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Convolutional neural networks have primarily led 3D medical image segmentation but may be limited by small receptive fields. Transformer models excel in capturing global relationships through self-attention but are challenged by high computational costs at high resolutions. Recently, Mamba, a state space model, has emerged as an effective approach for sequential modeling. Inspired by its success, we introduce a novel Mamba-based 3D medical image segmentation model called EM-Net. It not only efficiently captures attentive interaction between regions by integrating and selecting channels, but also effectively utilizes frequency domain to harmonize the learning of features across varying scales, while accelerating training speed. Comprehensive experiments on two challenging multi-organ datasets with other state-of-the-art (SOTA) algorithms show that our method exhibits better segmentation accuracy while requiring nearly half the parameter size of SOTA models and 2x faster training speed., Comment: 10 pages, 3 figures, accepted by MICCAI 2024

In the medical field, the limited availability of large-scale datasets and labor-intensive annotation processes hinder the performance of deep models. Diffusion-based generative augmentation approaches present a promising solution to this issue, having been proven effective in advancing downstream medical recognition tasks. Nevertheless, existing works lack sufficient semantic and sequential steerability for challenging video/3D sequence generation, and neglect quality control of noisy synthesized samples, resulting in unreliable synthetic databases and severely limiting the performance of downstream tasks. In this work, we present Ctrl-GenAug, a novel and general generative augmentation framework that enables highly semantic- and sequential-customized sequence synthesis and suppresses incorrectly synthesized samples, to aid medical sequence classification. Specifically, we first design a multimodal conditions-guided sequence generator for controllably synthesizing diagnosis-promotive samples. A sequential augmentation module is integrated to enhance the temporal/stereoscopic coherence of generated samples. Then, we propose a noisy synthetic data filter to suppress unreliable cases at semantic and sequential levels. Extensive experiments on 3 medical datasets, using 11 networks trained on 3 paradigms, comprehensively analyze the effectiveness and generality of Ctrl-GenAug, particularly in underrepresented high-risk populations and out-domain conditions., Comment: 17 pages, 7 figures, 7 tables

Different diseases, such as histological subtypes of breast lesions, have severely varying incidence rates. Even trained with substantial amount of in-distribution (ID) data, models often encounter out-of-distribution (OOD) samples belonging to unseen classes in clinical reality. To address this, we propose a novel framework built upon a long-tailed OOD detection task for breast ultrasound images. It is equipped with a triplet state augmentation (TriAug) which improves ID classification accuracy while maintaining a promising OOD detection performance. Meanwhile, we designed a balanced sphere loss to handle the class imbalanced problem. Experimental results show that the model outperforms state-of-art OOD approaches both in ID classification (F1-score=42.12%) and OOD detection (AUROC=78.06%).

Objective: Ultrasound (US) examination has unique advantages in diagnosing carpal tunnel syndrome (CTS) while identifying the median nerve (MN) and diagnosing CTS depends heavily on the expertise of examiners. To alleviate this problem, we aimed to develop a one-stop automated CTS diagnosis system (OSA-CTSD) and evaluate its effectiveness as a computer-aided diagnostic tool. Methods: We combined real-time MN delineation, accurate biometric measurements, and explainable CTS diagnosis into a unified framework, called OSA-CTSD. We collected a total of 32,301 static images from US videos of 90 normal wrists and 40 CTS wrists for evaluation using a simplified scanning protocol. Results: The proposed model showed better segmentation and measurement performance than competing methods, reporting that HD95 score of 7.21px, ASSD score of 2.64px, Dice score of 85.78%, and IoU score of 76.00%, respectively. In the reader study, it demonstrated comparable performance with the average performance of the experienced in classifying the CTS, while outperformed that of the inexperienced radiologists in terms of classification metrics (e.g., accuracy score of 3.59% higher and F1 score of 5.85% higher). Conclusion: The OSA-CTSD demonstrated promising diagnostic performance with the advantages of real-time, automation, and clinical interpretability. The application of such a tool can not only reduce reliance on the expertise of examiners, but also can help to promote the future standardization of the CTS diagnosis process, benefiting both patients and radiologists., Comment: Accepted by Ultrasound in Medicine & Biology

