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The fundamental problem with ultrasound-guided diagnosis is that the acquired images are often 2-D cross-sections of a 3-D anatomy, potentially missing important anatomical details. This limitation leads to challenges in ultrasound echocardiography, such as poor visualization of heart valves or foreshortening of ventricles. Clinicians must interpret these images with inherent uncertainty, a nuance absent in machine learning's one-hot labels. We propose Re-Training for Uncertainty (RT4U), a data-centric method to introduce uncertainty to weakly informative inputs in the training set. This simple approach can be incorporated to existing state-of-the-art aortic stenosis classification methods to further improve their accuracy. When combined with conformal prediction techniques, RT4U can yield adaptively sized prediction sets which are guaranteed to contain the ground truth class to a high accuracy. We validate the effectiveness of RT4U on three diverse datasets: a public (TMED-2) and a private AS dataset, along with a CIFAR-10-derived toy dataset. Results show improvement on all the datasets., Comment: This preprint has not undergone any post-submission improvements or corrections. The Version of Record of this contribution is published in: International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI), Springer (2024) under the same title

Standard deep learning-based classification approaches may not always be practical in real-world clinical applications, as they require a centralized collection of all samples. Federated learning (FL) provides a paradigm that can learn from distributed datasets across clients without requiring them to share data, which can help mitigate privacy and data ownership issues. In FL, sub-optimal convergence caused by data heterogeneity is common among data from different health centers due to the variety in data collection protocols and patient demographics across centers. Through experimentation in this study, we show that data heterogeneity leads to the phenomenon of catastrophic forgetting during local training. We propose FedImpres which alleviates catastrophic forgetting by restoring synthetic data that represents the global information as federated impression. To achieve this, we distill the global model resulting from each communication round. Subsequently, we use the synthetic data alongside the local data to enhance the generalization of local training. Extensive experiments show that the proposed method achieves state-of-the-art performance on both the BloodMNIST and Retina datasets, which contain label imbalance and domain shift, with an improvement in classification accuracy of up to 20%.

High resolution micro-ultrasound has demonstrated promise in real-time prostate cancer detection, with deep learning becoming a prominent tool for learning complex tissue properties reflected on ultrasound. However, a significant roadblock to real-world deployment remains, which prior works often overlook: model performance suffers when applied to data from different clinical centers due to variations in data distribution. This distribution shift significantly impacts the model's robustness, posing major challenge to clinical deployment. Domain adaptation and specifically its test-time adaption (TTA) variant offer a promising solution to address this challenge. In a setting designed to reflect real-world conditions, we compare existing methods to state-of-the-art TTA approaches adopted for cancer detection, demonstrating the lack of robustness to distribution shifts in the former. We then propose Diverse Ensemble Entropy Minimization (DEnEM), questioning the effectiveness of current TTA methods on ultrasound data. We show that these methods, although outperforming baselines, are suboptimal due to relying on neural networks output probabilities, which could be uncalibrated, or relying on data augmentation, which is not straightforward to define on ultrasound data. Our results show a significant improvement of $5\%$ to $7\%$ in AUROC over the existing methods and $3\%$ to $5\%$ over TTA methods, demonstrating the advantage of DEnEM in addressing distribution shift. \keywords{Ultrasound Imaging \and Prostate Cancer \and Computer-aided Diagnosis \and Distribution Shift Robustness \and Test-time Adaptation.}

In real-world clinical settings, traditional deep learning-based classification methods struggle with diagnosing newly introduced disease types because they require samples from all disease classes for offline training. Class incremental learning offers a promising solution by adapting a deep network trained on specific disease classes to handle new diseases. However, catastrophic forgetting occurs, decreasing the performance of earlier classes when adapting the model to new data. Prior proposed methodologies to overcome this require perpetual storage of previous samples, posing potential practical concerns regarding privacy and storage regulations in healthcare. To this end, we propose a novel data-free class incremental learning framework that utilizes data synthesis on learned classes instead of data storage from previous classes. Our key contributions include acquiring synthetic data known as Continual Class-Specific Impression (CCSI) for previously inaccessible trained classes and presenting a methodology to effectively utilize this data for updating networks when introducing new classes. We obtain CCSI by employing data inversion over gradients of the trained classification model on previous classes starting from the mean image of each class inspired by common landmarks shared among medical images and utilizing continual normalization layers statistics as a regularizer in this pixel-wise optimization process. Subsequently, we update the network by combining the synthesized data with new class data and incorporate several losses, including an intra-domain contrastive loss to generalize the deep network trained on the synthesized data to real data, a margin loss to increase separation among previous classes and new ones, and a cosine-normalized cross-entropy loss to alleviate the adverse effects of imbalanced distributions in training data.

