PASSION: Towards Effective Incomplete Multi-Modal Medical Image Segmentation with Imbalanced Missing Rates

Incomplete multi-modal image segmentation is a fundamental task in medical imaging to refine deployment efficiency when only partial modalities are available. However, the common practice that complete-modality data is visible during model training is far from realistic, as modalities can have imbalanced missing rates in clinical scenarios. In this paper, we, for the first time, formulate such a challenging setting and propose Preference-Aware Self-diStillatION (PASSION) for incomplete multi-modal medical image segmentation under imbalanced missing rates. Specifically, we first construct pixel-wise and semantic-wise self-distillation to balance the optimization objective of each modality. Then, we define relative preference to evaluate the dominance of each modality during training, based on which to design task-wise and gradient-wise regularization to balance the convergence rates of different modalities. Experimental results on two publicly available multi-modal datasets demonstrate the superiority of PASSION against existing approaches for modality balancing. More importantly, PASSION is validated to work as a plug-and-play module for consistent performance improvement across different backbones. Code is available at https://github.com/Jun-Jie-Shi/PASSION.

Non-parametric regularization for class imbalance federated medical image classification

Limited training data and severe class imbalance pose significant challenges to developing clinically robust deep learning models. Federated learning (FL) addresses the former by enabling different medical clients to collaboratively train a deep model without sharing privacy-sensitive data. However, class imbalance worsens due to variation in inter-client class distribution. We propose federated learning with non-parametric regularization (FedNPR and FedNPR-Per, a personalized version of FedNPR) to regularize the feature extractor and enhance useful and discriminative signal in the feature space. Our extensive experiments show that FedNPR outperform the existing state-of-the art FL approaches in class imbalance skin lesion classification and intracranial hemorrhage identification. Additionally, the non-parametric regularization module consistently improves the performance of existing state-of-the-art FL approaches. We believe that NPR is a valuable tool in FL under clinical settings.

FedIA: Federated Medical Image Segmentation with Heterogeneous Annotation Completeness

Federated learning has emerged as a compelling paradigm for medical image segmentation, particularly in light of increasing privacy concerns. However, most of the existing research relies on relatively stringent assumptions regarding the uniformity and completeness of annotations across clients. Contrary to this, this paper highlights a prevalent challenge in medical practice: incomplete annotations. Such annotations can introduce incorrectly labeled pixels, potentially undermining the performance of neural networks in supervised learning. To tackle this issue, we introduce a novel solution, named FedIA. Our insight is to conceptualize incomplete annotations as noisy data (\textit{i.e.}, low-quality data), with a focus on mitigating their adverse effects. We begin by evaluating the completeness of annotations at the client level using a designed indicator. Subsequently, we enhance the influence of clients with more comprehensive annotations and implement corrections for incomplete ones, thereby ensuring that models are trained on accurate data. Our method's effectiveness is validated through its superior performance on two extensively used medical image segmentation datasets, outperforming existing solutions. The code is available at https://github.com/HUSTxyy/FedIA.

FedMLP: Federated Multi-Label Medical Image Classification under Task Heterogeneity

Cross-silo federated learning (FL) enables decentralized organizations to collaboratively train models while preserving data privacy and has made significant progress in medical image classification. One common assumption is task homogeneity where each client has access to all classes during training. However, in clinical practice, given a multi-label classification task, constrained by the level of medical knowledge and the prevalence of diseases, each institution may diagnose only partial categories, resulting in task heterogeneity. How to pursue effective multi-label medical image classification under task heterogeneity is under-explored. In this paper, we first formulate such a realistic label missing setting in the multi-label FL domain and propose a two-stage method FedMLP to combat class missing from two aspects: pseudo label tagging and global knowledge learning. The former utilizes a warmed-up model to generate class prototypes and select samples with high confidence to supplement missing labels, while the latter uses a global model as a teacher for consistency regularization to prevent forgetting missing class knowledge. Experiments on two publicly-available medical datasets validate the superiority of FedMLP against the state-of-the-art both federated semi-supervised and noisy label learning approaches under task heterogeneity. Code is available at https://github.com/szbonaldo/FedMLP.

