, the model distilled for pre-training by AutoDistill with 28.5M parameters achieves an 81.69 average score, which is higher than BERT_BASE, DistillBERT, TinyBERT, NAS-BERT, and MobileBERT. The most compact model found by AutoDistill contains only 20.6M parameters but still outperform BERT_BASE(109M), DistillBERT(67M), TinyBERT(67M), and MobileBERT(25.3M) regarding the average GLUE score. By evaluating on SQuAD, a model found by AutoDistill achieves an 88.4% F1 score with 22.8M parameters, which reduces parameters by more than 62% while maintaining higher accuracy than DistillBERT, TinyBERT, and NAS-BERT.

Scaling language models with more data, compute and parameters has driven significant progress in natural language processing. For example, thanks to scaling, GPT-3 was able to achieve strong results on in-context learning tasks. However, training these large dense models requires significant amounts of computing resources. In this paper, we propose and develop a family of language models named GLaM (Generalist Language Model), which uses a sparsely activated mixture-of-experts architecture to scale the model capacity while also incurring substantially less training cost compared to dense variants. The largest GLaM has 1.2 trillion parameters, which is approximately 7x larger than GPT-3. It consumes only 1/3 of the energy used to train GPT-3 and requires half of the computation flops for inference, while still achieving better overall zero-shot and one-shot performance across 29 NLP tasks., Comment: Accepted to ICML 2022

Recent advances in automated skin cancer diagnosis have yielded performance on par with board-certified dermatologists. However, these approaches formulated skin cancer diagnosis as a simple classification task, dismissing the potential benefit from lesion segmentation. We argue that an accurate lesion segmentation can supplement the classification task with additive lesion information, such as asymmetry, border, intensity, and physical size; in turn, a faithful lesion classification can support the segmentation task with discriminant lesion features. To this end, this paper proposes a new multi-task framework, named MT-TransUNet, which is capable of segmenting and classifying skin lesions collaboratively by mediating multi-task tokens in Transformers. Furthermore, we have introduced dual-task and attended region consistency losses to take advantage of those images without pixel-level annotation, ensuring the model's robustness when it encounters the same image with an account of augmentation. Our MT-TransUNet exceeds the previous state of the art for lesion segmentation and classification tasks in ISIC-2017 and PH2; more importantly, it preserves compelling computational efficiency regarding model parameters (48M~vs.~130M) and inference speed (0.17s~vs.~2.02s per image). Code will be available at https://github.com/JingyeChen/MT-TransUNet., Comment: A technical report. Code will be released

Radiography imaging protocols focus on particular body regions, therefore producing images of great similarity and yielding recurrent anatomical structures across patients. To exploit this structured information, we propose the use of Space-aware Memory Queues for In-painting and Detecting anomalies from radiography images (abbreviated as SQUID). We show that SQUID can taxonomize the ingrained anatomical structures into recurrent patterns; and in the inference, it can identify anomalies (unseen/modified patterns) in the image. SQUID surpasses 13 state-of-the-art methods in unsupervised anomaly detection by at least 5 points on two chest X-ray benchmark datasets measured by the Area Under the Curve (AUC). Additionally, we have created a new dataset (DigitAnatomy), which synthesizes the spatial correlation and consistent shape in chest anatomy. We hope DigitAnatomy can prompt the development, evaluation, and interpretability of anomaly detection methods., Comment: CVPR 2023

Semi-supervised video action recognition tends to enable deep neural networks to achieve remarkable performance even with very limited labeled data. However, existing methods are mainly transferred from current image-based methods (e.g., FixMatch). Without specifically utilizing the temporal dynamics and inherent multimodal attributes, their results could be suboptimal. To better leverage the encoded temporal information in videos, we introduce temporal gradient as an additional modality for more attentive feature extraction in this paper. To be specific, our method explicitly distills the fine-grained motion representations from temporal gradient (TG) and imposes consistency across different modalities (i.e., RGB and TG). The performance of semi-supervised action recognition is significantly improved without additional computation or parameters during inference. Our method achieves the state-of-the-art performance on three video action recognition benchmarks (i.e., Kinetics-400, UCF-101, and HMDB-51) under several typical semi-supervised settings (i.e., different ratios of labeled data)., Comment: CVPR 2022

