Learning-Based Autonomous Navigation, Benchmark Environments and Simulation Framework for Endovascular Interventions

Endovascular interventions are a life-saving treatment for many diseases, yet suffer from drawbacks such as radiation exposure and potential scarcity of proficient physicians. Robotic assistance during these interventions could be a promising support towards these problems. Research focusing on autonomous endovascular interventions utilizing artificial intelligence-based methodologies is gaining popularity. However, variability in assessment environments hinders the ability to compare and contrast the efficacy of different approaches, primarily due to each study employing a unique evaluation framework. In this study, we present deep reinforcement learning-based autonomous endovascular device navigation on three distinct digital benchmark interventions: BasicWireNav, ArchVariety, and DualDeviceNav. The benchmark interventions were implemented with our modular simulation framework stEVE (simulated EndoVascular Environment). Autonomous controllers were trained solely in simulation and evaluated in simulation and on physical test benches with camera and fluoroscopy feedback. Autonomous control for BasicWireNav and ArchVariety reached high success rates and was successfully transferred from the simulated training environment to the physical test benches, while autonomous control for DualDeviceNav reached a moderate success rate. The experiments demonstrate the feasibility of stEVE and its potential for transferring controllers trained in simulation to real-world scenarios. Nevertheless, they also reveal areas that offer opportunities for future research. This study demonstrates the transferability of autonomous controllers from simulation to the real world in endovascular navigation and lowers the entry barriers and increases the comparability of research on endovascular assistance systems by providing open-source training scripts, benchmarks and the stEVE framework.

Domain and Content Adaptive Convolutions for Cross-Domain Adenocarcinoma Segmentation

Recent advances in computer-aided diagnosis for histopathology have been largely driven by the use of deep learning models for automated image analysis. While these networks can perform on par with medical experts, their performance can be impeded by out-of-distribution data. The Cross-Organ and Cross-Scanner Adenocarcinoma Segmentation (COSAS) challenge aimed to address the task of cross-domain adenocarcinoma segmentation in the presence of morphological and scanner-induced domain shifts. In this paper, we present a U-Net-based segmentation framework designed to tackle this challenge. Our approach achieved segmentation scores of 0.8020 for the cross-organ track and 0.8527 for the cross-scanner track on the final challenge test sets, ranking it the best-performing submission.

Leveraging image captions for selective whole slide image annotation

Acquiring annotations for whole slide images (WSIs)-based deep learning tasks, such as creating tissue segmentation masks or detecting mitotic figures, is a laborious process due to the extensive image size and the significant manual work involved in the annotation. This paper focuses on identifying and annotating specific image regions that optimize model training, given a limited annotation budget. While random sampling helps capture data variance by collecting annotation regions throughout the WSIs, insufficient data curation may result in an inadequate representation of minority classes. Recent studies proposed diversity sampling to select a set of regions that maximally represent unique characteristics of the WSIs. This is done by pretraining on unlabeled data through self-supervised learning and then clustering all regions in the latent space. However, establishing the optimal number of clusters can be difficult and not all clusters are task-relevant. This paper presents prototype sampling, a new method for annotation region selection. It discovers regions exhibiting typical characteristics of each task-specific class. The process entails recognizing class prototypes from extensive histopathology image-caption databases and detecting unlabeled image regions that resemble these prototypes. Our results show that prototype sampling is more effective than random and diversity sampling in identifying annotation regions with valuable training information, resulting in improved model performance in semantic segmentation and mitotic figure detection tasks. Code is available at https://github.com/DeepMicroscopy/Prototype-sampling.

