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Breast magnetic resonance imaging (MRI) is the imaging technique with the highest sensitivity for detecting breast cancer and is routinely used for women at high risk. Despite the comprehensive multiparametric protocol of breast MRI, existing artificial intelligence-based studies predominantly rely on single sequences and have limited validation. Here we report a large mixture-of-modality-experts model (MOME) that integrates multiparametric MRI information within a unified structure, offering a noninvasive method for personalized breast cancer management. We have curated the largest multiparametric breast MRI dataset, involving 5,205 patients from three hospitals in the north, southeast, and southwest of China, for the development and extensive evaluation of our model. MOME demonstrated accurate and robust identification of breast cancer. It achieved comparable performance for malignancy recognition to that of four senior radiologists and significantly outperformed a junior radiologist, with 0.913 AUROC, 0.948 AUPRC, 0.905 F1 score, and 0.723 MCC. Our findings suggest that MOME could reduce the need for biopsies in BI-RADS 4 patients with a ratio of 7.3%, classify triple-negative breast cancer with an AUROC of 0.709, and predict pathological complete response to neoadjuvant chemotherapy with an AUROC of 0.694. The model further supports scalable and interpretable inference, adapting to missing modalities and providing decision explanations by highlighting lesions and measuring modality contributions. MOME exemplifies a discriminative, robust, scalable, and interpretable multimodal model, paving the way for noninvasive, personalized management of breast cancer patients based on multiparametric breast imaging data., Comment: 27 pages, 8 figures, 10 tables

Existing state-of-the-art methods for surgical phase recognition either rely on the extraction of spatial-temporal features at a short-range temporal resolution or adopt the sequential extraction of the spatial and temporal features across the entire temporal resolution. However, these methods have limitations in modeling spatial-temporal dependency and addressing spatial-temporal redundancy: 1) These methods fail to effectively model spatial-temporal dependency, due to the lack of long-range information or joint spatial-temporal modeling. 2) These methods utilize dense spatial features across the entire temporal resolution, resulting in significant spatial-temporal redundancy. In this paper, we propose the Surgical Transformer (Surgformer) to address the issues of spatial-temporal modeling and redundancy in an end-to-end manner, which employs divided spatial-temporal attention and takes a limited set of sparse frames as input. Moreover, we propose a novel Hierarchical Temporal Attention (HTA) to capture both global and local information within varied temporal resolutions from a target frame-centric perspective. Distinct from conventional temporal attention that primarily emphasizes dense long-range similarity, HTA not only captures long-term information but also considers local latent consistency among informative frames. HTA then employs pyramid feature aggregation to effectively utilize temporal information across diverse temporal resolutions, thereby enhancing the overall temporal representation. Extensive experiments on two challenging benchmark datasets verify that our proposed Surgformer performs favorably against the state-of-the-art methods. The code is released at https://github.com/isyangshu/Surgformer.

The right to be forgotten, as stated in most data regulations, poses an underexplored challenge in federated learning (FL), leading to the development of federated unlearning (FU). However, current FU approaches often face trade-offs between efficiency, model performance, forgetting efficacy, and privacy preservation. In this paper, we delve into the paradigm of Federated Client Unlearning (FCU) to guarantee a client the right to erase the contribution or the influence, introducing the first FU framework in medical imaging. In the unlearning process of a client, the proposed model-contrastive unlearning marks a pioneering step towards feature-level unlearning, and frequency-guided memory preservation ensures smooth forgetting of local knowledge while maintaining the generalizability of the trained global model, thus avoiding performance compromises and guaranteeing rapid post-training. We evaluated our FCU framework on two public medical image datasets, including Intracranial hemorrhage diagnosis and skin lesion diagnosis, demonstrating that our framework outperformed other state-of-the-art FU frameworks, with an expected speed-up of 10-15 times compared with retraining from scratch. The code and the organized datasets can be found at: https://github.com/dzp2095/FCU.

