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In recent years, it has become increasingly clear that space weather disturbances can be triggered by transient upstream mesoscale structures (TUMS), independently of the occurrence of large-scale solar wind (SW) structures, such as interplanetary coronal mass ejections and stream interaction regions. Different types of magnetospheric pulsations, transient perturbations of the geomagnetic field and auroral structures are often observed during times when SW monitors indicate quiet conditions, and have been found to be associated to TUMS. In this mini-review we describe the space weather phenomena that have been associated with four of the largest-scale and the most energetic TUMS, namely hot flow anomalies, foreshock bubbles, travelling foreshocks and foreshock compressional boundaries. The space weather phenomena associated with TUMS tend to be more localized and less intense compared to geomagnetic storms. However, the quiet time space weather may occur more often since, especially during solar minima, quiet SW periods prevail over the perturbed times., Comment: 1 figure, 1 table

This chapter explores anomaly localization in medical images using denoising diffusion models. After providing a brief methodological background of these models, including their application to image reconstruction and their conditioning using guidance mechanisms, we provide an overview of available datasets and evaluation metrics suitable for their application to anomaly localization in medical images. In this context, we discuss supervision schemes ranging from fully supervised segmentation to semi-supervised, weakly supervised, self-supervised, and unsupervised methods, and provide insights into the effectiveness and limitations of these approaches. Furthermore, we highlight open challenges in anomaly localization, including detection bias, domain shift, computational cost, and model interpretability. Our goal is to provide an overview of the current state of the art in the field, outline research gaps, and highlight the potential of diffusion models for robust anomaly localization in medical images.

Deep generative modeling has emerged as a powerful tool for synthesizing realistic medical images, driving advances in medical image analysis, disease diagnosis, and treatment planning. This chapter explores various deep generative models for 3D medical image synthesis, with a focus on Variational Autoencoders (VAEs), Generative Adversarial Networks (GANs), and Denoising Diffusion Models (DDMs). We discuss the fundamental principles, recent advances, as well as strengths and weaknesses of these models and examine their applications in clinically relevant problems, including unconditional and conditional generation tasks like image-to-image translation and image reconstruction. We additionally review commonly used evaluation metrics for assessing image fidelity, diversity, utility, and privacy and provide an overview of current challenges in the field.

The human brain undergoes rapid development during the third trimester of pregnancy. In this work, we model the neonatal development of the infant brain in this age range. As a basis, we use MR images of preterm- and term-birth neonates from the developing human connectome project (dHCP). We propose a neural network, specifically an implicit neural representation (INR), to predict 2D- and 3D images of varying time points. In order to model a subject-specific development process, it is necessary to disentangle the age from the subjects' identity in the latent space of the INR. We propose two methods, Subject Specific Latent Vectors (SSL) and Stochastic Global Latent Augmentation (SGLA), enabling this disentanglement. We perform an analysis of the results and compare our proposed model to an age-conditioned denoising diffusion model as a baseline. We also show that our method can be applied in a memory-efficient way, which is especially important for 3D data., Comment: Preprint, Accepted for PRIME MICCAI 2024

Today's mechanical tools for bone cutting (osteotomy) cause mechanical trauma that prolongs the healing process. Medical device manufacturers aim to minimize this trauma, with minimally invasive surgery using laser cutting as one innovation. This method ablates tissue using laser light instead of mechanical tools, reducing post-surgery healing time. A reliable feedback system is crucial during laser surgery to prevent damage to surrounding tissues. We propose a tissue classification method analyzing acoustic waves generated during laser ablation, demonstrating its applicability in an ex-vivo experiment. The ablation process with a microsecond pulsed Er:YAG laser produces acoustic waves, acquired with an air-coupled transducer. These waves were used to classify five porcine tissue types: hard bone, soft bone, muscle, fat, and skin. For automated tissue classification, we compared five Neural Network (NN) approaches: a one-dimensional Convolutional Neural Network (CNN) with time-dependent input, a Fully-connected Neural Network (FcNN) with either the frequency spectrum or principal components of the frequency spectrum as input, and a combination of a CNN and an FcNN with time-dependent data and its frequency spectrum as input. Consecutive acoustic waves were used to improve classification accuracy. Grad-Cam identified the activation map of the frequencies, showing low frequencies as the most important for this task. Our results indicated that combining time-dependent data with its frequency spectrum achieved the highest classification accuracy (65.5%-75.5%). We also found that using the frequency spectrum alone was sufficient, with no additional benefit from applying Principal Components Analysis (PCA)., Comment: This paper is an updated version of Deep-Learning Approach for Tissue Classification using Acoustic Waves during Ablation with an Er:YAG Laser originally published in DOI:10.1109/ACCESS.2021.3113055. This update addresses several issues and incorporates corrections as outlined in DOI:10.1109/ACCESS.2024.3395071. We provide here a detailed description of our experiments and the new models we used

