Tumor Detection, Segmentation and Classification Challenge on Automated 3D Breast Ultrasound: The TDSC-ABUS Challenge

Breast cancer is one of the most common causes of death among women worldwide. Early detection helps in reducing the number of deaths. Automated 3D Breast Ultrasound (ABUS) is a newer approach for breast screening, which has many advantages over handheld mammography such as safety, speed, and higher detection rate of breast cancer. Tumor detection, segmentation, and classification are key components in the analysis of medical images, especially challenging in the context of 3D ABUS due to the significant variability in tumor size and shape, unclear tumor boundaries, and a low signal-to-noise ratio. The lack of publicly accessible, well-labeled ABUS datasets further hinders the advancement of systems for breast tumor analysis. Addressing this gap, we have organized the inaugural Tumor Detection, Segmentation, and Classification Challenge on Automated 3D Breast Ultrasound 2023 (TDSC-ABUS2023). This initiative aims to spearhead research in this field and create a definitive benchmark for tasks associated with 3D ABUS image analysis. In this paper, we summarize the top-performing algorithms from the challenge and provide critical analysis for ABUS image examination. We offer the TDSC-ABUS challenge as an open-access platform at https://tdsc-abus2023.grand-challenge.org/ to benchmark and inspire future developments in algorithmic research.

Salient Region Matching for Fully Automated MR-TRUS Registration

Prostate cancer is a leading cause of cancer-related mortality in men. The registration of magnetic resonance (MR) and transrectal ultrasound (TRUS) can provide guidance for the targeted biopsy of prostate cancer. In this study, we propose a salient region matching framework for fully automated MR-TRUS registration. The framework consists of prostate segmentation, rigid alignment and deformable registration. Prostate segmentation is performed using two segmentation networks on MR and TRUS respectively, and the predicted salient regions are used for the rigid alignment. The rigidly-aligned MR and TRUS images serve as initialization for the deformable registration. The deformable registration network has a dual-stream encoder with cross-modal spatial attention modules to facilitate multi-modality feature learning, and a salient region matching loss to consider both structure and intensity similarity within the prostate region. Experiments on a public MR-TRUS dataset demonstrate that our method achieves satisfactory registration results, outperforming several cutting-edge methods. The code is publicly available at https://github.com/mock1ngbrd/salient-region-matching.

Efficient MedSAMs: Segment Anything in Medical Images on Laptop

Promptable segmentation foundation models have emerged as a transformative approach to addressing the diverse needs in medical images, but most existing models require expensive computing, posing a big barrier to their adoption in clinical practice. In this work, we organized the first international competition dedicated to promptable medical image segmentation, featuring a large-scale dataset spanning nine common imaging modalities from over 20 different institutions. The top teams developed lightweight segmentation foundation models and implemented an efficient inference pipeline that substantially reduced computational requirements while maintaining state-of-the-art segmentation accuracy. Moreover, the post-challenge phase advanced the algorithms through the design of performance booster and reproducibility tasks, resulting in improved algorithms and validated reproducibility of the winning solution. Furthermore, the best-performing algorithms have been incorporated into the open-source software with a user-friendly interface to facilitate clinical adoption. The data and code are publicly available to foster the further development of medical image segmentation foundation models and pave the way for impactful real-world applications.

EchoONE: Segmenting Multiple echocardiography Planes in One Model

In clinical practice of echocardiography examinations, multiple planes containing the heart structures of different view are usually required in screening, diagnosis and treatment of cardiac disease. AI models for echocardiography have to be tailored for each specific plane due to the dramatic structure differences, thus resulting in repetition development and extra complexity. Effective solution for such a multi-plane segmentation (MPS) problem is highly demanded for medical images, yet has not been well investigated. In this paper, we propose a novel solution, EchoONE, for this problem with a SAM-based segmentation architecture, a prior-composable mask learning (PC-Mask) module for semantic-aware dense prompt generation, and a learnable CNN-branch with a simple yet effective local feature fusion and adaption (LFFA) module for SAM adapting. We extensively evaluated our method on multiple internal and external echocardiography datasets, and achieved consistently state-of-the-art performance for multi-source datasets with different heart planes. This is the first time that the MPS problem is solved in one model for echocardiography data. The code will be available at https://github.com/a2502503/EchoONE.

FiRework: Field Refinement Framework for Efficient Enhancement of Deformable Registration

Deformable image registration remains a fundamental task in clinical practice, yet solving registration problems involving complex deformations remains challenging. Current deep learning-based registration methods employ continuous deformation to model large deformations, which often suffer from accumulated registration errors and interpolation inaccuracies. Moreover, achieving satisfactory results with these frameworks typically requires a large number of cascade stages, demanding substantial computational resources. Therefore, we propose a novel approach, the field refinement framework (FiRework), tailored for unsupervised deformable registration, aiming to address these challenges. In FiRework, we redesign the continuous deformation framework to mitigate the aforementioned errors. Notably, our FiRework requires only one level of recursion during training and supports continuous inference, offering improved efficacy compared to continuous deformation frameworks. We conducted experiments on two brain MRI datasets, enhancing two existing deformable registration networks with FiRework. The experimental results demonstrate the superior performance of our proposed framework in deformable registration. The code is publicly available at https://github.com/ZAX130/FiRework.

