Diffusion Based Ambiguous Image Segmentation

Medical image segmentation often involves inherent uncertainty due to variations in expert annotations. Capturing this uncertainty is an important goal and previous works have used various generative image models for the purpose of representing the full distribution of plausible expert ground truths. In this work, we explore the design space of diffusion models for generative segmentation, investigating the impact of noise schedules, prediction types, and loss weightings. Notably, we find that making the noise schedule harder with input scaling significantly improves performance. We conclude that x- and v-prediction outperform epsilon-prediction, likely because the diffusion process is in the discrete segmentation domain. Many loss weightings achieve similar performance as long as they give enough weight to the end of the diffusion process. We base our experiments on the LIDC-IDRI lung lesion dataset and obtain state-of-the-art (SOTA) performance. Additionally, we introduce a randomly cropped variant of the LIDC-IDRI dataset that is better suited for uncertainty in image segmentation. Our model also achieves SOTA in this harder setting.

Hybrid CNN with Chebyshev Polynomial Expansion for Medical Image Analysis

Lung cancer remains one of the leading causes of cancer-related mortality worldwide, with early and accurate diagnosis playing a pivotal role in improving patient outcomes. Automated detection of pulmonary nodules in computed tomography (CT) scans is a challenging task due to variability in nodule size, shape, texture, and location. Traditional Convolutional Neural Networks (CNNs) have shown considerable promise in medical image analysis; however, their limited ability to capture fine-grained spatial-spectral variations restricts their performance in complex diagnostic scenarios. In this study, we propose a novel hybrid deep learning architecture that incorporates Chebyshev polynomial expansions into CNN layers to enhance expressive power and improve the representation of underlying anatomical structures. The proposed Chebyshev-CNN leverages the orthogonality and recursive properties of Chebyshev polynomials to extract high-frequency features and approximate complex nonlinear functions with greater fidelity. The model is trained and evaluated on benchmark lung cancer imaging datasets, including LUNA16 and LIDC-IDRI, achieving superior performance in classifying pulmonary nodules as benign or malignant. Quantitative results demonstrate significant improvements in accuracy, sensitivity, and specificity compared to traditional CNN-based approaches. This integration of polynomial-based spectral approximation within deep learning provides a robust framework for enhancing automated medical diagnostics and holds potential for broader applications in clinical decision support systems.

Hierarchical Vision Transformer with Prototypes for Interpretable Medical Image Classification

Explainability is a highly demanded requirement for applications in high-risk areas such as medicine. Vision Transformers have mainly been limited to attention extraction to provide insight into the model's reasoning. Our approach combines the high performance of Vision Transformers with the introduction of new explainability capabilities. We present HierViT, a Vision Transformer that is inherently interpretable and adapts its reasoning to that of humans. A hierarchical structure is used to process domain-specific features for prediction. It is interpretable by design, as it derives the target output with human-defined features that are visualized by exemplary images (prototypes). By incorporating domain knowledge about these decisive features, the reasoning is semantically similar to human reasoning and therefore intuitive. Moreover, attention heatmaps visualize the crucial regions for identifying each feature, thereby providing HierViT with a versatile tool for validating predictions. Evaluated on two medical benchmark datasets, LIDC-IDRI for lung nodule assessment and derm7pt for skin lesion classification, HierViT achieves superior and comparable prediction accuracy, respectively, while offering explanations that align with human reasoning.

S3TU-Net: Structured Convolution and Superpixel Transformer for Lung Nodule Segmentation

The irregular and challenging characteristics of lung adenocarcinoma nodules in computed tomography (CT) images complicate staging diagnosis, making accurate segmentation critical for clinicians to extract detailed lesion information. In this study, we propose a segmentation model, S3TU-Net, which integrates multi-dimensional spatial connectors and a superpixel-based visual transformer. S3TU-Net is built on a multi-view CNN-Transformer hybrid architecture, incorporating superpixel algorithms, structured weighting, and spatial shifting techniques to achieve superior segmentation performance. The model leverages structured convolution blocks (DWF-Conv/D2BR-Conv) to extract multi-scale local features while mitigating overfitting. To enhance multi-scale feature fusion, we introduce the S2-MLP Link, integrating spatial shifting and attention mechanisms at the skip connections. Additionally, the residual-based superpixel visual transformer (RM-SViT) effectively merges global and local features by employing sparse correlation learning and multi-branch attention to capture long-range dependencies, with residual connections enhancing stability and computational efficiency. Experimental results on the LIDC-IDRI dataset demonstrate that S3TU-Net achieves a DSC, precision, and IoU of 89.04%, 90.73%, and 90.70%, respectively. Compared to recent methods, S3TU-Net improves DSC by 4.52% and sensitivity by 3.16%, with other metrics showing an approximate 2% increase. In addition to comparison and ablation studies, we validated the generalization ability of our model on the EPDB private dataset, achieving a DSC of 86.40%.