We summarize the results of a host of efforts using giant automatic speech recognition (ASR) models pre-trained using large, diverse unlabeled datasets containing approximately a million hours of audio. We find that the combination of pre-training, self-training and scaling up model size greatly increases data efficiency, even for extremely large tasks with tens of thousands of hours of labeled data. In particular, on an ASR task with 34k hours of labeled data, by fine-tuning an 8 billion parameter pre-trained Conformer model we can match state-of-the-art (SoTA) performance with only 3% of the training data and significantly improve SoTA with the full training set. We also report on the universal benefits gained from using big pre-trained and self-trained models for a large set of downstream tasks that cover a wide range of speech domains and span multiple orders of magnitudes of dataset sizes, including obtaining SoTA performance on many public benchmarks. In addition, we utilize the learned representation of pre-trained networks to achieve SoTA results on non-ASR tasks., Comment: 14 pages, 7 figures, 13 tables; v2: minor corrections, reference baselines and bibliography updated; v3: corrections based on reviewer feedback, bibliography updated

The success of deep learning relies heavily on large labeled datasets, but we often only have access to several small datasets associated with partial labels. To address this problem, we propose a new initiative, "Label-Assemble", that aims to unleash the full potential of partial labels from an assembly of public datasets. We discovered that learning from negative examples facilitates both computer-aided disease diagnosis and detection. This discovery will be particularly crucial in novel disease diagnosis, where positive examples are hard to collect, yet negative examples are relatively easier to assemble. For example, assembling existing labels from NIH ChestX-ray14 (available since 2017) significantly improves the accuracy of COVID-19 diagnosis from 96.3% to 99.3%. In addition to diagnosis, assembling labels can also improve disease detection, e.g., the detection of pancreatic ductal adenocarcinoma (PDAC) can greatly benefit from leveraging the labels of Cysts and PanNets (two other types of pancreatic abnormalities), increasing sensitivity from 52.1% to 84.0% while maintaining a high specificity of 98.0%., Comment: ISBI 2023

Pulmonary embolism (PE) represents a thrombus ("blood clot"), usually originating from a lower extremity vein, that travels to the blood vessels in the lung, causing vascular obstruction and in some patients, death. This disorder is commonly diagnosed using CT pulmonary angiography (CTPA). Deep learning holds great promise for the computer-aided CTPA diagnosis (CAD) of PE. However, numerous competing methods for a given task in the deep learning literature exist, causing great confusion regarding the development of a CAD PE system. To address this confusion, we present a comprehensive analysis of competing deep learning methods applicable to PE diagnosis using CTPA at the both image and exam levels. At the image level, we compare convolutional neural networks (CNNs) with vision transformers, and contrast self-supervised learning (SSL) with supervised learning, followed by an evaluation of transfer learning compared with training from scratch. At the exam level, we focus on comparing conventional classification (CC) with multiple instance learning (MIL). Our extensive experiments consistently show: (1) transfer learning consistently boosts performance despite differences between natural images and CT scans, (2) transfer learning with SSL surpasses its supervised counterparts; (3) CNNs outperform vision transformers, which otherwise show satisfactory performance; and (4) CC is, surprisingly, superior to MIL. Compared with the state of the art, our optimal approach provides an AUC gain of 0.2\% and 1.05\% for image-level and exam-level, respectively.

Batch normalization (BN) uniformly shifts and scales the activations based on the statistics of a batch of images. However, the intensity distribution of the background pixels often dominates the BN statistics because the background accounts for a large proportion of the entire image. This paper focuses on enhancing BN with the intensity distribution of foreground pixels, the one that really matters for image segmentation. We propose a new normalization strategy, named categorical normalization (CateNorm), to normalize the activations according to categorical statistics. The categorical statistics are obtained by dynamically modulating specific regions in an image that belong to the foreground. CateNorm demonstrates both precise and robust segmentation results across five public datasets obtained from different domains, covering complex and variable data distributions. It is attributable to the ability of CateNorm to capture domain-invariant information from multiple domains (institutions) of medical data. Code is available at https://github.com/lambert-x/CateNorm., Comment: Accepted by MICCAI 2022 Workshop on Domain Adaptation and Representation Transfer (DART)