PURPOSE: Deep learning methods for classifying prostate cancer (PCa) in ultrasound images typically employ convolutional networks (CNNs) to detect cancer in small regions of interest (ROI) along a needle trace region. However, this approach suffers from weak labelling, since the ground-truth histopathology labels do not describe the properties of individual ROIs. Recently, multi-scale approaches have sought to mitigate this issue by combining the context awareness of transformers with a CNN feature extractor to detect cancer from multiple ROIs using multiple-instance learning (MIL). In this work, we present a detailed study of several image transformer architectures for both ROI-scale and multi-scale classification, and a comparison of the performance of CNNs and transformers for ultrasound-based prostate cancer classification. We also design a novel multi-objective learning strategy that combines both ROI and core predictions to further mitigate label noise. METHODS: We evaluate 3 image transformers on ROI-scale cancer classification, then use the strongest model to tune a multi-scale classifier with MIL. We train our MIL models using our novel multi-objective learning strategy and compare our results to existing baselines. RESULTS: We find that for both ROI-scale and multi-scale PCa detection, image transformer backbones lag behind their CNN counterparts. This deficit in performance is even more noticeable for larger models. When using multi-objective learning, we can improve performance of MIL, with a 77.9% AUROC, a sensitivity of 75.9%, and a specificity of 66.3%. CONCLUSION: Convolutional networks are better suited for modelling sparse datasets of prostate ultrasounds, producing more robust features than transformers in PCa detection. Multi-scale methods remain the best architecture for this task, with multi-objective learning presenting an effective way to improve performance., Comment: early draft, 7 pages; Accepted to SPIE Medical Imaging 2024

Echocardiography (echo) is an ultrasound imaging modality that is widely used for various cardiovascular diagnosis tasks. Due to inter-observer variability in echo-based diagnosis, which arises from the variability in echo image acquisition and the interpretation of echo images based on clinical experience, vision-based machine learning (ML) methods have gained popularity to act as secondary layers of verification. For such safety-critical applications, it is essential for any proposed ML method to present a level of explainability along with good accuracy. In addition, such methods must be able to process several echo videos obtained from various heart views and the interactions among them to properly produce predictions for a variety of cardiovascular measurements or interpretation tasks. Prior work lacks explainability or is limited in scope by focusing on a single cardiovascular task. To remedy this, we propose a General, Echo-based, Multi-Level Transformer (GEMTrans) framework that provides explainability, while simultaneously enabling multi-video training where the inter-play among echo image patches in the same frame, all frames in the same video, and inter-video relationships are captured based on a downstream task. We show the flexibility of our framework by considering two critical tasks including ejection fraction (EF) and aortic stenosis (AS) severity detection. Our model achieves mean absolute errors of 4.15 and 4.84 for single and dual-video EF estimation and an accuracy of 96.5 % for AS detection, while providing informative task-specific attention maps and prototypical explainability., Comment: To be published in MLMI 2023

Deep neural networks have proven to be highly effective when large amounts of data with clean labels are available. However, their performance degrades when training data contains noisy labels, leading to poor generalization on the test set. Real-world datasets contain noisy label samples that either have similar visual semantics to other classes (in-distribution) or have no semantic relevance to any class (out-of-distribution) in the dataset. Most state-of-the-art methods leverage ID labeled noisy samples as unlabeled data for semi-supervised learning, but OOD labeled noisy samples cannot be used in this way because they do not belong to any class within the dataset. Hence, in this paper, we propose incorporating the information from all the training data by leveraging the benefits of self-supervised training. Our method aims to extract a meaningful and generalizable embedding space for each sample regardless of its label. Then, we employ a simple yet effective K-nearest neighbor method to remove portions of out-of-distribution samples. By discarding these samples, we propose an iterative "Manifold DivideMix" algorithm to find clean and noisy samples, and train our model in a semi-supervised way. In addition, we propose "MixEMatch", a new algorithm for the semi-supervised step that involves mixup augmentation at the input and final hidden representations of the model. This will extract better representations by interpolating both in the input and manifold spaces. Extensive experiments on multiple synthetic-noise image benchmarks and real-world web-crawled datasets demonstrate the effectiveness of our proposed framework. Code is available at https://github.com/Fahim-F/ManifoldDivideMix.