Breast lesion segmentation from breast ultrasound (BUS) videos could assist in early diagnosis and treatment. Existing video object segmentation (VOS) methods usually require dense annotation, which is often inaccessible for medical datasets. Furthermore, they suffer from accumulative errors and a lack of explicit space-time awareness. In this work, we propose a novel two-shot training paradigm for BUS video segmentation. It not only is able to capture free-range space-time consistency but also utilizes a source-dependent augmentation scheme. This label-efficient learning framework is validated on a challenging in-house BUS video dataset. Results showed that it gained comparable performance to the fully annotated ones given only 1.9% training labels., Comment: 5 pages, 4 figure, 2 tables, accepted by ISBI 2024

Interactive medical image segmentation refers to the accurate segmentation of the target of interest through interaction (e.g., click) between the user and the image. It has been widely studied in recent years as it is less dependent on abundant annotated data and more flexible than fully automated segmentation. However, current studies have not fully explored user-provided prompt information (e.g., points), including the knowledge mined in one interaction, and the relationship between multiple interactions. Thus, in this paper, we introduce a novel framework equipped with prompt enhancement, called PE-MED, for interactive medical image segmentation. First, we introduce a Self-Loop strategy to generate warm initial segmentation results based on the first prompt. It can prevent the highly unfavorable scenarios, such as encountering a blank mask as the initial input after the first interaction. Second, we propose a novel Prompt Attention Learning Module (PALM) to mine useful prompt information in one interaction, enhancing the responsiveness of the network to user clicks. Last, we build a Time Series Information Propagation (TSIP) mechanism to extract the temporal relationships between multiple interactions and increase the model stability. Comparative experiments with other state-of-the-art (SOTA) medical image segmentation algorithms show that our method exhibits better segmentation accuracy and stability., Comment: Accepted by MICCAI MLMI 2023

Ultrasound is the primary modality to examine fetal growth during pregnancy, while the image quality could be affected by various factors. Quality assessment is essential for controlling the quality of ultrasound images to guarantee both the perceptual and diagnostic values. Existing automated approaches often require heavy structural annotations and the predictions may not necessarily be consistent with the assessment results by human experts. Furthermore, the overall quality of a scan and the correlation between the quality of frames should not be overlooked. In this work, we propose a reinforcement learning framework powered by two hierarchical agents that collaboratively learn to perform both frame-level and video-level quality assessments. It is equipped with a specially-designed reward mechanism that considers temporal dependency among frame quality and only requires sparse binary annotations to train. Experimental results on a challenging fetal brain dataset verify that the proposed framework could perform dual-level quality assessment and its predictions correlate well with the subjective assessment results.

Breast cancer is one of the leading causes of cancer deaths in women. As the primary output of breast screening, breast ultrasound (US) video contains exclusive dynamic information for cancer diagnosis. However, training models for video analysis is non-trivial as it requires a voluminous dataset which is also expensive to annotate. Furthermore, the diagnosis of breast lesion faces unique challenges such as inter-class similarity and intra-class variation. In this paper, we propose a pioneering approach that directly utilizes US videos in computer-aided breast cancer diagnosis. It leverages masked video modeling as pretraining to reduce reliance on dataset size and detailed annotations. Moreover, a correlation-aware contrastive loss is developed to facilitate the identifying of the internal and external relationship between benign and malignant lesions. Experimental results show that our proposed approach achieved promising classification performance and can outperform other state-of-the-art methods., Comment: Accepted by MICCAI-REMIA oral 2022

