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With the advancement of deep learning techniques, an increasing number of methods have been proposed for optic disc and cup (OD/OC) segmentation from the fundus images. Clinically, OD/OC segmentation is often annotated by multiple clinical experts to mitigate the personal bias. However, it is hard to train the automated deep learning models on multiple labels. A common practice to tackle the issue is majority vote, e.g., taking the average of multiple labels. However such a strategy ignores the different expertness of medical experts. Motivated by the observation that OD/OC segmentation is often used for the glaucoma diagnosis clinically, in this paper, we propose a novel strategy to fuse the multi-rater OD/OC segmentation labels via the glaucoma diagnosis performance. Specifically, we assess the expertness of each rater through an attentive glaucoma diagnosis network. For each rater, its contribution for the diagnosis will be reflected as an expertness map. To ensure the expertness maps are general for different glaucoma diagnosis models, we further propose an Expertness Generator (ExpG) to eliminate the high-frequency components in the optimization process. Based on the obtained expertness maps, the multi-rater labels can be fused as a single ground-truth which we dubbed as Diagnosis First Ground-truth (DiagFirstGT). Experimental results show that by using DiagFirstGT as ground-truth, OD/OC segmentation networks will predict the masks with superior glaucoma diagnosis performance., Comment: MICCAI 2022

The segmentation of optic disc(OD) and optic cup(OC) from fundus images is an important fundamental task for glaucoma diagnosis. In the clinical practice, it is often necessary to collect opinions from multiple experts to obtain the final OD/OC annotation. This clinical routine helps to mitigate the individual bias. But when data is multiply annotated, standard deep learning models will be inapplicable. In this paper, we propose a novel neural network framework to learn OD/OC segmentation from multi-rater annotations. The segmentation results are self-calibrated through the iterative optimization of multi-rater expertness estimation and calibrated OD/OC segmentation. In this way, the proposed method can realize a mutual improvement of both tasks and finally obtain a refined segmentation result. Specifically, we propose Diverging Model(DivM) and Converging Model(ConM) to process the two tasks respectively. ConM segments the raw image based on the multi-rater expertness map provided by DivM. DivM generates multi-rater expertness map from the segmentation mask provided by ConM. The experiment results show that by recurrently running ConM and DivM, the results can be self-calibrated so as to outperform a range of state-of-the-art(SOTA) multi-rater segmentation methods.

Clinically, the accurate annotation of lesions/tissues can significantly facilitate the disease diagnosis. For example, the segmentation of optic disc/cup (OD/OC) on fundus image would facilitate the glaucoma diagnosis, the segmentation of skin lesions on dermoscopic images is helpful to the melanoma diagnosis, etc. With the advancement of deep learning techniques, a wide range of methods proved the lesions/tissues segmentation can also facilitate the automated disease diagnosis models. However, existing methods are limited in the sense that they can only capture static regional correlations in the images. Inspired by the global and dynamic nature of Vision Transformer, in this paper, we propose Segmentation-Assisted diagnosis Transformer (SeATrans) to transfer the segmentation knowledge to the disease diagnosis network. Specifically, we first propose an asymmetric multi-scale interaction strategy to correlate each single low-level diagnosis feature with multi-scale segmentation features. Then, an effective strategy called SeA-block is adopted to vitalize diagnosis feature via correlated segmentation features. To model the segmentation-diagnosis interaction, SeA-block first embeds the diagnosis feature based on the segmentation information via the encoder, and then transfers the embedding back to the diagnosis feature space by a decoder. Experimental results demonstrate that SeATrans surpasses a wide range of state-of-the-art (SOTA) segmentation-assisted diagnosis methods on several disease diagnosis tasks.

Pre-training is essential to deep learning model performance, especially in medical image analysis tasks where limited training data are available. However, existing pre-training methods are inflexible as the pre-trained weights of one model cannot be reused by other network architectures. In this paper, we propose an architecture-irrelevant hyper-initializer, which can initialize any given network architecture well after being pre-trained for only once. The proposed initializer is a hypernetwork which takes a downstream architecture as input graphs and outputs the initialization parameters of the respective architecture. We show the effectiveness and efficiency of the hyper-initializer through extensive experimental results on multiple medical imaging modalities, especially in data-limited fields. Moreover, we prove that the proposed algorithm can be reused as a favorable plug-and-play initializer for any downstream architecture and task (both classification and segmentation) of the same modality.

Deep learning based medical imaging classification models usually suffer from the domain shift problem, where the classification performance drops when training data and real-world data differ in imaging equipment manufacturer, image acquisition protocol, patient populations, etc. We propose Feature Centroid Contrast Learning (FCCL), which can improve target domain classification performance by extra supervision during training with contrastive loss between instance and class centroid. Compared with current unsupervised domain adaptation and domain generalization methods, FCCL performs better while only requires labeled image data from a single source domain and no target domain. We verify through extensive experiments that FCCL can achieve superior performance on at least three imaging modalities, i.e. fundus photographs, dermatoscopic images, and H & E tissue images.

