Unpaired Cross-Modality Educed Distillation (CMEDL) for Medical Image Segmentation

Multi-organ segmentation: a progressive exploration of learning paradigms under scarce annotation

Precise delineation of multiple organs or abnormal regions in the human body from medical images plays an essential role in computer-aided diagnosis, surgical simulation, image-guided interventions, and especially in radiotherapy treatment planning. Thus, it is of great significance to explore automatic segmentation approaches, among which deep learning-based approaches have evolved rapidly and witnessed remarkable progress in multi-organ segmentation. However, obtaining an appropriately sized and fine-grained annotated dataset of multiple organs is extremely hard and expensive. Such scarce annotation limits the development of high-performance multi-organ segmentation models but promotes many annotation-efficient learning paradigms. Among these, studies on transfer learning leveraging external datasets, semi-supervised learning including unannotated datasets and partially-supervised learning integrating partially-labeled datasets have led the dominant way to break such dilemmas in multi-organ segmentation. We first review the fully supervised method, then present a comprehensive and systematic elaboration of the 3 abovementioned learning paradigms in the context of multi-organ segmentation from both technical and methodological perspectives, and finally summarize their challenges and future trends.

Auto-segmentation of neck nodal metastases using self-distilled masked image transformer on longitudinal MR images

Objectives

Auto-segmentation promises greater speed and lower inter-reader variability than manual segmentations in radiation oncology clinical practice. This study aims to implement and evaluate the accuracy of the auto-segmentation algorithm, "Masked Image modeling using the vision Transformers (SMIT)," for neck nodal metastases on longitudinal T2-weighted (T2w) MR images in oropharyngeal squamous cell carcinoma (OPSCC) patients.

Methods

This prospective clinical trial study included 123 human papillomaviruses (HPV-positive [+]) related OSPCC patients who received concurrent chemoradiotherapy. T2w MR images were acquired on 3 T at pre-treatment (Tx), week 0, and intra-Tx weeks (1-3). Manual delineations of metastatic neck nodes from 123 OPSCC patients were used for the SMIT auto-segmentation, and total tumor volumes were calculated. Standard statistical analyses compared contour volumes from SMIT vs manual segmentation (Wilcoxon signed-rank test [WSRT]), and Spearman's rank correlation coefficients (ρ) were computed. Segmentation accuracy was evaluated on the test data set using the dice similarity coefficient (DSC) metric value. P-values <0.05 were considered significant.

Results

No significant difference in manual and SMIT delineated tumor volume at pre-Tx (8.68 ± 7.15 vs 8.38 ± 7.01 cm3, P = 0.26 [WSRT]), and the Bland-Altman method established the limits of agreement as -1.71 to 2.31 cm3, with a mean difference of 0.30 cm3. SMIT model and manually delineated tumor volume estimates were highly correlated (ρ = 0.84-0.96, P < 0.001). The mean DSC metric values were 0.86, 0.85, 0.77, and 0.79 at the pre-Tx and intra-Tx weeks (1-3), respectively.

Conclusions

The SMIT algorithm provides sufficient segmentation accuracy for oncological applications in HPV+ OPSCC.

Advances in knowledge

First evaluation of auto-segmentation with SMIT using longitudinal T2w MRI in HPV+ OPSCC.

Segmentation of Portal Vein in Multiphase CTA Image Based on Unsupervised Domain Transfer and Pseudo Label

BACKGROUND

Clinically, physicians diagnose portal vein diseases on abdominal CT angiography (CTA) images scanned in the hepatic arterial phase (H-phase), portal vein phase (P-phase) and equilibrium phase (E-phase) simultaneously. However, existing studies typically segment the portal vein on P-phase images without considering other phase images.

METHOD

We propose a method for segmenting portal veins on multiphase images based on unsupervised domain transfer and pseudo labels by using annotated P-phase images. Firstly, unsupervised domain transfer is performed to make the H-phase and E-phase images of the same patient approach the P-phase image in style, reducing the image differences caused by contrast media. Secondly, the H-phase (or E-phase) image and its style transferred image are input into the segmentation module together with the P-phase image. Under the constraints of pseudo labels, accurate prediction results are obtained.

RESULTS

This method was evaluated on the multiphase CTA images of 169 patients. The portal vein segmented from the H-phase and E-phase images achieved DSC values of 0.76 and 0.86 and Jaccard values of 0.61 and 0.76, respectively.

CONCLUSION

The method can automatically segment the portal vein on H-phase and E-phase images when only the portal vein on the P-phase CTA image is annotated, which greatly assists in clinical diagnosis.