Ultrasound (US) is the primary imaging technique for the diagnosis of thyroid cancer. However, accurate identification of nodule malignancy is a challenging task that can elude less-experienced clinicians. Recently, many computer-aided diagnosis (CAD) systems have been proposed to assist this process. However, most of them do not provide the reasoning of their classification process, which may jeopardize their credibility in practical use. To overcome this, we propose a novel deep learning framework called multi-attribute attention network (MAA-Net) that is designed to mimic the clinical diagnosis process. The proposed model learns to predict nodular attributes and infer their malignancy based on these clinically-relevant features. A multi-attention scheme is adopted to generate customized attention to improve each task and malignancy diagnosis. Furthermore, MAA-Net utilizes nodule delineations as nodules spatial prior guidance for the training rather than cropping the nodules with additional models or human interventions to prevent losing the context information. Validation experiments were performed on a large and challenging dataset containing 4554 patients. Results show that the proposed method outperformed other state-of-the-art methods and provides interpretable predictions that may better suit clinical needs., Comment: 11 pages, 7 figures

Over the past decades, the incidence of thyroid cancer has been increasing globally. Accurate and early diagnosis allows timely treatment and helps to avoid over-diagnosis. Clinically, a nodule is commonly evaluated from both transverse and longitudinal views using thyroid ultrasound. However, the appearance of the thyroid gland and lesions can vary dramatically across individuals. Identifying key diagnostic information from both views requires specialized expertise. Furthermore, finding an optimal way to integrate multi-view information also relies on the experience of clinicians and adds further difficulty to accurate diagnosis. To address these, we propose a personalized diagnostic tool that can customize its decision-making process for different patients. It consists of a multi-view classification module for feature extraction and a personalized weighting allocation network that generates optimal weighting for different views. It is also equipped with a self-supervised view-aware contrastive loss to further improve the model robustness towards different patient groups. Experimental results show that the proposed framework can better utilize multi-view information and outperform the competing methods., Comment: Accepted by MICCAI 2022

Regression learning is classic and fundamental for medical image analysis. It provides the continuous mapping for many critical applications, like the attribute estimation, object detection, segmentation and non-rigid registration. However, previous studies mainly took the case-wise criteria, like the mean square errors, as the optimization objectives. They ignored the very important population-wise correlation criterion, which is exactly the final evaluation metric in many tasks. In this work, we propose to revisit the classic regression tasks with novel investigations on directly optimizing the fine-grained correlation losses. We mainly explore two complementary correlation indexes as learnable losses: Pearson linear correlation (PLC) and Spearman rank correlation (SRC). The contributions of this paper are two folds. First, for the PLC on global level, we propose a strategy to make it robust against the outliers and regularize the key distribution factors. These efforts significantly stabilize the learning and magnify the efficacy of PLC. Second, for the SRC on local level, we propose a coarse-to-fine scheme to ease the learning of the exact ranking order among samples. Specifically, we convert the learning for the ranking of samples into the learning of similarity relationships among samples. We extensively validate our method on two typical ultrasound image regression tasks, including the image quality assessment and bio-metric measurement. Experiments prove that, with the fine-grained guidance in directly optimizing the correlation, the regression performances are significantly improved. Our proposed correlation losses are general and can be extended to more important applications., Comment: Accepted by MICCAI 2022