Purpose: To introduce and evaluate TrueLung, an automated pipeline for computation and analysis of free-breathing and contrast-agent free pulmonary functional MRI. Material and Methods: time-resolved ultra-fast bSSFP acquisitions are transferred to TrueLung, which includes image quality checks, image registration, and computation of perfusion and ventilation maps with matrix pencil decomposition. Neural network whole-lung and lobar segmentations allow quantification of impaired relative perfusion (RQ) and fractional ventilation (RFV). TrueLung delivers functional maps and quantitative outcomes, reported for clinicians in concise documents. We evaluated the pipeline in 75 cystic fibrosis children. Whole-lung and lobar segmentations were manually refined when necessary, and the impact on RQ and RFV was quantified. Results: Functional imaging was performed at 7.9 $\pm$ 1.8 (mean $\pm$ SD) coronal slice positions per patient, totaling on average 6min 20s scan time per patient. The whole pipeline required 20min calculation time per subject. TrueLung delivered the functional maps of all the subjects for radiological assessment. Quality controlling maps and segmentations lasted 1min 12s per patient. The automated segmentations and quantification of whole-lung defects were satisfying in 88% of patients (97% of slices) and the lobar quantification in 73% (93% of slices). The segmentations refinements required 16s per patient for the whole-lung, and 2min 10s for the lobe masks. The relative differences in RFV and RQ between fully-automated and manually refined data were marginal. Conclusions: TrueLung quickly delivers functional maps and quantitative outcomes in an objective and standardized way, suitable for radiological and pneumological assessment with minimal manual input. TrueLung can be used for clinical research in cystic fibrosis and might be applied across various lung diseases.

Monitoring diseases that affect the brain's structural integrity requires automated analysis of magnetic resonance (MR) images, e.g., for the evaluation of volumetric changes. However, many of the evaluation tools are optimized for analyzing healthy tissue. To enable the evaluation of scans containing pathological tissue, it is therefore required to restore healthy tissue in the pathological areas. In this work, we explore and extend denoising diffusion models for consistent inpainting of healthy 3D brain tissue. We modify state-of-the-art 2D, pseudo-3D, and 3D methods working in the image space, as well as 3D latent and 3D wavelet diffusion models, and train them to synthesize healthy brain tissue. Our evaluation shows that the pseudo-3D model performs best regarding the structural-similarity index, peak signal-to-noise ratio, and mean squared error. To emphasize the clinical relevance, we fine-tune this model on data containing synthetic MS lesions and evaluate it on a downstream brain tissue segmentation task, whereby it outperforms the established FMRIB Software Library (FSL) lesion-filling method.

The high performance of denoising diffusion models for image generation has paved the way for their application in unsupervised medical anomaly detection. As diffusion-based methods require a lot of GPU memory and have long sampling times, we present a novel and fast unsupervised anomaly detection approach based on latent Bernoulli diffusion models. We first apply an autoencoder to compress the input images into a binary latent representation. Next, a diffusion model that follows a Bernoulli noise schedule is employed to this latent space and trained to restore binary latent representations from perturbed ones. The binary nature of this diffusion model allows us to identify entries in the latent space that have a high probability of flipping their binary code during the denoising process, which indicates out-of-distribution data. We propose a masking algorithm based on these probabilities, which improves the anomaly detection scores. We achieve state-of-the-art performance compared to other diffusion-based unsupervised anomaly detection algorithms while significantly reducing sampling time and memory consumption. The code is available at https://github.com/JuliaWolleb/Anomaly_berdiff.

Due to the three-dimensional nature of CT- or MR-scans, generative modeling of medical images is a particularly challenging task. Existing approaches mostly apply patch-wise, slice-wise, or cascaded generation techniques to fit the high-dimensional data into the limited GPU memory. However, these approaches may introduce artifacts and potentially restrict the model's applicability for certain downstream tasks. This work presents WDM, a wavelet-based medical image synthesis framework that applies a diffusion model on wavelet decomposed images. The presented approach is a simple yet effective way of scaling 3D diffusion models to high resolutions and can be trained on a single \SI{40}{\giga\byte} GPU. Experimental results on BraTS and LIDC-IDRI unconditional image generation at a resolution of $128 \times 128 \times 128$ demonstrate state-of-the-art image fidelity (FID) and sample diversity (MS-SSIM) scores compared to recent GANs, Diffusion Models, and Latent Diffusion Models. Our proposed method is the only one capable of generating high-quality images at a resolution of $256 \times 256 \times 256$, outperforming all comparing methods., Comment: Accepted at DGM4MICCAI 2024. Project page: https://pfriedri.github.io/wdm-3d-io Code: https://github.com/pfriedri/wdm-3d