This paper introduces a new concept called "transferable visual words" (TransVW), aiming to achieve annotation efficiency for deep learning in medical image analysis. Medical imaging--focusing on particular parts of the body for defined clinical purposes--generates images of great similarity in anatomy across patients and yields sophisticated anatomical patterns across images, which are associated with rich semantics about human anatomy and which are natural visual words. We show that these visual words can be automatically harvested according to anatomical consistency via self-discovery, and that the self-discovered visual words can serve as strong yet free supervision signals for deep models to learn semantics-enriched generic image representation via self-supervision (self-classification and self-restoration). Our extensive experiments demonstrate the annotation efficiency of TransVW by offering higher performance and faster convergence with reduced annotation cost in several applications. Our TransVW has several important advantages, including (1) TransVW is a fully autodidactic scheme, which exploits the semantics of visual words for self-supervised learning, requiring no expert annotation; (2) visual word learning is an add-on strategy, which complements existing self-supervised methods, boosting their performance; and (3) the learned image representation is semantics-enriched models, which have proven to be more robust and generalizable, saving annotation efforts for a variety of applications through transfer learning. Our code, pre-trained models, and curated visual words are available at https://github.com/JLiangLab/TransVW., Comment: Journal version of arXiv:2007.06959, accepted by IEEE Transactions on Medical Imaging (TMI)

Medical images are naturally associated with rich semantics about the human anatomy, reflected in an abundance of recurring anatomical patterns, offering unique potential to foster deep semantic representation learning and yield semantically more powerful models for different medical applications. But how exactly such strong yet free semantics embedded in medical images can be harnessed for self-supervised learning remains largely unexplored. To this end, we train deep models to learn semantically enriched visual representation by self-discovery, self-classification, and self-restoration of the anatomy underneath medical images, resulting in a semantics-enriched, general-purpose, pre-trained 3D model, named Semantic Genesis. We examine our Semantic Genesis with all the publicly-available pre-trained models, by either self-supervision or fully supervision, on the six distinct target tasks, covering both classification and segmentation in various medical modalities (i.e.,CT, MRI, and X-ray). Our extensive experiments demonstrate that Semantic Genesis significantly exceeds all of its 3D counterparts as well as the de facto ImageNet-based transfer learning in 2D. This performance is attributed to our novel self-supervised learning framework, encouraging deep models to learn compelling semantic representation from abundant anatomical patterns resulting from consistent anatomies embedded in medical images. Code and pre-trained Semantic Genesis are available at https://github.com/JLiangLab/SemanticGenesis ., Comment: International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2020)

Transfer learning from natural images to medical images has been established as one of the most practical paradigms in deep learning for medical image analysis. To fit this paradigm, however, 3D imaging tasks in the most prominent imaging modalities (e.g., CT and MRI) have to be reformulated and solved in 2D, losing rich 3D anatomical information, thereby inevitably compromising its performance. To overcome this limitation, we have built a set of models, called Generic Autodidactic Models, nicknamed Models Genesis, because they are created ex nihilo (with no manual labeling), self-taught (learnt by self-supervision), and generic (served as source models for generating application-specific target models). Our extensive experiments demonstrate that our Models Genesis significantly outperform learning from scratch and existing pre-trained 3D models in all five target 3D applications covering both segmentation and classification. More importantly, learning a model from scratch simply in 3D may not necessarily yield performance better than transfer learning from ImageNet in 2D, but our Models Genesis consistently top any 2D/2.5D approaches including fine-tuning the models pre-trained from ImageNet as well as fine-tuning the 2D versions of our Models Genesis, confirming the importance of 3D anatomical information and significance of Models Genesis for 3D medical imaging. This performance is attributed to our unified self-supervised learning framework, built on a simple yet powerful observation: the sophisticated and recurrent anatomy in medical images can serve as strong yet free supervision signals for deep models to learn common anatomical representation automatically via self-supervision. As open science, all codes and pre-trained Models Genesis are available at https://github.com/MrGiovanni/ModelsGenesis., Comment: Journal version of arXiv:1908.06912, accepted by Medical Image Analysis