Despite major advances in artificial intelligence (AI) for medicine and healthcare, the deployment and adoption of AI technologies remain limited in real-world clinical practice. In recent years, concerns have been raised about the technical, clinical, ethical and legal risks associated with medical AI. To increase real world adoption, it is essential that medical AI tools are trusted and accepted by patients, clinicians, health organisations and authorities. This work describes the FUTURE-AI guideline as the first international consensus framework for guiding the development and deployment of trustworthy AI tools in healthcare. The FUTURE-AI consortium was founded in 2021 and currently comprises 118 inter-disciplinary experts from 51 countries representing all continents, including AI scientists, clinicians, ethicists, and social scientists. Over a two-year period, the consortium defined guiding principles and best practices for trustworthy AI through an iterative process comprising an in-depth literature review, a modified Delphi survey, and online consensus meetings. The FUTURE-AI framework was established based on 6 guiding principles for trustworthy AI in healthcare, i.e. Fairness, Universality, Traceability, Usability, Robustness and Explainability. Through consensus, a set of 28 best practices were defined, addressing technical, clinical, legal and socio-ethical dimensions. The recommendations cover the entire lifecycle of medical AI, from design, development and validation to regulation, deployment, and monitoring. FUTURE-AI is a risk-informed, assumption-free guideline which provides a structured approach for constructing medical AI tools that will be trusted, deployed and adopted in real-world practice. Researchers are encouraged to take the recommendations into account in proof-of-concept stages to facilitate future translation towards clinical practice of medical AI.

Aortic stenosis (AS) is a common heart valve disease that requires accurate and timely diagnosis for appropriate treatment. Most current automatic AS severity detection methods rely on black-box models with a low level of trustworthiness, which hinders clinical adoption. To address this issue, we propose ProtoASNet, a prototypical network that directly detects AS from B-mode echocardiography videos, while making interpretable predictions based on the similarity between the input and learned spatio-temporal prototypes. This approach provides supporting evidence that is clinically relevant, as the prototypes typically highlight markers such as calcification and restricted movement of aortic valve leaflets. Moreover, ProtoASNet utilizes abstention loss to estimate aleatoric uncertainty by defining a set of prototypes that capture ambiguity and insufficient information in the observed data. This provides a reliable system that can detect and explain when it may fail. We evaluate ProtoASNet on a private dataset and the publicly available TMED-2 dataset, where it outperforms existing state-of-the-art methods with an accuracy of 80.0% and 79.7%, respectively. Furthermore, ProtoASNet provides interpretability and an uncertainty measure for each prediction, which can improve transparency and facilitate the interactive usage of deep networks to aid clinical decision-making. Our source code is available at: https://github.com/hooman007/ProtoASNet., Comment: To be published in MICCAI 2023

The functional assessment of the left ventricle chamber of the heart requires detecting four landmark locations and measuring the internal dimension of the left ventricle and the approximate mass of the surrounding muscle. The key challenge of automating this task with machine learning is the sparsity of clinical labels, i.e., only a few landmark pixels in a high-dimensional image are annotated, leading many prior works to heavily rely on isotropic label smoothing. However, such a label smoothing strategy ignores the anatomical information of the image and induces some bias. To address this challenge, we introduce an echocardiogram-based, hierarchical graph neural network (GNN) for left ventricle landmark detection (EchoGLAD). Our main contributions are: 1) a hierarchical graph representation learning framework for multi-resolution landmark detection via GNNs; 2) induced hierarchical supervision at different levels of granularity using a multi-level loss. We evaluate our model on a public and a private dataset under the in-distribution (ID) and out-of-distribution (OOD) settings. For the ID setting, we achieve the state-of-the-art mean absolute errors (MAEs) of 1.46 mm and 1.86 mm on the two datasets. Our model also shows better OOD generalization than prior works with a testing MAE of 4.3 mm., Comment: To be published in MICCAI 2023

