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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.

With the rapid development of artificial intelligence (AI) in medical image processing, deep learning in color fundus photography (CFP) analysis is also evolving. Although there are some open-source, labeled datasets of CFPs in the ophthalmology community, large-scale datasets for screening only have labels of disease categories, and datasets with annotations of fundus structures are usually small in size. In addition, labeling standards are not uniform across datasets, and there is no clear information on the acquisition device. Here we release a multi-annotation, multi-quality, and multi-device color fundus image dataset for glaucoma analysis on an original challenge -- Retinal Fundus Glaucoma Challenge 2nd Edition (REFUGE2). The REFUGE2 dataset contains 2000 color fundus images with annotations of glaucoma classification, optic disc/cup segmentation, as well as fovea localization. Meanwhile, the REFUGE2 challenge sets three sub-tasks of automatic glaucoma diagnosis and fundus structure analysis and provides an online evaluation framework. Based on the characteristics of multi-device and multi-quality data, some methods with strong generalizations are provided in the challenge to make the predictions more robust. This shows that REFUGE2 brings attention to the characteristics of real-world multi-domain data, bridging the gap between scientific research and clinical application., Comment: 29 pages, 21 figures

Medical image classification has been widely adopted in medical image analysis. However, due to the difficulty of collecting and labeling data in the medical area, medical image datasets are usually highly-imbalanced. To address this problem, previous works utilized class samples as prior for re-weighting or re-sampling but the feature representation is usually still not discriminative enough. In this paper, we adopt the contrastive learning to tackle the long-tailed medical imbalance problem. Specifically, we first propose the category prototype and adversarial proto-instance to generate representative contrastive pairs. Then, the prototype recalibration strategy is proposed to address the highly imbalanced data distribution. Finally, a unified proto-loss is designed to train our framework. The overall framework, namely as Prototype-aware Contrastive learning (ProCo), is unified as a single-stage pipeline in an end-to-end manner to alleviate the imbalanced problem in medical image classification, which is also a distinct progress than existing works as they follow the traditional two-stage pipeline. Extensive experiments on two highly-imbalanced medical image classification datasets demonstrate that our method outperforms the existing state-of-the-art methods by a large margin., Comment: Accept to MICCAI 2022. Zhixiong Yang and Junwen Pan contributed equally to this work

Unsupervised domain adaption has proven to be an effective approach for alleviating the intensive workload of manual annotation by aligning the synthetic source-domain data and the real-world target-domain samples. Unfortunately, mapping the target-domain distribution to the source-domain unconditionally may distort the essential structural information of the target-domain data. To this end, we firstly propose to introduce a novel multi-anchor based active learning strategy to assist domain adaptation regarding the semantic segmentation task. By innovatively adopting multiple anchors instead of a single centroid, the source domain can be better characterized as a multimodal distribution, thus more representative and complimentary samples are selected from the target domain. With little workload to manually annotate these active samples, the distortion of the target-domain distribution can be effectively alleviated, resulting in a large performance gain. The multi-anchor strategy is additionally employed to model the target-distribution. By regularizing the latent representation of the target samples compact around multiple anchors through a novel soft alignment loss, more precise segmentation can be achieved. Extensive experiments are conducted on public datasets to demonstrate that the proposed approach outperforms state-of-the-art methods significantly, along with thorough ablation study to verify the effectiveness of each component., ICCV 2021 Oral

Domain shift happens in cross-domain scenarios commonly because of the wide gaps between different domains: when applying a deep learning model well-trained in one domain to another target domain, the model usually performs poorly. To tackle this problem, unsupervised domain adaptation (UDA) techniques are proposed to bridge the gap between different domains, for the purpose of improving model performance without annotation in the target domain. Particularly, UDA has a great value for multimodal medical image analysis, where annotation difficulty is a practical concern. However, most existing UDA methods can only achieve satisfactory improvements in one adaptation direction (e.g., MRI to CT), but often perform poorly in the other (CT to MRI), limiting their practical usage. In this paper, we propose a bidirectional UDA (BiUDA) framework based on disentangled representation learning for equally competent two-way UDA performances. This framework employs a unified domain-aware pattern encoder which not only can adaptively encode images in different domains through a domain controller, but also improve model efficiency by eliminating redundant parameters. Furthermore, to avoid distortion of contents and patterns of input images during the adaptation process, a content-pattern consistency loss is introduced. Additionally, for better UDA segmentation performance, a label consistency strategy is proposed to provide extra supervision by recomposing target-domain-styled images and corresponding source-domain annotations. Comparison experiments and ablation studies conducted on two public datasets demonstrate the superiority of our BiUDA framework to current state-of-the-art UDA methods and the effectiveness of its novel designs. By successfully addressing two-way adaptations, our BiUDA framework offers a flexible solution of UDA techniques to the real-world scenario., IPMI 2021