The state-of-the-art models for medical image segmentation are variants of U-Net and fully convolutional networks (FCN). Despite their success, these models have two limitations: (1) their optimal depth is apriori unknown, requiring extensive architecture search or inefficient ensemble of models of varying depths; and (2) their skip connections impose an unnecessarily restrictive fusion scheme, forcing aggregation only at the same-scale feature maps of the encoder and decoder sub-networks. To overcome these two limitations, we propose UNet++, a new neural architecture for semantic and instance segmentation, by (1) alleviating the unknown network depth with an efficient ensemble of U-Nets of varying depths, which partially share an encoder and co-learn simultaneously using deep supervision; (2) redesigning skip connections to aggregate features of varying semantic scales at the decoder sub-networks, leading to a highly flexible feature fusion scheme; and (3) devising a pruning scheme to accelerate the inference speed of UNet++. We have evaluated UNet++ using six different medical image segmentation datasets, covering multiple imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and electron microscopy (EM), and demonstrating that (1) UNet++ consistently outperforms the baseline models for the task of semantic segmentation across different datasets and backbone architectures; (2) UNet++ enhances segmentation quality of varying-size objects -- an improvement over the fixed-depth U-Net; (3) Mask RCNN++ (Mask R-CNN with UNet++ design) outperforms the original Mask R-CNN for the task of instance segmentation; and (4) pruned UNet++ models achieve significant speedup while showing only modest performance degradation. Our implementation and pre-trained models are available at https://github.com/MrGiovanni/UNetPlusPlus., Comment: Journal of IEEE Transactions on Medical Imaging

The recent submission of Google TPU-v3 Pods to the industry wide MLPerf v0.6 training benchmark demonstrates the scalability of a suite of industry relevant ML models. MLPerf defines a suite of models, datasets and rules to follow when benchmarking to ensure results are comparable across hardware, frameworks and companies. Using this suite of models, we discuss the optimizations and techniques including choice of optimizer, spatial partitioning and weight update sharding necessary to scale to 1024 TPU chips. Furthermore, we identify properties of models that make scaling them challenging, such as limited data parallelism and unscaled weights. These optimizations contribute to record performance in transformer, Resnet-50 and SSD in the Google MLPerf-0.6 submission.

Transfer learning from natural image to medical image has established as one of the most practical paradigms in deep learning for medical image analysis. However, to fit this paradigm, 3D imaging tasks in the most prominent imaging modalities (e.g., CT and MRI) have to be reformulated and solved in 2D, losing rich 3D anatomical information and inevitably compromising the performance. To overcome this limitation, we have built a set of models, called Generic Autodidactic Models, nicknamed Models Genesis, because they are created ex nihilo (with no manual labeling), self-taught (learned by self-supervision), and generic (served as source models for generating application-specific target models). Our extensive experiments demonstrate that our Models Genesis significantly outperform learning from scratch in all five target 3D applications covering both segmentation and classification. More importantly, learning a model from scratch simply in 3D may not necessarily yield performance better than transfer learning from ImageNet in 2D, but our Models Genesis consistently top any 2D approaches including fine-tuning the models pre-trained from ImageNet as well as fine-tuning the 2D versions of our Models Genesis, confirming the importance of 3D anatomical information and significance of our Models Genesis for 3D medical imaging. This performance is attributed to our unified self-supervised learning framework, built on a simple yet powerful observation: the sophisticated yet recurrent anatomy in medical images can serve as strong supervision signals for deep models to learn common anatomical representation automatically via self-supervision. As open science, all pre-trained Models Genesis are available at https://github.com/MrGiovanni/ModelsGenesis., Comment: International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI)

Generative adversarial networks (GANs) have ushered in a revolution in image-to-image translation. The development and proliferation of GANs raises an interesting question: can we train a GAN to remove an object, if present, from an image while otherwise preserving the image? Specifically, can a GAN "virtually heal" anyone by turning his medical image, with an unknown health status (diseased or healthy), into a healthy one, so that diseased regions could be revealed by subtracting those two images? Such a task requires a GAN to identify a minimal subset of target pixels for domain translation, an ability that we call fixed-point translation, which no GAN is equipped with yet. Therefore, we propose a new GAN, called Fixed-Point GAN, trained by (1) supervising same-domain translation through a conditional identity loss, and (2) regularizing cross-domain translation through revised adversarial, domain classification, and cycle consistency loss. Based on fixed-point translation, we further derive a novel framework for disease detection and localization using only image-level annotation. Qualitative and quantitative evaluations demonstrate that the proposed method outperforms the state of the art in multi-domain image-to-image translation and that it surpasses predominant weakly-supervised localization methods in both disease detection and localization. Implementation is available at https://github.com/jlianglab/Fixed-Point-GAN.