The essence of precision oncology lies in its commitment to tailor targeted treatments and care measures to each patient based on the individual characteristics of the tumor. The inherent heterogeneity of tumors necessitates gathering information from diverse data sources to provide valuable insights from various perspectives, fostering a holistic comprehension of the tumor. Over the past decade, multimodal data integration technology for precision oncology has made significant strides, showcasing remarkable progress in understanding the intricate details within heterogeneous data modalities. These strides have exhibited tremendous potential for improving clinical decision-making and model interpretation, contributing to the advancement of cancer care and treatment. Given the rapid progress that has been achieved, we provide a comprehensive overview of about 300 papers detailing cutting-edge multimodal data integration techniques in precision oncology. In addition, we conclude the primary clinical applications that have reaped significant benefits, including early assessment, diagnosis, prognosis, and biomarker discovery. Finally, derived from the findings of this survey, we present an in-depth analysis that explores the pivotal challenges and reveals essential pathways for future research in the field of multimodal data integration for precision oncology., Comment: 15 pages, 4 figures

Medical report generation has achieved remarkable advancements yet has still been faced with several challenges. First, the inherent imbalance in the distribution of normal and abnormal cases may lead models to exhibit a biased focus on normal samples, resulting in unreliable diagnoses. Second, the frequent occurrence of common template sentences in the reports may overwhelm the critical abnormal information. Moreover, existing works focus on 2D chest X-rays, leaving CT report generation underexplored due to the high-dimensional nature of CT images and the limited availability of CT-report pairs. Recently, LLM has shown a great ability to generate reliable answers with appropriate prompts, which shed light on addressing the aforementioned challenges. In this paper, we propose Dia-LLaMA, a framework to adapt the LLaMA2-7B for CT report generation by incorporating diagnostic information as guidance prompts. Considering the high dimension of CT, we leverage a pre-trained ViT3D with perceiver to extract the visual information. To tailor the LLM for report generation and emphasize abnormality, we extract additional diagnostic information by referring to a disease prototype memory bank, which is updated during training to capture common disease representations. Furthermore, we introduce disease-aware attention to enable the model to adjust attention for different diseases. Experiments on the chest CT dataset demonstrated that our proposed method outperformed previous methods and achieved state-of-the-art on both clinical efficacy performance and natural language generation metrics. The code will be made publically available., Comment: 10 pages

Utilizing potent representations of the large vision-language models (VLMs) to accomplish various downstream tasks has attracted increasing attention. Within this research field, soft prompt learning has become a representative approach for efficiently adapting VLMs such as CLIP, to tasks like image classification. However, most existing prompt learning methods learn text tokens that are unexplainable, which cannot satisfy the stringent interpretability requirements of Explainable Artificial Intelligence (XAI) in high-stakes scenarios like healthcare. To address this issue, we propose a novel explainable prompt learning framework that leverages medical knowledge by aligning the semantics of images, learnable prompts, and clinical concept-driven prompts at multiple granularities. Moreover, our framework addresses the lack of valuable concept annotations by eliciting knowledge from large language models and offers both visual and textual explanations for the prompts. Extensive experiments and explainability analyses conducted on various datasets, with and without concept labels, demonstrate that our method simultaneously achieves superior diagnostic performance, flexibility, and interpretability, shedding light on the effectiveness of foundation models in facilitating XAI. The code will be made publically available.

Deep learning could be prone to learning shortcuts raised by dataset bias and result in inaccurate, unreliable, and unfair models, which impedes its adoption in real-world clinical applications. Despite its significance, there is a dearth of research in the medical image classification domain to address dataset bias. Furthermore, the bias labels are often agnostic, as identifying biases can be laborious and depend on post-hoc interpretation. This paper proposes learning Adaptive Agreement from a Biased Council (Ada-ABC), a debiasing framework that does not rely on explicit bias labels to tackle dataset bias in medical images. Ada-ABC develops a biased council consisting of multiple classifiers optimized with generalized cross entropy loss to learn the dataset bias. A debiasing model is then simultaneously trained under the guidance of the biased council. Specifically, the debiasing model is required to learn adaptive agreement with the biased council by agreeing on the correctly predicted samples and disagreeing on the wrongly predicted samples by the biased council. In this way, the debiasing model could learn the target attribute on the samples without spurious correlations while also avoiding ignoring the rich information in samples with spurious correlations. We theoretically demonstrated that the debiasing model could learn the target features when the biased model successfully captures dataset bias. Moreover, to our best knowledge, we constructed the first medical debiasing benchmark from four datasets containing seven different bias scenarios. Our extensive experiments practically showed that our proposed Ada-ABC outperformed competitive approaches, verifying its effectiveness in mitigating dataset bias for medical image classification. The codes and organized benchmark datasets will be made publicly available., Comment: 10 pages, 5 figures, 3 tables. Code and benchmark will be released via https://github.com/LLYXC/Ada-ABC/tree/main