Different from handcrafted features, deep neural networks can automatically learn task-specific features from data. Due to this data-driven nature, they have achieved remarkable success in various areas. However, manual design and selection of suitable network architectures are time-consuming and require substantial effort of human experts. To address this problem, researchers have proposed neural architecture search (NAS) algorithms which can automatically generate network architectures but suffer from heavy computational cost and instability if searching from scratch. In this paper, we propose a hybrid NAS framework for ultrasound (US) image classification and segmentation. The hybrid framework consists of a pre-trained backbone and several searched cells (i.e., network building blocks), which takes advantage of the strengths of both NAS and the expert knowledge from existing convolutional neural networks. Specifically, two effective and lightweight operations, a mixed depth-wise convolution operator and a squeeze-and-excitation block, are introduced into the candidate operations to enhance the variety and capacity of the searched cells. These two operations not only decrease model parameters but also boost network performance. Moreover, we propose a re-aggregation strategy for the searched cells, aiming to further improve the performance for different vision tasks. We tested our method on two large US image datasets, including a 9-class echinococcosis dataset containing 9566 images for classification and an ovary dataset containing 3204 images for segmentation. Ablation experiments and comparison with other handcrafted or automatically searched architectures demonstrate that our method can generate more powerful and lightweight models for the above US image classification and segmentation tasks., Comment: 17 pages,11 figures. Accepted by Expert Systems and Applications, 2022

Standard plane recognition plays an important role in prenatal ultrasound (US) screening. Automatically recognizing the standard plane along with the corresponding anatomical structures in US image can not only facilitate US image interpretation but also improve diagnostic efficiency. In this study, we build a novel multi-label learning (MLL) scheme to identify multiple standard planes and corresponding anatomical structures of fetus simultaneously. Our contribution is three-fold. First, we represent the class correlation by word embeddings to capture the fine-grained semantic and latent statistical concurrency. Second, we equip the MLL with a graph convolutional network to explore the inner and outer relationship among categories. Third, we propose a novel cluster relabel-based contrastive learning algorithm to encourage the divergence among ambiguous classes. Extensive validation was performed on our large in-house dataset. Our approach reports the highest accuracy as 90.25% for standard planes labeling, 85.59% for planes and structures labeling and mAP as 94.63%. The proposed MLL scheme provides a novel perspective for standard plane recognition and can be easily extended to other medical image classification tasks., Comment: Accepted by MICCAI-MLMI 2021

3D ultrasound (US) has become prevalent due to its rich spatial and diagnostic information not contained in 2D US. Moreover, 3D US can contain multiple standard planes (SPs) in one shot. Thus, automatically localizing SPs in 3D US has the potential to improve user-independence and scanning-efficiency. However, manual SP localization in 3D US is challenging because of the low image quality, huge search space and large anatomical variability. In this work, we propose a novel multi-agent reinforcement learning (MARL) framework to simultaneously localize multiple SPs in 3D US. Our contribution is four-fold. First, our proposed method is general and it can accurately localize multiple SPs in different challenging US datasets. Second, we equip the MARL system with a recurrent neural network (RNN) based collaborative module, which can strengthen the communication among agents and learn the spatial relationship among planes effectively. Third, we explore to adopt the neural architecture search (NAS) to automatically design the network architecture of both the agents and the collaborative module. Last, we believe we are the first to realize automatic SP localization in pelvic US volumes, and note that our approach can handle both normal and abnormal uterus cases. Extensively validated on two challenging datasets of the uterus and fetal brain, our proposed method achieves the average localization accuracy of 7.03 degrees/1.59mm and 9.75 degrees/1.19mm. Experimental results show that our light-weight MARL model has higher accuracy than state-of-the-art methods., Comment: Accepted by Medical Image Analysis (10 figures, 8 tabels)

