Weakly Supervised Universal Fracture Detection in Pelvic X-rays

Hip and pelvic fractures are serious injuries with life-threatening complications. However, diagnostic errors of fractures in pelvic X-rays (PXRs) are very common, driving the demand for computer-aided diagnosis (CAD) solutions. A major challenge lies in the fact that fractures are localized patterns that require localized analyses. Unfortunately, the PXRs residing in hospital picture archiving and communication system do not typically specify region of interests. In this paper, we propose a two-stage hip and pelvic fracture detection method that executes localized fracture classification using weakly supervised ROI mining. The first stage uses a large capacity fully-convolutional network, i.e., deep with high levels of abstraction, in a multiple instance learning setting to automatically mine probable true positive and definite hard negative ROIs from the whole PXR in the training data. The second stage trains a smaller capacity model, i.e., shallower and more generalizable, with the mined ROIs to perform localized analyses to classify fractures. During inference, our method detects hip and pelvic fractures in one pass by chaining the probability outputs of the two stages together. We evaluate our method on 4 410 PXRs, reporting an area under the ROC curve value of 0.975, the highest among state-of-the-art fracture detection methods. Moreover, we show that our two-stage approach can perform comparably to human physicians (even outperforming emergency physicians and surgeons), in a preliminary reader study of 23 readers.Comment: MICCAI 2019 (early accept

Anatomy-Aware Siamese Network: Exploiting Semantic Asymmetry for Accurate Pelvic Fracture Detection in X-ray Images

Visual cues of enforcing bilaterally symmetric anatomies as normal findings are widely used in clinical practice to disambiguate subtle abnormalities from medical images. So far, inadequate research attention has been received on effectively emulating this practice in CAD methods. In this work, we exploit semantic anatomical symmetry or asymmetry analysis in a complex CAD scenario, i.e., anterior pelvic fracture detection in trauma PXRs, where semantically pathological (refer to as fracture) and non-pathological (e.g., pose) asymmetries both occur. Visually subtle yet pathologically critical fracture sites can be missed even by experienced clinicians, when limited diagnosis time is permitted in emergency care. We propose a novel fracture detection framework that builds upon a Siamese network enhanced with a spatial transformer layer to holistically analyze symmetric image features. Image features are spatially formatted to encode bilaterally symmetric anatomies. A new contrastive feature learning component in our Siamese network is designed to optimize the deep image features being more salient corresponding to the underlying semantic asymmetries (caused by pelvic fracture occurrences). Our proposed method have been extensively evaluated on 2,359 PXRs from unique patients (the largest study to-date), and report an area under ROC curve score of 0.9771. This is the highest among state-of-the-art fracture detection methods, with improved clinical indications.Comment: ECCV 2020 (camera-ready

Towards Trainable Saliency Maps in Medical Imaging

While success of Deep Learning (DL) in automated diagnosis can be transformative to the medicinal practice especially for people with little or no access to doctors, its widespread acceptability is severely limited by inherent black-box decision making and unsafe failure modes. While saliency methods attempt to tackle this problem in non-medical contexts, their apriori explanations do not transfer well to medical usecases. With this study we validate a model design element agnostic to both architecture complexity and model task, and show how introducing this element gives an inherently self-explanatory model. We compare our results with state of the art non-trainable saliency maps on RSNA Pneumonia Dataset and demonstrate a much higher localization efficacy using our adopted technique. We also compare, with a fully supervised baseline and provide a reasonable alternative to it's high data labelling overhead. We further investigate the validity of our claims through qualitative evaluation from an expert reader.Comment: Machine Learning for Health (ML4H) at NeurIPS 2020 - Extended Abstrac

E2^2Net: An Edge Enhanced Network for Accurate Liver and Tumor Segmentation on CT Scans

Developing an effective liver and liver tumor segmentation model from CT scans is very important for the success of liver cancer diagnosis, surgical planning and cancer treatment. In this work, we propose a two-stage framework for 2D liver and tumor segmentation. The first stage is a coarse liver segmentation network, while the second stage is an edge enhanced network (E$^2$Net) for more accurate liver and tumor segmentation. E$^2$Net explicitly models complementary objects (liver and tumor) and their edge information within the network to preserve the organ and lesion boundaries. We introduce an edge prediction module in E$^2$Net and design an edge distance map between liver and tumor boundaries, which is used as an extra supervision signal to train the edge enhanced network. We also propose a deep cross feature fusion module to refine multi-scale features from both objects and their edges. E$^2$Net is more easily and efficiently trained with a small labeled dataset, and it can be trained/tested on the original 2D CT slices (resolve resampling error issue in 3D models). The proposed framework has shown superior performance on both liver and liver tumor segmentation compared to several state-of-the-art 2D, 3D and 2D/3D hybrid frameworks

Region Proposals for Saliency Map Refinement for Weakly-supervised Disease Localisation and Classification

The deployment of automated systems to diagnose diseases from medical images is challenged by the requirement to localise the diagnosed diseases to justify or explain the classification decision. This requirement is hard to fulfil because most of the training sets available to develop these systems only contain global annotations, making the localisation of diseases a weakly supervised approach. The main methods designed for weakly supervised disease classification and localisation rely on saliency or attention maps that are not specifically trained for localisation, or on region proposals that can not be refined to produce accurate detections. In this paper, we introduce a new model that combines region proposal and saliency detection to overcome both limitations for weakly supervised disease classification and localisation. Using the ChestX-ray14 data set, we show that our proposed model establishes the new state-of-the-art for weakly-supervised disease diagnosis and localisation.Comment: Early accept at MICCAI 202