A large body of previous machine learning methods for ultrasound-based prostate cancer detection classify small regions of interest (ROIs) of ultrasound signals that lie within a larger needle trace corresponding to a prostate tissue biopsy (called biopsy core). These ROI-scale models suffer from weak labeling as histopathology results available for biopsy cores only approximate the distribution of cancer in the ROIs. ROI-scale models do not take advantage of contextual information that are normally considered by pathologists, i.e. they do not consider information about surrounding tissue and larger-scale trends when identifying cancer. We aim to improve cancer detection by taking a multi-scale, i.e. ROI-scale and biopsy core-scale, approach. Methods: Our multi-scale approach combines (i) an "ROI-scale" model trained using self-supervised learning to extract features from small ROIs and (ii) a "core-scale" transformer model that processes a collection of extracted features from multiple ROIs in the needle trace region to predict the tissue type of the corresponding core. Attention maps, as a byproduct, allow us to localize cancer at the ROI scale. We analyze this method using a dataset of micro-ultrasound acquired from 578 patients who underwent prostate biopsy, and compare our model to baseline models and other large-scale studies in the literature. Results and Conclusions: Our model shows consistent and substantial performance improvements compared to ROI-scale-only models. It achieves 80.3% AUROC, a statistically significant improvement over ROI-scale classification. We also compare our method to large studies on prostate cancer detection, using other imaging modalities. Our code is publicly available at www.github.com/med-i-lab/TRUSFormer

Lung ultrasound (LUS) is an important imaging modality used by emergency physicians to assess pulmonary congestion at the patient bedside. B-line artifacts in LUS videos are key findings associated with pulmonary congestion. Not only can the interpretation of LUS be challenging for novice operators, but visual quantification of B-lines remains subject to observer variability. In this work, we investigate the strengths and weaknesses of multiple deep learning approaches for automated B-line detection and localization in LUS videos. We curate and publish, BEDLUS, a new ultrasound dataset comprising 1,419 videos from 113 patients with a total of 15,755 expert-annotated B-lines. Based on this dataset, we present a benchmark of established deep learning methods applied to the task of B-line detection. To pave the way for interpretable quantification of B-lines, we propose a novel "single-point" approach to B-line localization using only the point of origin. Our results show that (a) the area under the receiver operating characteristic curve ranges from 0.864 to 0.955 for the benchmarked detection methods, (b) within this range, the best performance is achieved by models that leverage multiple successive frames as input, and (c) the proposed single-point approach for B-line localization reaches an F1-score of 0.65, performing on par with the inter-observer agreement. The dataset and developed methods can facilitate further biomedical research on automated interpretation of lung ultrasound with the potential to expand the clinical utility., Comment: 10 pages, 4 figures

Deep learning-based analysis of high-frequency, high-resolution micro-ultrasound data shows great promise for prostate cancer detection. Previous approaches to analysis of ultrasound data largely follow a supervised learning paradigm. Ground truth labels for ultrasound images used for training deep networks often include coarse annotations generated from the histopathological analysis of tissue samples obtained via biopsy. This creates inherent limitations on the availability and quality of labeled data, posing major challenges to the success of supervised learning methods. On the other hand, unlabeled prostate ultrasound data are more abundant. In this work, we successfully apply self-supervised representation learning to micro-ultrasound data. Using ultrasound data from 1028 biopsy cores of 391 subjects obtained in two clinical centres, we demonstrate that feature representations learnt with this method can be used to classify cancer from non-cancer tissue, obtaining an AUROC score of 91% on an independent test set. To the best of our knowledge, this is the first successful end-to-end self-supervised learning approach for prostate cancer detection using ultrasound data. Our method outperforms baseline supervised learning approaches, generalizes well between different data centers, and scale well in performance as more unlabeled data are added, making it a promising approach for future research using large volumes of unlabeled data.