FusionLungNet: Multi-scale Fusion Convolution with Refinement Network for Lung CT Image Segmentation

Early detection of lung cancer is crucial as it increases the chances of successful treatment. Automatic lung image segmentation assists doctors in identifying diseases such as lung cancer, COVID-19, and respiratory disorders. However, lung segmentation is challenging due to overlapping features like vascular and bronchial structures, along with pixel-level fusion of brightness, color, and texture. New lung segmentation methods face difficulties in identifying long-range relationships between image components, reliance on convolution operations that may not capture all critical features, and the complex structures of the lungs. Furthermore, semantic gaps between feature maps can hinder the integration of relevant information, reducing model accuracy. Skip connections can also limit the decoder's access to complete information, resulting in partial information loss during encoding. To overcome these challenges, we propose a hybrid approach using the FusionLungNet network, which has a multi-level structure with key components, including the ResNet-50 encoder, Channel-wise Aggregation Attention (CAA) module, Multi-scale Feature Fusion (MFF) block, self refinement (SR) module, and multiple decoders. The refinement sub-network uses convolutional neural networks for image post-processing to improve quality. Our method employs a combination of loss functions, including SSIM, IOU, and focal loss, to optimize image reconstruction quality. We created and publicly released a new dataset for lung segmentation called LungSegDB, including 1800 CT images from the LIDC-IDRI dataset (dataset version 1) and 700 images from the Chest CT Cancer Images from Kaggle dataset (dataset version 2). Our method achieved an IOU score of 98.04, outperforming existing methods and demonstrating significant improvements in segmentation accuracy. https://github.com/sadjadrz/FusionLungNet

MedUHIP: Towards Human-In-the-Loop Medical Segmentation

Although segmenting natural images has shown impressive performance, these techniques cannot be directly applied to medical image segmentation. Medical image segmentation is particularly complicated by inherent uncertainties. For instance, the ambiguous boundaries of tissues can lead to diverse but plausible annotations from different clinicians. These uncertainties cause significant discrepancies in clinical interpretations and impact subsequent medical interventions. Therefore, achieving quantitative segmentations from uncertain medical images becomes crucial in clinical practice. To address this, we propose a novel approach that integrates an \textbf{uncertainty-aware model} with \textbf{human-in-the-loop interaction}. The uncertainty-aware model proposes several plausible segmentations to address the uncertainties inherent in medical images, while the human-in-the-loop interaction iteratively modifies the segmentation under clinician supervision. This collaborative model ensures that segmentation is not solely dependent on automated techniques but is also refined through clinician expertise. As a result, our approach represents a significant advancement in the field which enhances the safety of medical image segmentation. It not only offers a comprehensive solution to produce quantitative segmentation from inherent uncertain medical images, but also establishes a synergistic balance between algorithmic precision and clincian knowledge. We evaluated our method on various publicly available multi-clinician annotated datasets: REFUGE2, LIDC-IDRI and QUBIQ. Our method showcases superior segmentation capabilities, outperforming a wide range of deterministic and uncertainty-aware models. We also demonstrated that our model produced significantly better results with fewer interactions compared to previous interactive models. We will release the code to foster further research in this area.

Sparse Bayesian Networks: Efficient Uncertainty Quantification in Medical Image Analysis

Efficiently quantifying predictive uncertainty in medical images remains a challenge. While Bayesian neural networks (BNN) offer predictive uncertainty, they require substantial computational resources to train. Although Bayesian approximations such as ensembles have shown promise, they still suffer from high training and inference costs. Existing approaches mainly address the costs of BNN inference post-training, with little focus on improving training efficiency and reducing parameter complexity. This study introduces a training procedure for a sparse (partial) Bayesian network. Our method selectively assigns a subset of parameters as Bayesian by assessing their deterministic saliency through gradient sensitivity analysis. The resulting network combines deterministic and Bayesian parameters, exploiting the advantages of both representations to achieve high task-specific performance and minimize predictive uncertainty. Demonstrated on multi-label ChestMNIST for classification and ISIC, LIDC-IDRI for segmentation, our approach achieves competitive performance and predictive uncertainty estimation by reducing Bayesian parameters by over 95\%, significantly reducing computational expenses compared to fully Bayesian and ensemble methods.

