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The biological brain has inspired multiple advances in machine learning. However, most state-of-the-art models in computer vision do not operate like the human brain, simply because they are not capable of changing or improving their decisions/outputs based on a deeper analysis. The brain is recurrent, while these models are not. It is therefore relevant to explore what would be the impact of adding recurrent mechanisms to existing state-of-the-art architectures and to answer the question of whether recurrency can improve existing architectures. To this end, we build on a feed-forward segmentation model and explore multiple types of recurrency for image segmentation. We explore self-organizing, relational, and memory retrieval types of recurrency that minimize a specific energy function. In our experiments, we tested these models on artificial and medical imaging data, while analyzing the impact of high levels of noise and few-shot learning settings. Our results do not validate our initial hypothesis that recurrent models should perform better in these settings, suggesting that these recurrent architectures, by themselves, are not sufficient to surpass state-of-the-art feed-forward versions and that additional work needs to be done on the topic., Comment: 24 pages

While convolutional neural networks (CNNs) excel at clean image classification, they struggle to classify images corrupted with different common corruptions, limiting their real-world applicability. Recent work has shown that incorporating a CNN front-end block that simulates some features of the primate primary visual cortex (V1) can improve overall model robustness. Here, we expand on this approach by introducing two novel biologically-inspired CNN model families that incorporate a new front-end block designed to simulate pre-cortical visual processing. RetinaNet, a hybrid architecture containing the novel front-end followed by a standard CNN back-end, shows a relative robustness improvement of 12.3% when compared to the standard model; and EVNet, which further adds a V1 block after the pre-cortical front-end, shows a relative gain of 18.5%. The improvement in robustness was observed for all the different corruption categories, though accompanied by a small decrease in clean image accuracy, and generalized to a different back-end architecture. These findings show that simulating multiple stages of early visual processing in CNN early layers provides cumulative benefits for model robustness.

Whole Slide Images (WSI), obtained by high-resolution digital scanning of microscope slides at multiple scales, are the cornerstone of modern Digital Pathology. However, they represent a particular challenge to AI-based/AI-mediated analysis because pathology labeling is typically done at slide-level, instead of tile-level. It is not just that medical diagnostics is recorded at the specimen level, the detection of oncogene mutation is also experimentally obtained, and recorded by initiatives like The Cancer Genome Atlas (TCGA), at the slide level. This configures a dual challenge: a) accurately predicting the overall cancer phenotype and b) finding out what cellular morphologies are associated with it at the tile level. To address these challenges, a weakly supervised Multiple Instance Learning (MIL) approach was explored for two prevalent cancer types, Invasive Breast Carcinoma (TCGA-BRCA) and Lung Squamous Cell Carcinoma (TCGA-LUSC). This approach was explored for tumor detection at low magnification levels and TP53 mutations at various levels. Our results show that a novel additive implementation of MIL matched the performance of reference implementation (AUC 0.96), and was only slightly outperformed by Attention MIL (AUC 0.97). More interestingly from the perspective of the molecular pathologist, these different AI architectures identify distinct sensitivities to morphological features (through the detection of Regions of Interest, RoI) at different amplification levels. Tellingly, TP53 mutation was most sensitive to features at the higher applications where cellular morphology is resolved.

Uncertainty in medical image segmentation tasks, especially inter-rater variability, arising from differences in interpretations and annotations by various experts, presents a significant challenge in achieving consistent and reliable image segmentation. This variability not only reflects the inherent complexity and subjective nature of medical image interpretation but also directly impacts the development and evaluation of automated segmentation algorithms. Accurately modeling and quantifying this variability is essential for enhancing the robustness and clinical applicability of these algorithms. We report the set-up and summarize the benchmark results of the Quantification of Uncertainties in Biomedical Image Quantification Challenge (QUBIQ), which was organized in conjunction with International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2020 and 2021. The challenge focuses on the uncertainty quantification of medical image segmentation which considers the omnipresence of inter-rater variability in imaging datasets. The large collection of images with multi-rater annotations features various modalities such as MRI and CT; various organs such as the brain, prostate, kidney, and pancreas; and different image dimensions 2D-vs-3D. A total of 24 teams submitted different solutions to the problem, combining various baseline models, Bayesian neural networks, and ensemble model techniques. The obtained results indicate the importance of the ensemble models, as well as the need for further research to develop efficient 3D methods for uncertainty quantification methods in 3D segmentation tasks., Comment: initial technical report

