Touchstone Benchmark: Are We on the Right Way for Evaluating AI Algorithms for Medical Segmentation?

How can we test AI performance? This question seems trivial, but it isn't. Standard benchmarks often have problems such as in-distribution and small-size test sets, oversimplified metrics, unfair comparisons, and short-term outcome pressure. As a consequence, good performance on standard benchmarks does not guarantee success in real-world scenarios. To address these problems, we present Touchstone, a large-scale collaborative segmentation benchmark of 9 types of abdominal organs. This benchmark is based on 5,195 training CT scans from 76 hospitals around the world and 5,903 testing CT scans from 11 additional hospitals. This diverse test set enhances the statistical significance of benchmark results and rigorously evaluates AI algorithms across various out-of-distribution scenarios. We invited 14 inventors of 19 AI algorithms to train their algorithms, while our team, as a third party, independently evaluated these algorithms on three test sets. In addition, we also evaluated pre-existing AI frameworks--which, differing from algorithms, are more flexible and can support different algorithms--including MONAI from NVIDIA, nnU-Net from DKFZ, and numerous other open-source frameworks. We are committed to expanding this benchmark to encourage more innovation of AI algorithms for the medical domain.

Bidirectional Recurrence for Cardiac Motion Tracking with Gaussian Process Latent Coding

Quantitative analysis of cardiac motion is crucial for assessing cardiac function. This analysis typically uses imaging modalities such as MRI and Echocardiograms that capture detailed image sequences throughout the heartbeat cycle. Previous methods predominantly focused on the analysis of image pairs lacking consideration of the motion dynamics and spatial variability. Consequently, these methods often overlook the long-term relationships and regional motion characteristic of cardiac. To overcome these limitations, we introduce the \textbf{GPTrack}, a novel unsupervised framework crafted to fully explore the temporal and spatial dynamics of cardiac motion. The GPTrack enhances motion tracking by employing the sequential Gaussian Process in the latent space and encoding statistics by spatial information at each time stamp, which robustly promotes temporal consistency and spatial variability of cardiac dynamics. Also, we innovatively aggregate sequential information in a bidirectional recursive manner, mimicking the behavior of diffeomorphic registration to better capture consistent long-term relationships of motions across cardiac regions such as the ventricles and atria. Our GPTrack significantly improves the precision of motion tracking in both 3D and 4D medical images while maintaining computational efficiency. The code is available at: https://github.com/xmed-lab/GPTrack

Collaborative Knowledge Fusion: A Novel Approach for Multi-task Recommender Systems via LLMs

Owing to the impressive general intelligence of large language models (LLMs), there has been a growing trend to integrate them into recommender systems to gain a more profound insight into human interests and intentions. Existing LLMs-based recommender systems primarily leverage item attributes and user interaction histories in textual format, improving the single task like rating prediction or explainable recommendation. Nevertheless, these approaches overlook the crucial contribution of traditional collaborative signals in discerning users' profound intentions and disregard the interrelatedness among tasks. To address these limitations, we introduce a novel framework known as CKF, specifically developed to boost multi-task recommendations via personalized collaborative knowledge fusion into LLMs. Specifically, our method synergizes traditional collaborative filtering models to produce collaborative embeddings, subsequently employing the meta-network to construct personalized mapping bridges tailored for each user. Upon mapped, the embeddings are incorporated into meticulously designed prompt templates and then fed into an advanced LLM to represent user interests. To investigate the intrinsic relationship among diverse recommendation tasks, we develop Multi-Lora, a new parameter-efficient approach for multi-task optimization, adept at distinctly segregating task-shared and task-specific information. This method forges a connection between LLMs and recommendation scenarios, while simultaneously enriching the supervisory signal through mutual knowledge transfer among various tasks. Extensive experiments and in-depth robustness analyses across four common recommendation tasks on four large public data sets substantiate the effectiveness and superiority of our framework.

