GAUDA: Generative Adaptive Uncertainty-guided Diffusion-based Augmentation for Surgical Segmentation

Augmentation by generative modelling yields a promising alternative to the accumulation of surgical data, where ethical, organisational and regulatory aspects must be considered. Yet, the joint synthesis of (image, mask) pairs for segmentation, a major application in surgery, is rather unexplored. We propose to learn semantically comprehensive yet compact latent representations of the (image, mask) space, which we jointly model with a Latent Diffusion Model. We show that our approach can effectively synthesise unseen high-quality paired segmentation data of remarkable semantic coherence. Generative augmentation is typically applied pre-training by synthesising a fixed number of additional training samples to improve downstream task models. To enhance this approach, we further propose Generative Adaptive Uncertainty-guided Diffusion-based Augmentation (GAUDA), leveraging the epistemic uncertainty of a Bayesian downstream model for targeted online synthesis. We condition the generative model on classes with high estimated uncertainty during training to produce additional unseen samples for these classes. By adaptively utilising the generative model online, we can minimise the number of additional training samples and centre them around the currently most uncertain parts of the data distribution. GAUDA effectively improves downstream segmentation results over comparable methods by an average absolute IoU of 1.6% on CaDISv2 and 1.5% on CholecSeg8k, two prominent surgical datasets for semantic segmentation.

Federated-Continual Dynamic Segmentation of Histopathology guided by Barlow Continuity

Federated- and Continual Learning have been established as approaches to enable privacy-aware learning on continuously changing data, as required for deploying AI systems in histopathology images. However, data shifts can occur in a dynamic world, spatially between institutions and temporally, due to changing data over time. This leads to two issues: Client Drift, where the central model degrades from aggregating data from clients trained on shifted data, and Catastrophic Forgetting, from temporal shifts such as changes in patient populations. Both tend to degrade the model's performance of previously seen data or spatially distributed training. Despite both problems arising from the same underlying problem of data shifts, existing research addresses them only individually. In this work, we introduce a method that can jointly alleviate Client Drift and Catastrophic Forgetting by using our proposed Dynamic Barlow Continuity that evaluates client updates on a public reference dataset and uses this to guide the training process to a spatially and temporally shift-invariant model. We evaluate our approach on the histopathology datasets BCSS and Semicol and prove our method to be highly effective by jointly improving the dice score as much as from 15.8% to 71.6% in Client Drift and from 42.5% to 62.8% in Catastrophic Forgetting. This enables Dynamic Learning by establishing spatio-temporal shift-invariance.

MedSegDiffNCA: Diffusion Models With Neural Cellular Automata for Skin Lesion Segmentation

Denoising Diffusion Models (DDMs) are widely used for high-quality image generation and medical image segmentation but often rely on Unet-based architectures, leading to high computational overhead, especially with high-resolution images. This work proposes three NCA-based improvements for diffusion-based medical image segmentation. First, Multi-MedSegDiffNCA uses a multilevel NCA framework to refine rough noise estimates generated by lower level NCA models. Second, CBAM-MedSegDiffNCA incorporates channel and spatial attention for improved segmentation. Third, MultiCBAM-MedSegDiffNCA combines these methods with a new RGB channel loss for semantic guidance. Evaluations on Lesion segmentation show that MultiCBAM-MedSegDiffNCA matches Unet-based model performance with dice score of 87.84% while using 60-110 times fewer parameters, offering a more efficient solution for low resource medical settings.

Federated Voxel Scene Graph for Intracranial Hemorrhage

Intracranial Hemorrhage is a potentially lethal condition whose manifestation is vastly diverse and shifts across clinical centers worldwide. Deep-learning-based solutions are starting to model complex relations between brain structures, but still struggle to generalize. While gathering more diverse data is the most natural approach, privacy regulations often limit the sharing of medical data. We propose the first application of Federated Scene Graph Generation. We show that our models can leverage the increased training data diversity. For Scene Graph Generation, they can recall up to 20% more clinically relevant relations across datasets compared to models trained on a single centralized dataset. Learning structured data representation in a federated setting can open the way to the development of new methods that can leverage this finer information to regularize across clients more effectively.

NCAdapt: Dynamic adaptation with domain-specific Neural Cellular Automata for continual hippocampus segmentation

Continual learning (CL) in medical imaging presents a unique challenge, requiring models to adapt to new domains while retaining previously acquired knowledge. We introduce NCAdapt, a Neural Cellular Automata (NCA) based method designed to address this challenge. NCAdapt features a domain-specific multi-head structure, integrating adaptable convolutional layers into the NCA backbone for each new domain encountered. After initial training, the NCA backbone is frozen, and only the newly added adaptable convolutional layers, consisting of 384 parameters, are trained along with domain-specific NCA convolutions. We evaluate NCAdapt on hippocampus segmentation tasks, benchmarking its performance against Lifelong nnU-Net and U-Net models with state-of-the-art (SOTA) CL methods. Our lightweight approach achieves SOTA performance, underscoring its effectiveness in addressing CL challenges in medical imaging. Upon acceptance, we will make our code base publicly accessible to support reproducibility and foster further advancements in medical CL.

