InterSliceBoost: Identifying Tissue Layers in Three-dimensional Ultrasound Images for Chronic Lower Back Pain (cLBP) Assessment

Available studies on chronic lower back pain (cLBP) typically focus on one or a few specific tissues rather than conducting a comprehensive layer-by-layer analysis. Since three-dimensional (3-D) images often contain hundreds of slices, manual annotation of these anatomical structures is both time-consuming and error-prone. We aim to develop and validate a novel approach called InterSliceBoost to enable the training of a segmentation model on a partially annotated dataset without compromising segmentation performance. The architecture of InterSliceBoost includes two components: an inter-slice generator and a segmentation model. The generator utilizes residual block-based encoders to extract features from adjacent image-mask pairs (IMPs). Differential features are calculated and input into a decoder to generate inter-slice IMPs. The segmentation model is trained on partially annotated datasets (e.g., skipping 1, 2, 3, or 7 images) and the generated inter-slice IMPs. To validate the performance of InterSliceBoost, we utilized a dataset of 76 B-mode ultrasound scans acquired on 29 subjects enrolled in an ongoing cLBP study. InterSliceBoost, trained on only 33% of the image slices, achieved a mean Dice coefficient of 80.84% across all six layers on the independent test set, with Dice coefficients of 73.48%, 61.11%, 81.87%, 95.74%, 83.52% and 88.74% for segmenting dermis, superficial fat, superficial fascial membrane, deep fat, deep fascial membrane, and muscle. This performance is significantly higher than the conventional model trained on fully annotated images (p<0.05). InterSliceBoost can effectively segment the six tissue layers depicted on 3-D B-model ultrasound images in settings with partial annotations.

Segmentation-Aware Generative Reinforcement Network (GRN) for Tissue Layer Segmentation in 3-D Ultrasound Images for Chronic Low-back Pain (cLBP) Assessment

We introduce a novel segmentation-aware joint training framework called generative reinforcement network (GRN) that integrates segmentation loss feedback to optimize both image generation and segmentation performance in a single stage. An image enhancement technique called segmentation-guided enhancement (SGE) is also developed, where the generator produces images tailored specifically for the segmentation model. Two variants of GRN were also developed, including GRN for sample-efficient learning (GRN-SEL) and GRN for semi-supervised learning (GRN-SSL). GRN's performance was evaluated using a dataset of 69 fully annotated 3D ultrasound scans from 29 subjects. The annotations included six anatomical structures: dermis, superficial fat, superficial fascial membrane (SFM), deep fat, deep fascial membrane (DFM), and muscle. Our results show that GRN-SEL with SGE reduces labeling efforts by up to 70% while achieving a 1.98% improvement in the Dice Similarity Coefficient (DSC) compared to models trained on fully labeled datasets. GRN-SEL alone reduces labeling efforts by 60%, GRN-SSL with SGE decreases labeling requirements by 70%, and GRN-SSL alone by 60%, all while maintaining performance comparable to fully supervised models. These findings suggest the effectiveness of the GRN framework in optimizing segmentation performance with significantly less labeled data, offering a scalable and efficient solution for ultrasound image analysis and reducing the burdens associated with data annotation.