Concept-based Explainable Malignancy Scoring on Pulmonary Nodules in CT Images

To increase the transparency of modern computer-aided diagnosis (CAD) systems for assessing the malignancy of lung nodules, an interpretable model based on applying the generalized additive models and the concept-based learning is proposed. The model detects a set of clinically significant attributes in addition to the final malignancy regression score and learns the association between the lung nodule attributes and a final diagnosis decision as well as their contributions into the decision. The proposed concept-based learning framework provides human-readable explanations in terms of different concepts (numerical and categorical), their values, and their contribution to the final prediction. Numerical experiments with the LIDC-IDRI dataset demonstrate that the diagnosis results obtained using the proposed model, which explicitly explores internal relationships, are in line with similar patterns observed in clinical practice. Additionally, the proposed model shows the competitive classification and the nodule attribute scoring performance, highlighting its potential for effective decision-making in the lung nodule diagnosis.

Uncertainty-Aware Adapter: Adapting Segment Anything Model (SAM) for Ambiguous Medical Image Segmentation

The Segment Anything Model (SAM) gained significant success in natural image segmentation, and many methods have tried to fine-tune it to medical image segmentation. An efficient way to do so is by using Adapters, specialized modules that learn just a few parameters to tailor SAM specifically for medical images. However, unlike natural images, many tissues and lesions in medical images have blurry boundaries and may be ambiguous. Previous efforts to adapt SAM ignore this challenge and can only predict distinct segmentation. It may mislead clinicians or cause misdiagnosis, especially when encountering rare variants or situations with low model confidence. In this work, we propose a novel module called the Uncertainty-aware Adapter, which efficiently fine-tuning SAM for uncertainty-aware medical image segmentation. Utilizing a conditional variational autoencoder, we encoded stochastic samples to effectively represent the inherent uncertainty in medical imaging. We designed a new module on a standard adapter that utilizes a condition-based strategy to interact with samples to help SAM integrate uncertainty. We evaluated our method on two multi-annotated datasets with different modalities: LIDC-IDRI (lung abnormalities segmentation) and REFUGE2 (optic-cup segmentation). The experimental results show that the proposed model outperforms all the previous methods and achieves the new state-of-the-art (SOTA) on both benchmarks. We also demonstrated that our method can generate diverse segmentation hypotheses that are more realistic as well as heterogeneous.

Diversified and Personalized Multi-rater Medical Image Segmentation

Annotation ambiguity due to inherent data uncertainties such as blurred boundaries in medical scans and different observer expertise and preferences has become a major obstacle for training deep-learning based medical image segmentation models. To address it, the common practice is to gather multiple annotations from different experts, leading to the setting of multi-rater medical image segmentation. Existing works aim to either merge different annotations into the "groundtruth" that is often unattainable in numerous medical contexts, or generate diverse results, or produce personalized results corresponding to individual expert raters. Here, we bring up a more ambitious goal for multi-rater medical image segmentation, i.e., obtaining both diversified and personalized results. Specifically, we propose a two-stage framework named D-Persona (first Diversification and then Personalization). In Stage I, we exploit multiple given annotations to train a Probabilistic U-Net model, with a bound-constrained loss to improve the prediction diversity. In this way, a common latent space is constructed in Stage I, where different latent codes denote diversified expert opinions. Then, in Stage II, we design multiple attention-based projection heads to adaptively query the corresponding expert prompts from the shared latent space, and then perform the personalized medical image segmentation. We evaluated the proposed model on our in-house Nasopharyngeal Carcinoma dataset and the public lung nodule dataset (i.e., LIDC-IDRI). Extensive experiments demonstrated our D-Persona can provide diversified and personalized results at the same time, achieving new SOTA performance for multi-rater medical image segmentation. Our code will be released at https://github.com/ycwu1997/D-Persona.