CardiacNet: Learning to Reconstruct Abnormalities for Cardiac Disease Assessment from Echocardiogram Videos

Echocardiogram video plays a crucial role in analysing cardiac function and diagnosing cardiac diseases. Current deep neural network methods primarily aim to enhance diagnosis accuracy by incorporating prior knowledge, such as segmenting cardiac structures or lesions annotated by human experts. However, diagnosing the inconsistent behaviours of the heart, which exist across both spatial and temporal dimensions, remains extremely challenging. For instance, the analysis of cardiac motion acquires both spatial and temporal information from the heartbeat cycle. To address this issue, we propose a novel reconstruction-based approach named CardiacNet to learn a better representation of local cardiac structures and motion abnormalities through echocardiogram videos. CardiacNet is accompanied by the Consistency Deformation Codebook (CDC) and the Consistency Deformed-Discriminator (CDD) to learn the commonalities across abnormal and normal samples by incorporating cardiac prior knowledge. In addition, we propose benchmark datasets named CardiacNet-PAH and CardiacNet-ASD to evaluate the effectiveness of cardiac disease assessment. In experiments, our CardiacNet can achieve state-of-the-art results in three different cardiac disease assessment tasks on public datasets CAMUS, EchoNet, and our datasets. The code and dataset are available at: https://github.com/xmed-lab/CardiacNet.

Interpretable Bilingual Multimodal Large Language Model for Diverse Biomedical Tasks

Several medical Multimodal Large Languange Models (MLLMs) have been developed to address tasks involving visual images with textual instructions across various medical modalities, achieving impressive results. Most current medical generalist models are region-agnostic, treating the entire image as a holistic representation. However, they struggle to identify which specific regions they are focusing on when generating a sentence.To mimic the behavior of doctors, who typically begin by reviewing the entire image before concentrating on specific regions for a thorough evaluation, we aim to enhance the capability of medical MLLMs in understanding anatomical regions within entire medical scans. To achieve it, we first formulate Region-Centric tasks and construct a large-scale dataset, MedRegInstruct, to incorporate regional information into training. Combining our collected dataset with other medical multimodal corpora for training, we propose a Region-Aware medical MLLM, MedRegA, which is the first bilingual generalist medical AI system to simultaneously handle image-level and region-level medical vision-language tasks across a broad range of modalities. Our MedRegA not only enables three region-centric tasks, but also achieves the best performance for visual question answering, report generation and medical image classification over 8 modalities, showcasing significant versatility. Experiments demonstrate that our model can not only accomplish powerful performance across various medical vision-language tasks in bilingual settings, but also recognize and detect structures in multimodal medical scans, boosting the interpretability and user interactivity of medical MLLMs. Our project page is https://medrega.github.io.

PSFHS Challenge Report: Pubic Symphysis and Fetal Head Segmentation from Intrapartum Ultrasound Images

Segmentation of the fetal and maternal structures, particularly intrapartum ultrasound imaging as advocated by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for monitoring labor progression, is a crucial first step for quantitative diagnosis and clinical decision-making. This requires specialized analysis by obstetrics professionals, in a task that i) is highly time- and cost-consuming and ii) often yields inconsistent results. The utility of automatic segmentation algorithms for biometry has been proven, though existing results remain suboptimal. To push forward advancements in this area, the Grand Challenge on Pubic Symphysis-Fetal Head Segmentation (PSFHS) was held alongside the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to enhance the development of automatic segmentation algorithms at an international scale, providing the largest dataset to date with 5,101 intrapartum ultrasound images collected from two ultrasound machines across three hospitals from two institutions. The scientific community's enthusiastic participation led to the selection of the top 8 out of 179 entries from 193 registrants in the initial phase to proceed to the competition's second stage. These algorithms have elevated the state-of-the-art in automatic PSFHS from intrapartum ultrasound images. A thorough analysis of the results pinpointed ongoing challenges in the field and outlined recommendations for future work. The top solutions and the complete dataset remain publicly available, fostering further advancements in automatic segmentation and biometry for intrapartum ultrasound imaging.

Tri-Plane Mamba: Efficiently Adapting Segment Anything Model for 3D Medical Images

General networks for 3D medical image segmentation have recently undergone extensive exploration. Behind the exceptional performance of these networks lies a significant demand for a large volume of pixel-level annotated data, which is time-consuming and labor-intensive. The emergence of the Segment Anything Model (SAM) has enabled this model to achieve superior performance in 2D medical image segmentation tasks via parameter- and data-efficient feature adaptation. However, the introduction of additional depth channels in 3D medical images not only prevents the sharing of 2D pre-trained features but also results in a quadratic increase in the computational cost for adapting SAM. To overcome these challenges, we present the Tri-Plane Mamba (TP-Mamba) adapters tailored for the SAM, featuring two major innovations: 1) multi-scale 3D convolutional adapters, optimized for efficiently processing local depth-level information, 2) a tri-plane mamba module, engineered to capture long-range depth-level representation without significantly increasing computational costs. This approach achieves state-of-the-art performance in 3D CT organ segmentation tasks. Remarkably, this superior performance is maintained even with scarce training data. Specifically using only three CT training samples from the BTCV dataset, it surpasses conventional 3D segmentation networks, attaining a Dice score that is up to 12% higher.