In object detection, multi-level prediction (e.g., FPN) and reweighting skills (e.g., focal loss) have drastically improved one-stage detector performance. However, the synergy between these two techniques is not fully explored in a unified framework. We find that, during training, the one-stage detector's optimization is not only restricted to the static hard-case mining loss (gradient drift) but also suffered from the diverse positive samples' proportions split by different pyramid levels (level discrepancy). Under this concern, we propose Hierarchical Progressive Focus (HPF) consisting of two key designs: 1) progressive focus, a more flexible hard-case mining setting calculated adaptive to the convergence progress, 2) hierarchical sampling, automatically generating a set of progressive focus for level-specific target optimization. Based on focal loss with ATSS-R50, our approach achieves 40.5 AP, surpassing the state-of-the-art QFL (Quality Focal Loss, 39.9 AP) and VFL (Varifocal Loss, 40.1 AP). Our best model achieves 55.1 AP on COCO test-dev, obtaining excellent results with only a typical training setting. Moreover, as a plug-and-play scheme, HPF can cooperate well with recent advances, providing a stable performance improvement on nine mainstream detectors.

Weiwei Liu,1,* Hua Shao,2,* Jing Liao,1 Dalu Yang,1 Maoliang Ma,3 Jianli Yang2 1Tianjin Medical University, Tianjin, People’s Republic of China; 2Clinical Psychology Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 3Tianjin Medical University General Hospital Airport Site, Tianjin, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianli YangClinical Psychology Department, Tianjin Medical University General Hospital, Anshan Road #154, Heping District, Tianjin, People’s Republic of ChinaEmail adyy005@163.comPurpose: Examining whether modulation of right orbitofrontal cortex (OFC) activity by continuous theta-burst stimulation (cTBS) affects obsessive-compulsive disorder (OCD) symptoms.Patients and Methods: A total of 28 treatment-resistant OCD participants were treated with either active or sham cTBS of the OFC twice per day, for five days a week, for 2 weeks, in a double-blinded manner. Clinical response to treatment was determined using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS).Results: There were no statistically significant differences between the 2 groups after two weeks of treatment in the Yale–Brown Obsessive-Compulsive Scale score (group*time interaction, F2,20=0.996, p=0.387) and other secondary outcome measures, including anxiety symptoms and responder rates. Depressive symptoms improved significantly in the active group (p=0.027), but the significant difference disappeared at 6 weeks (p=0.089).Conclusion: This is the first randomized controlled study using cTBS in the right OFC to observe the improvement of treatment-resistant OCD symptoms. It is safe to use cTBS, but 2 weeks of treatment is not enough to achieve a curative effect. Future studies are needed to explore more advanced stimulation parameters suitable for the treatment of OCD.Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2000034814.Keywords

Diabetic retinopathy (DR) grading from fundus images has attracted increasing interest in both academic and industrial communities. Most convolutional neural network (CNN) based algorithms treat DR grading as a classification task via image-level annotations. However, these algorithms have not fully explored the valuable information in the DR-related lesions. In this paper, we present a robust framework, which collaboratively utilizes patch-level and image-level annotations, for DR severity grading. By an end-to-end optimization, this framework can bi-directionally exchange the fine-grained lesion and image-level grade information. As a result, it exploits more discriminative features for DR grading. The proposed framework shows better performance than the recent state-of-the-art algorithms and three clinical ophthalmologists with over nine years of experience. By testing on datasets of different distributions (such as label and camera), we prove that our algorithm is robust when facing image quality and distribution variations that commonly exist in real-world practice. We inspect the proposed framework through extensive ablation studies to indicate the effectiveness and necessity of each motivation. The code and some valuable annotations are now publicly available.

There are extensive researches focusing on automated diabetic reti-nopathy (DR) detection from fundus images. However, the accuracy drop is ob-served when applying these models in real-world DR screening, where the fun-dus camera brands are different from the ones used to capture the training im-ages. How can we train a classification model on labeled fundus images ac-quired from only one camera brand, yet still achieves good performance on im-ages taken by other brands of cameras? In this paper, we quantitatively verify the impact of fundus camera brands related domain shift on the performance of DR classification models, from an experimental perspective. Further, we pro-pose camera-oriented residual-CycleGAN to mitigate the camera brand differ-ence by domain adaptation and achieve increased classification performance on target camera images. Extensive ablation experiments on both the EyePACS da-taset and a private dataset show that the camera brand difference can signifi-cantly impact the classification performance and prove that our proposed meth-od can effectively improve the model performance on the target domain. We have inferred and labeled the camera brand for each image in the EyePACS da-taset and will publicize the camera brand labels for further research on domain adaptation.