Multiple Instance Learning (MIL) has demonstrated promise in Whole Slide Image (WSI) classification. However, a major challenge persists due to the high computational cost associated with processing these gigapixel images. Existing methods generally adopt a two-stage approach, comprising a non-learnable feature embedding stage and a classifier training stage. Though it can greatly reduce the memory consumption by using a fixed feature embedder pre-trained on other domains, such scheme also results in a disparity between the two stages, leading to suboptimal classification accuracy. To address this issue, we propose that a bag-level classifier can be a good instance-level teacher. Based on this idea, we design Iteratively Coupled Multiple Instance Learning (ICMIL) to couple the embedder and the bag classifier at a low cost. ICMIL initially fix the patch embedder to train the bag classifier, followed by fixing the bag classifier to fine-tune the patch embedder. The refined embedder can then generate better representations in return, leading to a more accurate classifier for the next iteration. To realize more flexible and more effective embedder fine-tuning, we also introduce a teacher-student framework to efficiently distill the category knowledge in the bag classifier to help the instance-level embedder fine-tuning. Thorough experiments were conducted on four distinct datasets to validate the effectiveness of ICMIL. The experimental results consistently demonstrate that our method significantly improves the performance of existing MIL backbones, achieving state-of-the-art results. The code is available at: https://github.com/Dootmaan/ICMIL/tree/confidence_based

Deep-learning (DL) based methods are playing an important role in the task of abdominal organs and tumors segmentation in CT scans. However, the large requirements of annotated datasets heavily limit its development. The FLARE23 challenge provides a large-scale dataset with both partially and fully annotated data, which also focuses on both segmentation accuracy and computational efficiency. In this study, we propose to use the strategy of Semi-Supervised Learning (SSL) and iterative pseudo labeling to address FLARE23. Initially, a deep model (nn-UNet) trained on datasets with complete organ annotations (about 220 scans) generates pseudo labels for the whole dataset. These pseudo labels are then employed to train a more powerful segmentation model. Employing the FLARE23 dataset, our approach achieves an average DSC score of 89.63% for organs and 46.07% for tumors on online validation leaderboard. For organ segmentation, We obtain 0.9007\% DSC and 0.9493\% NSD. For tumor segmentation, we obtain 0.3785% DSC and 0.2842% NSD. Our code is available at https://github.com/USTguy/Flare23., Comment: arXiv admin note: text overlap with arXiv:2309.05405

Deep learning (DL)-based rib fracture detection has shown promise of playing an important role in preventing mortality and improving patient outcome. Normally, developing DL-based object detection models requires a huge amount of bounding box annotation. However, annotating medical data is time-consuming and expertise-demanding, making obtaining a large amount of fine-grained annotations extremely infeasible. This poses a pressing need {for} developing label-efficient detection models to alleviate radiologists' labeling burden. To tackle this challenge, the literature on object detection has witnessed an increase of weakly-supervised and semi-supervised approaches, yet still lacks a unified framework that leverages various forms of fully-labeled, weakly-labeled, and unlabeled data. In this paper, we present a novel omni-supervised object detection network, ORF-Netv2, to leverage as much available supervision as possible. Specifically, a multi-branch omni-supervised detection head is introduced with each branch trained with a specific type of supervision. A co-training-based dynamic label assignment strategy is then proposed to enable flexible and robust learning from the weakly-labeled and unlabeled data. Extensive evaluation was conducted for the proposed framework with three rib fracture datasets on both chest CT and X-ray. By leveraging all forms of supervision, ORF-Netv2 achieves mAPs of 34.7, 44.7, and 19.4 on the three datasets, respectively, surpassing the baseline detector which uses only box annotations by mAP gains of 3.8, 4.8, and 5.0, respectively. Furthermore, ORF-Netv2 consistently outperforms other competitive label-efficient methods over various scenarios, showing a promising framework for label-efficient fracture detection. The code is available at: https://github.com/zhizhongchai/ORF-Net., Comment: TMI 2024. Zhizhong Chai and Luyang Luo contributed equally. Code is available via: https://github.com/zhizhongchai/ORF-Net/tree/main

