Masked autoencoders (MAEs) have displayed significant potential in the classification and semantic segmentation of medical images in the last year. Due to the high similarity of human tissues, even slight changes in medical images may represent diseased tissues, necessitating fine-grained inspection to pinpoint diseased tissues. The random masking strategy of MAEs is likely to result in areas of lesions being overlooked by the model. At the same time, inconsistencies between the pre-training and fine-tuning phases impede the performance and efficiency of MAE in medical image classification. To address these issues, we propose a medical supervised masked autoencoder (MSMAE) in this paper. In the pre-training phase, MSMAE precisely masks medical images via the attention maps obtained from supervised training, contributing to the representation learning of human tissue in the lesion area. During the fine-tuning phase, MSMAE is also driven by attention to the accurate masking of medical images. This improves the computational efficiency of the MSMAE while increasing the difficulty of fine-tuning, which indirectly improves the quality of MSMAE medical diagnosis. Extensive experiments demonstrate that MSMAE achieves state-of-the-art performance in case with three official medical datasets for various diseases. Meanwhile, transfer learning for MSMAE also demonstrates the great potential of our approach for medical semantic segmentation tasks. Moreover, the MSMAE accelerates the inference time in the fine-tuning phase by 11.2% and reduces the number of floating-point operations (FLOPs) by 74.08% compared to a traditional MAE.
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Deep learning has been widely used in medical image segmentation and other aspects. However, the performance of existing medical image segmentation models has been limited by the challenge of obtaining sufficient high-quality labeled data due to the prohibitive data annotation cost. To alleviate this limitation, we propose a new text-augmented medical image segmentation model LViT (Language meets Vision Transformer). In our LViT model, medical text annotation is incorporated to compensate for the quality deficiency in image data. In addition, the text information can guide to generate pseudo labels of improved quality in the semi-supervised learning. We also propose an Exponential Pseudo label Iteration mechanism (EPI) to help the Pixel-Level Attention Module (PLAM) preserve local image features in semi-supervised LViT setting. In our model, LV (Language-Vision) loss is designed to supervise the training of unlabeled images using text information directly. For evaluation, we construct three multimodal medical segmentation datasets (image + text) containing X-rays and CT images. Experimental results show that our proposed LViT has superior segmentation performance in both fully-supervised and semi-supervised setting. The code and datasets are available at //github.com/HUANGLIZI/LViT.
Semi-supervised learning has demonstrated great potential in medical image segmentation by utilizing knowledge from unlabeled data. However, most existing approaches do not explicitly capture high-level semantic relations between distant regions, which limits their performance. In this paper, we focus on representation learning for semi-supervised learning, by developing a novel Multi-Scale Cross Supervised Contrastive Learning (MCSC) framework, to segment structures in medical images. We jointly train CNN and Transformer models, regularising their features to be semantically consistent across different scales. Our approach contrasts multi-scale features based on ground-truth and cross-predicted labels, in order to extract robust feature representations that reflect intra- and inter-slice relationships across the whole dataset. To tackle class imbalance, we take into account the prevalence of each class to guide contrastive learning and ensure that features adequately capture infrequent classes. Extensive experiments on two multi-structure medical segmentation datasets demonstrate the effectiveness of MCSC. It not only outperforms state-of-the-art semi-supervised methods by more than 3.0% in Dice, but also greatly reduces the performance gap with fully supervised methods.
In this paper we delve into the properties of transformers, attained through self-supervision, in the point cloud domain. Specifically, we evaluate the effectiveness of Masked Autoencoding as a pretraining scheme, and explore Momentum Contrast as an alternative. In our study we investigate the impact of data quantity on the learned features, and uncover similarities in the transformer's behavior across domains. Through comprehensive visualiations, we observe that the transformer learns to attend to semantically meaningful regions, indicating that pretraining leads to a better understanding of the underlying geometry. Moreover, we examine the finetuning process and its effect on the learned representations. Based on that, we devise an unfreezing strategy which consistently outperforms our baseline without introducing any other modifications to the model or the training pipeline, and achieve state-of-the-art results in the classification task among transformer models.
Time-to-event (TTE) models are used in medicine and other fields for estimating the probability distribution of the time until a specific event occurs. TTE models provide many advantages over classification using fixed time horizons, including naturally handling censored observations, but require more parameters and are challenging to train in settings with limited labeled data. Existing approaches, e.g. proportional hazards or accelerated failure time, employ distributional assumptions to reduce parameters but are vulnerable to model misspecification. In this work, we address these challenges with MOTOR (Many Outcome Time Oriented Representations), a self-supervised model that leverages temporal structure found in collections of timestamped events in electronic health records (EHR) and health insurance claims. MOTOR uses a TTE pretraining objective that predicts the probability distribution of times when events occur, making it well-suited to transfer learning for medical prediction tasks. Having pretrained on EHR and claims data of up to 55M patient records (9B clinical events), we evaluate performance after finetuning for 19 tasks across two datasets. Task-specific models built using MOTOR improve time-dependent C statistics by 4.6% over state-of-the-art while greatly improving sample efficiency, achieving comparable performance to existing methods using only 5% of available task data.