While some convolutional neural networks (CNNs) have achieved great success in object recognition, they struggle to identify objects in images corrupted with different types of common noise patterns. Recently, it was shown that simulating computations in early visual areas at the front of CNNs leads to improvements in robustness to image corruptions. Here, we further explore this result and show that the neuronal representations that emerge from precisely matching the distribution of RF properties found in primate V1 is key for this improvement in robustness. We built two variants of a model with a front-end modeling the primate primary visual cortex (V1): one sampling RF properties uniformly and the other sampling from empirical biological distributions. The model with the biological sampling has a considerably higher robustness to image corruptions that the uniform variant (relative difference of 8.72%). While similar neuronal sub-populations across the two variants have similar response properties and learn similar downstream weights, the impact on downstream processing is strikingly different. This result sheds light on the origin of the improvements in robustness observed in some biologically-inspired models, pointing to the need of precisely mimicking the neuronal representations found in the primate brain.

Modern artificial neural networks, including convolutional neural networks and vision transformers, have mastered several computer vision tasks, including object recognition. However, there are many significant differences between the behavior and robustness of these systems and of the human visual system. Deep neural networks remain brittle and susceptible to many changes in the image that do not cause humans to misclassify images. Part of this different behavior may be explained by the type of features humans and deep neural networks use in vision tasks. Humans tend to classify objects according to their shape while deep neural networks seem to rely mostly on texture. Exploring this question is relevant, since it may lead to better performing neural network architectures and to a better understanding of the workings of the vision system of primates. In this work, we advance the state of the art in our understanding of this phenomenon, by extending previous analyses to a much larger set of deep neural network architectures. We found that the performance of models in image classification tasks is highly correlated with their shape bias measured at the output and penultimate layer. Furthermore, our results showed that the number of neurons that represent shape and texture are strongly anti-correlated, thus providing evidence that there is competition between these two types of features. Finally, we observed that while in general there is a correlation between performance and shape bias, there are significant variations between architecture families., Comment: 7 pages, 3 figures

The number of international benchmarking competitions is steadily increasing in various fields of machine learning (ML) research and practice. So far, however, little is known about the common practice as well as bottlenecks faced by the community in tackling the research questions posed. To shed light on the status quo of algorithm development in the specific field of biomedical imaging analysis, we designed an international survey that was issued to all participants of challenges conducted in conjunction with the IEEE ISBI 2021 and MICCAI 2021 conferences (80 competitions in total). The survey covered participants' expertise and working environments, their chosen strategies, as well as algorithm characteristics. A median of 72% challenge participants took part in the survey. According to our results, knowledge exchange was the primary incentive (70%) for participation, while the reception of prize money played only a minor role (16%). While a median of 80 working hours was spent on method development, a large portion of participants stated that they did not have enough time for method development (32%). 25% perceived the infrastructure to be a bottleneck. Overall, 94% of all solutions were deep learning-based. Of these, 84% were based on standard architectures. 43% of the respondents reported that the data samples (e.g., images) were too large to be processed at once. This was most commonly addressed by patch-based training (69%), downsampling (37%), and solving 3D analysis tasks as a series of 2D tasks. K-fold cross-validation on the training set was performed by only 37% of the participants and only 50% of the participants performed ensembling based on multiple identical models (61%) or heterogeneous models (39%). 48% of the respondents applied postprocessing steps.

Attention mechanisms have raised significant interest in the research community, since they promise significant improvements in the performance of neural network architectures. However, in any specific problem, we still lack a principled way to choose specific mechanisms and hyper-parameters that lead to guaranteed improvements. More recently, self-attention has been proposed and widely used in transformer-like architectures, leading to significant breakthroughs in some applications. In this work we focus on two forms of attention mechanisms: attention modules and self-attention. Attention modules are used to reweight the features of each layer input tensor. Different modules have different ways to perform this reweighting in fully connected or convolutional layers. The attention models studied are completely modular and in this work they will be used with the popular ResNet architecture. Self-Attention, originally proposed in the area of Natural Language Processing makes it possible to relate all the items in an input sequence. Self-Attention is becoming increasingly popular in Computer Vision, where it is sometimes combined with convolutional layers, although some recent architectures do away entirely with convolutions. In this work, we study and perform an objective comparison of a number of different attention mechanisms in a specific computer vision task, the classification of samples in the widely used Skin Cancer MNIST dataset. The results show that attention modules do sometimes improve the performance of convolutional neural network architectures, but also that this improvement, although noticeable and statistically significant, is not consistent in different settings. The results obtained with self-attention mechanisms, on the other hand, show consistent and significant improvements, leading to the best results even in architectures with a reduced number of parameters.

