Abstract:Objective: There exist several X-ray computed tomography (CT) scanning strategies to reduce a radiation dose, such as (1) sparse-view CT, (2) low-dose CT, and (3) region-of-interest (ROI) CT (called interior tomography). To further reduce the dose, the sparse-view and/or low-dose CT settings can be applied together with interior tomography. Interior tomography has various advantages in terms of reducing the number of detectors and decreasing the X-ray radiation dose. However, a large patient or small field-of-view (FOV) detector can cause truncated projections, and then the reconstructed images suffer from severe cupping artifacts. In addition, although the low-dose CT can reduce the radiation exposure dose, analytic reconstruction algorithms produce image noise. Recently, many researchers have utilized image-domain deep learning (DL) approaches to remove each artifact and demonstrated impressive performances, and the theory of deep convolutional framelets supports the reason for the performance improvement. Approach: In this paper, we found that the image-domain convolutional neural network (CNN) is difficult to solve coupled artifacts, based on deep convolutional framelets. Significance: To address the coupled problem, we decouple it into two sub-problems: (i) image domain noise reduction inside truncated projection to solve low-dose CT problem and (ii) extrapolation of projection outside truncated projection to solve the ROI CT problem. The decoupled sub-problems are solved directly with a novel proposed end-to-end learning using dual-domain CNNs. Main results: We demonstrate that the proposed method outperforms the conventional image-domain deep learning methods, and a projection-domain CNN shows better performance than the image-domain CNNs which are commonly used by many researchers.
Abstract:Diffusion bridge models have demonstrated promising performance in conditional image generation tasks, such as image restoration and translation, by initializing the generative process from corrupted images instead of pure Gaussian noise. However, existing diffusion bridge models often rely on Stochastic Differential Equation (SDE) samplers, which result in slower inference speed compared to diffusion models that employ high-order Ordinary Differential Equation (ODE) solvers for acceleration. To mitigate this gap, we propose a high-order ODE sampler with a stochastic start for diffusion bridge models. To overcome the singular behavior of the probability flow ODE (PF-ODE) at the beginning of the reverse process, a posterior sampling approach was introduced at the first reverse step. The sampling was designed to ensure a smooth transition from corrupted images to the generative trajectory while reducing discretization errors. Following this stochastic start, Heun's second-order solver is applied to solve the PF-ODE, achieving high perceptual quality with significantly reduced neural function evaluations (NFEs). Our method is fully compatible with pretrained diffusion bridge models and requires no additional training. Extensive experiments on image restoration and translation tasks, including super-resolution, JPEG restoration, Edges-to-Handbags, and DIODE-Outdoor, demonstrated that our sampler outperforms state-of-the-art methods in both visual quality and Frechet Inception Distance (FID).
Abstract:Generative image reconstruction algorithms such as measurement conditioned diffusion models are increasingly popular in the field of medical imaging. These powerful models can transform low signal-to-noise ratio (SNR) inputs into outputs with the appearance of high SNR. However, the outputs can have a new type of error called hallucinations. In medical imaging, these hallucinations may not be obvious to a Radiologist but could cause diagnostic errors. Generally, hallucination refers to error in estimation of object structure caused by a machine learning model, but there is no widely accepted method to evaluate hallucination magnitude. In this work, we propose a new image quality metric called the hallucination index. Our approach is to compute the Hellinger distance from the distribution of reconstructed images to a zero hallucination reference distribution. To evaluate our approach, we conducted a numerical experiment with electron microscopy images, simulated noisy measurements, and applied diffusion based reconstructions. We sampled the measurements and the generative reconstructions repeatedly to compute the sample mean and covariance. For the zero hallucination reference, we used the forward diffusion process applied to ground truth. Our results show that higher measurement SNR leads to lower hallucination index for the same apparent image quality. We also evaluated the impact of early stopping in the reverse diffusion process and found that more modest denoising strengths can reduce hallucination. We believe this metric could be useful for evaluation of generative image reconstructions or as a warning label to inform radiologists about the degree of hallucinations in medical images.
