AMNCutter: Affinity-Attention-Guided Multi-View Normalized Cutter for Unsupervised Surgical Instrument Segmentation

Surgical instrument segmentation (SIS) is pivotal for robotic-assisted minimally invasive surgery, assisting surgeons by identifying surgical instruments in endoscopic video frames. Recent unsupervised surgical instrument segmentation (USIS) methods primarily rely on pseudo-labels derived from low-level features such as color and optical flow, but these methods show limited effectiveness and generalizability in complex and unseen endoscopic scenarios. In this work, we propose a label-free unsupervised model featuring a novel module named Multi-View Normalized Cutter (m-NCutter). Different from previous USIS works, our model is trained using a graph-cutting loss function that leverages patch affinities for supervision, eliminating the need for pseudo-labels. The framework adaptively determines which affinities from which levels should be prioritized. Therefore, the low- and high-level features and their affinities are effectively integrated to train a label-free unsupervised model, showing superior effectiveness and generalization ability. We conduct comprehensive experiments across multiple SIS datasets to validate our approach's state-of-the-art (SOTA) performance, robustness, and exceptional potential as a pre-trained model. Our code is released at https://github.com/MingyuShengSMY/AMNCutter.

Revisiting Surgical Instrument Segmentation Without Human Intervention: A Graph Partitioning View

Surgical instrument segmentation (SIS) on endoscopic images stands as a long-standing and essential task in the context of computer-assisted interventions for boosting minimally invasive surgery. Given the recent surge of deep learning methodologies and their data-hungry nature, training a neural predictive model based on massive expert-curated annotations has been dominating and served as an off-the-shelf approach in the field, which could, however, impose prohibitive burden to clinicians for preparing fine-grained pixel-wise labels corresponding to the collected surgical video frames. In this work, we propose an unsupervised method by reframing the video frame segmentation as a graph partitioning problem and regarding image pixels as graph nodes, which is significantly different from the previous efforts. A self-supervised pre-trained model is firstly leveraged as a feature extractor to capture high-level semantic features. Then, Laplacian matrixs are computed from the features and are eigendecomposed for graph partitioning. On the "deep" eigenvectors, a surgical video frame is meaningfully segmented into different modules such as tools and tissues, providing distinguishable semantic information like locations, classes, and relations. The segmentation problem can then be naturally tackled by applying clustering or threshold on the eigenvectors. Extensive experiments are conducted on various datasets (e.g., EndoVis2017, EndoVis2018, UCL, etc.) for different clinical endpoints. Across all the challenging scenarios, our method demonstrates outstanding performance and robustness higher than unsupervised state-of-the-art (SOTA) methods. The code is released at https://github.com/MingyuShengSMY/GraphClusteringSIS.git.

LNQ 2023 challenge: Benchmark of weakly-supervised techniques for mediastinal lymph node quantification

Accurate assessment of lymph node size in 3D CT scans is crucial for cancer staging, therapeutic management, and monitoring treatment response. Existing state-of-the-art segmentation frameworks in medical imaging often rely on fully annotated datasets. However, for lymph node segmentation, these datasets are typically small due to the extensive time and expertise required to annotate the numerous lymph nodes in 3D CT scans. Weakly-supervised learning, which leverages incomplete or noisy annotations, has recently gained interest in the medical imaging community as a potential solution. Despite the variety of weakly-supervised techniques proposed, most have been validated only on private datasets or small publicly available datasets. To address this limitation, the Mediastinal Lymph Node Quantification (LNQ) challenge was organized in conjunction with the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to advance weakly-supervised segmentation methods by providing a new, partially annotated dataset and a robust evaluation framework. A total of 16 teams from 5 countries submitted predictions to the validation leaderboard, and 6 teams from 3 countries participated in the evaluation phase. The results highlighted both the potential and the current limitations of weakly-supervised approaches. On one hand, weakly-supervised approaches obtained relatively good performance with a median Dice score of $61.0\%$. On the other hand, top-ranked teams, with a median Dice score exceeding $70\%$, boosted their performance by leveraging smaller but fully annotated datasets to combine weak supervision and full supervision. This highlights both the promise of weakly-supervised methods and the ongoing need for high-quality, fully annotated data to achieve higher segmentation performance.

Rule-based outlier detection of AI-generated anatomy segmentations

There is a dire need for medical imaging datasets with accompanying annotations to perform downstream patient analysis. However, it is difficult to manually generate these annotations, due to the time-consuming nature, and the variability in clinical conventions. Artificial intelligence has been adopted in the field as a potential method to annotate these large datasets, however, a lack of expert annotations or ground truth can inhibit the adoption of these annotations. We recently made a dataset publicly available including annotations and extracted features of up to 104 organs for the National Lung Screening Trial using the TotalSegmentator method. However, the released dataset does not include expert-derived annotations or an assessment of the accuracy of the segmentations, limiting its usefulness. We propose the development of heuristics to assess the quality of the segmentations, providing methods to measure the consistency of the annotations and a comparison of results to the literature. We make our code and related materials publicly available at https://github.com/ImagingDataCommons/CloudSegmentatorResults and interactive tools at https://huggingface.co/spaces/ImagingDataCommons/CloudSegmentatorResults.