Ejection fraction (EF) is a key indicator of cardiac function, allowing identification of patients prone to heart dysfunctions such as heart failure. EF is estimated from cardiac ultrasound videos known as echocardiograms (echo) by manually tracing the left ventricle and estimating its volume on certain frames. These estimations exhibit high inter-observer variability due to the manual process and varying video quality. Such sources of inaccuracy and the need for rapid assessment necessitate reliable and explainable machine learning techniques. In this work, we introduce EchoGNN, a model based on graph neural networks (GNNs) to estimate EF from echo videos. Our model first infers a latent echo-graph from the frames of one or multiple echo cine series. It then estimates weights over nodes and edges of this graph, indicating the importance of individual frames that aid EF estimation. A GNN regressor uses this weighted graph to predict EF. We show, qualitatively and quantitatively, that the learned graph weights provide explainability through identification of critical frames for EF estimation, which can be used to determine when human intervention is required. On EchoNet-Dynamic public EF dataset, EchoGNN achieves EF prediction performance that is on par with state of the art and provides explainability, which is crucial given the high inter-observer variability inherent in this task., Comment: Published in MICCAI 2022

MOTIVATION: Detection of prostate cancer during transrectal ultrasound-guided biopsy is challenging. The highly heterogeneous appearance of cancer, presence of ultrasound artefacts, and noise all contribute to these difficulties. Recent advancements in high-frequency ultrasound imaging - micro-ultrasound - have drastically increased the capability of tissue imaging at high resolution. Our aim is to investigate the development of a robust deep learning model specifically for micro-ultrasound-guided prostate cancer biopsy. For the model to be clinically adopted, a key challenge is to design a solution that can confidently identify the cancer, while learning from coarse histopathology measurements of biopsy samples that introduce weak labels. METHODS: We use a dataset of micro-ultrasound images acquired from 194 patients, who underwent prostate biopsy. We train a deep model using a co-teaching paradigm to handle noise in labels, together with an evidential deep learning method for uncertainty estimation. We evaluate the performance of our model using the clinically relevant metric of accuracy vs. confidence. RESULTS: Our model achieves a well-calibrated estimation of predictive uncertainty with area under the curve of 88$\%$. The use of co-teaching and evidential deep learning in combination yields significantly better uncertainty estimation than either alone. We also provide a detailed comparison against state-of-the-art in uncertainty estimation.

Standard deep learning-based classification approaches require collecting all samples from all classes in advance and are trained offline. This paradigm may not be practical in real-world clinical applications, where new classes are incrementally introduced through the addition of new data. Class incremental learning is a strategy allowing learning from such data. However, a major challenge is catastrophic forgetting, i.e., performance degradation on previous classes when adapting a trained model to new data. Prior methodologies to alleviate this challenge save a portion of training data require perpetual storage of such data that may introduce privacy issues. Here, we propose a novel data-free class incremental learning framework that first synthesizes data from the model trained on previous classes to generate a \ours. Subsequently, it updates the model by combining the synthesized data with new class data. Furthermore, we incorporate a cosine normalized Cross-entropy loss to mitigate the adverse effects of the imbalance, a margin loss to increase separation among previous classes and new ones, and an intra-domain contrastive loss to generalize the model trained on the synthesized data to real data. We compare our proposed framework with state-of-the-art methods in class incremental learning, where we demonstrate improvement in accuracy for the classification of 11,062 echocardiography cine series of patients., Comment: To be appeared in MICCAI 2022

In echocardiography (echo), an electrocardiogram (ECG) is conventionally used to temporally align different cardiac views for assessing critical measurements. However, in emergencies or point-of-care situations, acquiring an ECG is often not an option, hence motivating the need for alternative temporal synchronization methods. Here, we propose Echo-SyncNet, a self-supervised learning framework to synchronize various cross-sectional 2D echo series without any external input. The proposed framework takes advantage of both intra-view and inter-view self supervisions. The former relies on spatiotemporal patterns found between the frames of a single echo cine and the latter on the interdependencies between multiple cines. The combined supervisions are used to learn a feature-rich embedding space where multiple echo cines can be temporally synchronized. We evaluate the framework with multiple experiments: 1) Using data from 998 patients, Echo-SyncNet shows promising results for synchronizing Apical 2 chamber and Apical 4 chamber cardiac views; 2) Using data from 3070 patients, our experiments reveal that the learned representations of Echo-SyncNet outperform a supervised deep learning method that is optimized for automatic detection of fine-grained cardiac phase; 3) We show the usefulness of the learned representations in a one-shot learning scenario of cardiac keyframe detection. Without any fine-tuning, keyframes in 1188 validation patient studies are identified by synchronizing them with only one labeled reference study. We do not make any prior assumption about what specific cardiac views are used for training and show that Echo-SyncNet can accurately generalize to views not present in its training set. Project repository: github.com/fatemehtd/Echo-SyncNet., Comment: 13 pages, 15 figures, submitted

