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Clinical artificial intelligence (AI) methods have been proposed for predicting social behaviors which could be reasonably understood from patient-reported data. This raises ethical concerns about respect, privacy, and patient awareness/control over how their health data is used. Ethical concerns surrounding clinical AI systems for social behavior verification were divided into three main categories: (1) the use of patient data retrospectively without informed consent for the specific task of verification, (2) the potential for inaccuracies or biases within such systems, and (3) the impact on trust in patient-provider relationships with the introduction of automated AI systems for fact-checking. Additionally, this report showed the simulated misuse of a verification system and identified a potential LLM bias against patient-reported information in favor of multimodal data, published literature, and the outputs of other AI methods (i.e., AI self-trust). Finally, recommendations were presented for mitigating the risk that AI verification systems will cause harm to patients or undermine the purpose of the healthcare system., Comment: 9 pages, 1 figure, 2 tables

Large AI models trained on audio data may have the potential to rapidly classify patients, enhancing medical decision-making and potentially improving outcomes through early detection. Existing technologies depend on limited datasets using expensive recording equipment in high-income, English-speaking countries. This challenges deployment in resource-constrained, high-volume settings where audio data may have a profound impact. This report introduces a novel data type and a corresponding collection system that captures health data through guided questions using only a mobile/web application. This application ultimately results in an audio electronic health record (voice EHR) which may contain complex biomarkers of health from conventional voice/respiratory features, speech patterns, and language with semantic meaning - compensating for the typical limitations of unimodal clinical datasets. This report introduces a consortium of partners for global work, presents the application used for data collection, and showcases the potential of informative voice EHR to advance the scalability and diversity of audio AI., Comment: 19 pages, 2 figures, 7 tables

Blood vessel segmentation in medical imaging is one of the essential steps for vascular disease diagnosis and interventional planning in a broad spectrum of clinical scenarios in image-based medicine and interventional medicine. Unfortunately, manual annotation of the vessel masks is challenging and resource-intensive due to subtle branches and complex structures. To overcome this issue, this paper presents a self-supervised vessel segmentation method, dubbed the contrastive diffusion adversarial representation learning (C-DARL) model. Our model is composed of a diffusion module and a generation module that learns the distribution of multi-domain blood vessel data by generating synthetic vessel images from diffusion latent. Moreover, we employ contrastive learning through a mask-based contrastive loss so that the model can learn more realistic vessel representations. To validate the efficacy, C-DARL is trained using various vessel datasets, including coronary angiograms, abdominal digital subtraction angiograms, and retinal imaging. Experimental results confirm that our model achieves performance improvement over baseline methods with noise robustness, suggesting the effectiveness of C-DARL for vessel segmentation.

In this work, we propose to explicitly use the landmarks of prostate to guide the MR-TRUS image registration. We first train a deep neural network to automatically localize a set of meaningful landmarks, and then directly generate the affine registration matrix from the location of these landmarks. For landmark localization, instead of directly training a network to predict the landmark coordinates, we propose to regress a full-resolution distance map of the landmark, which is demonstrated effective in avoiding statistical bias to unsatisfactory performance and thus improving performance. We then use the predicted landmarks to generate the affine transformation matrix, which outperforms the clinicians' manual rigid registration by a significant margin in terms of TRE., Comment: Submitted to SPIE Medical Imaging 2023

Federated learning (FL) is a distributed machine learning technique that enables collaborative model training while avoiding explicit data sharing. The inherent privacy-preserving property of FL algorithms makes them especially attractive to the medical field. However, in case of heterogeneous client data distributions, standard FL methods are unstable and require intensive hyperparameter tuning to achieve optimal performance. Conventional hyperparameter optimization algorithms are impractical in real-world FL applications as they involve numerous training trials, which are often not affordable with limited compute budgets. In this work, we propose an efficient reinforcement learning (RL)-based federated hyperparameter optimization algorithm, termed Auto-FedRL, in which an online RL agent can dynamically adjust hyperparameters of each client based on the current training progress. Extensive experiments are conducted to investigate different search strategies and RL agents. The effectiveness of the proposed method is validated on a heterogeneous data split of the CIFAR-10 dataset as well as two real-world medical image segmentation datasets for COVID-19 lesion segmentation in chest CT and pancreas segmentation in abdominal CT.