This paper is a contribution to the "BraTS 2023 Local Synthesis of Healthy Brain Tissue via Inpainting Challenge". The task of this challenge is to transform tumor tissue into healthy tissue in brain magnetic resonance (MR) images. This idea originates from the problem that MR images can be evaluated using automatic processing tools, however, many of these tools are optimized for the analysis of healthy tissue. By solving the given inpainting task, we enable the automatic analysis of images featuring lesions, and further downstream tasks. Our approach builds on denoising diffusion probabilistic models. We use a 2D model that is trained using slices in which healthy tissue was cropped out and is learned to be inpainted again. This allows us to use the ground truth healthy tissue during training. In the sampling stage, we replace the slices containing diseased tissue in the original 3D volume with the slices containing the healthy tissue inpainting. With our approach, we achieve comparable results to the competing methods. On the validation set our model achieves a mean SSIM of 0.7804, a PSNR of 20.3525 and a MSE of 0.0113. In future we plan to extend our 2D model to a 3D model, allowing to inpaint the region of interest as a whole without losing context information of neighboring slices., Comment: 12 pages, 5 figures, MICCAI challenge submission

A myriad of algorithms for the automatic analysis of brain MR images is available to support clinicians in their decision-making. For brain tumor patients, the image acquisition time series typically starts with an already pathological scan. This poses problems, as many algorithms are designed to analyze healthy brains and provide no guarantee for images featuring lesions. Examples include, but are not limited to, algorithms for brain anatomy parcellation, tissue segmentation, and brain extraction. To solve this dilemma, we introduce the BraTS inpainting challenge. Here, the participants explore inpainting techniques to synthesize healthy brain scans from lesioned ones. The following manuscript contains the task formulation, dataset, and submission procedure. Later, it will be updated to summarize the findings of the challenge. The challenge is organized as part of the ASNR-BraTS MICCAI challenge., Comment: 14 pages, 6 figures

Denoising diffusion models have recently achieved state-of-the-art performance in many image-generation tasks. They do, however, require a large amount of computational resources. This limits their application to medical tasks, where we often deal with large 3D volumes, like high-resolution three-dimensional data. In this work, we present a number of different ways to reduce the resource consumption for 3D diffusion models and apply them to a dataset of 3D images. The main contribution of this paper is the memory-efficient patch-based diffusion model \textit{PatchDDM}, which can be applied to the total volume during inference while the training is performed only on patches. While the proposed diffusion model can be applied to any image generation tasks, we evaluate the method on the tumor segmentation task of the BraTS2020 dataset and demonstrate that we can generate meaningful three-dimensional segmentations., Comment: Accepted at MIDL 2023

Magnetic resonance (MR) images from multiple sources often show differences in image contrast related to acquisition settings or the used scanner type. For long-term studies, longitudinal comparability is essential but can be impaired by these contrast differences, leading to biased results when using automated evaluation tools. This study presents a diffusion model-based approach for contrast harmonization. We use a data set consisting of scans of 18 Multiple Sclerosis patients and 22 healthy controls. Each subject was scanned in two MR scanners of different magnetic field strengths (1.5 T and 3 T), resulting in a paired data set that shows scanner-inherent differences. We map images from the source contrast to the target contrast for both directions, from 3 T to 1.5 T and from 1.5 T to 3 T. As we only want to change the contrast, not the anatomical information, our method uses the original image to guide the image-to-image translation process by adding structural information. The aim is that the mapped scans display increased comparability with scans of the target contrast for downstream tasks. We evaluate this method for the task of segmentation of cerebrospinal fluid, grey matter and white matter. Our method achieves good and consistent results for both directions of the mapping.

Advances in 3D printing of biocompatible materials make patient-specific implants increasingly popular. The design of these implants is, however, still a tedious and largely manual process. Existing approaches to automate implant generation are mainly based on 3D U-Net architectures on downsampled or patch-wise data, which can result in a loss of detail or contextual information. Following the recent success of Diffusion Probabilistic Models, we propose a novel approach for implant generation based on a combination of 3D point cloud diffusion models and voxelization networks. Due to the stochastic sampling process in our diffusion model, we can propose an ensemble of different implants per defect, from which the physicians can choose the most suitable one. We evaluate our method on the SkullBreak and SkullFix datasets, generating high-quality implants and achieving competitive evaluation scores., Comment: Accepted to MICCAI 2023. Project page: https://pfriedri.github.io/pcdiff-implant-io/ . Code: https://github.com/pfriedri/pcdiff-implant/

