UDCR: Unsupervised Aortic DSA/CTA Rigid Registration Using Deep Reinforcement Learning and Overlap Degree Calculation

The rigid registration of aortic Digital Subtraction Angiography (DSA) and Computed Tomography Angiography (CTA) can provide 3D anatomical details of the vasculature for the interventional surgical treatment of conditions such as aortic dissection and aortic aneurysms, holding significant value for clinical research. However, the current methods for 2D/3D image registration are dependent on manual annotations or synthetic data, as well as the extraction of landmarks, which is not suitable for cross-modal registration of aortic DSA/CTA. In this paper, we propose an unsupervised method, UDCR, for aortic DSA/CTA rigid registration based on deep reinforcement learning. Leveraging the imaging principles and characteristics of DSA and CTA, we have constructed a cross-dimensional registration environment based on spatial transformations. Specifically, we propose an overlap degree calculation reward function that measures the intensity difference between the foreground and background, aimed at assessing the accuracy of registration between segmentation maps and DSA images. This method is highly flexible, allowing for the loading of pre-trained models to perform registration directly or to seek the optimal spatial transformation parameters through online learning. We manually annotated 61 pairs of aortic DSA/CTA for algorithm evaluation. The results indicate that the proposed UDCR achieved a Mean Absolute Error (MAE) of 2.85 mm in translation and 4.35{\deg} in rotation, showing significant potential for clinical applications.

Image-Guided Autonomous Guidewire Navigation in Robot-Assisted Endovascular Interventions using Reinforcement Learning

Autonomous robots in endovascular interventions possess the potential to navigate guidewires with safety and reliability, while reducing human error and shortening surgical time. However, current methods of guidewire navigation based on Reinforcement Learning (RL) depend on manual demonstration data or magnetic guidance. In this work, we propose an Image-guided Autonomous Guidewire Navigation (IAGN) method. Specifically, we introduce BDA-star, a path planning algorithm with boundary distance constraints, for the trajectory planning of guidewire navigation. We established an IAGN-RL environment where the observations are real-time guidewire feeding images highlighting the position of the guidewire tip and the planned path. We proposed a reward function based on the distances from both the guidewire tip to the planned path and the target to evaluate the agent's actions. Furthermore, in policy network, we employ a pre-trained convolutional neural network to extract features, mitigating stability issues and slow convergence rates associated with direct learning from raw pixels. Experiments conducted on the aortic simulation IAGN platform demonstrated that the proposed method, targeting the left subclavian artery and the brachiocephalic artery, achieved a 100% guidewire navigation success rate, along with reduced movement and retraction distances and trajectories tend to the center of the vessels.

An Automatic Cascaded Model for Hemorrhagic Stroke Segmentation and Hemorrhagic Volume Estimation

Hemorrhagic Stroke (HS) has a rapid onset and is a serious condition that poses a great health threat. Promptly and accurately delineating the bleeding region and estimating the volume of bleeding in Computer Tomography (CT) images can assist clinicians in treatment planning, leading to improved treatment outcomes for patients. In this paper, a cascaded 3D model is constructed based on UNet to perform a two-stage segmentation of the hemorrhage area in CT images from rough to fine, and the hemorrhage volume is automatically calculated from the segmented area. On a dataset with 341 cases of hemorrhagic stroke CT scans, the proposed model provides high-quality segmentation outcome with higher accuracy (DSC 85.66%) and better computation efficiency (6.2 second per sample) when compared to the traditional Tada formula with respect to hemorrhage volume estimation.

Cross-head mutual Mean-Teaching for semi-supervised medical image segmentation

Semi-supervised medical image segmentation (SSMIS) has witnessed substantial advancements by leveraging limited labeled data and abundant unlabeled data. Nevertheless, existing state-of-the-art (SOTA) methods encounter challenges in accurately predicting labels for the unlabeled data, giving rise to disruptive noise during training and susceptibility to erroneous information overfitting. Moreover, applying perturbations to inaccurate predictions further reduces consistent learning. To address these concerns, we propose a novel Cross-head mutual mean-teaching Network (CMMT-Net) incorporated strong-weak data augmentation, thereby benefitting both self-training and consistency learning. Specifically, our CMMT-Net consists of both teacher-student peer networks with a share encoder and dual slightly different decoders, and the pseudo labels generated by one mean teacher head are adopted to supervise the other student branch to achieve a mutual consistency. Furthermore, we propose mutual virtual adversarial training (MVAT) to smooth the decision boundary and enhance feature representations. To diversify the consistency training samples, we employ Cross-Set CutMix strategy, which also helps address distribution mismatch issues. Notably, CMMT-Net simultaneously implements data, feature, and network perturbations, amplifying model diversity and generalization performance. Experimental results on three publicly available datasets indicate that our approach yields remarkable improvements over previous SOTA methods across various semi-supervised scenarios. Code and logs will be available at https://github.com/Leesoon1984/CMMT-Net.

