Uncertainty Propagation for Echocardiography Clinical Metric Estimation via Contour Sampling

Echocardiography plays a fundamental role in the extraction of important clinical parameters (e.g. left ventricular volume and ejection fraction) required to determine the presence and severity of heart-related conditions. When deploying automated techniques for computing these parameters, uncertainty estimation is crucial for assessing their utility. Since clinical parameters are usually derived from segmentation maps, there is no clear path for converting pixel-wise uncertainty values into uncertainty estimates in the downstream clinical metric calculation. In this work, we propose a novel uncertainty estimation method based on contouring rather than segmentation. Our method explicitly predicts contour location uncertainty from which contour samples can be drawn. Finally, the sampled contours can be used to propagate uncertainty to clinical metrics. Our proposed method not only provides accurate uncertainty estimations for the task of contouring but also for the downstream clinical metrics on two cardiac ultrasound datasets. Code is available at: https://github.com/ThierryJudge/contouring-uncertainty.

Domain Adaptation of Echocardiography Segmentation Via Reinforcement Learning

Performance of deep learning segmentation models is significantly challenged in its transferability across different medical imaging domains, particularly when aiming to adapt these models to a target domain with insufficient annotated data for effective fine-tuning. While existing domain adaptation (DA) methods propose strategies to alleviate this problem, these methods do not explicitly incorporate human-verified segmentation priors, compromising the potential of a model to produce anatomically plausible segmentations. We introduce RL4Seg, an innovative reinforcement learning framework that reduces the need to otherwise incorporate large expertly annotated datasets in the target domain, and eliminates the need for lengthy manual human review. Using a target dataset of 10,000 unannotated 2D echocardiographic images, RL4Seg not only outperforms existing state-of-the-art DA methods in accuracy but also achieves 99% anatomical validity on a subset of 220 expert-validated subjects from the target domain. Furthermore, our framework's reward network offers uncertainty estimates comparable with dedicated state-of-the-art uncertainty methods, demonstrating the utility and effectiveness of RL4Seg in overcoming domain adaptation challenges in medical image segmentation.

TractOracle: towards an anatomically-informed reward function for RL-based tractography

Reinforcement learning (RL)-based tractography is a competitive alternative to machine learning and classical tractography algorithms due to its high anatomical accuracy obtained without the need for any annotated data. However, the reward functions so far used to train RL agents do not encapsulate anatomical knowledge which causes agents to generate spurious false positives tracts. In this paper, we propose a new RL tractography system, TractOracle, which relies on a reward network trained for streamline classification. This network is used both as a reward function during training as well as a mean for stopping the tracking process early and thus reduce the number of false positive streamlines. This makes our system a unique method that evaluates and reconstructs WM streamlines at the same time. We report an improvement of true positive ratios by almost 20\% and a reduction of 3x of false positive ratios on one dataset and an increase between 2x and 7x in the number true positive streamlines on another dataset.

Fusing Echocardiography Images and Medical Records for Continuous Patient Stratification

Deep learning now enables automatic and robust extraction of cardiac function descriptors from echocardiographic sequences, such as ejection fraction or strain. These descriptors provide fine-grained information that physicians consider, in conjunction with more global variables from the clinical record, to assess patients' condition. Drawing on novel transformer models applied to tabular data (e.g., variables from electronic health records), we propose a method that considers all descriptors extracted from medical records and echocardiograms to learn the representation of a difficult-to-characterize cardiovascular pathology, namely hypertension. Our method first projects each variable into its own representation space using modality-specific approaches. These standardized representations of multimodal data are then fed to a transformer encoder, which learns to merge them into a comprehensive representation of the patient through a pretext task of predicting a clinical rating. This pretext task is formulated as an ordinal classification to enforce a pathological continuum in the representation space. We observe the major trends along this continuum for a cohort of 239 hypertensive patients to describe, with unprecedented gradation, the effect of hypertension on a number of cardiac function descriptors. Our analysis shows that i) pretrained weights from a foundation model allow to reach good performance (83% accuracy) even with limited data (less than 200 training samples), ii) trends across the population are reproducible between trainings, and iii) for descriptors whose interactions with hypertension are well documented, patterns are consistent with prior physiological knowledge.

Merging multiple input descriptors and supervisors in a deep neural network for tractogram filtering

One of the main issues of the current tractography methods is their high false-positive rate. Tractogram filtering is an option to remove false-positive streamlines from tractography data in a post-processing step. In this paper, we train a deep neural network for filtering tractography data in which every streamline of a tractogram is classified as {\em plausible, implausible}, or {\em inconclusive}. For this, we use four different tractogram filtering strategies as supervisors: TractQuerier, RecobundlesX, TractSeg, and an anatomy-inspired filter. Their outputs are combined to obtain the classification labels for the streamlines. We assessed the importance of different types of information along the streamlines for performing this classification task, including the coordinates of the streamlines, diffusion data, landmarks, T1-weighted information, and a brain parcellation. We found that the streamline coordinates are the most relevant followed by the diffusion data in this particular classification task.