On the Value of PHH3 for Mitotic Figure Detection on H&E-stained Images

The count of mitotic figures (MFs) observed in hematoxylin and eosin (H&E)-stained slides is an important prognostic marker as it is a measure for tumor cell proliferation. However, the identification of MFs has a known low inter-rater agreement. Deep learning algorithms can standardize this task, but they require large amounts of annotated data for training and validation. Furthermore, label noise introduced during the annotation process may impede the algorithm's performance. Unlike H&E, the mitosis-specific antibody phospho-histone H3 (PHH3) specifically highlights MFs. Counting MFs on slides stained against PHH3 leads to higher agreement among raters and has therefore recently been used as a ground truth for the annotation of MFs in H&E. However, as PHH3 facilitates the recognition of cells indistinguishable from H&E stain alone, the use of this ground truth could potentially introduce noise into the H&E-related dataset, impacting model performance. This study analyzes the impact of PHH3-assisted MF annotation on inter-rater reliability and object level agreement through an extensive multi-rater experiment. We found that the annotators' object-level agreement increased when using PHH3-assisted labeling. Subsequently, MF detectors were evaluated on the resulting datasets to investigate the influence of PHH3-assisted labeling on the models' performance. Additionally, a novel dual-stain MF detector was developed to investigate the interpretation-shift of PHH3-assisted labels used in H&E, which clearly outperformed single-stain detectors. However, the PHH3-assisted labels did not have a positive effect on solely H&E-based models. The high performance of our dual-input detector reveals an information mismatch between the H&E and PHH3-stained images as the cause of this effect.

Comprehensive Multimodal Deep Learning Survival Prediction Enabled by a Transformer Architecture: A Multicenter Study in Glioblastoma

Background: This research aims to improve glioblastoma survival prediction by integrating MR images, clinical and molecular-pathologic data in a transformer-based deep learning model, addressing data heterogeneity and performance generalizability. Method: We propose and evaluate a transformer-based non-linear and non-proportional survival prediction model. The model employs self-supervised learning techniques to effectively encode the high-dimensional MRI input for integration with non-imaging data using cross-attention. To demonstrate model generalizability, the model is assessed with the time-dependent concordance index (Cdt) in two training setups using three independent public test sets: UPenn-GBM, UCSF-PDGM, and RHUH-GBM, each comprising 378, 366, and 36 cases, respectively. Results: The proposed transformer model achieved promising performance for imaging as well as non-imaging data, effectively integrating both modalities for enhanced performance (UPenn-GBM test-set, imaging Cdt 0.645, multimodal Cdt 0.707) while outperforming state-of-the-art late-fusion 3D-CNN-based models. Consistent performance was observed across the three independent multicenter test sets with Cdt values of 0.707 (UPenn-GBM, internal test set), 0.672 (UCSF-PDGM, first external test set) and 0.618 (RHUH-GBM, second external test set). The model achieved significant discrimination between patients with favorable and unfavorable survival for all three datasets (logrank p 1.9\times{10}^{-8}, 9.7\times{10}^{-3}, and 1.2\times{10}^{-2}). Conclusions: The proposed transformer-based survival prediction model integrates complementary information from diverse input modalities, contributing to improved glioblastoma survival prediction compared to state-of-the-art methods. Consistent performance was observed across institutions supporting model generalizability.

Analysing Diffusion Segmentation for Medical Images

Denoising Diffusion Probabilistic models have become increasingly popular due to their ability to offer probabilistic modeling and generate diverse outputs. This versatility inspired their adaptation for image segmentation, where multiple predictions of the model can produce segmentation results that not only achieve high quality but also capture the uncertainty inherent in the model. Here, powerful architectures were proposed for improving diffusion segmentation performance. However, there is a notable lack of analysis and discussions on the differences between diffusion segmentation and image generation, and thorough evaluations are missing that distinguish the improvements these architectures provide for segmentation in general from their benefit for diffusion segmentation specifically. In this work, we critically analyse and discuss how diffusion segmentation for medical images differs from diffusion image generation, with a particular focus on the training behavior. Furthermore, we conduct an assessment how proposed diffusion segmentation architectures perform when trained directly for segmentation. Lastly, we explore how different medical segmentation tasks influence the diffusion segmentation behavior and the diffusion process could be adapted accordingly. With these analyses, we aim to provide in-depth insights into the behavior of diffusion segmentation that allow for a better design and evaluation of diffusion segmentation methods in the future.

Style-Extracting Diffusion Models for Semi-Supervised Histopathology Segmentation

Deep learning-based image generation has seen significant advancements with diffusion models, notably improving the quality of generated images. Despite these developments, generating images with unseen characteristics beneficial for downstream tasks has received limited attention. To bridge this gap, we propose Style-Extracting Diffusion Models, featuring two conditioning mechanisms. Specifically, we utilize 1) a style conditioning mechanism which allows to inject style information of previously unseen images during image generation and 2) a content conditioning which can be targeted to a downstream task, e.g., layout for segmentation. We introduce a trainable style encoder to extract style information from images, and an aggregation block that merges style information from multiple style inputs. This architecture enables the generation of images with unseen styles in a zero-shot manner, by leveraging styles from unseen images, resulting in more diverse generations. In this work, we use the image layout as target condition and first show the capability of our method on a natural image dataset as a proof-of-concept. We further demonstrate its versatility in histopathology, where we combine prior knowledge about tissue composition and unannotated data to create diverse synthetic images with known layouts. This allows us to generate additional synthetic data to train a segmentation network in a semi-supervised fashion. We verify the added value of the generated images by showing improved segmentation results and lower performance variability between patients when synthetic images are included during segmentation training. Our code will be made publicly available at [LINK].