Fusing intra-operative 2D transrectal ultrasound (TRUS) image with pre-operative 3D magnetic resonance (MR) volume to guide prostate biopsy can significantly increase the yield. However, such a multimodal 2D/3D registration problem is a very challenging task. In this paper, we propose an end-to-end frame-to-volume registration network (FVR-Net), which can efficiently bridge the previous research gaps by aligning a 2D TRUS frame with a 3D TRUS volume without requiring hardware tracking. The proposed FVR-Net utilizes a dual-branch feature extraction module to extract the information from TRUS frame and volume to estimate transformation parameters. We also introduce a differentiable 2D slice sampling module which allows gradients backpropagating from an unsupervised image similarity loss for content correspondence learning. Our model shows superior efficiency for real-time interventional guidance with highly competitive registration accuracy., Comment: Early accepted by MICCAI-2021

Prostate cancer biopsy benefits from accurate fusion of transrectal ultrasound (TRUS) and magnetic resonance (MR) images. In the past few years, convolutional neural networks (CNNs) have been proved powerful in extracting image features crucial for image registration. However, challenging applications and recent advances in computer vision suggest that CNNs are quite limited in its ability to understand spatial correspondence between features, a task in which the self-attention mechanism excels. This paper aims to develop a self-attention mechanism specifically for cross-modal image registration. Our proposed cross-modal attention block effectively maps each of the features in one volume to all features in the corresponding volume. Our experimental results demonstrate that a CNN network designed with the cross-modal attention block embedded outperforms an advanced CNN network 10 times of its size. We also incorporated visualization techniques to improve the interpretability of our network. The source code of our work is available at https://github.com/DIAL-RPI/Attention-Reg ., Comment: This paper has been accepted by MICCAI 2021

Federated learning (FL) enables collaborative model training while preserving each participant's privacy, which is particularly beneficial to the medical field. FedAvg is a standard algorithm that uses fixed weights, often originating from the dataset sizes at each client, to aggregate the distributed learned models on a server during the FL process. However, non-identical data distribution across clients, known as the non-i.i.d problem in FL, could make this assumption for setting fixed aggregation weights sub-optimal. In this work, we design a new data-driven approach, namely Auto-FedAvg, where aggregation weights are dynamically adjusted, depending on data distributions across data silos and the current training progress of the models. We disentangle the parameter set into two parts, local model parameters and global aggregation parameters, and update them iteratively with a communication-efficient algorithm. We first show the validity of our approach by outperforming state-of-the-art FL methods for image recognition on a heterogeneous data split of CIFAR-10. Furthermore, we demonstrate our algorithm's effectiveness on two multi-institutional medical image analysis tasks, i.e., COVID-19 lesion segmentation in chest CT and pancreas segmentation in abdominal CT.

The recent outbreak of COVID-19 has led to urgent needs for reliable diagnosis and management of SARS-CoV-2 infection. As a complimentary tool, chest CT has been shown to be able to reveal visual patterns characteristic for COVID-19, which has definite value at several stages during the disease course. To facilitate CT analysis, recent efforts have focused on computer-aided characterization and diagnosis, which has shown promising results. However, domain shift of data across clinical data centers poses a serious challenge when deploying learning-based models. In this work, we attempt to find a solution for this challenge via federated and semi-supervised learning. A multi-national database consisting of 1704 scans from three countries is adopted to study the performance gap, when training a model with one dataset and applying it to another. Expert radiologists manually delineated 945 scans for COVID-19 findings. In handling the variability in both the data and annotations, a novel federated semi-supervised learning technique is proposed to fully utilize all available data (with or without annotations). Federated learning avoids the need for sensitive data-sharing, which makes it favorable for institutions and nations with strict regulatory policy on data privacy. Moreover, semi-supervision potentially reduces the annotation burden under a distributed setting. The proposed framework is shown to be effective compared to fully supervised scenarios with conventional data sharing instead of model weight sharing., Comment: Accepted with minor revision to Medical Image Analysis

Reconstructed 3D ultrasound volume provides more context information compared to a sequence of 2D scanning frames, which is desirable for various clinical applications such as ultrasound-guided prostate biopsy. Nevertheless, 3D volume reconstruction from freehand 2D scans is a very challenging problem, especially without the use of external tracking devices. Recent deep learning based methods demonstrate the potential of directly estimating inter-frame motion between consecutive ultrasound frames. However, such algorithms are specific to particular transducers and scanning trajectories associated with the training data, which may not be generalized to other image acquisition settings. In this paper, we tackle the data acquisition difference as a domain shift problem and propose a novel domain adaptation strategy to adapt deep learning algorithms to data acquired with different transducers. Specifically, feature extractors that generate transducer-invariant features from different datasets are trained by minimizing the discrepancy between deep features of paired samples in a latent space. Our results show that the proposed domain adaptation method can successfully align different feature distributions while preserving the transducer-specific information for universal freehand ultrasound volume reconstruction., Comment: In submission to ISBI 2021

Multi-domain data are widely leveraged in vision applications taking advantage of complementary information from different modalities, e.g., brain tumor segmentation from multi-parametric magnetic resonance imaging (MRI). However, due to possible data corruption and different imaging protocols, the availability of images for each domain could vary amongst multiple data sources in practice, which makes it challenging to build a universal model with a varied set of input data. To tackle this problem, we propose a general approach to complete the random missing domain(s) data in real applications. Specifically, we develop a novel multi-domain image completion method that utilizes a generative adversarial network (GAN) with a representational disentanglement scheme to extract shared skeleton encoding and separate flesh encoding across multiple domains. We further illustrate that the learned representation in multi-domain image completion could be leveraged for high-level tasks, e.g., segmentation, by introducing a unified framework consisting of image completion and segmentation with a shared content encoder. The experiments demonstrate consistent performance improvement on three datasets for brain tumor segmentation, prostate segmentation, and facial expression image completion respectively.