Abstract:Invariant-based Contrastive Learning (ICL) methods have achieved impressive performance across various domains. However, the absence of latent space representation for distortion (augmentation)-related information in the latent space makes ICL sub-optimal regarding training efficiency and robustness in downstream tasks. Recent studies suggest that introducing equivariance into Contrastive Learning (CL) can improve overall performance. In this paper, we rethink the roles of augmentation strategies and equivariance in improving CL efficacy. We propose a novel Equivariant-based Contrastive Learning (ECL) framework, CLeVER (Contrastive Learning Via Equivariant Representation), compatible with augmentation strategies of arbitrary complexity for various mainstream CL methods and model frameworks. Experimental results demonstrate that CLeVER effectively extracts and incorporates equivariant information from data, thereby improving the training efficiency and robustness of baseline models in downstream tasks.
Abstract:Conditional diffusion models have gained recognition for their effectiveness in image restoration tasks, yet their iterative denoising process, starting from Gaussian noise, often leads to slow inference speeds. As a promising alternative, the Image-to-Image Schr\"odinger Bridge (I2SB) initializes the generative process from corrupted images and integrates training techniques from conditional diffusion models. In this study, we extended the I2SB method by introducing the Implicit Image-to-Image Schrodinger Bridge (I3SB), transitioning its generative process to a non-Markovian process by incorporating corrupted images in each generative step. This enhancement empowers I3SB to generate images with better texture restoration using a small number of generative steps. The proposed method was validated on CT super-resolution and denoising tasks and outperformed existing methods, including the conditional denoising diffusion probabilistic model (cDDPM) and I2SB, in both visual quality and quantitative metrics. These findings underscore the potential of I3SB in improving medical image restoration by providing fast and accurate generative modeling.
Abstract:The Segment Anything Model (SAM), a foundation model for general image segmentation, has demonstrated impressive zero-shot performance across numerous natural image segmentation tasks. However, SAM's performance significantly declines when applied to medical images, primarily due to the substantial disparity between natural and medical image domains. To effectively adapt SAM to medical images, it is important to incorporate critical third-dimensional information, i.e., volumetric or temporal knowledge, during fine-tuning. Simultaneously, we aim to harness SAM's pre-trained weights within its original 2D backbone to the fullest extent. In this paper, we introduce a modality-agnostic SAM adaptation framework, named as MA-SAM, that is applicable to various volumetric and video medical data. Our method roots in the parameter-efficient fine-tuning strategy to update only a small portion of weight increments while preserving the majority of SAM's pre-trained weights. By injecting a series of 3D adapters into the transformer blocks of the image encoder, our method enables the pre-trained 2D backbone to extract third-dimensional information from input data. The effectiveness of our method has been comprehensively evaluated on four medical image segmentation tasks, by using 10 public datasets across CT, MRI, and surgical video data. Remarkably, without using any prompt, our method consistently outperforms various state-of-the-art 3D approaches, surpassing nnU-Net by 0.9%, 2.6%, and 9.9% in Dice for CT multi-organ segmentation, MRI prostate segmentation, and surgical scene segmentation respectively. Our model also demonstrates strong generalization, and excels in challenging tumor segmentation when prompts are used. Our code is available at: https://github.com/cchen-cc/MA-SAM.
