MRI and CT are essential clinical cross-sectional imaging techniques for diagnosing complex conditions. However, large 3D datasets with annotations for deep learning are scarce. While methods like DINOv2 are encouraging for 2D image analysis, these methods have not been applied to 3D medical images. Furthermore, deep learning models often lack explainability due to their "black-box" nature. This study aims to extend 2D self-supervised models, specifically DINOv2, to 3D medical imaging while evaluating their potential for explainable outcomes. We introduce the Medical Slice Transformer (MST) framework to adapt 2D self-supervised models for 3D medical image analysis. MST combines a Transformer architecture with a 2D feature extractor, i.e., DINOv2. We evaluate its diagnostic performance against a 3D convolutional neural network (3D ResNet) across three clinical datasets: breast MRI (651 patients), chest CT (722 patients), and knee MRI (1199 patients). Both methods were tested for diagnosing breast cancer, predicting lung nodule dignity, and detecting meniscus tears. Diagnostic performance was assessed by calculating the Area Under the Receiver Operating Characteristic Curve (AUC). Explainability was evaluated through a radiologist's qualitative comparison of saliency maps based on slice and lesion correctness. P-values were calculated using Delong's test. MST achieved higher AUC values compared to ResNet across all three datasets: breast (0.94$\pm$0.01 vs. 0.91$\pm$0.02, P=0.02), chest (0.95$\pm$0.01 vs. 0.92$\pm$0.02, P=0.13), and knee (0.85$\pm$0.04 vs. 0.69$\pm$0.05, P=0.001). Saliency maps were consistently more precise and anatomically correct for MST than for ResNet. Self-supervised 2D models like DINOv2 can be effectively adapted for 3D medical imaging using MST, offering enhanced diagnostic accuracy and explainability compared to convolutional neural networks.
Lung cancer is responsible for 21% of cancer deaths in the UK and five-year survival rates are heavily influenced by the stage the cancer was identified at. Recent studies have demonstrated the capability of AI methods for accurate and early diagnosis of lung cancer from routine scans. However, this evidence has not translated into clinical practice with one barrier being a lack of interpretable models. This study investigates the application Variational Autoencoders (VAEs), a type of generative AI model, to lung cancer lesions. Proposed models were trained on lesions extracted from 3D CT scans in the LIDC-IDRI public dataset. Latent vector representations of 2D slices produced by the VAEs were explored through clustering to justify their quality and used in an MLP classifier model for lung cancer diagnosis, the best model achieved state-of-the-art metrics of AUC 0.98 and 93.1% accuracy. Cluster analysis shows the VAE latent space separates the dataset of malignant and benign lesions based on meaningful feature components including tumour size, shape, patient and malignancy class. We also include a comparative analysis of the standard Gaussian VAE (GVAE) and the more recent Dirichlet VAE (DirVAE), which replaces the prior with a Dirichlet distribution to encourage a more explainable latent space with disentangled feature representation. Finally, we demonstrate the potential for latent space traversals corresponding to clinically meaningful feature changes.
Automatic pulmonary nodules classification is significant for early diagnosis of lung cancers. Recently, deep learning techniques have enabled remarkable progress in this field. However, these deep models are typically of high computational complexity and work in a black-box manner. To combat these challenges, in this work, we aim to build an efficient and (partially) explainable classification model. Specially, we use \emph{neural architecture search} (NAS) to automatically search 3D network architectures with excellent accuracy/speed trade-off. Besides, we use the convolutional block attention module (CBAM) in the networks, which helps us understand the reasoning process. During training, we use A-Softmax loss to learn angularly discriminative representations. In the inference stage, we employ an ensemble of diverse neural networks to improve the prediction accuracy and robustness. We conduct extensive experiments on the LIDC-IDRI database. Compared with previous state-of-the-art, our model shows highly comparable performance by using less than 1/40 parameters. Besides, empirical study shows that the reasoning process of learned networks is in conformity with physicians' diagnosis. Related code and results have been released at: https://github.com/fei-hdu/NAS-Lung.
This paper investigates lung nodule classification by using deep neural networks (DNNs). Hyperparameter optimization in DNNs is a computationally expensive problem, where evaluating a hyperparameter configuration may take several hours or even days. Bayesian optimization has been recently introduced for the automatically searching of optimal hyperparameter configurations of DNNs. It applies probabilistic surrogate models to approximate the validation error function of hyperparameter configurations, such as Gaussian processes, and reduce the computational complexity to a large extent. However, most existing surrogate models adopt stationary covariance functions to measure the difference between hyperparameter points based on spatial distance without considering its spatial locations. This distance-based assumption together with the condition of constant smoothness throughout the whole hyperparameter search space clearly violates the property that the points far away from optimal points usually get similarly poor performance even though each two of them have huge spatial distance between them. In this paper, a non-stationary kernel is proposed which allows the surrogate model to adapt to functions whose smoothness varies with the spatial location of inputs, and a multi-level convolutional neural network (ML-CNN) is built for lung nodule classification whose hyperparameter configuration is optimized by using the proposed non-stationary kernel based Gaussian surrogate model. Our algorithm searches the surrogate for optimal setting via hyperparameter importance based evolutionary strategy, and the experiments demonstrate our algorithm outperforms manual tuning and well-established hyperparameter optimization methods such as Random search, Gaussian processes with stationary kernels, and recently proposed Hyperparameter Optimization via RBF and Dynamic coordinate search.