Accuracy segmentation of brain structures could be helpful for glioma and radiotherapy planning. However, due to the visual and anatomical differences between different modalities, the accurate segmentation of brain structures becomes challenging. To address this problem, we first construct a residual block based U-shape network with a deep encoder and shallow decoder, which can trade off the framework performance and efficiency. Then, we introduce the Tversky loss to address the issue of the class imbalance between different foreground and the background classes. Finally, a model ensemble strategy is utilized to remove outliers and further boost performance.

Segmentation of cardiac images, particularly late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) widely used for visualizing diseased cardiac structures, is a crucial first step for clinical diagnosis and treatment. However, direct segmentation of LGE-MRIs is challenging due to its attenuated contrast. Since most clinical studies have relied on manual and labor-intensive approaches, automatic methods are of high interest, particularly optimized machine learning approaches. To address this, we organized the "2018 Left Atrium Segmentation Challenge" using 154 3D LGE-MRIs, currently the world's largest cardiac LGE-MRI dataset, and associated labels of the left atrium segmented by three medical experts, ultimately attracting the participation of 27 international teams. In this paper, extensive analysis of the submitted algorithms using technical and biological metrics was performed by undergoing subgroup analysis and conducting hyper-parameter analysis, offering an overall picture of the major design choices of convolutional neural networks (CNNs) and practical considerations for achieving state-of-the-art left atrium segmentation. Results show the top method achieved a dice score of 93.2% and a mean surface to a surface distance of 0.7 mm, significantly outperforming prior state-of-the-art. Particularly, our analysis demonstrated that double, sequentially used CNNs, in which a first CNN is used for automatic region-of-interest localization and a subsequent CNN is used for refined regional segmentation, achieved far superior results than traditional methods and pipelines containing single CNNs. This large-scale benchmarking study makes a significant step towards much-improved segmentation methods for cardiac LGE-MRIs, and will serve as an important benchmark for evaluating and comparing the future works in the field.

Primary angle closure glaucoma (PACG) is the leading cause of irreversible blindness among Asian people. Early detection of PACG is essential, so as to provide timely treatment and minimize the vision loss. In the clinical practice, PACG is diagnosed by analyzing the angle between the cornea and iris with anterior segment optical coherence tomography (AS-OCT). The rapid development of deep learning technologies provides the feasibility of building a computer-aided system for the fast and accurate segmentation of cornea and iris tissues. However, the application of deep learning methods in the medical imaging field is still restricted by the lack of enough fully-annotated samples. In this paper, we propose a novel framework to segment the target tissues accurately for the AS-OCT images, by using the combination of weakly-annotated images (majority) and fully-annotated images (minority). The proposed framework consists of two models which provide reliable guidance for each other. In addition, uncertainty guided strategies are adopted to increase the accuracy and stability of the guidance. Detailed experiments on the publicly available AGE dataset demonstrate that the proposed framework outperforms the state-of-the-art semi-/weakly-supervised methods and has a comparable performance as the fully-supervised method. Therefore, the proposed method is demonstrated to be effective in exploiting information contained in the weakly-annotated images and has the capability to substantively relieve the annotation workload., Comment: MICCAI 2020

Medical images are generally labeled by multiple experts before the final ground-truth labels are determined. Consensus or disagreement among experts regarding individual images reflects the gradeability and difficulty levels of the image. However, when being used for model training, only the final ground-truth label is utilized, while the critical information contained in the raw multi-rater gradings regarding the image being an easy/hard case is discarded. In this paper, we aim to take advantage of the raw multi-rater gradings to improve the deep learning model performance for the glaucoma classification task. Specifically, a multi-branch model structure is proposed to predict the most sensitive, most specifical and a balanced fused result for the input images. In order to encourage the sensitivity branch and specificity branch to generate consistent results for consensus labels and opposite results for disagreement labels, a consensus loss is proposed to constrain the output of the two branches. Meanwhile, the consistency/inconsistency between the prediction results of the two branches implies the image being an easy/hard case, which is further utilized to encourage the balanced fusion branch to concentrate more on the hard cases. Compared with models trained only with the final ground-truth labels, the proposed method using multi-rater consensus information has achieved superior performance, and it is also able to estimate the difficulty levels of individual input images when making the prediction.