Abstract:Participant recruitment based on unstructured medical texts such as clinical notes and radiology reports has been a challenging yet important task for the cohort establishment in clinical research. Recently, Large Language Models (LLMs) such as ChatGPT have achieved tremendous success in various downstream tasks thanks to their promising performance in language understanding, inference, and generation. It is then natural to test their feasibility in solving the cohort recruitment task, which involves the classification of a given paragraph of medical text into disease label(s). However, when applied to knowledge-intensive problem settings such as medical text classification, where the LLMs are expected to understand the decision made by human experts and accurately identify the implied disease labels, the LLMs show a mediocre performance. A possible explanation is that, by only using the medical text, the LLMs neglect to use the rich context of additional information that languages afford. To this end, we propose to use a knowledge graph as auxiliary information to guide the LLMs in making predictions. Moreover, to further boost the LLMs adapt to the problem setting, we apply a chain-of-thought (CoT) sample selection strategy enhanced by reinforcement learning, which selects a set of CoT samples given each individual medical report. Experimental results and various ablation studies show that our few-shot learning method achieves satisfactory performance compared with fine-tuning strategies and gains superb advantages when the available data is limited. The code and sample dataset of the proposed CohortGPT model is available at: https://anonymous.4open.science/r/CohortGPT-4872/
Abstract:We proved that a trained model in supervised deep learning minimizes the conditional risk for each input (Theorem 2.1). This property provided insights into the behavior of trained models and established a connection between supervised and unsupervised learning in some cases. In addition, when the labels are intractable but can be written as a conditional risk minimizer, we proved an equivalent form of the original supervised learning problem with accessible labels (Theorem 2.2). We demonstrated that many existing works, such as Noise2Score, Noise2Noise and score function estimation can be explained by our theorem. Moreover, we derived a property of classification problem with noisy labels using Theorem 2.1 and validated it using MNIST dataset. Furthermore, We proposed a method to estimate uncertainty in image super-resolution based on Theorem 2.2 and validated it using ImageNet dataset. Our code is available on github.
Abstract:COVID-19 patient triaging with predictive outcome of the patients upon first present to emergency department (ED) is crucial for improving patient prognosis, as well as better hospital resources management and cross-infection control. We trained a deep feature fusion model to predict patient outcomes, where the model inputs were EHR data including demographic information, co-morbidities, vital signs and laboratory measurements, plus patient's CXR images. The model output was patient outcomes defined as the most insensitive oxygen therapy required. For patients without CXR images, we employed Random Forest method for the prediction. Predictive risk scores for COVID-19 severe outcomes ("CO-RISK" score) were derived from model output and evaluated on the testing dataset, as well as compared to human performance. The study's dataset (the "MGB COVID Cohort") was constructed from all patients presenting to the Mass General Brigham (MGB) healthcare system from March 1st to June 1st, 2020. ED visits with incomplete or erroneous data were excluded. Patients with no test order for COVID or confirmed negative test results were excluded. Patients under the age of 15 were also excluded. Finally, electronic health record (EHR) data from a total of 11060 COVID-19 confirmed or suspected patients were used in this study. Chest X-ray (CXR) images were also collected from each patient if available. Results show that CO-RISK score achieved area under the Curve (AUC) of predicting MV/death (i.e. severe outcomes) in 24 hours of 0.95, and 0.92 in 72 hours on the testing dataset. The model shows superior performance to the commonly used risk scores in ED (CURB-65 and MEWS). Comparing with physician's decisions, CO-RISK score has demonstrated superior performance to human in making ICU/floor decisions.
Abstract:In recent years, deep learning-based image analysis methods have been widely applied in computer-aided detection, diagnosis and prognosis, and has shown its value during the public health crisis of the novel coronavirus disease 2019 (COVID-19) pandemic. Chest radiograph (CXR) has been playing a crucial role in COVID-19 patient triaging, diagnosing and monitoring, particularly in the United States. Considering the mixed and unspecific signals in CXR, an image retrieval model of CXR that provides both similar images and associated clinical information can be more clinically meaningful than a direct image diagnostic model. In this work we develop a novel CXR image retrieval model based on deep metric learning. Unlike traditional diagnostic models which aims at learning the direct mapping from images to labels, the proposed model aims at learning the optimized embedding space of images, where images with the same labels and similar contents are pulled together. It utilizes multi-similarity loss with hard-mining sampling strategy and attention mechanism to learn the optimized embedding space, and provides similar images to the query image. The model is trained and validated on an international multi-site COVID-19 dataset collected from 3 different sources. Experimental results of COVID-19 image retrieval and diagnosis tasks show that the proposed model can serve as a robust solution for CXR analysis and patient management for COVID-19. The model is also tested on its transferability on a different clinical decision support task, where the pre-trained model is applied to extract image features from a new dataset without any further training. These results demonstrate our deep metric learning based image retrieval model is highly efficient in the CXR retrieval, diagnosis and prognosis, and thus has great clinical value for the treatment and management of COVID-19 patients.