From Optimization to Generalization: Fair Federated Learning against Quality Shift via Inter-Client Sharpness Matching

Due to escalating privacy concerns, federated learning has been recognized as a vital approach for training deep neural networks with decentralized medical data. In practice, it is challenging to ensure consistent imaging quality across various institutions, often attributed to equipment malfunctions affecting a minority of clients. This imbalance in image quality can cause the federated model to develop an inherent bias towards higher-quality images, thus posing a severe fairness issue. In this study, we pioneer the identification and formulation of this new fairness challenge within the context of the imaging quality shift. Traditional methods for promoting fairness in federated learning predominantly focus on balancing empirical risks across diverse client distributions. This strategy primarily facilitates fair optimization across different training data distributions, yet neglects the crucial aspect of generalization. To address this, we introduce a solution termed Federated learning with Inter-client Sharpness Matching (FedISM). FedISM enhances both local training and global aggregation by incorporating sharpness-awareness, aiming to harmonize the sharpness levels across clients for fair generalization. Our empirical evaluations, conducted using the widely-used ICH and ISIC 2019 datasets, establish FedISM's superiority over current state-of-the-art federated learning methods in promoting fairness. Code is available at https://github.com/wnn2000/FFL4MIA.

SAMCT: Segment Any CT Allowing Labor-Free Task-Indicator Prompts

Segment anything model (SAM), a foundation model with superior versatility and generalization across diverse segmentation tasks, has attracted widespread attention in medical imaging. However, it has been proved that SAM would encounter severe performance degradation due to the lack of medical knowledge in training and local feature encoding. Though several SAM-based models have been proposed for tuning SAM in medical imaging, they still suffer from insufficient feature extraction and highly rely on high-quality prompts. In this paper, we construct a large CT dataset consisting of 1.1M CT images and 5M masks from public datasets and propose a powerful foundation model SAMCT allowing labor-free prompts. Specifically, based on SAM, SAMCT is further equipped with a U-shaped CNN image encoder, a cross-branch interaction module, and a task-indicator prompt encoder. The U-shaped CNN image encoder works in parallel with the ViT image encoder in SAM to supplement local features. Cross-branch interaction enhances the feature expression capability of the CNN image encoder and the ViT image encoder by exchanging global perception and local features from one to the other. The task-indicator prompt encoder is a plug-and-play component to effortlessly encode task-related indicators into prompt embeddings. In this way, SAMCT can work in an automatic manner in addition to the semi-automatic interactive strategy in SAM. Extensive experiments demonstrate the superiority of SAMCT against the state-of-the-art task-specific and SAM-based medical foundation models on various tasks. The code, data, and models are released at https://github.com/xianlin7/SAMCT.

FedA3I: Annotation Quality-Aware Aggregation for Federated Medical Image Segmentation Against Heterogeneous Annotation Noise

Federated learning (FL) has emerged as a promising paradigm for training segmentation models on decentralized medical data, owing to its privacy-preserving property. However, existing research overlooks the prevalent annotation noise encountered in real-world medical datasets, which limits the performance ceilings of FL. In this paper, we, for the first time, identify and tackle this problem. For problem formulation, we propose a contour evolution for modeling non-independent and identically distributed (Non-IID) noise across pixels within each client and then extend it to the case of multi-source data to form a heterogeneous noise model (\textit{i.e.}, Non-IID annotation noise across clients). For robust learning from annotations with such two-level Non-IID noise, we emphasize the importance of data quality in model aggregation, allowing high-quality clients to have a greater impact on FL. To achieve this, we propose \textbf{Fed}erated learning with \textbf{A}nnotation qu\textbf{A}lity-aware \textbf{A}ggregat\textbf{I}on, named \textbf{FedA$^3$I}, by introducing a quality factor based on client-wise noise estimation. Specifically, noise estimation at each client is accomplished through the Gaussian mixture model and then incorporated into model aggregation in a layer-wise manner to up-weight high-quality clients. Extensive experiments on two real-world medical image segmentation datasets demonstrate the superior performance of FedA$^3$I against the state-of-the-art approaches in dealing with cross-client annotation noise. The code is available at \color{blue}{https://github.com/wnn2000/FedAAAI}.