This paper presents U-LanD, a framework for joint detection of key frames and landmarks in videos. We tackle a specifically challenging problem, where training labels are noisy and highly sparse. U-LanD builds upon a pivotal observation: a deep Bayesian landmark detector solely trained on key video frames, has significantly lower predictive uncertainty on those frames vs. other frames in videos. We use this observation as an unsupervised signal to automatically recognize key frames on which we detect landmarks. As a test-bed for our framework, we use ultrasound imaging videos of the heart, where sparse and noisy clinical labels are only available for a single frame in each video. Using data from 4,493 patients, we demonstrate that U-LanD can exceedingly outperform the state-of-the-art non-Bayesian counterpart by a noticeable absolute margin of 42% in R2 score, with almost no overhead imposed on the model size. Our approach is generic and can be potentially applied to other challenging data with noisy and sparse training labels.

Localization of anatomical landmarks to perform two-dimensional measurements in echocardiography is part of routine clinical workflow in cardiac disease diagnosis. Automatic localization of those landmarks is highly desirable to improve workflow and reduce interobserver variability. Training a machine learning framework to perform such localization is hindered given the sparse nature of gold standard labels; only few percent of cardiac cine series frames are normally manually labeled for clinical use. In this paper, we propose a new end-to-end reciprocal detection and tracking model that is specifically designed to handle the sparse nature of echocardiography labels. The model is trained using few annotated frames across the entire cardiac cine sequence to generate consistent detection and tracking of landmarks, and an adversarial training for the model is proposed to take advantage of these annotated frames. The superiority of the proposed reciprocal model is demonstrated using a series of experiments.

Ensembling is now recognized as an effective approach for increasing the predictive performance and calibration of deep networks. We introduce a new approach, Parameter Ensembling by Perturbation (PEP), that constructs an ensemble of parameter values as random perturbations of the optimal parameter set from training by a Gaussian with a single variance parameter. The variance is chosen to maximize the log-likelihood of the ensemble average ($\mathbb{L}$) on the validation data set. Empirically, and perhaps surprisingly, $\mathbb{L}$ has a well-defined maximum as the variance grows from zero (which corresponds to the baseline model). Conveniently, calibration level of predictions also tends to grow favorably until the peak of $\mathbb{L}$ is reached. In most experiments, PEP provides a small improvement in performance, and, in some cases, a substantial improvement in empirical calibration. We show that this "PEP effect" (the gain in log-likelihood) is related to the mean curvature of the likelihood function and the empirical Fisher information. Experiments on ImageNet pre-trained networks including ResNet, DenseNet, and Inception showed improved calibration and likelihood. We further observed a mild improvement in classification accuracy on these networks. Experiments on classification benchmarks such as MNIST and CIFAR-10 showed improved calibration and likelihood, as well as the relationship between the PEP effect and overfitting; this demonstrates that PEP can be used to probe the level of overfitting that occurred during training. In general, no special training procedure or network architecture is needed, and in the case of pre-trained networks, no additional training is needed., Comment: NeurIPS 2020

Unsupervised learning of disentangled representations is an open problem in machine learning. The Disentanglement-PyTorch library is developed to facilitate research, implementation, and testing of new variational algorithms. In this modular library, neural architectures, dimensionality of the latent space, and the training algorithms are fully decoupled, allowing for independent and consistent experiments across variational methods. The library handles the training scheduling, logging, and visualizations of reconstructions and latent space traversals. It also evaluates the encodings based on various disentanglement metrics. The library, so far, includes implementations of the following unsupervised algorithms VAE, Beta-VAE, Factor-VAE, DIP-I-VAE, DIP-II-VAE, Info-VAE, and Beta-TCVAE, as well as conditional approaches such as CVAE and IFCVAE. The library is compatible with the Disentanglement Challenge of NeurIPS 2019, hosted on AICrowd, and achieved the 3rd rank in both the first and second stages of the challenge., Comment: Disentanglement Challenge - 33rd Conference on Neural Information Processing Systems (NeurIPS) - NeurIPS 2019