Transrectal ultrasound (US) is the most commonly used imaging modality to guide prostate biopsy and its 3D volume provides even richer context information. Current methods for 3D volume reconstruction from freehand US scans require external tracking devices to provide spatial position for every frame. In this paper, we propose a deep contextual learning network (DCL-Net), which can efficiently exploit the image feature relationship between US frames and reconstruct 3D US volumes without any tracking device. The proposed DCL-Net utilizes 3D convolutions over a US video segment for feature extraction. An embedded self-attention module makes the network focus on the speckle-rich areas for better spatial movement prediction. We also propose a novel case-wise correlation loss to stabilize the training process for improved accuracy. Highly promising results have been obtained by using the developed method. The experiments with ablation studies demonstrate superior performance of the proposed method by comparing against other state-of-the-art methods. Source code of this work is publicly available at https://github.com/DIAL-RPI/FreehandUSRecon., Comment: Provisionally accepted by MICCAI 2020

Automatic medical image segmentation, an essential component of medical image analysis, plays an importantrole in computer-aided diagnosis. For example, locating and segmenting the liver can be very helpful in livercancer diagnosis and treatment. The state-of-the-art models in medical image segmentation are variants ofthe encoder-decoder architecture such as fully convolutional network (FCN) and U-Net.1A major focus ofthe FCN based segmentation methods has been on network structure engineering by incorporating the latestCNN structures such as ResNet2and DenseNet.3In addition to exploring new network structures for efficientlyabstracting high level features, incorporating structures for multi-scale image feature extraction in FCN hashelped to improve performance in segmentation tasks. In this paper, we design a new multi-scale networkarchitecture, which takes multi-scale inputs with dedicated convolutional paths to efficiently combine featuresfrom different scales to better utilize the hierarchical information., Comment: Abstract of SPIE Medical Imaging (Oral)

There are at least two categories of errors in radiology screening that can lead to suboptimal diagnostic decisions and interventions:(i)human fallibility and (ii)complexity of visual search. Computer aided diagnostic (CAD) tools are developed to help radiologists to compensate for some of these errors. However, despite their significant improvements over conventional screening strategies, most CAD systems do not go beyond their use as second opinion tools due to producing a high number of false positives, which human interpreters need to correct. In parallel with efforts in computerized analysis of radiology scans, several researchers have examined behaviors of radiologists while screening medical images to better understand how and why they miss tumors, how they interact with the information in an image, and how they search for unknown pathology in the images. Eye-tracking tools have been instrumental in exploring answers to these fundamental questions. In this paper, we aim to develop a paradigm shift CAD system, called collaborative CAD (C-CAD), that unifies both of the above mentioned research lines: CAD and eye-tracking. We design an eye-tracking interface providing radiologists with a real radiology reading room experience. Then, we propose a novel algorithm that unifies eye-tracking data and a CAD system. Specifically, we present a new graph based clustering and sparsification algorithm to transform eye-tracking data (gaze) into a signal model to interpret gaze patterns quantitatively and qualitatively. The proposed C-CAD collaborates with radiologists via eye-tracking technology and helps them to improve diagnostic decisions. The C-CAD learns radiologists' search efficiency by processing their gaze patterns. To do this, the C-CAD uses a deep learning algorithm in a newly designed multi-task learning platform to segment and diagnose cancers simultaneously., Comment: Submitted to Medical Image Analysis Journal (MedIA)

This study introduced a novel system, called Gaze2Segment, integrating biological and computer vision techniques to support radiologists' reading experience with an automatic image segmentation task. During diagnostic assessment of lung CT scans, the radiologists' gaze information were used to create a visual attention map. This map was then combined with a computer-derived saliency map, extracted from the gray-scale CT images. The visual attention map was used as an input for indicating roughly the location of a object of interest. With computer-derived saliency information, on the other hand, we aimed at finding foreground and background cues for the object of interest. At the final step, these cues were used to initiate a seed-based delineation process. Segmentation accuracy of the proposed Gaze2Segment was found to be 86% with dice similarity coefficient and 1.45 mm with Hausdorff distance. To the best of our knowledge, Gaze2Segment is the first true integration of eye-tracking technology into a medical image segmentation task without the need for any further user-interaction., Comment: MICCAI-Medical Computer Vision 2016, 11 pages