We can achieve fast and consistent early skin cancer detection with recent developments in computer vision and deep learning techniques. However, the existing skin lesion segmentation and classification prediction models run independently, thus missing potential efficiencies from their integrated execution. To unify skin lesion analysis, our paper presents the Gaussian Splatting - Transformer UNet (GS-TransUNet), a novel approach that synergistically combines 2D Gaussian splatting with the Transformer UNet architecture for automated skin cancer diagnosis. Our unified deep learning model efficiently delivers dual-function skin lesion classification and segmentation for clinical diagnosis. Evaluated on ISIC-2017 and PH2 datasets, our network demonstrates superior performance compared to existing state-of-the-art models across multiple metrics through 5-fold cross-validation. Our findings illustrate significant advancements in the precision of segmentation and classification. This integration sets new benchmarks in the field and highlights the potential for further research into multi-task medical image analysis methodologies, promising enhancements in automated diagnostic systems.
Prostate cancer, a growing global health concern, necessitates precise diagnostic tools, with Magnetic Resonance Imaging (MRI) offering high-resolution soft tissue imaging that significantly enhances diagnostic accuracy. Recent advancements in explainable AI and representation learning have significantly improved prostate cancer diagnosis by enabling automated and precise lesion classification. However, existing explainable AI methods, particularly those based on frameworks like generative adversarial networks (GANs), are predominantly developed for natural image generation, and their application to medical imaging often leads to suboptimal performance due to the unique characteristics and complexity of medical image. To address these challenges, our paper introduces three key contributions. First, we propose ProjectedEx, a generative framework that provides interpretable, multi-attribute explanations, effectively linking medical image features to classifier decisions. Second, we enhance the encoder module by incorporating feature pyramids, which enables multiscale feedback to refine the latent space and improves the quality of generated explanations. Additionally, we conduct comprehensive experiments on both the generator and classifier, demonstrating the clinical relevance and effectiveness of ProjectedEx in enhancing interpretability and supporting the adoption of AI in medical settings. Code will be released at https://github.com/Richardqiyi/ProjectedEx
The global outbreak of the Mpox virus, classified as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization, presents significant diagnostic challenges due to its visual similarity to other skin lesion diseases. Traditional diagnostic methods for Mpox, which rely on clinical symptoms and laboratory tests, are slow and labor intensive. Deep learning-based approaches for skin lesion classification offer a promising alternative. However, developing a model that balances efficiency with accuracy is crucial to ensure reliable and timely diagnosis without compromising performance. This study introduces the Cascaded Atrous Group Attention (CAGA) framework to address these challenges, combining the Cascaded Atrous Attention module and the Cascaded Group Attention mechanism. The Cascaded Atrous Attention module utilizes dilated convolutions and cascades the outputs to enhance multi-scale representation. This is integrated into the Cascaded Group Attention mechanism, which reduces redundancy in Multi-Head Self-Attention. By integrating the Cascaded Atrous Group Attention module with EfficientViT-L1 as the backbone architecture, this approach achieves state-of-the-art performance, reaching an accuracy of 98% on the Mpox Close Skin Image (MCSI) dataset while reducing model parameters by 37.5% compared to the original EfficientViT-L1. The model's robustness is demonstrated through extensive validation on two additional benchmark datasets, where it consistently outperforms existing approaches.
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.
Continual Learning (CL) is crucial for enabling networks to dynamically adapt as they learn new tasks sequentially, accommodating new data and classes without catastrophic forgetting. Diverging from conventional perspectives on CL, our paper introduces a new perspective wherein forgetting could actually benefit the sequential learning paradigm. Specifically, we present BiasPruner, a CL framework that intentionally forgets spurious correlations in the training data that could lead to shortcut learning. Utilizing a new bias score that measures the contribution of each unit in the network to learning spurious features, BiasPruner prunes those units with the highest bias scores to form a debiased subnetwork preserved for a given task. As BiasPruner learns a new task, it constructs a new debiased subnetwork, potentially incorporating units from previous subnetworks, which improves adaptation and performance on the new task. During inference, BiasPruner employs a simple task-agnostic approach to select the best debiased subnetwork for predictions. We conduct experiments on three medical datasets for skin lesion classification and chest X-Ray classification and demonstrate that BiasPruner consistently outperforms SOTA CL methods in terms of classification performance and fairness. Our code is available here.