Teach CLIP to Develop a Number Sense for Ordinal Regression

Ordinal regression is a fundamental problem within the field of computer vision, with customised well-trained models on specific tasks. While pre-trained vision-language models (VLMs) have exhibited impressive performance on various vision tasks, their potential for ordinal regression has received less exploration. In this study, we first investigate CLIP's potential for ordinal regression, from which we expect the model could generalise to different ordinal regression tasks and scenarios. Unfortunately, vanilla CLIP fails on this task, since current VLMs have a well-documented limitation of encapsulating compositional concepts such as number sense. We propose a simple yet effective method called NumCLIP to improve the quantitative understanding of VLMs. We disassemble the exact image to number-specific text matching problem into coarse classification and fine prediction stages. We discretize and phrase each numerical bin with common language concept to better leverage the available pre-trained alignment in CLIP. To consider the inherent continuous property of ordinal regression, we propose a novel fine-grained cross-modal ranking-based regularisation loss specifically designed to keep both semantic and ordinal alignment in CLIP's feature space. Experimental results on three general ordinal regression tasks demonstrate the effectiveness of NumCLIP, with 10% and 3.83% accuracy improvement on historical image dating and image aesthetics assessment task, respectively. Code is publicly available at https://github.com/xmed-lab/NumCLIP.

CoMoTo: Unpaired Cross-Modal Lesion Distillation Improves Breast Lesion Detection in Tomosynthesis

Digital Breast Tomosynthesis (DBT) is an advanced breast imaging modality that offers superior lesion detection accuracy compared to conventional mammography, albeit at the trade-off of longer reading time. Accelerating lesion detection from DBT using deep learning is hindered by limited data availability and huge annotation costs. A possible solution to this issue could be to leverage the information provided by a more widely available modality, such as mammography, to enhance DBT lesion detection. In this paper, we present a novel framework, CoMoTo, for improving lesion detection in DBT. Our framework leverages unpaired mammography data to enhance the training of a DBT model, improving practicality by eliminating the need for mammography during inference. Specifically, we propose two novel components, Lesion-specific Knowledge Distillation (LsKD) and Intra-modal Point Alignment (ImPA). LsKD selectively distills lesion features from a mammography teacher model to a DBT student model, disregarding background features. ImPA further enriches LsKD by ensuring the alignment of lesion features within the teacher before distilling knowledge to the student. Our comprehensive evaluation shows that CoMoTo is superior to traditional pretraining and image-level KD, improving performance by 7% Mean Sensitivity under low-data setting. Our code is available at https://github.com/Muhammad-Al-Barbary/CoMoTo .

Spatial-Division Augmented Occupancy Field for Bone Shape Reconstruction from Biplanar X-Rays

Retrieving 3D bone anatomy from biplanar X-ray images is crucial since it can significantly reduce radiation exposure compared to traditional CT-based methods. Although various deep learning models have been proposed to address this complex task, they suffer from two limitations: 1) They employ voxel representation for bone shape and exploit 3D convolutional layers to capture anatomy prior, which are memory-intensive and limit the reconstruction resolution. 2) They overlook the prevalent occlusion effect within X-ray images and directly extract features using a simple loss, which struggles to fully exploit complex X-ray information. To tackle these concerns, we present Spatial-division Augmented Occupancy Field~(SdAOF). SdAOF adopts the continuous occupancy field for shape representation, reformulating the reconstruction problem as a per-point occupancy value prediction task. Its implicit and continuous nature enables memory-efficient training and fine-scale surface reconstruction at different resolutions during the inference. Moreover, we propose a novel spatial-division augmented distillation strategy to provide feature-level guidance for capturing the occlusion relationship. Extensive experiments on the pelvis reconstruction dataset show that SdAOF outperforms state-of-the-art methods and reconstructs fine-scale bone surfaces.The code is available at https://github.com/xmed-lab/SdAOF