Masked autoencoder (MAE) is a promising self-supervised pre-training technique that can improve the representation learning of a neural network without human intervention. However, applying MAE directly to volumetric medical images poses two challenges: (i) a lack of global information that is crucial for understanding the clinical context of the holistic data, (ii) no guarantee of stabilizing the representations learned from randomly masked inputs. To address these limitations, we propose the \textbf{G}lobal-\textbf{L}ocal \textbf{M}asked \textbf{A}uto\textbf{E}ncoder (GL-MAE), a simple yet effective self-supervised pre-training strategy. In addition to reconstructing masked local views, as in previous methods, GL-MAE incorporates global context learning by reconstructing masked global views. Furthermore, a complete global view is integrated as an anchor to guide the reconstruction and stabilize the learning process through global-to-global consistency learning and global-to-local consistency learning. Finetuning results on multiple datasets demonstrate the superiority of our method over other state-of-the-art self-supervised algorithms, highlighting its effectiveness on versatile volumetric medical image segmentation tasks, even when annotations are scarce. Our codes and models will be released upon acceptance.

Convolutional Neural Networks (CNNs) have shown remarkable progress in medical image segmentation. However, lesion segmentation remains a challenge to state-of-the-art CNN-based algorithms due to the variance in scales and shapes. On the one hand, tiny lesions are hard to be delineated precisely from the medical images which are often of low resolutions. On the other hand, segmenting large-size lesions requires large receptive fields, which exacerbates the first challenge. In this paper, we present a scale-aware super-resolution network to adaptively segment lesions of various sizes from the low-resolution medical images. Our proposed network contains dual branches to simultaneously conduct lesion mask super-resolution and lesion image super-resolution. The image super-resolution branch will provide more detailed features for the segmentation branch, i.e., the mask super-resolution branch, for fine-grained segmentation. Meanwhile, we introduce scale-aware dilated convolution blocks into the multi-task decoders to adaptively adjust the receptive fields of the convolutional kernels according to the lesion sizes. To guide the segmentation branch to learn from richer high-resolution features, we propose a feature affinity module and a scale affinity module to enhance the multi-task learning of the dual branches. On multiple challenging lesion segmentation datasets, our proposed network achieved consistent improvements compared to other state-of-the-art methods., Comment: Journal paper under review. 10 pages. The first two authors contributed equally

Federated learning (FL) has been introduced to the healthcare domain as a decentralized learning paradigm that allows multiple parties to train a model collaboratively without privacy leakage. However, most previous studies have assumed that every client holds an identical label set. In reality, medical specialists tend to annotate only diseases within their area of expertise or interest. This implies that label sets in each client can be different and even disjoint. In this paper, we propose the framework FedLSM to solve the problem of Label Set Mismatch. FedLSM adopts different training strategies on data with different uncertainty levels to efficiently utilize unlabeled or partially labeled data as well as class-wise adaptive aggregation in the classification layer to avoid inaccurate aggregation when clients have missing labels. We evaluated FedLSM on two public real-world medical image datasets, including chest X-ray (CXR) diagnosis with 112,120 CXR images and skin lesion diagnosis with 10,015 dermoscopy images, and showed that it significantly outperformed other state-of-the-art FL algorithms. The code can be found at https://github.com/dzp2095/FedLSM.

