UWAFA-GAN: Ultra-Wide-Angle Fluorescein Angiography Transformation via Multi-scale Generation and Registration Enhancement

Fundus photography, in combination with the ultra-wide-angle fundus (UWF) techniques, becomes an indispensable diagnostic tool in clinical settings by offering a more comprehensive view of the retina. Nonetheless, UWF fluorescein angiography (UWF-FA) necessitates the administration of a fluorescent dye via injection into the patient's hand or elbow unlike UWF scanning laser ophthalmoscopy (UWF-SLO). To mitigate potential adverse effects associated with injections, researchers have proposed the development of cross-modality medical image generation algorithms capable of converting UWF-SLO images into their UWF-FA counterparts. Current image generation techniques applied to fundus photography encounter difficulties in producing high-resolution retinal images, particularly in capturing minute vascular lesions. To address these issues, we introduce a novel conditional generative adversarial network (UWAFA-GAN) to synthesize UWF-FA from UWF-SLO. This approach employs multi-scale generators and an attention transmit module to efficiently extract both global structures and local lesions. Additionally, to counteract the image blurriness issue that arises from training with misaligned data, a registration module is integrated within this framework. Our method performs non-trivially on inception scores and details generation. Clinical user studies further indicate that the UWF-FA images generated by UWAFA-GAN are clinically comparable to authentic images in terms of diagnostic reliability. Empirical evaluations on our proprietary UWF image datasets elucidate that UWAFA-GAN outperforms extant methodologies. The code is accessible at https://github.com/Tinysqua/UWAFA-GAN.

GlanceSeg: Real-time microaneurysm lesion segmentation with gaze-map-guided foundation model for early detection of diabetic retinopathy

Early-stage diabetic retinopathy (DR) presents challenges in clinical diagnosis due to inconspicuous and minute microangioma lesions, resulting in limited research in this area. Additionally, the potential of emerging foundation models, such as the segment anything model (SAM), in medical scenarios remains rarely explored. In this work, we propose a human-in-the-loop, label-free early DR diagnosis framework called GlanceSeg, based on SAM. GlanceSeg enables real-time segmentation of microangioma lesions as ophthalmologists review fundus images. Our human-in-the-loop framework integrates the ophthalmologist's gaze map, allowing for rough localization of minute lesions in fundus images. Subsequently, a saliency map is generated based on the located region of interest, which provides prompt points to assist the foundation model in efficiently segmenting microangioma lesions. Finally, a domain knowledge filter refines the segmentation of minute lesions. We conducted experiments on two newly-built public datasets, i.e., IDRiD and Retinal-Lesions, and validated the feasibility and superiority of GlanceSeg through visualized illustrations and quantitative measures. Additionally, we demonstrated that GlanceSeg improves annotation efficiency for clinicians and enhances segmentation performance through fine-tuning using annotations. This study highlights the potential of GlanceSeg-based annotations for self-model optimization, leading to enduring performance advancements through continual learning.

Label-noise-tolerant medical image classification via self-attention and self-supervised learning

Deep neural networks (DNNs) have been widely applied in medical image classification and achieve remarkable classification performance. These achievements heavily depend on large-scale accurately annotated training data. However, label noise is inevitably introduced in the medical image annotation, as the labeling process heavily relies on the expertise and experience of annotators. Meanwhile, DNNs suffer from overfitting noisy labels, degrading the performance of models. Therefore, in this work, we innovatively devise noise-robust training approach to mitigate the adverse effects of noisy labels in medical image classification. Specifically, we incorporate contrastive learning and intra-group attention mixup strategies into the vanilla supervised learning. The contrastive learning for feature extractor helps to enhance visual representation of DNNs. The intra-group attention mixup module constructs groups and assigns self-attention weights for group-wise samples, and subsequently interpolates massive noisy-suppressed samples through weighted mixup operation. We conduct comparative experiments on both synthetic and real-world noisy medical datasets under various noise levels. Rigorous experiments validate that our noise-robust method with contrastive learning and attention mixup can effectively handle with label noise, and is superior to state-of-the-art methods. An ablation study also shows that both components contribute to boost model performance. The proposed method demonstrates its capability of curb label noise and has certain potential toward real-world clinic applications.

Eye tracking guided deep multiple instance learning with dual cross-attention for fundus disease detection

Deep neural networks (DNNs) have promoted the development of computer aided diagnosis (CAD) systems for fundus diseases, helping ophthalmologists reduce missed diagnosis and misdiagnosis rate. However, the majority of CAD systems are data-driven but lack of medical prior knowledge which can be performance-friendly. In this regard, we innovatively proposed a human-in-the-loop (HITL) CAD system by leveraging ophthalmologists' eye-tracking information, which is more efficient and accurate. Concretely, the HITL CAD system was implemented on the multiple instance learning (MIL), where eye-tracking gaze maps were beneficial to cherry-pick diagnosis-related instances. Furthermore, the dual-cross-attention MIL (DCAMIL) network was utilized to curb the adverse effects of noisy instances. Meanwhile, both sequence augmentation module and domain adversarial module were introduced to enrich and standardize instances in the training bag, respectively, thereby enhancing the robustness of our method. We conduct comparative experiments on our newly constructed datasets (namely, AMD-Gaze and DR-Gaze), respectively for the AMD and early DR detection. Rigorous experiments demonstrate the feasibility of our HITL CAD system and the superiority of the proposed DCAMIL, fully exploring the ophthalmologists' eye-tracking information. These investigations indicate that physicians' gaze maps, as medical prior knowledge, is potential to contribute to the CAD systems of clinical diseases.