Accurate lesion classification in Wireless Capsule Endoscopy (WCE) images is vital for early diagnosis and treatment of gastrointestinal (GI) cancers. However, this task is confronted with challenges like tiny lesions and background interference. Additionally, WCE images exhibit higher intra-class variance and inter-class similarities, adding complexity. To tackle these challenges, we propose Decoupled Supervised Contrastive Learning for WCE image classification, learning robust representations from zoomed-in WCE images generated by Saliency Augmentor. Specifically, We use uniformly down-sampled WCE images as anchors and WCE images from the same class, especially their zoomed-in images, as positives. This approach empowers the Feature Extractor to capture rich representations from various views of the same image, facilitated by Decoupled Supervised Contrastive Learning. Training a linear Classifier on these representations within 10 epochs yields an impressive 92.01% overall accuracy, surpassing the prior state-of-the-art (SOTA) by 0.72% on a blend of two publicly accessible WCE datasets. Code is available at: https://github.com/Qiukunpeng/DSCL.
Computer-aided diagnosis of skin diseases is an important tool. However, the interpretability of computer-aided diagnosis is currently poor. Dermatologists and patients cannot intuitively understand the learning and prediction process of neural networks, which will lead to a decrease in the credibility of computer-aided diagnosis. In addition, traditional methods need to be trained using negative samples in order to predict the presence or absence of a lesion, but medical data is often in short supply. In this paper, we propose a multiple high-order attention interaction model (MHA-UNet) for use in a highly explainable skin lesion segmentation task. MHA-UNet is able to obtain the presence or absence of a lesion by explainable reasoning without the need for training on negative samples. Specifically, we propose a high-order attention interaction mechanism that introduces squeeze attention to a higher level for feature attention. In addition, a multiple high-order attention interaction (MHAblock) module is proposed by combining the different features of different orders. For classifying the presence or absence of lesions, we conducted classification experiments on several publicly available datasets in the absence of negative samples, based on explainable reasoning about the interaction of 5 attention orders of MHAblock. The highest positive detection rate obtained from the experiments was 81.0% and the highest negative detection rate was 83.5%. For segmentation experiments, comparison experiments of the proposed method with 13 medical segmentation models and external validation experiments with 8 state-of-the-art models in three public datasets and our clinical dataset demonstrate the state-of-the-art performance of our model. The code is available from https://github.com/wurenkai/MHA-UNet.
Concept-based models naturally lend themselves to the development of inherently interpretable skin lesion diagnosis, as medical experts make decisions based on a set of visual patterns of the lesion. Nevertheless, the development of these models depends on the existence of concept-annotated datasets, whose availability is scarce due to the specialized knowledge and expertise required in the annotation process. In this work, we show that vision-language models can be used to alleviate the dependence on a large number of concept-annotated samples. In particular, we propose an embedding learning strategy to adapt CLIP to the downstream task of skin lesion classification using concept-based descriptions as textual embeddings. Our experiments reveal that vision-language models not only attain better accuracy when using concepts as textual embeddings, but also require a smaller number of concept-annotated samples to attain comparable performance to approaches specifically devised for automatic concept generation.
The clinical diagnosis of skin lesion involves the analysis of dermoscopic and clinical modalities. Dermoscopic images provide a detailed view of the surface structures whereas clinical images offer a complementary macroscopic information. The visual diagnosis of melanoma is also based on seven-point checklist which involves identifying different visual attributes. Recently, supervised learning approaches such as convolutional neural networks (CNNs) have shown great performances using both dermoscopic and clinical modalities (Multi-modality). The seven different visual attributes in the checklist are also used to further improve the the diagnosis. The performances of these approaches, however, are still reliant on the availability of large-scaled labeled data. The acquisition of annotated dataset is an expensive and time-consuming task, more so with annotating multi-attributes. To overcome this limitation, we propose a self-supervised learning (SSL) algorithm for multi-modality skin lesion classification. Our algorithm enables the multi-modality learning by maximizing the similarities between paired dermoscopic and clinical images from different views. In addition, we generate surrogate pseudo-multi-labels that represent seven attributes via clustering analysis. We also propose a label-relation-aware module to refine each pseudo-label embedding and capture the interrelationships between pseudo-multi-labels. We validated the effectiveness of our algorithm using well-benchmarked seven-point skin lesion dataset. Our results show that our algorithm achieved better performances than other state-of-the-art SSL counterparts.