Accurate standard plane (SP) localization is the fundamental step for prenatal ultrasound (US) diagnosis. Typically, dozens of US SPs are collected to determine the clinical diagnosis. 2D US has to perform scanning for each SP, which is time-consuming and operator-dependent. While 3D US containing multiple SPs in one shot has the inherent advantages of less user-dependency and more efficiency. Automatically locating SP in 3D US is very challenging due to the huge search space and large fetal posture variations. Our previous study proposed a deep reinforcement learning (RL) framework with an alignment module and active termination to localize SPs in 3D US automatically. However, termination of agent search in RL is important and affects the practical deployment. In this study, we enhance our previous RL framework with a newly designed adaptive dynamic termination to enable an early stop for the agent searching, saving at most 67% inference time, thus boosting the accuracy and efficiency of the RL framework at the same time. Besides, we validate the effectiveness and generalizability of our algorithm extensively on our in-house multi-organ datasets containing 433 fetal brain volumes, 519 fetal abdomen volumes, and 683 uterus volumes. Our approach achieves localization error of 2.52mm/10.26 degrees, 2.48mm/10.39 degrees, 2.02mm/10.48 degrees, 2.00mm/14.57 degrees, 2.61mm/9.71 degrees, 3.09mm/9.58 degrees, 1.49mm/7.54 degrees for the transcerebellar, transventricular, transthalamic planes in fetal brain, abdominal plane in fetal abdomen, and mid-sagittal, transverse and coronal planes in uterus, respectively. Experimental results show that our method is general and has the potential to improve the efficiency and standardization of US scanning., Comment: Accepted by IEEE Transactions on Medical Imaging (12 pages, 8 figures, 11 tabels)

Ultrasound (US) image segmentation embraced its significant improvement in deep learning era. However, the lack of sharp boundaries in US images still remains an inherent challenge for segmentation. Previous methods often resort to global context, multi-scale cues or auxiliary guidance to estimate the boundaries. It is hard for these methods to approach pixel-level learning for fine-grained boundary generating. In this paper, we propose a novel and effective framework to improve boundary estimation in US images. Our work has three highlights. First, we propose to formulate the boundary estimation as a rendering task, which can recognize ambiguous points (pixels/voxels) and calibrate the boundary prediction via enriched feature representation learning. Second, we introduce point-wise contrastive learning to enhance the similarity of points from the same class and contrastively decrease the similarity of points from different classes. Boundary ambiguities are therefore further addressed. Third, both rendering and contrastive learning tasks contribute to consistent improvement while reducing network parameters. As a proof-of-concept, we performed validation experiments on a challenging dataset of 86 ovarian US volumes. Results show that our proposed method outperforms state-of-the-art methods and has the potential to be used in clinical practice., Comment: 10 pages, 5 figures, 2 tables, 13 references

3D ultrasound (US) can facilitate detailed prenatal examinations for fetal growth monitoring. To analyze a 3D US volume, it is fundamental to identify anatomical landmarks of the evaluated organs accurately. Typical deep learning methods usually regress the coordinates directly or involve heatmap-matching. However, these methods struggle to deal with volumes with large sizes and the highly-varying positions and orientations of fetuses. In this work, we exploit an object detection framework to detect landmarks in 3D fetal facial US volumes. By regressing multiple parameters of the landmark-centered bounding box (B-box) with a strict criteria, the proposed model is able to pinpoint the exact location of the targeted landmarks. Specifically, the model uses a 3D region proposal network (RPN) to generate 3D candidate regions, followed by several 3D classification branches to select the best candidate. It also adopts an IoU-balance loss to improve communications between branches that benefits the learning process. Furthermore, it leverages a distance-based graph prior to regularize the training and helps to reduce false positive predictions. The performance of the proposed framework is evaluated on a 3D US dataset to detect five key fetal facial landmarks. Results showed the proposed method outperforms some of the state-of-the-art methods in efficacy and efficiency., Comment: IEEE International Symposium on Biomedical Imaging (IEEE ISBI 2020)

To improve the performance of most neuroimiage analysis pipelines, brain extraction is used as a fundamental first step in the image processing. But in the case of fetal brain development, there is a need for a reliable US-specific tool. In this work we propose a fully automated 3D CNN approach to fetal brain extraction from 3D US clinical volumes with minimal preprocessing. Our method accurately and reliably extracts the brain regardless of the large data variation inherent in this imaging modality. It also performs consistently throughout a gestational age range between 14 and 31 weeks, regardless of the pose variation of the subject, the scale, and even partial feature-obstruction in the image, outperforming all current alternatives., Comment: 13 pages, 7 figures, MIUA conference