Breast cancer has reached the highest incidence rate worldwide among all malignancies since 2020. Breast imaging plays a significant role in early diagnosis and intervention to improve the outcome of breast cancer patients. In the past decade, deep learning has shown remarkable progress in breast cancer imaging analysis, holding great promise in interpreting the rich information and complex context of breast imaging modalities. Considering the rapid improvement in deep learning technology and the increasing severity of breast cancer, it is critical to summarize past progress and identify future challenges to be addressed. This paper provides an extensive review of deep learning-based breast cancer imaging research, covering studies on mammogram, ultrasound, magnetic resonance imaging, and digital pathology images over the past decade. The major deep learning methods and applications on imaging-based screening, diagnosis, treatment response prediction, and prognosis are elaborated and discussed. Drawn from the findings of this survey, we present a comprehensive discussion of the challenges and potential avenues for future research in deep learning-based breast cancer imaging., Comment: IEEE RBME 2024

Collecting annotations from multiple independent sources could mitigate the impact of potential noises and biases from a single source, which is a common practice in medical image segmentation. Learning segmentation networks from multi-source annotations remains a challenge due to the uncertainties brought by the variance of annotations and the quality of images. In this paper, we propose an Uncertainty-guided Multi-source Annotation Network (UMA-Net), which guides the training process by uncertainty estimation at both the pixel and the image levels. First, we developed the annotation uncertainty estimation module (AUEM) to learn the pixel-wise uncertainty of each annotation, which then guided the network to learn from reliable pixels by weighted segmentation loss. Second, a quality assessment module (QAM) was proposed to assess the image-level quality of the input samples based on the former assessed annotation uncertainties. Importantly, we introduced an auxiliary predictor to learn from the low-quality samples instead of discarding them, which ensured the preservation of their representation knowledge in the backbone without directly accumulating errors within the primary predictor. Extensive experiments demonstrated the effectiveness and feasibility of our proposed UMA-Net on various datasets, including 2D chest X-ray segmentation, fundus image segmentation, and 3D breast DCE-MRI segmentation.

Whole Slide Image (WSI) classification remains a challenge due to their extremely high resolution and the absence of fine-grained labels. Presently, WSI classification is usually regarded as a Multiple Instance Learning (MIL) problem when only slide-level labels are available. MIL methods involve a patch embedding module and a bag-level classification module, but they are prohibitively expensive to be trained in an end-to-end manner. Therefore, existing methods usually train them separately, or directly skip the training of the embedder. Such schemes hinder the patch embedder's access to slide-level semantic labels, resulting in inconsistency within the entire MIL pipeline. To overcome this issue, we propose a novel framework called Iteratively Coupled MIL (ICMIL), which bridges the loss back-propagation process from the bag-level classifier to the patch embedder. In ICMIL, we use category information in the bag-level classifier to guide the patch-level fine-tuning of the patch feature extractor. The refined embedder then generates better instance representations for achieving a more accurate bag-level classifier. By coupling the patch embedder and bag classifier at a low cost, our proposed framework enables information exchange between the two modules, benefiting the entire MIL classification model. We tested our framework on two datasets using three different backbones, and our experimental results demonstrate consistent performance improvements over state-of-the-art MIL methods. The code is available at: https://github.com/Dootmaan/ICMIL.

Deep learning has seen rapid growth in recent years and achieved state-of-the-art performance in a wide range of applications. However, training models typically requires expensive and time-consuming collection of large quantities of labeled data. This is particularly true within the scope of medical imaging analysis (MIA), where data are limited and labels are expensive to be acquired. Thus, label-efficient deep learning methods are developed to make comprehensive use of the labeled data as well as the abundance of unlabeled and weak-labeled data. In this survey, we extensively investigated over 300 recent papers to provide a comprehensive overview of recent progress on label-efficient learning strategies in MIA. We first present the background of label-efficient learning and categorize the approaches into different schemes. Next, we examine the current state-of-the-art methods in detail through each scheme. Specifically, we provide an in-depth investigation, covering not only canonical semi-supervised, self-supervised, and multi-instance learning schemes, but also recently emerged active and annotation-efficient learning strategies. Moreover, as a comprehensive contribution to the field, this survey not only elucidates the commonalities and unique features of the surveyed methods but also presents a detailed analysis of the current challenges in the field and suggests potential avenues for future research., Comment: Update Few-shot Methods