Deployment of Deep Neural Networks in medical imaging is hindered by distribution shift between training data and data processed after deployment, causing performance degradation. Post-Deployment Adaptation (PDA) addresses this by tailoring a pre-trained, deployed model to the target data distribution using limited labelled or entirely unlabelled target data, while assuming no access to source training data as they cannot be deployed with the model due to privacy concerns and their large size. This makes reliable adaptation challenging due to limited learning signal. This paper challenges this assumption and introduces FedPDA, a novel adaptation framework that brings the utility of learning from remote data from Federated Learning into PDA. FedPDA enables a deployed model to obtain information from source data via remote gradient exchange, while aiming to optimize the model specifically for the target domain. Tailored for FedPDA, we introduce a novel optimization method StarAlign (Source-Target Remote Gradient Alignment) that aligns gradients between source-target domain pairs by maximizing their inner product, to facilitate learning a target-specific model. We demonstrate the method's effectiveness using multi-center databases for the tasks of cancer metastases detection and skin lesion classification, where our method compares favourably to previous work. Code is available at: https://github.com/FelixWag/StarAlign
Skin cancer is a treatable disease if discovered early. We provide a production-specific solution to the skin cancer classification problem that matches human performance in melanoma identification by training a vision transformer on melanoma medical images annotated by experts. Since inference cost, both time and memory wise is important in practice, we employ knowledge distillation to obtain a model that retains 98.33% of the teacher's balanced multi-class accuracy, at a fraction of the cost. Memory-wise, our model is 49.60% smaller than the teacher. Time-wise, our solution is 69.25% faster on GPU and 97.96% faster on CPU. By adding classification heads at each level of the transformer and employing a cascading distillation process, we improve the balanced multi-class accuracy of the base model by 2.1%, while creating a range of models of various sizes but comparable performance. We provide the code at https://github.com/Longman-Stan/SkinDistilVit.
Addressing fairness in lesion classification from dermatological images is crucial due to variations in how skin diseases manifest across skin tones. However, the absence of skin tone labels in public datasets hinders building a fair classifier. To date, such skin tone labels have been estimated prior to fairness analysis in independent studies using the Individual Typology Angle (ITA). Briefly, ITA calculates an angle based on pixels extracted from skin images taking into account the lightness and yellow-blue tints. These angles are then categorised into skin tones that are subsequently used to analyse fairness in skin cancer classification. In this work, we review and compare four ITA-based approaches of skin tone classification on the ISIC18 dataset, a common benchmark for assessing skin cancer classification fairness in the literature. Our analyses reveal a high disagreement among previously published studies demonstrating the risks of ITA-based skin tone estimation methods. Moreover, we investigate the causes of such large discrepancy among these approaches and find that the lack of diversity in the ISIC18 dataset limits its use as a testbed for fairness analysis. Finally, we recommend further research on robust ITA estimation and diverse dataset acquisition with skin tone annotation to facilitate conclusive fairness assessments of artificial intelligence tools in dermatology. Our code is available at https://github.com/tkalbl/RevisitingSkinToneFairness.
Skin image datasets often suffer from imbalanced data distribution, exacerbating the difficulty of computer-aided skin disease diagnosis. Some recent works exploit supervised contrastive learning (SCL) for this long-tailed challenge. Despite achieving significant performance, these SCL-based methods focus more on head classes, yet ignoring the utilization of information in tail classes. In this paper, we propose class-Enhancement Contrastive Learning (ECL), which enriches the information of minority classes and treats different classes equally. For information enhancement, we design a hybrid-proxy model to generate class-dependent proxies and propose a cycle update strategy for parameters optimization. A balanced-hybrid-proxy loss is designed to exploit relations between samples and proxies with different classes treated equally. Taking both "imbalanced data" and "imbalanced diagnosis difficulty" into account, we further present a balanced-weighted cross-entropy loss following curriculum learning schedule. Experimental results on the classification of imbalanced skin lesion data have demonstrated the superiority and effectiveness of our method.