In deep learning era, pretrained models play an important role in medical image analysis, in which ImageNet pretraining has been widely adopted as the best way. However, it is undeniable that there exists an obvious domain gap between natural images and medical images. To bridge this gap, we propose a new pretraining method which learns from 700k radiographs given no manual annotations. We call our method as Comparing to Learn (C2L) because it learns robust features by comparing different image representations. To verify the effectiveness of C2L, we conduct comprehensive ablation studies and evaluate it on different tasks and datasets. The experimental results on radiographs show that C2L can outperform ImageNet pretraining and previous state-of-the-art approaches significantly. Code and models are available., Comment: MICCAI 2020 early accept; Code and pretrained models available at http://github.com/funnyzhou/C2L_MICCAI2020

Primary angle-closure disease (PACD) is a severe retinal disease, which might cause irreversible vision loss. In clinic, accurate identification of angle-closure and localization of the scleral spur's position on anterior segment optical coherence tomography (AS-OCT) is essential for the diagnosis of PACD. However, manual delineation might confine in low accuracy and low efficiency. In this paper, we propose an efficient and accurate end-to-end architecture for angle-closure classification and scleral spur localization. Specifically, we utilize a revised ResNet152 as our backbone to improve the accuracy of the angle-closure identification. For scleral spur localization, we adopt EfficientNet as encoder because of its powerful feature extraction potential. By combining the skip-connect module and pyramid pooling module, the network is able to collect semantic cues in feature maps from multiple dimensions and scales. Afterward, we propose a novel keypoint registration loss to constrain the model's attention to the intensity and location of the scleral spur area. Several experiments are extensively conducted to evaluate our method on the angle-closure glaucoma evaluation (AGE) Challenge dataset. The results show that our proposed architecture ranks the first place of the classification task on the test dataset and achieves the average Euclidean distance error of 12.00 pixels in the scleral spur localization task., The third place in angle-closure glaucoma evaluation (AGE) Challenge, MICCAI 2019

Automatic and accurate segmentation for retinal and choroidal layers of Optical Coherence Tomography (OCT) is crucial for detection of various ocular diseases. However, because of the variations in different equipments, OCT data obtained from different manufacturers might encounter appearance discrepancy, which could lead to performance fluctuation to a deep neural network. In this paper, we propose an uncertainty-guided domain alignment method to aim at alleviating this problem to transfer discriminative knowledge across distinct domains. We disign a novel uncertainty-guided cross-entropy loss for boosting the performance over areas with high uncertainty. An uncertainty-guided curriculum transfer strategy is developed for the self-training (ST), which regards uncertainty as efficient and effective guidance to optimize the learning process in target domain. Adversarial learning with feature recalibration module (FRM) is applied to transfer informative knowledge from the domain feature spaces adaptively. The experiments on two OCT datasets show that the proposed methods can obtain significant segmentation improvements compared with the baseline models.

Accurately segmenting left atrium in MR volume can benefit the ablation procedure of atrial fibrillation. Traditional automated solutions often fail in relieving experts from the labor-intensive manual labeling. In this paper, we propose a deep neural network based solution for automated left atrium segmentation in gadolinium-enhanced MR volumes with promising performance. We firstly argue that, for this volumetric segmentation task, networks in 2D fashion can present great superiorities in time efficiency and segmentation accuracy than networks with 3D fashion. Considering the highly varying shape of atrium and the branchy structure of associated pulmonary veins, we propose to adopt a pyramid module to collect semantic cues in feature maps from multiple scales for fine-grained segmentation. Also, to promote our network in classifying the hard examples, we propose an Online Hard Negative Example Mining strategy to identify voxels in slices with low classification certainties and penalize the wrong predictions on them. Finally, we devise a competitive training scheme to further boost the generalization ability of networks. Extensively verified on 20 testing volumes, our proposed framework achieves an average Dice of 92.83% in segmenting the left atria and pulmonary veins., Comment: 9 pages, 4 figures. MICCAI Workshop on STACOM 2018