SAMUS: Adapting Segment Anything Model for Clinically-Friendly and Generalizable Ultrasound Image Segmentation

Segment anything model (SAM), an eminent universal image segmentation model, has recently gathered considerable attention within the domain of medical image segmentation. Despite the remarkable performance of SAM on natural images, it grapples with significant performance degradation and limited generalization when confronted with medical images, particularly with those involving objects of low contrast, faint boundaries, intricate shapes, and diminutive sizes. In this paper, we propose SAMUS, a universal model tailored for ultrasound image segmentation. In contrast to previous SAM-based universal models, SAMUS pursues not only better generalization but also lower deployment cost, rendering it more suitable for clinical applications. Specifically, based on SAM, a parallel CNN branch is introduced to inject local features into the ViT encoder through cross-branch attention for better medical image segmentation. Then, a position adapter and a feature adapter are developed to adapt SAM from natural to medical domains and from requiring large-size inputs (1024x1024) to small-size inputs (256x256) for more clinical-friendly deployment. A comprehensive ultrasound dataset, comprising about 30k images and 69k masks and covering six object categories, is collected for verification. Extensive comparison experiments demonstrate SAMUS's superiority against the state-of-the-art task-specific models and universal foundation models under both task-specific evaluation and generalization evaluation. Moreover, SAMUS is deployable on entry-level GPUs, as it has been liberated from the constraints of long sequence encoding. The code, data, and models will be released at https://github.com/xianlin7/SAMUS.

ConvFormer: Plug-and-Play CNN-Style Transformers for Improving Medical Image Segmentation

Transformers have been extensively studied in medical image segmentation to build pairwise long-range dependence. Yet, relatively limited well-annotated medical image data makes transformers struggle to extract diverse global features, resulting in attention collapse where attention maps become similar or even identical. Comparatively, convolutional neural networks (CNNs) have better convergence properties on small-scale training data but suffer from limited receptive fields. Existing works are dedicated to exploring the combinations of CNN and transformers while ignoring attention collapse, leaving the potential of transformers under-explored. In this paper, we propose to build CNN-style Transformers (ConvFormer) to promote better attention convergence and thus better segmentation performance. Specifically, ConvFormer consists of pooling, CNN-style self-attention (CSA), and convolutional feed-forward network (CFFN) corresponding to tokenization, self-attention, and feed-forward network in vanilla vision transformers. In contrast to positional embedding and tokenization, ConvFormer adopts 2D convolution and max-pooling for both position information preservation and feature size reduction. In this way, CSA takes 2D feature maps as inputs and establishes long-range dependency by constructing self-attention matrices as convolution kernels with adaptive sizes. Following CSA, 2D convolution is utilized for feature refinement through CFFN. Experimental results on multiple datasets demonstrate the effectiveness of ConvFormer working as a plug-and-play module for consistent performance improvement of transformer-based frameworks. Code is available at https://github.com/xianlin7/ConvFormer.

FedNoRo: Towards Noise-Robust Federated Learning by Addressing Class Imbalance and Label Noise Heterogeneity

Federated noisy label learning (FNLL) is emerging as a promising tool for privacy-preserving multi-source decentralized learning. Existing research, relying on the assumption of class-balanced global data, might be incapable to model complicated label noise, especially in medical scenarios. In this paper, we first formulate a new and more realistic federated label noise problem where global data is class-imbalanced and label noise is heterogeneous, and then propose a two-stage framework named FedNoRo for noise-robust federated learning. Specifically, in the first stage of FedNoRo, per-class loss indicators followed by Gaussian Mixture Model are deployed for noisy client identification. In the second stage, knowledge distillation and a distance-aware aggregation function are jointly adopted for noise-robust federated model updating. Experimental results on the widely-used ICH and ISIC2019 datasets demonstrate the superiority of FedNoRo against the state-of-the-art FNLL methods for addressing class imbalance and label noise heterogeneity in real-world FL scenarios.