Clinically Accurate Chest X-Ray Report Generation

The automatic generation of radiology reports given medical radiographs has significant potential to operationally and improve clinical patient care. A number of prior works have focused on this problem, employing advanced methods from computer vision and natural language generation to produce readable reports. However, these works often fail to account for the particular nuances of the radiology domain, and, in particular, the critical importance of clinical accuracy in the resulting generated reports. In this work, we present a domain-aware automatic chest X-ray radiology report generation system which first predicts what topics will be discussed in the report, then conditionally generates sentences corresponding to these topics. The resulting system is fine-tuned using reinforcement learning, considering both readability and clinical accuracy, as assessed by the proposed Clinically Coherent Reward. We verify this system on two datasets, Open-I and MIMIC-CXR, and demonstrate that our model offers marked improvements on both language generation metrics and CheXpert assessed accuracy over a variety of competitive baselines

Learning to Segment Anatomical Structures Accurately from One Exemplar

Accurate segmentation of critical anatomical structures is at the core of medical image analysis. The main bottleneck lies in gathering the requisite expert-labeled image annotations in a scalable manner. Methods that permit to produce accurate anatomical structure segmentation without using a large amount of fully annotated training images are highly desirable. In this work, we propose a novel contribution of Contour Transformer Network (CTN), a one-shot anatomy segmentor including a naturally built-in human-in-the-loop mechanism. Segmentation is formulated by learning a contour evolution behavior process based on graph convolutional networks (GCNs). Training of our CTN model requires only one labeled image exemplar and leverages additional unlabeled data through newly introduced loss functions that measure the global shape and appearance consistency of contours. We demonstrate that our one-shot learning method significantly outperforms non-learning-based methods and performs competitively to the state-of-the-art fully supervised deep learning approaches. With minimal human-in-the-loop editing feedback, the segmentation performance can be further improved and tailored towards the observer desired outcomes. This can facilitate the clinician designed imaging-based biomarker assessments (to support personalized quantitative clinical diagnosis) and outperforms fully supervised baselines.Comment: MICCAI2020 (Early accept

Reliable Liver Fibrosis Assessment from Ultrasound using Global Hetero-Image Fusion and View-Specific Parameterization

Ultrasound (US) is a critical modality for diagnosing liver fibrosis. Unfortunately, assessment is very subjective, motivating automated approaches. We introduce a principled deep convolutional neural network (CNN) workflow that incorporates several innovations. First, to avoid overfitting on non-relevant image features, we force the network to focus on a clinical region of interest (ROI), encompassing the liver parenchyma and upper border. Second, we introduce global heteroimage fusion (GHIF), which allows the CNN to fuse features from any arbitrary number of images in a study, increasing its versatility and flexibility. Finally, we use 'style'-based view-specific parameterization (VSP) to tailor the CNN processing for different viewpoints of the liver, while keeping the majority of parameters the same across views. Experiments on a dataset of 610 patient studies (6979 images) demonstrate that our pipeline can contribute roughly 7% and 22% improvements in partial area under the curve and recall at 90% precision, respectively, over conventional classifiers, validating our approach to this crucial problem.Comment: 10 pages, MICCAI 202

Region proposals for saliency map refinement for weakly-supervised disease localisation and classification

First Online: 29 September 2020The deployment of automated systems to diagnose diseases from medical images is challenged by the requirement to localise the diagnosed diseases to justify or explain the classification decision. This requirement is hard to fulfil because most of the training sets available to develop these systems only contain global annotations, making the localisation of diseases a weakly supervised approach. The main methods designed for weakly supervised disease classification and localisation rely on saliency or attention maps that are not specifically trained for localisation, or on region proposals that can not be refined to produce accurate detections. In this paper, we introduce a new model that combines region proposal and saliency detection to overcome both limitations for weakly supervised disease classification and localisation. Using the ChestX-ray14 data set, we show that our proposed model establishes the new state-of-the-art for weakly-supervised disease diagnosis and localisation. We make our code available at https://github.com/renato145/RpSalWeaklyDet.Renato Hermoza, Gabriel Maicas, Jacinto C. Nascimento, Gustavo Carneir

DeepPrognosis: Preoperative Prediction of Pancreatic Cancer Survival and Surgical Margin via Contrast-Enhanced CT Imaging

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers and carries a dismal prognosis. Surgery remains the best chance of a potential cure for patients who are eligible for initial resection of PDAC. However, outcomes vary significantly even among the resected patients of the same stage and received similar treatments. Accurate preoperative prognosis of resectable PDACs for personalized treatment is thus highly desired. Nevertheless, there are no automated methods yet to fully exploit the contrast-enhanced computed tomography (CE-CT) imaging for PDAC. Tumor attenuation changes across different CT phases can reflect the tumor internal stromal fractions and vascularization of individual tumors that may impact the clinical outcomes. In this work, we propose a novel deep neural network for the survival prediction of resectable PDAC patients, named as 3D Contrast-Enhanced Convolutional Long Short-Term Memory network(CE-ConvLSTM), which can derive the tumor attenuation signatures or patterns from CE-CT imaging studies. We present a multi-task CNN to accomplish both tasks of outcome and margin prediction where the network benefits from learning the tumor resection margin related features to improve survival prediction. The proposed framework can improve the prediction performances compared with existing state-of-the-art survival analysis approaches. The tumor signature built from our model has evidently added values to be combined with the existing clinical staging system.Comment: 11 pages, 3 figures, Early accepted to Medical Image Computing and Computer Assisted Interventions Conference (MICCAI) 202