Purpose: Automated distinct bone segmentation from CT scans is widely used in planning and navigation workflows. U-Net variants are known to provide excellent results in supervised semantic segmentation. However, in distinct bone segmentation from upper body CTs a large field of view and a computationally taxing 3D architecture are required. This leads to low-resolution results lacking detail or localisation errors due to missing spatial context when using high-resolution inputs. Methods: We propose to solve this problem by using end-to-end trainable segmentation networks that combine several 3D U-Nets working at different resolutions. Our approach, which extends and generalizes HookNet and MRN, captures spatial information at a lower resolution and skips the encoded information to the target network, which operates on smaller high-resolution inputs. We evaluated our proposed architecture against single resolution networks and performed an ablation study on information concatenation and the number of context networks. Results: Our proposed best network achieves a median DSC of 0.86 taken over all 125 segmented bone classes and reduces the confusion among similar-looking bones in different locations. These results outperform our previously published 3D U-Net baseline results on the task and distinct-bone segmentation results reported by other groups. Conclusion: The presented multi-resolution 3D U-Nets address current shortcomings in bone segmentation from upper-body CT scans by allowing for capturing a larger field of view while avoiding the cubic growth of the input pixels and intermediate computations that quickly outgrow the computational capacities in 3D. The approach thus improves the accuracy and efficiency of distinct bone segmentation from upper-body CT., Comment: Under submission

In recent years, anomaly detection has become an essential field in medical image analysis. Most current anomaly detection methods for medical images are based on image reconstruction. In this work, we propose a novel anomaly detection approach based on coordinate regression. Our method estimates the position of patches within a volume, and is trained only on data of healthy subjects. During inference, we can detect and localize anomalies by considering the error of the position estimate of a given patch. We apply our method to 3D CT volumes and evaluate it on patients with intracranial haemorrhages and cranial fractures. The results show that our method performs well in detecting these anomalies. Furthermore, we show that our method requires less memory than comparable approaches that involve image reconstruction. This is highly relevant for processing large 3D volumes, for instance, CT or MRI scans.

Fiber optic shape sensors have enabled unique advances in various navigation tasks, from medical tool tracking to industrial applications. Eccentric fiber Bragg gratings (FBG) are cheap and easy-to-fabricate shape sensors that are often interrogated with simple setups. However, using low-cost interrogation systems for such intensity-based quasi-distributed sensors introduces further complications to the sensor's signal. Therefore, eccentric FBGs have not been able to accurately estimate complex multi-bend shapes. Here, we present a novel technique to overcome these limitations and provide accurate and precise shape estimation in eccentric FBG sensors. We investigate the most important bending-induced effects in curved optical fibers that are usually eliminated in intensity-based fiber sensors. These effects contain shape deformation information with a higher spatial resolution that we are now able to extract using deep learning techniques. We design a deep learning model based on a convolutional neural network that is trained to predict shapes given the sensor's spectra. We also provide a visual explanation, highlighting wavelength elements whose intensities are more relevant in making shape predictions. These findings imply that deep learning techniques benefit from the bending-induced effects that impact the desired signal in a complex manner. This is the first step toward cheap yet accurate fiber shape sensing solutions., Comment: 18 pages, 5 figures, preprint

Continuum robots in robot-assisted minimally invasive surgeries provide adequate access to target anatomies that are not directly reachable through small incisions. Achieving precise and reliable motion control of such snake-like manipulators necessitates an accurate navigation system that requires no line-of-sight and is immune to electromagnetic noises. Fiber Bragg Grating (FBG) shape sensors, particularly edge-FBGs, are promising tools for this task. However, in edge-FBG sensors, the intensity ratio between Bragg wavelengths carries the strain information that can be affected by undesired bending-related phenomena, making standard characterization techniques less suitable for these sensors. We showed in our previous work that a deep learning model has the potential to extract the strain information from the full edge-FBG spectrum and accurately predict the sensor's shape. In this paper, we conduct a more thorough investigation to find a suitable architectural design with lower prediction errors. We use the Hyperband algorithm to search for optimal hyperparameters in two steps. First, we limit the search space to layer settings, where the best-performing configuration gets selected. Then, we modify the search space for tuning the training and loss calculation hyperparameters. We also analyze various data transformations on the input and output variables, as data rescaling can directly influence the model's performance. Moreover, we performed discriminative training using Siamese network architecture that employs two CNNs with identical parameters to learn similarity metrics between the spectra of similar target values. The best-performing network architecture among all evaluated configurations can predict the sensor's shape with a median tip error of 3.11 mm., Comment: 27 pages, 12 figures, preprint

Recently, diffusion models were applied to a wide range of image analysis tasks. We build on a method for image-to-image translation using denoising diffusion implicit models and include a regression problem and a segmentation problem for guiding the image generation to the desired output. The main advantage of our approach is that the guidance during the denoising process is done by an external gradient. Consequently, the diffusion model does not need to be retrained for the different tasks on the same dataset. We apply our method to simulate the aging process on facial photos using a regression task, as well as on a brain magnetic resonance (MR) imaging dataset for the simulation of brain tumor growth. Furthermore, we use a segmentation model to inpaint tumors at the desired location in healthy slices of brain MR images. We achieve convincing results for all problems.