EM-Net: Efficient Channel and Frequency Learning with Mamba for 3D Medical Image Segmentation

Convolutional neural networks have primarily led 3D medical image segmentation but may be limited by small receptive fields. Transformer models excel in capturing global relationships through self-attention but are challenged by high computational costs at high resolutions. Recently, Mamba, a state space model, has emerged as an effective approach for sequential modeling. Inspired by its success, we introduce a novel Mamba-based 3D medical image segmentation model called EM-Net. It not only efficiently captures attentive interaction between regions by integrating and selecting channels, but also effectively utilizes frequency domain to harmonize the learning of features across varying scales, while accelerating training speed. Comprehensive experiments on two challenging multi-organ datasets with other state-of-the-art (SOTA) algorithms show that our method exhibits better segmentation accuracy while requiring nearly half the parameter size of SOTA models and 2x faster training speed.

Ctrl-GenAug: Controllable Generative Augmentation for Medical Sequence Classification

In the medical field, the limited availability of large-scale datasets and labor-intensive annotation processes hinder the performance of deep models. Diffusion-based generative augmentation approaches present a promising solution to this issue, having been proven effective in advancing downstream medical recognition tasks. Nevertheless, existing works lack sufficient semantic and sequential steerability for challenging video/3D sequence generation, and neglect quality control of noisy synthesized samples, resulting in unreliable synthetic databases and severely limiting the performance of downstream tasks. In this work, we present Ctrl-GenAug, a novel and general generative augmentation framework that enables highly semantic- and sequential-customized sequence synthesis and suppresses incorrectly synthesized samples, to aid medical sequence classification. Specifically, we first design a multimodal conditions-guided sequence generator for controllably synthesizing diagnosis-promotive samples. A sequential augmentation module is integrated to enhance the temporal/stereoscopic coherence of generated samples. Then, we propose a noisy synthetic data filter to suppress unreliable cases at semantic and sequential levels. Extensive experiments on 3 medical datasets, using 11 networks trained on 3 paradigms, comprehensively analyze the effectiveness and generality of Ctrl-GenAug, particularly in underrepresented high-risk populations and out-domain conditions.

PSFHS Challenge Report: Pubic Symphysis and Fetal Head Segmentation from Intrapartum Ultrasound Images

Segmentation of the fetal and maternal structures, particularly intrapartum ultrasound imaging as advocated by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for monitoring labor progression, is a crucial first step for quantitative diagnosis and clinical decision-making. This requires specialized analysis by obstetrics professionals, in a task that i) is highly time- and cost-consuming and ii) often yields inconsistent results. The utility of automatic segmentation algorithms for biometry has been proven, though existing results remain suboptimal. To push forward advancements in this area, the Grand Challenge on Pubic Symphysis-Fetal Head Segmentation (PSFHS) was held alongside the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to enhance the development of automatic segmentation algorithms at an international scale, providing the largest dataset to date with 5,101 intrapartum ultrasound images collected from two ultrasound machines across three hospitals from two institutions. The scientific community's enthusiastic participation led to the selection of the top 8 out of 179 entries from 193 registrants in the initial phase to proceed to the competition's second stage. These algorithms have elevated the state-of-the-art in automatic PSFHS from intrapartum ultrasound images. A thorough analysis of the results pinpointed ongoing challenges in the field and outlined recommendations for future work. The top solutions and the complete dataset remain publicly available, fostering further advancements in automatic segmentation and biometry for intrapartum ultrasound imaging.

Mitral Regurgitation Recogniton based on Unsupervised Out-of-Distribution Detection with Residual Diffusion Amplification

Mitral regurgitation (MR) is a serious heart valve disease. Early and accurate diagnosis of MR via ultrasound video is critical for timely clinical decision-making and surgical intervention. However, manual MR diagnosis heavily relies on the operator's experience, which may cause misdiagnosis and inter-observer variability. Since MR data is limited and has large intra-class variability, we propose an unsupervised out-of-distribution (OOD) detection method to identify MR rather than building a deep classifier. To our knowledge, we are the first to explore OOD in MR ultrasound videos. Our method consists of a feature extractor, a feature reconstruction model, and a residual accumulation amplification algorithm. The feature extractor obtains features from the video clips and feeds them into the feature reconstruction model to restore the original features. The residual accumulation amplification algorithm then iteratively performs noise feature reconstruction, amplifying the reconstructed error of OOD features. This algorithm is straightforward yet efficient and can seamlessly integrate as a plug-and-play component in reconstruction-based OOD detection methods. We validated the proposed method on a large ultrasound dataset containing 893 non-MR and 267 MR videos. Experimental results show that our OOD detection method can effectively identify MR samples.

Explainable and Controllable Motion Curve Guided Cardiac Ultrasound Video Generation

Echocardiography video is a primary modality for diagnosing heart diseases, but the limited data poses challenges for both clinical teaching and machine learning training. Recently, video generative models have emerged as a promising strategy to alleviate this issue. However, previous methods often relied on holistic conditions during generation, hindering the flexible movement control over specific cardiac structures. In this context, we propose an explainable and controllable method for echocardiography video generation, taking an initial frame and a motion curve as guidance. Our contributions are three-fold. First, we extract motion information from each heart substructure to construct motion curves, enabling the diffusion model to synthesize customized echocardiography videos by modifying these curves. Second, we propose the structure-to-motion alignment module, which can map semantic features onto motion curves across cardiac structures. Third, The position-aware attention mechanism is designed to enhance video consistency utilizing Gaussian masks with structural position information. Extensive experiments on three echocardiography datasets show that our method outperforms others regarding fidelity and consistency. The full code will be released at https://github.com/mlmi-2024-72/ECM.