Chest radiographs are the most commonly performed radiological examinations for lesion detection. Recent advances in deep learning have led to encouraging results in various thoracic disease detection tasks. Particularly, the architecture with feature pyramid network performs the ability to recognise targets with different sizes. However, such networks are difficult to focus on lesion regions in chest X-rays due to their high resemblance in vision. In this paper, we propose a dual attention supervised module for multi-label lesion detection in chest radiographs, named DualAttNet. It efficiently fuses global and local lesion classification information based on an image-level attention block and a fine-grained disease attention algorithm. A binary cross entropy loss function is used to calculate the difference between the attention map and ground truth at image level. The generated gradient flow is leveraged to refine pyramid representations and highlight lesion-related features. We evaluate the proposed model on VinDr-CXR, ChestX-ray8 and COVID-19 datasets. The experimental results show that DualAttNet surpasses baselines by 0.6% to 2.7% mAP and 1.4% to 4.7% AP50 with different detection architectures. The code for our work and more technical details can be found at https://github.com/xq141839/DualAttNet.
Representational transfer from publicly available models is a promising technique for improving medical image classification, especially in long-tailed datasets with rare diseases. However, existing methods often overlook the frequency-dependent behavior of these models, thereby limiting their effectiveness in transferring representations and generalizations to rare diseases. In this paper, we propose FoPro-KD, a novel framework that leverages the power of frequency patterns learned from frozen pre-trained models to enhance their transferability and compression, presenting a few unique insights: 1) We demonstrate that leveraging representations from publicly available pre-trained models can substantially improve performance, specifically for rare classes, even when utilizing representations from a smaller pre-trained model. 2) We observe that pre-trained models exhibit frequency preferences, which we explore using our proposed Fourier Prompt Generator (FPG), allowing us to manipulate specific frequencies in the input image, enhancing the discriminative representational transfer. 3) By amplifying or diminishing these frequencies in the input image, we enable Effective Knowledge Distillation (EKD). EKD facilitates the transfer of knowledge from pre-trained models to smaller models. Through extensive experiments in long-tailed gastrointestinal image recognition and skin lesion classification, where rare diseases are prevalent, our FoPro-KD framework outperforms existing methods, enabling more accessible medical models for rare disease classification. Code is available at https://github.com/xmed-lab/FoPro-KD.
Limited training data and severe class imbalance impose 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 data. However, the class imbalance problem persists due to inter-client class distribution variations. To overcome this, we propose federated classifier anchoring (FCA) by adding a personalized classifier at each client to guide and debias the federated model through consistency learning. Additionally, FCA debiases the federated classifier and each client's personalized classifier based on their respective class distributions, thus mitigating divergence. With FCA, the federated feature extractor effectively learns discriminative features suitably globally for federation as well as locally for all participants. In clinical practice, the federated model is expected to be both generalized, performing well across clients, and specialized, benefiting each individual client from collaboration. According to this, we propose a novel evaluation metric to assess models' generalization and specialization performance globally on an aggregated public test set and locally at each client. Through comprehensive comparison and evaluation, FCA outperforms the state-of-the-art methods with large margins for federated long-tailed skin lesion classification and intracranial hemorrhage classification, making it a more feasible solution in clinical settings.