NCA-Morph: Medical Image Registration with Neural Cellular Automata

Medical image registration is a critical process that aligns various patient scans, facilitating tasks like diagnosis, surgical planning, and tracking. Traditional optimization based methods are slow, prompting the use of Deep Learning (DL) techniques, such as VoxelMorph and Transformer-based strategies, for faster results. However, these DL methods often impose significant resource demands. In response to these challenges, we present NCA-Morph, an innovative approach that seamlessly blends DL with a bio-inspired communication and networking approach, enabled by Neural Cellular Automata (NCAs). NCA-Morph not only harnesses the power of DL for efficient image registration but also builds a network of local communications between cells and respective voxels over time, mimicking the interaction observed in living systems. In our extensive experiments, we subject NCA-Morph to evaluations across three distinct 3D registration tasks, encompassing Brain, Prostate and Hippocampus images from both healthy and diseased patients. The results showcase NCA-Morph's ability to achieve state-of-the-art performance. Notably, NCA-Morph distinguishes itself as a lightweight architecture with significantly fewer parameters; 60% and 99.7% less than VoxelMorph and TransMorph. This characteristic positions NCA-Morph as an ideal solution for resource-constrained medical applications, such as primary care settings and operating rooms.

Detection of Intracranial Hemorrhage for Trauma Patients

Whole-body CT is used for multi-trauma patients in the search of any and all injuries. Since an initial assessment needs to be rapid and the search for lesions is done for the whole body, very little time can be allocated for the inspection of a specific anatomy. In particular, intracranial hemorrhages are still missed, especially by clinical students. In this work, we present a Deep Learning approach for highlighting such lesions to improve the diagnostic accuracy. While most works on intracranial hemorrhages perform segmentation, detection only requires bounding boxes for the localization of the bleeding. In this paper, we propose a novel Voxel-Complete IoU (VC-IoU) loss that encourages the network to learn the 3D aspect ratios of bounding boxes and leads to more precise detections. We extensively experiment on brain bleeding detection using a publicly available dataset, and validate it on a private cohort, where we achieve 0.877 AR30, 0.728 AP30, and 0.653 AR30, 0.514 AP30 respectively. These results constitute a relative +5% improvement in Average Recall for both datasets compared to other loss functions. Finally, as there is little data currently publicly available for 3D object detection and as annotation resources are limited in the clinical setting, we evaluate the cost of different annotation methods, as well as the impact of imprecise bounding boxes in the training data on the detection performance.

Voxel Scene Graph for Intracranial Hemorrhage

Patients with Intracranial Hemorrhage (ICH) face a potentially life-threatening condition, and patient-centered individualized treatment remains challenging due to possible clinical complications. Deep-Learning-based methods can efficiently analyze the routinely acquired head CTs to support the clinical decision-making. The majority of early work focuses on the detection and segmentation of ICH, but do not model the complex relations between ICH and adjacent brain structures. In this work, we design a tailored object detection method for ICH, which we unite with segmentation-grounded Scene Graph Generation (SGG) methods to learn a holistic representation of the clinical cerebral scene. To the best of our knowledge, this is the first application of SGG for 3D voxel images. We evaluate our method on two head-CT datasets and demonstrate that our model can recall up to 74% of clinically relevant relations. This work lays the foundation towards SGG for 3D voxel data. The generated Scene Graphs can already provide insights for the clinician, but are also valuable for all downstream tasks as a compact and interpretable representation.

Distribution-Aware Replay for Continual MRI Segmentation

Medical image distributions shift constantly due to changes in patient population and discrepancies in image acquisition. These distribution changes result in performance deterioration; deterioration that continual learning aims to alleviate. However, only adaptation with data rehearsal strategies yields practically desirable performance for medical image segmentation. Such rehearsal violates patient privacy and, as most continual learning approaches, overlooks unexpected changes from out-of-distribution instances. To transcend both of these challenges, we introduce a distribution-aware replay strategy that mitigates forgetting through auto-encoding of features, while simultaneously leveraging the learned distribution of features to detect model failure. We provide empirical corroboration on hippocampus and prostate MRI segmentation.

Unsupervised Training of Neural Cellular Automata on Edge Devices

The disparity in access to machine learning tools for medical imaging across different regions significantly limits the potential for universal healthcare innovation, particularly in remote areas. Our research addresses this issue by implementing Neural Cellular Automata (NCA) training directly on smartphones for accessible X-ray lung segmentation. We confirm the practicality and feasibility of deploying and training these advanced models on five Android devices, improving medical diagnostics accessibility and bridging the tech divide to extend machine learning benefits in medical imaging to low- and middle-income countries (LMICs). We further enhance this approach with an unsupervised adaptation method using the novel Variance-Weighted Segmentation Loss (VWSL), which efficiently learns from unlabeled data by minimizing the variance from multiple NCA predictions. This strategy notably improves model adaptability and performance across diverse medical imaging contexts without the need for extensive computational resources or labeled datasets, effectively lowering the participation threshold. Our methodology, tested on three multisite X-ray datasets -- Padchest, ChestX-ray8, and MIMIC-III -- demonstrates improvements in segmentation Dice accuracy by 0.7 to 2.8%, compared to the classic Med-NCA. Additionally, in extreme cases where no digital copy is available and images must be captured by a phone from an X-ray lightbox or monitor, VWSL enhances Dice accuracy by 5-20%, demonstrating the method's robustness even with suboptimal image sources.