Re-identification from histopathology images

In numerous studies, deep learning algorithms have proven their potential for the analysis of histopathology images, for example, for revealing the subtypes of tumors or the primary origin of metastases. These models require large datasets for training, which must be anonymized to prevent possible patient identity leaks. This study demonstrates that even relatively simple deep learning algorithms can re-identify patients in large histopathology datasets with substantial accuracy. We evaluated our algorithms on two TCIA datasets including lung squamous cell carcinoma (LSCC) and lung adenocarcinoma (LUAD). We also demonstrate the algorithm's performance on an in-house dataset of meningioma tissue. We predicted the source patient of a slide with F1 scores of 50.16 % and 52.30 % on the LSCC and LUAD datasets, respectively, and with 62.31 % on our meningioma dataset. Based on our findings, we formulated a risk assessment scheme to estimate the risk to the patient's privacy prior to publication.

Rethinking U-net Skip Connections for Biomedical Image Segmentation

The U-net architecture has significantly impacted deep learning-based segmentation of medical images. Through the integration of long-range skip connections, it facilitated the preservation of high-resolution features. Out-of-distribution data can, however, substantially impede the performance of neural networks. Previous works showed that the trained network layers differ in their susceptibility to this domain shift, e.g., shallow layers are more affected than deeper layers. In this work, we investigate the implications of this observation of layer sensitivity to domain shifts of U-net-style segmentation networks. By copying features of shallow layers to corresponding decoder blocks, these bear the risk of re-introducing domain-specific information. We used a synthetic dataset to model different levels of data distribution shifts and evaluated the impact on downstream segmentation performance. We quantified the inherent domain susceptibility of each network layer, using the Hellinger distance. These experiments confirmed the higher domain susceptibility of earlier network layers. When gradually removing skip connections, a decrease in domain susceptibility of deeper layers could be observed. For downstream segmentation performance, the original U-net outperformed the variant without any skip connections. The best performance, however, was achieved when removing the uppermost skip connection - not only in the presence of domain shifts but also for in-domain test data. We validated our results on three clinical datasets - two histopathology datasets and one magnetic resonance dataset - with performance increases of up to 10% in-domain and 13% cross-domain when removing the uppermost skip connection.

Deep Learning model predicts the c-Kit-11 mutational status of canine cutaneous mast cell tumors by HE stained histological slides

Numerous prognostic factors are currently assessed histopathologically in biopsies of canine mast cell tumors to evaluate clinical behavior. In addition, PCR analysis of the c-Kit exon 11 mutational status is often performed to evaluate the potential success of a tyrosine kinase inhibitor therapy. This project aimed at training deep learning models (DLMs) to identify the c-Kit-11 mutational status of MCTs solely based on morphology without additional molecular analysis. HE slides of 195 mutated and 173 non-mutated tumors were stained consecutively in two different laboratories and scanned with three different slide scanners. This resulted in six different datasets (stain-scanner variations) of whole slide images. DLMs were trained with single and mixed datasets and their performances was assessed under scanner and staining domain shifts. The DLMs correctly classified HE slides according to their c-Kit 11 mutation status in, on average, 87% of cases for the best-suited stain-scanner variant. A relevant performance drop could be observed when the stain-scanner combination of the training and test dataset differed. Multi-variant datasets improved the average accuracy but did not reach the maximum accuracy of algorithms trained and tested on the same stain-scanner variant. In summary, DLM-assisted morphological examination of MCTs can predict c-Kit-exon 11 mutational status of MCTs with high accuracy. However, the recognition performance is impeded by a change of scanner or staining protocol. Larger data sets with higher numbers of scans originating from different laboratories and scanners may lead to more robust DLMs to identify c-Kit mutations in HE slides.