Deep neural networks often rely on spurious correlations to make predictions, which hinders generalization beyond training environments. For instance, models that associate cats with bed backgrounds can fail to predict the existence of cats in other environments without beds. Mitigating spurious correlations is crucial in building trustworthy models. However, the existing works lack transparency to offer insights into the mitigation process. In this work, we propose an interpretable framework, Discover and Cure (DISC), to tackle the issue. With human-interpretable concepts, DISC iteratively 1) discovers unstable concepts across different environments as spurious attributes, then 2) intervenes on the training data using the discovered concepts to reduce spurious correlation. Across systematic experiments, DISC provides superior generalization ability and interpretability than the existing approaches. Specifically, it outperforms the state-of-the-art methods on an object recognition task and a skin-lesion classification task by 7.5% and 9.6%, respectively. Additionally, we offer theoretical analysis and guarantees to understand the benefits of models trained by DISC. Code and data are available at https://github.com/Wuyxin/DISC.
Early detection of melanoma is crucial for preventing severe complications and increasing the chances of successful treatment. Existing deep learning approaches for melanoma skin lesion diagnosis are deemed black-box models, as they omit the rationale behind the model prediction, compromising the trustworthiness and acceptability of these diagnostic methods. Attempts to provide concept-based explanations are based on post-hoc approaches, which depend on an additional model to derive interpretations. In this paper, we propose an inherently interpretable framework to improve the interpretability of concept-based models by incorporating a hard attention mechanism and a coherence loss term to assure the visual coherence of concept activations by the concept encoder, without requiring the supervision of additional annotations. The proposed framework explains its decision in terms of human-interpretable concepts and their respective contribution to the final prediction, as well as a visual interpretation of the locations where the concept is present in the image. Experiments on skin image datasets demonstrate that our method outperforms existing black-box and concept-based models for skin lesion classification.
Diffusion Probabilistic Models have recently shown remarkable performance in generative image modeling, attracting significant attention in the computer vision community. However, while a substantial amount of diffusion-based research has focused on generative tasks, few studies have applied diffusion models to general medical image classification. In this paper, we propose the first diffusion-based model (named DiffMIC) to address general medical image classification by eliminating unexpected noise and perturbations in medical images and robustly capturing semantic representation. To achieve this goal, we devise a dual conditional guidance strategy that conditions each diffusion step with multiple granularities to improve step-wise regional attention. Furthermore, we propose learning the mutual information in each granularity by enforcing Maximum-Mean Discrepancy regularization during the diffusion forward process. We evaluate the effectiveness of our DiffMIC on three medical classification tasks with different image modalities, including placental maturity grading on ultrasound images, skin lesion classification using dermatoscopic images, and diabetic retinopathy grading using fundus images. Our experimental results demonstrate that DiffMIC outperforms state-of-the-art methods by a significant margin, indicating the universality and effectiveness of the proposed model. Our code will be publicly available at https://github.com/scott-yjyang/DiffMIC.
Magnetic resonance imaging (MRI) is highly sensitive for lesion detection in the breasts. Sequences obtained with different settings can capture the specific characteristics of lesions. Such multi-parameter MRI information has been shown to improve radiologist performance in lesion classification, as well as improving the performance of artificial intelligence models in various tasks. However, obtaining multi-parameter MRI makes the examination costly in both financial and time perspectives, and there may be safety concerns for special populations, thus making acquisition of the full spectrum of MRI sequences less durable. In this study, different than naive input fusion or feature concatenation from existing MRI parameters, a novel $\textbf{I}$ntegrated MRI $\textbf{M}$ulti-$\textbf{P}$arameter reinf$\textbf{O}$rcement fusion generato$\textbf{R}$ wi$\textbf{T}$h $\textbf{A}$tte$\textbf{NT}$ion Network (IMPORTANT-Net) is developed to generate missing parameters. First, the parameter reconstruction module is used to encode and restore the existing MRI parameters to obtain the corresponding latent representation information at any scale level. Then the multi-parameter fusion with attention module enables the interaction of the encoded information from different parameters through a set of algorithmic strategies, and applies different weights to the information through the attention mechanism after information fusion to obtain refined representation information. Finally, a reinforcement fusion scheme embedded in a $V^{-}$-shape generation module is used to combine the hierarchical representations to generate the missing MRI parameter. Results showed that our IMPORTANT-Net is capable of generating missing MRI parameters and outperforms comparable state-of-the-art networks. Our code is available at https://github.com/Netherlands-Cancer-Institute/MRI_IMPORTANT_NET.