Transthoracic echo is one of the most common means of cardiac studies in the clinical routines. During the echo exam, the sonographer captures a set of standard cross sections (echo views) of the heart. Each 2D echo view cuts through the 3D cardiac geometry via a unique plane. Consequently, different views share some limited information. In this work, we investigate the feasibility of generating a 2D echo view using another view based on adversarial generative models. The objective optimized to train the view-conversion model is based on the ideas introduced by LSGAN, PatchGAN and Conditional GAN (cGAN). The size and length of the left ventricle in the generated target echo view is compared against that of the target ground-truth to assess the validity of the echo view conversion. Results show that there is a correlation of 0.50 between the LV areas and 0.49 between the LV lengths of the generated target frames and the real target frames., Comment: Workshop of Medical Imaging Meets NeurIPS, NeurIPS 2019

Fully convolutional neural networks (FCNs), and in particular U-Nets, have achieved state-of-the-art results in semantic segmentation for numerous medical imaging applications. Moreover, batch normalization and Dice loss have been used successfully to stabilize and accelerate training. However, these networks are poorly calibrated i.e. they tend to produce overconfident predictions both in correct and erroneous classifications, making them unreliable and hard to interpret. In this paper, we study predictive uncertainty estimation in FCNs for medical image segmentation. We make the following contributions: 1) We systematically compare cross entropy loss with Dice loss in terms of segmentation quality and uncertainty estimation of FCNs; 2) We propose model ensembling for confidence calibration of the FCNs trained with batch normalization and Dice loss; 3) We assess the ability of calibrated FCNs to predict segmentation quality of structures and detect out-of-distribution test examples. We conduct extensive experiments across three medical image segmentation applications of the brain, the heart, and the prostate to evaluate our contributions. The results of this study offer considerable insight into the predictive uncertainty estimation and out-of-distribution detection in medical image segmentation and provide practical recipes for confidence calibration. Moreover, we consistently demonstrate that model ensembling improves confidence calibration., Comment: Journal of IEEE Transactions on Medical Imaging

Disentangled encoding is an important step towards a better representation learning. However, despite the numerous efforts, there still is no clear winner that captures the independent features of the data in an unsupervised fashion. In this work we empirically evaluate the performance of six unsupervised disentanglement approaches on the mpi3d toy dataset curated and released for the NeurIPS 2019 Disentanglement Challenge. The methods investigated in this work are Beta-VAE, Factor-VAE, DIP-I-VAE, DIP-II-VAE, Info-VAE, and Beta-TCVAE. The capacities of all models were progressively increased throughout the training and the hyper-parameters were kept intact across experiments. The methods were evaluated based on five disentanglement metrics, namely, DCI, Factor-VAE, IRS, MIG, and SAP-Score. Within the limitations of this study, the Beta-TCVAE approach was found to outperform its alternatives with respect to the normalized sum of metrics. However, a qualitative study of the encoded latents reveal that there is not a consistent correlation between the reported metrics and the disentanglement potential of the model., Comment: Disentanglement Challenge - NeurIPS 2019

Echocardiography (echo) is a common means of evaluating cardiac conditions. Due to the label scarcity, semi-supervised paradigms in automated echo analysis are getting traction. One of the most sought-after problems in echo is the segmentation of cardiac structures (e.g. chambers). Accordingly, we propose an echocardiogram generation approach using generative adversarial networks with a conditional patch-based discriminator. In this work, we validate the feasibility of GAN-enhanced echo generation with different conditions (segmentation masks), namely, the left ventricle, ventricular myocardium, and atrium. Results show that the proposed adversarial algorithm can generate high-quality echo frames whose cardiac structures match the given segmentation masks. This method is expected to facilitate the training of other machine learning models in a semi-supervised fashion as suggested in similar researches., Comment: Workshop of Medical Imaging Meets NeurIPS, NeurIPS 2019