Mixup-Privacy: A simple yet effective approach for privacy-preserving segmentation

Privacy protection in medical data is a legitimate obstacle for centralized machine learning applications. Here, we propose a client-server image segmentation system which allows for the analysis of multi-centric medical images while preserving patient privacy. In this approach, the client protects the to-be-segmented patient image by mixing it to a reference image. As shown in our work, it is challenging to separate the image mixture to exact original content, thus making the data unworkable and unrecognizable for an unauthorized person. This proxy image is sent to a server for processing. The server then returns the mixture of segmentation maps, which the client can revert to a correct target segmentation. Our system has two components: 1) a segmentation network on the server side which processes the image mixture, and 2) a segmentation unmixing network which recovers the correct segmentation map from the segmentation mixture. Furthermore, the whole system is trained end-to-end. The proposed method is validated on the task of MRI brain segmentation using images from two different datasets. Results show that the segmentation accuracy of our method is comparable to a system trained on raw images, and outperforms other privacy-preserving methods with little computational overhead.

What Matters in Reinforcement Learning for Tractography

Recently, deep reinforcement learning (RL) has been proposed to learn the tractography procedure and train agents to reconstruct the structure of the white matter without manually curated reference streamlines. While the performances reported were competitive, the proposed framework is complex, and little is still known about the role and impact of its multiple parts. In this work, we thoroughly explore the different components of the proposed framework, such as the choice of the RL algorithm, seeding strategy, the input signal and reward function, and shed light on their impact. Approximately 7,400 models were trained for this work, totalling nearly 41,000 hours of GPU time. Our goal is to guide researchers eager to explore the possibilities of deep RL for tractography by exposing what works and what does not work with the category of approach. As such, we ultimately propose a series of recommendations concerning the choice of RL algorithm, the input to the agents, the reward function and more to help future work using reinforcement learning for tractography. We also release the open source codebase, trained models, and datasets for users and researchers wanting to explore reinforcement learning for tractography.

Extraction of volumetric indices from echocardiography: which deep learning solution for clinical use?

Deep learning-based methods have spearheaded the automatic analysis of echocardiographic images, taking advantage of the publication of multiple open access datasets annotated by experts (CAMUS being one of the largest public databases). However, these models are still considered unreliable by clinicians due to unresolved issues concerning i) the temporal consistency of their predictions, and ii) their ability to generalize across datasets. In this context, we propose a comprehensive comparison between the current best performing methods in medical/echocardiographic image segmentation, with a particular focus on temporal consistency and cross-dataset aspects. We introduce a new private dataset, named CARDINAL, of apical two-chamber and apical four-chamber sequences, with reference segmentation over the full cardiac cycle. We show that the proposed 3D nnU-Net outperforms alternative 2D and recurrent segmentation methods. We also report that the best models trained on CARDINAL, when tested on CAMUS without any fine-tuning, still manage to perform competitively with respect to prior methods. Overall, the experimental results suggest that with sufficient training data, 3D nnU-Net could become the first automated tool to finally meet the standards of an everyday clinical device.

FIESTA: Autoencoders for accurate fiber segmentation in tractography

White matter bundle segmentation is a cornerstone of modern tractography to study the brain's structural connectivity in domains such as neurological disorders, neurosurgery, and aging. In this study, we present FIESTA (FIbEr Segmentation in Tractography using Autoencoders), a reliable and robust, fully automated, and easily semi-automatically calibrated pipeline based on deep autoencoders that can dissect and fully populate WM bundles. Our framework allows the transition from one anatomical bundle definition to another with marginal calibrating time. This pipeline is built upon FINTA, CINTA, and GESTA methods that demonstrated how autoencoders can be used successfully for streamline filtering, bundling, and streamline generation in tractography. Our proposed method improves bundling coverage by recovering hard-to-track bundles with generative sampling through the latent space seeding of the subject bundle and the atlas bundle. A latent space of streamlines is learned using autoencoder-based modeling combined with contrastive learning. Using an atlas of bundles in standard space (MNI), our proposed method segments new tractograms using the autoencoder latent distance between each tractogram streamline and its closest neighbor bundle in the atlas of bundles. Intra-subject bundle reliability is improved by recovering hard-to-track streamlines, using the autoencoder to generate new streamlines that increase each bundle's spatial coverage while remaining anatomically meaningful. Results show that our method is more reliable than state-of-the-art automated virtual dissection methods such as RecoBundles, RecoBundlesX, TractSeg, White Matter Analysis and XTRACT. Overall, these results show that our framework improves the practicality and usability of current state-of-the-art bundling framework

ProstAttention-Net: A deep attention model for prostate cancer segmentation by aggressiveness in MRI scans

Multiparametric magnetic resonance imaging (mp-MRI) has shown excellent results in the detection of prostate cancer (PCa). However, characterizing prostate lesions aggressiveness in mp-MRI sequences is impossible in clinical practice, and biopsy remains the reference to determine the Gleason score (GS). In this work, we propose a novel end-to-end multi-class network that jointly segments the prostate gland and cancer lesions with GS group grading. After encoding the information on a latent space, the network is separated in two branches: 1) the first branch performs prostate segmentation 2) the second branch uses this zonal prior as an attention gate for the detection and grading of prostate lesions. The model was trained and validated with a 5-fold cross-validation on an heterogeneous series of 219 MRI exams acquired on three different scanners prior prostatectomy. In the free-response receiver operating characteristics (FROC) analysis for clinically significant lesions (defined as GS > 6) detection, our model achieves 69.0% $\pm$14.5% sensitivity at 2.9 false positive per patient on the whole prostate and 70.8% $\pm$14.4% sensitivity at 1.5 false positive when considering the peripheral zone (PZ) only. Regarding the automatic GS group