Most of the existing object detection works are based on the bounding box annotation: each object has a precise annotated box. However, for rib fractures, the bounding box annotation is very labor-intensive and time-consuming because radiologists need to investigate and annotate the rib fractures on a slice-by-slice basis. Although a few studies have proposed weakly-supervised methods or semi-supervised methods, they could not handle different forms of supervision simultaneously. In this paper, we proposed a novel omni-supervised object detection network, which can exploit multiple different forms of annotated data to further improve the detection performance. Specifically, the proposed network contains an omni-supervised detection head, in which each form of annotation data corresponds to a unique classification branch. Furthermore, we proposed a dynamic label assignment strategy for different annotated forms of data to facilitate better learning for each branch. Moreover, we also design a confidence-aware classification loss to emphasize the samples with high confidence and further improve the model's performance. Extensive experiments conducted on the testing dataset show our proposed method outperforms other state-of-the-art approaches consistently, demonstrating the efficacy of deep omni-supervised learning on improving rib fracture detection performance.

Deep learning models were frequently reported to learn from shortcuts like dataset biases. As deep learning is playing an increasingly important role in the modern healthcare system, it is of great need to combat shortcut learning in medical data as well as develop unbiased and trustworthy models. In this paper, we study the problem of developing debiased chest X-ray diagnosis models from the biased training data without knowing exactly the bias labels. We start with the observations that the imbalance of bias distribution is one of the key reasons causing shortcut learning, and the dataset biases are preferred by the model if they were easier to be learned than the intended features. Based on these observations, we proposed a novel algorithm, pseudo bias-balanced learning, which first captures and predicts per-sample bias labels via generalized cross entropy loss and then trains a debiased model using pseudo bias labels and bias-balanced softmax function. We constructed several chest X-ray datasets with various dataset bias situations and demonstrated with extensive experiments that our proposed method achieved consistent improvements over other state-of-the-art approaches., Comment: To appear in MICCAI 2022. Code available at https://github.com/LLYXC/PBBL

Two DL models were developed using radiograph-level annotations (yes or no disease) and fine-grained lesion-level annotations (lesion bounding boxes), respectively named CheXNet and CheXDet. The models' internal classification performance and lesion localization performance were compared on a testing set (n=2,922), external classification performance was compared on NIH-Google (n=4,376) and PadChest (n=24,536) datasets, and external lesion localization performance was compared on NIH-ChestX-ray14 dataset (n=880). The models were also compared to radiologists on a subset of the internal testing set (n=496). Given sufficient training data, both models performed comparably to radiologists. CheXDet achieved significant improvement for external classification, such as in classifying fracture on NIH-Google (CheXDet area under the ROC curve [AUC]: 0.67, CheXNet AUC: 0.51; p<.001) and PadChest (CheXDet AUC: 0.78, CheXNet AUC: 0.55; p<.001). CheXDet achieved higher lesion detection performance than CheXNet for most abnormalities on all datasets, such as in detecting pneumothorax on the internal set (CheXDet jacknife alternative free-response ROC-figure of merit [JAFROC-FOM]: 0.87, CheXNet JAFROC-FOM: 0.13; p<.001) and NIH-ChestX-ray14 (CheXDet JAFROC-FOM: 0.55, CheXNet JAFROC-FOM: 0.04; p<.001). To summarize, fine-grained annotations overcame shortcut learning and enabled DL models to identify correct lesion patterns, improving the models' generalizability., Comment: Radiology: Artificial Intelligence