Two-Stage Hybrid Supervision Framework for Fast, Low-resource, and Accurate Organ and Pan-cancer Segmentation in Abdomen CT

Abdominal organ and tumour segmentation has many important clinical applications, such as organ quantification, surgical planning, and disease diagnosis. However, manual assessment is inherently subjective with considerable inter- and intra-expert variability. In the paper, we propose a hybrid supervised framework, StMt, that integrates self-training and mean teacher for the segmentation of abdominal organs and tumors using partially labeled and unlabeled data. We introduce a two-stage segmentation pipeline and whole-volume-based input strategy to maximize segmentation accuracy while meeting the requirements of inference time and GPU memory usage. Experiments on the validation set of FLARE2023 demonstrate that our method achieves excellent segmentation performance as well as fast and low-resource model inference. Our method achieved an average DSC score of 89.79\% and 45.55 \% for the organs and lesions on the validation set and the average running time and area under GPU memory-time cure are 11.25s and 9627.82MB, respectively.

TSI-Net: A Timing Sequence Image Segmentation Network for Intracranial Artery Segmentation in Digital Subtraction Angiography

Cerebrovascular disease is one of the major diseases facing the world today. Automatic segmentation of intracranial artery (IA) in digital subtraction angiography (DSA) sequences is an important step in the diagnosis of vascular related diseases and in guiding neurointerventional procedures. While, a single image can only show part of the IA within the contrast medium according to the imaging principle of DSA technology. Therefore, 2D DSA segmentation methods are unable to capture the complete IA information and treatment of cerebrovascular diseases. We propose A timing sequence image segmentation network with U-shape, called TSI-Net, which incorporates a bi-directional ConvGRU module (BCM) in the encoder. The network incorporates a bi-directional ConvGRU module (BCM) in the encoder, which can input variable-length DSA sequences, retain past and future information, segment them into 2D images. In addition, we introduce a sensitive detail branch (SDB) at the end for supervising fine vessels. Experimented on the DSA sequence dataset DIAS, the method performs significantly better than state-of-the-art networks in recent years. In particular, it achieves a Sen evaluation metric of 0.797, which is a 3% improvement compared to other methods.

DIAS: A Comprehensive Benchmark for DSA-sequence Intracranial Artery Segmentation

Automatic segmentation of the intracranial artery (IA) in digital subtraction angiography (DSA) sequence is an essential step in diagnosing IA-related diseases and guiding neuro-interventional surgery. However, the lack of publicly available datasets has impeded research in this area. In this paper, we release DIAS, an IA segmentation dataset, consisting of 120 DSA sequences from intracranial interventional therapy. In addition to pixel-wise annotations, this dataset provides two types of scribble annotations for weakly supervised IA segmentation research. We present a comprehensive benchmark for evaluating the performance of this challenging dataset by utilizing fully-, weakly-, and semi-supervised learning approaches. Specifically, we propose a method that incorporates a dimensionality reduction module into a 2D/3D model to achieve vessel segmentation in DSA sequences. For weakly-supervised learning, we propose a scribble learning-based image segmentation framework, SSCR, which comprises scribble supervision and consistency regularization. Furthermore, we introduce a random patch-based self-training framework that utilizes unlabeled DSA sequences to improve segmentation performance. Our extensive experiments on the DIAS dataset demonstrate the effectiveness of these methods as potential baselines for future research and clinical applications.

Combining Hybrid Architecture and Pseudo-label for Semi-supervised Abdominal Organ Segmentation

Abdominal organ segmentation has many important clinical applications, such as organ quantification, surgical planning, and disease diagnosis. However, manually annotating organs from CT scans is time-consuming and labor-intensive. Semi-supervised learning has shown the potential to alleviate this challenge by learning from a large set of unlabeled images and limited labeled samples. In this work, we follow the self-training strategy and employ a hybrid architecture (PHTrans) with CNN and Transformer for both teacher and student models to generate precise pseudo-labels. Afterward, we introduce them with label data together into a two-stage segmentation framework with lightweight PHTrans for training to improve the performance and generalization ability of the model while remaining efficient. Experiments on the validation set of FLARE2022 demonstrate that our method achieves excellent segmentation performance as well as fast and low-resource model inference. The average DSC and HSD are 0.8956 and 0.9316, respectively. Under our development environments, the average inference time is 18.62 s, the average maximum GPU memory is 1995.04 MB, and the area under the GPU memory-time curve and the average area under the CPU utilization-time curve are 23196.84 and 319.67.

PHTrans: Parallelly Aggregating Global and Local Representations for Medical Image Segmentation

The success of Transformer in computer vision has attracted increasing attention in the medical imaging community. Especially for medical image segmentation, many excellent hybrid architectures based on convolutional neural networks (CNNs) and Transformer have been presented and achieve impressive performance. However, most of these methods, which embed modular Transformer into CNNs, struggle to reach their full potential. In this paper, we propose a novel hybrid architecture for medical image segmentation called PHTrans, which parallelly hybridizes Transformer and CNN in main building blocks to produce hierarchical representations from global and local features and adaptively aggregate them, aiming to fully exploit their strengths to obtain better segmentation performance. Specifically, PHTrans follows the U-shaped encoder-decoder design and introduces the parallel hybird module in deep stages, where convolution blocks and the modified 3D Swin Transformer learn local features and global dependencies separately, then a sequence-to-volume operation unifies the dimensions of the outputs to achieve feature aggregation. Extensive experimental results on both Multi-Atlas Labeling Beyond the Cranial Vault and Automated Cardiac Diagnosis Challeng datasets corroborate its effectiveness, consistently outperforming state-of-the-art methods.