Over the past few years, the rapid development of deep learning technologies for computer vision has greatly promoted the performance of medical image segmentation (MedISeg). However, the recent MedISeg publications usually focus on presentations of the major contributions (e.g., network architectures, training strategies, and loss functions) while unwittingly ignoring some marginal implementation details (also known as "tricks"), leading to a potential problem of the unfair experimental result comparisons. In this paper, we collect a series of MedISeg tricks for different model implementation phases (i.e., pre-training model, data pre-processing, data augmentation, model implementation, model inference, and result post-processing), and experimentally explore the effectiveness of these tricks on the consistent baseline models. Compared to paper-driven surveys that only blandly focus on the advantages and limitation analyses of segmentation models, our work provides a large number of solid experiments and is more technically operable. With the extensive experimental results on both the representative 2D and 3D medical image datasets, we explicitly clarify the effect of these tricks. Moreover, based on the surveyed tricks, we also open-sourced a strong MedISeg repository, where each of its components has the advantage of plug-and-play. We believe that this milestone work not only completes a comprehensive and complementary survey of the state-of-the-art MedISeg approaches, but also offers a practical guide for addressing the future medical image processing challenges including but not limited to small dataset learning, class imbalance learning, multi-modality learning, and domain adaptation. The code has been released at: //github.com/hust-linyi/MedISeg
A key requirement for the success of supervised deep learning is a large labeled dataset - a condition that is difficult to meet in medical image analysis. Self-supervised learning (SSL) can help in this regard by providing a strategy to pre-train a neural network with unlabeled data, followed by fine-tuning for a downstream task with limited annotations. Contrastive learning, a particular variant of SSL, is a powerful technique for learning image-level representations. In this work, we propose strategies for extending the contrastive learning framework for segmentation of volumetric medical images in the semi-supervised setting with limited annotations, by leveraging domain-specific and problem-specific cues. Specifically, we propose (1) novel contrasting strategies that leverage structural similarity across volumetric medical images (domain-specific cue) and (2) a local version of the contrastive loss to learn distinctive representations of local regions that are useful for per-pixel segmentation (problem-specific cue). We carry out an extensive evaluation on three Magnetic Resonance Imaging (MRI) datasets. In the limited annotation setting, the proposed method yields substantial improvements compared to other self-supervision and semi-supervised learning techniques. When combined with a simple data augmentation technique, the proposed method reaches within 8% of benchmark performance using only two labeled MRI volumes for training, corresponding to only 4% (for ACDC) of the training data used to train the benchmark.
Deep neural network architectures have traditionally been designed and explored with human expertise in a long-lasting trial-and-error process. This process requires huge amount of time, expertise, and resources. To address this tedious problem, we propose a novel algorithm to optimally find hyperparameters of a deep network architecture automatically. We specifically focus on designing neural architectures for medical image segmentation task. Our proposed method is based on a policy gradient reinforcement learning for which the reward function is assigned a segmentation evaluation utility (i.e., dice index). We show the efficacy of the proposed method with its low computational cost in comparison with the state-of-the-art medical image segmentation networks. We also present a new architecture design, a densely connected encoder-decoder CNN, as a strong baseline architecture to apply the proposed hyperparameter search algorithm. We apply the proposed algorithm to each layer of the baseline architectures. As an application, we train the proposed system on cine cardiac MR images from Automated Cardiac Diagnosis Challenge (ACDC) MICCAI 2017. Starting from a baseline segmentation architecture, the resulting network architecture obtains the state-of-the-art results in accuracy without performing any trial-and-error based architecture design approaches or close supervision of the hyperparameters changes.
In this paper, we focus on three problems in deep learning based medical image segmentation. Firstly, U-net, as a popular model for medical image segmentation, is difficult to train when convolutional layers increase even though a deeper network usually has a better generalization ability because of more learnable parameters. Secondly, the exponential ReLU (ELU), as an alternative of ReLU, is not much different from ReLU when the network of interest gets deep. Thirdly, the Dice loss, as one of the pervasive loss functions for medical image segmentation, is not effective when the prediction is close to ground truth and will cause oscillation during training. To address the aforementioned three problems, we propose and validate a deeper network that can fit medical image datasets that are usually small in the sample size. Meanwhile, we propose a new loss function to accelerate the learning process and a combination of different activation functions to improve the network performance. Our experimental results suggest that our network is comparable or superior to state-of-the-art methods.
A variety of deep neural networks have been applied in medical image segmentation and achieve good performance. Unlike natural images, medical images of the same imaging modality are characterized by the same pattern, which indicates that same normal organs or tissues locate at similar positions in the images. Thus, in this paper we try to incorporate the prior knowledge of medical images into the structure of neural networks such that the prior knowledge can be utilized for accurate segmentation. Based on this idea, we propose a novel deep network called knowledge-based fully convolutional network (KFCN) for medical image segmentation. The segmentation function and corresponding error is analyzed. We show the existence of an asymptotically stable region for KFCN which traditional FCN doesn't possess. Experiments validate our knowledge assumption about the incorporation of prior knowledge into the convolution kernels of KFCN and show that KFCN can achieve a reasonable segmentation and a satisfactory accuracy.
Medical image segmentation requires consensus ground truth segmentations to be derived from multiple expert annotations. A novel approach is proposed that obtains consensus segmentations from experts using graph cuts (GC) and semi supervised learning (SSL). Popular approaches use iterative Expectation Maximization (EM) to estimate the final annotation and quantify annotator's performance. Such techniques pose the risk of getting trapped in local minima. We propose a self consistency (SC) score to quantify annotator consistency using low level image features. SSL is used to predict missing annotations by considering global features and local image consistency. The SC score also serves as the penalty cost in a second order Markov random field (MRF) cost function optimized using graph cuts to derive the final consensus label. Graph cut obtains a global maximum without an iterative procedure. Experimental results on synthetic images, real data of Crohn's disease patients and retinal images show our final segmentation to be accurate and more consistent than competing methods.
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