Deep learning has achieved unprecedented success in various object detection tasks with huge amounts of labeled data. However, obtaining large-scale annotations for medical images is extremely challenging due to the high demand of labour and expertise. In this paper, we propose a novel deep semi-supervised metric learning method to effectively leverage both labeled and unlabeled data for cervical cancer cell detection. Specifically, our model learns a metric space and conducts dual alignment of semantic features on both the proposal level and the prototype levels. On the proposal level, we align the unlabeled data with class proxies derived from the labeled data. We further align the prototypes of the labeled and unlabeled data to alleviate the influence of possibly noisy pseudo labels generated at the proposal alignment stage. Moreover, we adopt a memory bank to store the labeled prototypes, which significantly enrich the metric learning information from larger batches. Extensive experiments show our proposed method outperforms other state-of-the-art semi-supervised approaches consistently, demonstrating the efficacy of our proposed deep semi-supervised metric learning with dual alignment., Comment: 5 pages

Chest X-ray (CXR) is the most typical diagnostic X-ray examination for screening various thoracic diseases. Automatically localizing lesions from CXR is promising for alleviating radiologists' reading burden. However, CXR datasets are often with massive image-level annotations and scarce lesion-level annotations, and more often, without annotations. Thus far, unifying different supervision granularities to develop thoracic disease detection algorithms has not been comprehensively addressed. In this paper, we present OXnet, the first deep omni-supervised thoracic disease detection network to our best knowledge that uses as much available supervision as possible for CXR diagnosis. We first introduce supervised learning via a one-stage detection model. Then, we inject a global classification head to the detection model and propose dual attention alignment to guide the global gradient to the local detection branch, which enables learning lesion detection from image-level annotations. We also impose intra-class compactness and inter-class separability with global prototype alignment to further enhance the global information learning. Moreover, we leverage a soft focal loss to distill the soft pseudo-labels of unlabeled data generated by a teacher model. Extensive experiments on a large-scale chest X-ray dataset show the proposed OXnet outperforms competitive methods with significant margins. Further, we investigate omni-supervision under various annotation granularities and corroborate OXnet is a promising choice to mitigate the plight of annotation shortage for medical image diagnosis., Comment: Accepted to MICCAI2021. Code is available at https://github.com/LLYXC/OXnet

The novel coronavirus disease 2019 (COVID-19) characterized by atypical pneumonia has caused millions of deaths worldwide. Automatically segmenting lesions from chest Computed Tomography (CT) is a promising way to assist doctors in COVID-19 screening, treatment planning, and follow-up monitoring. However, voxel-wise annotations are extremely expert-demanding and scarce, especially when it comes to novel diseases, while an abundance of unlabeled data could be available. To tackle the challenge of limited annotations, in this paper, we propose an uncertainty-guided dual-consistency learning network (UDC-Net) for semi-supervised COVID-19 lesion segmentation from CT images. Specifically, we present a dual-consistency learning scheme that simultaneously imposes image transformation equivalence and feature perturbation invariance to effectively harness the knowledge from unlabeled data. We then quantify the segmentation uncertainty in two forms and employ them together to guide the consistency regularization for more reliable unsupervised learning. Extensive experiments showed that our proposed UDC-Net improves the fully supervised method by 6.3% in Dice and outperforms other competitive semi-supervised approaches by significant margins, demonstrating high potential in real-world clinical practice., Comment: Accepted to MICCAI2021. The first two authors contributed equally. Code is available at https://github.com/poiuohke/UDC-Net

Deep learning approaches have demonstrated remarkable progress in automatic Chest X-ray analysis. The data-driven feature of deep models requires training data to cover a large distribution. Therefore, it is substantial to integrate knowledge from multiple datasets, especially for medical images. However, learning a disease classification model with extra Chest X-ray (CXR) data is yet challenging. Recent researches have demonstrated that performance bottleneck exists in joint training on different CXR datasets, and few made efforts to address the obstacle. In this paper, we argue that incorporating an external CXR dataset leads to imperfect training data, which raises the challenges. Specifically, the imperfect data is in two folds: domain discrepancy, as the image appearances vary across datasets; and label discrepancy, as different datasets are partially labeled. To this end, we formulate the multi-label thoracic disease classification problem as weighted independent binary tasks according to the categories. For common categories shared across domains, we adopt task-specific adversarial training to alleviate the feature differences. For categories existing in a single dataset, we present uncertainty-aware temporal ensembling of model predictions to mine the information from the missing labels further. In this way, our framework simultaneously models and tackles the domain and label discrepancies, enabling superior knowledge mining ability. We conduct extensive experiments on three datasets with more than 360,000 Chest X-ray images. Our method outperforms other competing models and sets state-of-the-art performance on the official NIH test set with 0.8349 AUC, demonstrating its effectiveness of utilizing the external dataset to improve the internal classification., Comment: Accepted to IEEE Transactions on Medical Imaging