Artificial Intelligence in CT and MR Imaging for Oncological Applications

Cancer care increasingly relies on imaging for patient management. The two most common cross-sectional imaging modalities in oncology are computed tomography (CT) and magnetic resonance imaging (MRI), which provide high-resolution anatomic and physiological imaging. Herewith is a summary of recent applications of rapidly advancing artificial intelligence (AI) in CT and MRI oncological imaging that addresses the benefits and challenges of the resultant opportunities with examples. Major challenges remain, such as how best to integrate AI developments into clinical radiology practice, the vigorous assessment of quantitative CT and MR imaging data accuracy, and reliability for clinical utility and research integrity in oncology. Such challenges necessitate an evaluation of the robustness of imaging biomarkers to be included in AI developments, a culture of data sharing, and the cooperation of knowledgeable academics with vendor scientists and companies operating in radiology and oncology fields. Herein, we will illustrate a few challenges and solutions of these efforts using novel methods for synthesizing different contrast modality images, auto-segmentation, and image reconstruction with examples from lung CT as well as abdome, pelvis, and head and neck MRI. The imaging community must embrace the need for quantitative CT and MRI metrics beyond lesion size measurement. AI methods for the extraction and longitudinal tracking of imaging metrics from registered lesions and understanding the tumor environment will be invaluable for interpreting disease status and treatment efficacy. This is an exciting time to work together to move the imaging field forward with narrow AI-specific tasks. New AI developments using CT and MRI datasets will be used to improve the personalized management of cancer patients.

A self-supervised guided knowledge distillation framework for unpaired low-dose CT image denoising

Low-dose computed tomography (LDCT) can significantly reduce the damage of X-ray to the human body, but the reduction of CT dose will produce images with severe noise and artifacts, which will affect the diagnosis of doctors. Recently, deep learning has attracted more and more attention from researchers. However, most of the denoising networks applied to deep learning-based LDCT imaging are supervised methods, which require paired data for network training. In a realistic imaging scenario, obtaining well-aligned image pairs is challenging due to the error in the table re-positioning and the patient's physiological movement during data acquisition. In contrast, the unpaired learning method can overcome the drawbacks of supervised learning, making it more feasible to collect unpaired training data in most real-world imaging applications. In this study, we develop a novel unpaired learning framework, Self-Supervised Guided Knowledge Distillation (SGKD), which enables the guidance of supervised learning using the results generated by self-supervised learning. The proposed SGKD scheme contains two stages of network training. First, we can achieve the LDCT image quality improvement by the designed self-supervised cycle network. Meanwhile, it can also produce two complementary training datasets from the unpaired LDCT and NDCT images. Second, a knowledge distillation strategy with the above two datasets is exploited to further improve the LDCT image denoising performance. To evaluate the effectiveness and feasibility of the proposed method, extensive experiments were performed on the simulated AAPM challenging and real-world clinical LDCT datasets. The qualitative and quantitative results show that the proposed SGKD achieves better performance in terms of noise suppression and detail preservation compared with some state-of-the-art network models.

Deep learning based unpaired image-to-image translation applications for medical physics: a systematic review

Purpose. There is a growing number of publications on the application of unpaired image-to-image (I2I) translation in medical imaging. However, a systematic review covering the current state of this topic for medical physicists is lacking. The aim of this article is to provide a comprehensive review of current challenges and opportunities for medical physicists and engineers to apply I2I translation in practice.Methods and materials. The PubMed electronic database was searched using terms referring to unpaired (unsupervised), I2I translation, and medical imaging. This review has been reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From each full-text article, we extracted information extracted regarding technical and clinical applications of methods, Transparent Reporting for Individual Prognosis Or Diagnosis (TRIPOD) study type, performance of algorithm and accessibility of source code and pre-trained models.Results. Among 461 unique records, 55 full-text articles were included in the review. The major technical applications described in the selected literature are segmentation (26 studies), unpaired domain adaptation (18 studies), and denoising (8 studies). In terms of clinical applications, unpaired I2I translation has been used for automatic contouring of regions of interest in MRI, CT, x-ray and ultrasound images, fast MRI or low dose CT imaging, CT or MRI only based radiotherapy planning, etc Only 5 studies validated their models using an independent test set and none were externally validated by independent researchers. Finally, 12 articles published their source code and only one study published their pre-trained models.Conclusion. I2I translation of medical images offers a range of valuable applications for medical physicists. However, the scarcity of external validation studies of I2I models and the shortage of publicly available pre-trained models limits the immediate applicability of the proposed methods in practice.

Self-supervised 3D anatomy segmentation using self-distilled masked image transformer (SMIT)

Vision transformers efficiently model long-range context and thus have demonstrated impressive accuracy gains in several image analysis tasks including segmentation. However, such methods need large labeled datasets for training, which is hard to obtain for medical image analysis. Self-supervised learning (SSL) has demonstrated success in medical image segmentation using convolutional networks. In this work, we developed a self-distillation learning with masked image modeling method to perform SSL for vision transformers (SMIT) applied to 3D multi-organ segmentation from CT and MRI. Our contribution combines a dense pixel-wise regression pretext task performed within masked patches called masked image prediction with masked patch token distillation to pre-train vision transformers. Our approach is more accurate and requires fewer fine tuning datasets than other pretext tasks. Unlike prior methods, which typically used image sets arising from disease sites and imaging modalities corresponding to the target tasks, we used 3,643 CT scans (602,708 images) arising from head and neck, lung, and kidney cancers as well as COVID-19 for pre-training and applied it to abdominal organs segmentation from MRI pancreatic cancer patients as well as publicly available 13 different abdominal organs segmentation from CT. Our method showed clear accuracy improvement (average DSC of 0.875 from MRI and 0.878 from CT) with reduced requirement for fine-tuning datasets over commonly used pretext tasks. Extensive comparisons against multiple current SSL methods were done. Our code is available at: https://github.com/harveerar/SMIT.git.