Medical image segmentation is inherently uncertain. For a given image, there may be multiple plausible segmentation hypotheses, and physicians will often disagree on lesion and organ boundaries. To be suited to real-world application, automatic segmentation systems must be able to capture this uncertainty and variability. Thus far, this has been addressed by building deep learning models that, through dropout, multiple heads, or variational inference, can produce a set - infinite, in some cases - of plausible segmentation hypotheses for any given image. However, in clinical practice, it may not be practical to browse all hypotheses. Furthermore, recent work shows that segmentation variability plateaus after a certain number of independent annotations, suggesting that a large enough group of physicians may be able to represent the whole space of possible segmentations. Inspired by this, we propose a simple method to obtain soft labels from the annotations of multiple physicians and train models that, for each image, produce a single well-calibrated output that can be thresholded at multiple confidence levels, according to each application's precision-recall requirements. We evaluated our method on the MICCAI 2021 QUBIQ challenge, showing that it performs well across multiple medical image segmentation tasks, produces well-calibrated predictions, and, on average, performs better at matching physicians' predictions than other physicians., Comment: 8 pages, 1 figure, 3 tables

Coronary X-ray angiography is a crucial clinical procedure for the diagnosis and treatment of coronary artery disease, which accounts for roughly 16% of global deaths every year. However, the images acquired in these procedures have low resolution and poor contrast, making lesion detection and assessment challenging. Accurate coronary artery segmentation not only helps mitigate these problems, but also allows the extraction of relevant anatomical features for further analysis by quantitative methods. Although automated segmentation of coronary arteries has been proposed before, previous approaches have used non-optimal segmentation criteria, leading to less useful results. Most methods either segment only the major vessel, discarding important information from the remaining ones, or segment the whole coronary tree based mostly on contrast information, producing a noisy output that includes vessels that are not relevant for diagnosis. We adopt a better-suited clinical criterion and segment vessels according to their clinical relevance. Additionally, we simultaneously perform catheter segmentation, which may be useful for diagnosis due to the scale factor provided by the catheter's known diameter, and is a task that has not yet been performed with good results. To derive the optimal approach, we conducted an extensive comparative study of encoder-decoder architectures trained on a combination of focal loss and a variant of generalized dice loss. Based on the EfficientNet and the UNet++ architectures, we propose a line of efficient and high-performance segmentation models using a new decoder architecture, the EfficientUNet++, whose best-performing version achieved average dice scores of 0.8904 and 0.7526 for the artery and catheter classes, respectively, and an average generalized dice score of 0.9234.

Coronary artery disease leading up to stenosis, the partial or total blocking of coronary arteries, is a severe condition that affects millions of patients each year. Automated identification and classification of stenosis severity from minimally invasive procedures would be of great clinical value, but existing methods do not match the accuracy of experienced cardiologists, due to the complexity of the task. Although a number of computational approaches for quantitative assessment of stenosis have been proposed to date, the performance of these methods is still far from the required levels for clinical applications. In this paper, we propose a two-step deep-learning framework to partially automate the detection of stenosis from X-ray coronary angiography images. In the two steps, we used two distinct convolutional neural network architectures, one to automatically identify and classify the angle of view, and another to determine the bounding boxes of the regions of interest in frames where stenosis is visible. Transfer learning and data augmentation techniques were used to boost the performance of the system in both tasks. We achieved a 0.97 accuracy on the task of classifying the Left/Right Coronary Artery (LCA/RCA) angle view and 0.68/0.73 recall on the determination of the regions of interest, for LCA and RCA, respectively. These results compare favorably with previous results obtained using related approaches, and open the way to a fully automated method for the identification of stenosis severity from X-ray angiographies., Comment: 10 pages, 4 Figures

Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that underwent gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset., Comment: The International Multimodal Brain Tumor Segmentation (BraTS) Challenge

The Conditional Random Field as a Recurrent Neural Network layer is a recently proposed algorithm meant to be placed on top of an existing Fully-Convolutional Neural Network to improve the quality of semantic segmentation. In this paper, we test whether this algorithm, which was shown to improve semantic segmentation for 2D RGB images, is able to improve segmentation quality for 3D multi-modal medical images. We developed an implementation of the algorithm which works for any number of spatial dimensions, input/output image channels, and reference image channels. As far as we know this is the first publicly available implementation of this sort. We tested the algorithm with two distinct 3D medical imaging datasets, we concluded that the performance differences observed were not statistically significant. Finally, in the discussion section of the paper, we go into the reasons as to why this technique transfers poorly from natural images to medical images., Comment: 11 pages, 3 figures (with 11 subfigures)