Training deep neural networks usually requires a large amount of labeled data to obtain good performance. However, in medical image analysis, obtaining high-quality labels for the data is laborious and expensive, as accurately annotating medical images demands expertise knowledge of the clinicians. In this paper, we present a novel relation-driven semi-supervised framework for medical image classification. It is a consistency-based method which exploits the unlabeled data by encouraging the prediction consistency of given input under perturbations, and leverages a self-ensembling model to produce high-quality consistency targets for the unlabeled data. Considering that human diagnosis often refers to previous analogous cases to make reliable decisions, we introduce a novel sample relation consistency (SRC) paradigm to effectively exploit unlabeled data by modeling the relationship information among different samples. Superior to existing consistency-based methods which simply enforce consistency of individual predictions, our framework explicitly enforces the consistency of semantic relation among different samples under perturbations, encouraging the model to explore extra semantic information from unlabeled data. We have conducted extensive experiments to evaluate our method on two public benchmark medical image classification datasets, i.e.,skin lesion diagnosis with ISIC 2018 challenge and thorax disease classification with ChestX-ray14. Our method outperforms many state-of-the-art semi-supervised learning methods on both single-label and multi-label image classification scenarios., Comment: IEEE Transactions on Medical Imaging, 2020

Optical Coherence Tomography (OCT) imaging plays an important role in glaucoma diagnosis in clinical practice. Early detection and timely treatment can prevent glaucoma patients from permanent vision loss. However, only a dearth of automated methods has been developed based on OCT images for glaucoma study. In this paper, we present a novel framework to effectively classify glaucoma OCT images from normal ones. A semi-supervised learning strategy with smoothness assumption is applied for surrogate assignment of missing function regression labels. Besides, the proposed multi-task learning network is capable of exploring the structure and function relationship from the OCT image and visual field measurement simultaneously, which contributes to classification performance boosting. Essentially, we are the first to unify the structure analysis and function regression for glaucoma screening. It is also worth noting that we build the largest glaucoma OCT image dataset involving 4877 volumes to develop and evaluate the proposed method. Extensive experiments demonstrate that our framework outperforms the baseline methods and two glaucoma experts by a large margin, achieving 93.2%, 93.2% and 97.8% on accuracy, F1 score and AUC, respectively., Comment: 9 pages, 2 figures, MICCAI2019

Accurate and automatic analysis of breast MRI plays an important role in early diagnosis and successful treatment planning for breast cancer. Due to the heterogeneity nature, accurate diagnosis of tumors remains a challenging task. In this paper, we propose to identify breast tumor in MRI by Cosine Margin Sigmoid Loss (CMSL) with deep learning (DL) and localize possible cancer lesion by COrrelation Attention Map (COAM) based on the learned features. The CMSL embeds tumor features onto a hypersphere and imposes a decision margin through cosine constraints. In this way, the DL model could learn more separable inter-class features and more compact intra-class features in the angular space. Furthermore, we utilize the correlations among feature vectors to generate attention maps that could accurately localize cancer candidates with only image-level label. We build the largest breast cancer dataset involving 10,290 DCE-MRI scan volumes for developing and evaluating the proposed methods. The model driven by CMSL achieved classification accuracy of 0.855 and AUC of 0.902 on the testing set, with sensitivity and specificity of 0.857 and 0.852, respectively, outperforming other competitive methods overall. In addition, the proposed COAM accomplished more accurate localization of the cancer center compared with other state-of-the-art weakly supervised localization method., Comment: Accepted by MICCAI 2019