Towards Automatic Abdominal MRI Organ Segmentation: Leveraging Synthesized Data Generated From CT Labels

Deep learning has shown great promise in the ability to automatically annotate organs in magnetic resonance imaging (MRI) scans, for example, of the brain. However, despite advancements in the field, the ability to accurately segment abdominal organs remains difficult across MR. In part, this may be explained by the much greater variability in image appearance and severely limited availability of training labels. The inherent nature of computed tomography (CT) scans makes it easier to annotate, resulting in a larger availability of expert annotations for the latter. We leverage a modality-agnostic domain randomization approach, utilizing CT label maps to generate synthetic images on-the-fly during training, further used to train a U-Net segmentation network for abdominal organs segmentation. Our approach shows comparable results compared to fully-supervised segmentation methods trained on MR data. Our method results in Dice scores of 0.90 (0.08) and 0.91 (0.08) for the right and left kidney respectively, compared to a pretrained nnU-Net model yielding 0.87 (0.20) and 0.91 (0.03). We will make our code publicly available.

Real-Time Dynamic Data Driven Deformable Registration for Image-Guided Neurosurgery: Computational Aspects

Current neurosurgical procedures utilize medical images of various modalities to enable the precise location of tumors and critical brain structures to plan accurate brain tumor resection. The difficulty of using preoperative images during the surgery is caused by the intra-operative deformation of the brain tissue (brain shift), which introduces discrepancies concerning the preoperative configuration. Intra-operative imaging allows tracking such deformations but cannot fully substitute for the quality of the pre-operative data. Dynamic Data Driven Deformable Non-Rigid Registration (D4NRR) is a complex and time-consuming image processing operation that allows the dynamic adjustment of the pre-operative image data to account for intra-operative brain shift during the surgery. This paper summarizes the computational aspects of a specific adaptive numerical approximation method and its variations for registering brain MRIs. It outlines its evolution over the last 15 years and identifies new directions for the computational aspects of the technique.

Advancing Intra-operative Precision: Dynamic Data-Driven Non-Rigid Registration for Enhanced Brain Tumor Resection in Image-Guided Neurosurgery

During neurosurgery, medical images of the brain are used to locate tumors and critical structures, but brain tissue shifts make pre-operative images unreliable for accurate removal of tumors. Intra-operative imaging can track these deformations but is not a substitute for pre-operative data. To address this, we use Dynamic Data-Driven Non-Rigid Registration (NRR), a complex and time-consuming image processing operation that adjusts the pre-operative image data to account for intra-operative brain shift. Our review explores a specific NRR method for registering brain MRI during image-guided neurosurgery and examines various strategies for improving the accuracy and speed of the NRR method. We demonstrate that our implementation enables NRR results to be delivered within clinical time constraints while leveraging Distributed Computing and Machine Learning to enhance registration accuracy by identifying optimal parameters for the NRR method. Additionally, we highlight challenges associated with its use in the operating room.

Reconstructing the somatotopic organization of the corticospinal tract remains a challenge for modern tractography methods

The corticospinal tract (CST) is a critically important white matter fiber tract in the human brain that enables control of voluntary movements of the body. Diffusion MRI tractography is the only method that enables the study of the anatomy and variability of the CST pathway in human health. In this work, we explored the performance of six widely used tractography methods for reconstructing the CST and its somatotopic organization. We perform experiments using diffusion MRI data from the Human Connectome Project. Four quantitative measurements including reconstruction rate, the WM-GM interface coverage, anatomical distribution of streamlines, and correlation with cortical volumes to assess the advantages and limitations of each method. Overall, we conclude that while current tractography methods have made progress toward the well-known challenge of improving the reconstruction of the lateral projections of the CST, the overall problem of performing a comprehensive CST reconstruction, including clinically important projections in the lateral (hand and face area) and medial portions (leg area), remains an important challenge for diffusion MRI tractography.

Enrichment of the NLST and NSCLC-Radiomics computed tomography collections with AI-derived annotations

Public imaging datasets are critical for the development and evaluation of automated tools in cancer imaging. Unfortunately, many do not include annotations or image-derived features, complicating their downstream analysis. Artificial intelligence-based annotation tools have been shown to achieve acceptable performance and thus can be used to automatically annotate large datasets. As part of the effort to enrich public data available within NCI Imaging Data Commons (IDC), here we introduce AI-generated annotations for two collections of computed tomography images of the chest, NSCLC-Radiomics, and the National Lung Screening Trial. Using publicly available AI algorithms we derived volumetric annotations of thoracic organs at risk, their corresponding radiomics features, and slice-level annotations of anatomical landmarks and regions. The resulting annotations are publicly available within IDC, where the DICOM format is used to harmonize the data and achieve FAIR principles. The annotations are accompanied by cloud-enabled notebooks demonstrating their use. This study reinforces the need for large, publicly accessible curated datasets and demonstrates how AI can be used to aid in cancer imaging.

A Registration- and Uncertainty-based Framework for White Matter Tract Segmentation With Only One Annotated Subject

White matter (WM) tract segmentation based on diffusion magnetic resonance imaging (dMRI) plays an important role in the analysis of human health and brain diseases. However, the annotation of WM tracts is time-consuming and needs experienced neuroanatomists. In this study, to explore tract segmentation in the challenging setting of minimal annotations, we propose a novel framework utilizing only one annotated subject (subject-level one-shot) for tract segmentation. Our method is constructed by proposed registration-based peak augmentation (RPA) and uncertainty-based refining (URe) modules. RPA module synthesizes pseudo subjects and their corresponding labels to improve the tract segmentation performance. The proposed URe module alleviates the negative influence of the low-confidence voxels on pseudo subjects. Experimental results show that our method outperforms other state-of-the-art methods by a large margin, and our proposed modules are effective. Overall, our method achieves accurate whole-brain tract segmentation with only one annotated subject. Our code is available at https://github.com/HaoXu0507/ISBI2023-One-Shot-WM-Tract-Segmentation.