Uncertainty of labels in clinical data resulting from intra-observer variability can have direct impact on the reliability of assessments made by deep neural networks. In this paper, we propose a method for modelling such uncertainty in the context of 2D echocardiography (echo), which is a routine procedure for detecting cardiovascular disease at point-of-care. Echo imaging quality and acquisition time is highly dependent on the operator's experience level. Recent developments have shown the possibility of automating echo image quality quantification by mapping an expert's assessment of quality to the echo image via deep learning techniques. Nevertheless, the observer variability in the expert's assessment can impact the quality quantification accuracy. Here, we aim to model the intra-observer variability in echo quality assessment as an aleatoric uncertainty modelling regression problem with the introduction of a novel method that handles the regression problem with categorical labels. A key feature of our design is that only a single forward pass is sufficient to estimate the level of uncertainty for the network output. Compared to the $0.11 \pm 0.09$ absolute error (in a scale from 0 to 1) archived by the conventional regression method, the proposed method brings the error down to $0.09 \pm 0.08$, where the improvement is statistically significant and equivalents to $5.7\%$ test accuracy improvement. The simplicity of the proposed approach means that it could be generalized to other applications of deep learning in medical imaging, where there is often uncertainty in clinical labels.

The premorbid geometry of the mandible is of significant relevance in jaw reconstructive surgeries and occasionally unknown to the surgical team. In this paper, an optimization framework is introduced to train deep models for completion (reconstruction) of the missing segments of the bone based on the remaining healthy structure. To leverage the contextual information of the surroundings of the dissected region, the voxel-weighted Dice loss is introduced. To address the non-deterministic nature of the shape completion problem, we leverage a weighted multi-target probabilistic solution which is an extension to the conditional variational autoencoder (CVAE). This approach considers multiple targets as acceptable reconstructions, each weighted according to their conformity with the original shape. We quantify the performance gain of the proposed method against similar algorithms, including CVAE, where we report statistically significant improvements in both deterministic and probabilistic paradigms. The probabilistic model is also evaluated on its ability to generate anatomically relevant variations for the missing bone. As a unique aspect of this work, the model is tested on real surgical cases where the clinical relevancy of its reconstructions and their compliance with surgeon's virtual plan are demonstrated as necessary steps towards clinical adoption., Comment: Proceedings of Medical Image Computing and Computer Assisted Intervention - {MICCAI} 2019

We introduce a new unsupervised representation learning and visualization using deep convolutional networks and self organizing maps called Deep Neural Maps (DNM). DNM jointly learns an embedding of the input data and a mapping from the embedding space to a two-dimensional lattice. We compare visualizations of DNM with those of t-SNE and LLE on the MNIST and COIL-20 data sets. Our experiments show that the DNM can learn efficient representations of the input data, which reflects characteristics of each class. This is shown via back-projecting the neurons of the map on the data space.

Magnetic Resonance Imaging (MRI) is widely used in routine clinical diagnosis and treatment. However, variations in MRI acquisition protocols result in different appearances of normal and diseased tissue in the images. Convolutional neural networks (CNNs), which have shown to be successful in many medical image analysis tasks, are typically sensitive to the variations in imaging protocols. Therefore, in many cases, networks trained on data acquired with one MRI protocol, do not perform satisfactorily on data acquired with different protocols. This limits the use of models trained with large annotated legacy datasets on a new dataset with a different domain which is often a recurring situation in clinical settings. In this study, we aim to answer the following central questions regarding domain adaptation in medical image analysis: Given a fitted legacy model, 1) How much data from the new domain is required for a decent adaptation of the original network?; and, 2) What portion of the pre-trained model parameters should be retrained given a certain number of the new domain training samples? To address these questions, we conducted extensive experiments in white matter hyperintensity segmentation task. We trained a CNN on legacy MR images of brain and evaluated the performance of the domain-adapted network on the same task with images from a different domain. We then compared the performance of the model to the surrogate scenarios where either the same trained network is used or a new network is trained from scratch on the new dataset.The domain-adapted network tuned only by two training examples achieved a Dice score of 0.63 substantially outperforming a similar network trained on the same set of examples from scratch., Comment: 8 pages, 3 figures