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.
Disease diagnosis from medical images via supervised learning is usually dependent on tedious, error-prone, and costly image labeling by medical experts. Alternatively, semi-supervised learning and self-supervised learning offer effectiveness through the acquisition of valuable insights from readily available unlabeled images. We present Semi-Supervised Relational Contrastive Learning (SRCL), a novel semi-supervised learning model that leverages self-supervised contrastive loss and sample relation consistency for the more meaningful and effective exploitation of unlabeled data. Our experimentation with the SRCL model explores both pre-train/fine-tune and joint learning of the pretext (contrastive learning) and downstream (diagnostic classification) tasks. We validate against the ISIC 2018 Challenge benchmark skin lesion classification dataset and demonstrate the effectiveness of our semi-supervised method on varying amounts of labeled data.
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.
In this paper, we propose a CNN fine-tuning method which enables users to give simultaneous feedback on two outputs: the classification itself and the visual explanation for the classification. We present the effect of this feedback strategy in a skin lesion classification task and measure how CNNs react to the two types of user feedback. To implement this approach, we propose a novel CNN architecture that integrates the Grad-CAM technique for explaining the model's decision in the training loop. Using simulated user feedback, we found that fine-tuning our model on both classification and explanation improves visual explanation while preserving classification accuracy, thus potentially increasing the trust of users in using CNN-based skin lesion classifiers.
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.
Although deep learning (DL) models have shown great success in many medical image analysis tasks, deployment of the resulting models into real clinical contexts requires: (1) that they exhibit robustness and fairness across different sub-populations, and (2) that the confidence in DL model predictions be accurately expressed in the form of uncertainties. Unfortunately, recent studies have indeed shown significant biases in DL models across demographic subgroups (e.g., race, sex, age) in the context of medical image analysis, indicating a lack of fairness in the models. Although several methods have been proposed in the ML literature to mitigate a lack of fairness in DL models, they focus entirely on the absolute performance between groups without considering their effect on uncertainty estimation. In this work, we present the first exploration of the effect of popular fairness models on overcoming biases across subgroups in medical image analysis in terms of bottom-line performance, and their effects on uncertainty quantification. We perform extensive experiments on three different clinically relevant tasks: (i) skin lesion classification, (ii) brain tumour segmentation, and (iii) Alzheimer's disease clinical score regression. Our results indicate that popular ML methods, such as data-balancing and distributionally robust optimization, succeed in mitigating fairness issues in terms of the model performances for some of the tasks. However, this can come at the cost of poor uncertainty estimates associated with the model predictions. This tradeoff must be mitigated if fairness models are to be adopted in medical image analysis.
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.
Transformer has achieved impressive successes for various computer vision tasks. However, most of existing studies require to pretrain the Transformer backbone on a large-scale labeled dataset (e.g., ImageNet) for achieving satisfactory performance, which is usually unavailable for medical images. Additionally, due to the gap between medical and natural images, the improvement generated by the ImageNet pretrained weights significantly degrades while transferring the weights to medical image processing tasks. In this paper, we propose Bootstrap Own Latent of Transformer (BOLT), a self-supervised learning approach specifically for medical image classification with the Transformer backbone. Our BOLT consists of two networks, namely online and target branches, for self-supervised representation learning. Concretely, the online network is trained to predict the target network representation of the same patch embedding tokens with a different perturbation. To maximally excavate the impact of Transformer from limited medical data, we propose an auxiliary difficulty ranking task. The Transformer is enforced to identify which branch (i.e., online/target) is processing the more difficult perturbed tokens. Overall, the Transformer endeavours itself to distill the transformation-invariant features from the perturbed tokens to simultaneously achieve difficulty measurement and maintain the consistency of self-supervised representations. The proposed BOLT is evaluated on three medical image processing tasks, i.e., skin lesion classification, knee fatigue fracture grading and diabetic retinopathy grading. The experimental results validate the superiority of our BOLT for medical image classification, compared to ImageNet pretrained weights and state-of-the-art self-supervised learning approaches.
Masked Image Modelling (MIM) has been shown to be an efficient self-supervised learning (SSL) pre-training paradigm when paired with transformer architectures and in the presence of a large amount of unlabelled natural images. The combination of the difficulties in accessing and obtaining large amounts of labeled data and the availability of unlabelled data in the medical imaging domain makes MIM an interesting approach to advance deep learning (DL) applications based on 3D medical imaging data. Nevertheless, SSL and, in particular, MIM applications with medical imaging data are rather scarce and there is still uncertainty. around the potential of such a learning paradigm in the medical domain. We study MIM in the context of Prostate Cancer (PCa) lesion classification with T2 weighted (T2w) axial magnetic resonance imaging (MRI) data. In particular, we explore the effect of using MIM when coupled with convolutional neural networks (CNNs) under different conditions such as different masking strategies, obtaining better results in terms of AUC than other pre-training strategies like ImageNet weight initialization.
Model pruning can enable the deployment of neural networks in environments with resource constraints. While pruning may have a small effect on the overall performance of the model, it can exacerbate existing biases into the model such that subsets of samples see significantly degraded performance. In this paper, we introduce the performance weighted loss function, a simple modified cross-entropy loss function that can be used to limit the introduction of biases during pruning. Experiments using the CelebA, Fitzpatrick17k and CIFAR-10 datasets demonstrate that the proposed method is a simple and effective tool that can enable existing pruning methods to be used in fairness sensitive contexts. Code used to produce all experiments contained in this paper can be found at https://github.com/robbiemeyer/pw_loss_pruning.
AI-powered Medical Imaging has recently achieved enormous attention due to its ability to provide fast-paced healthcare diagnoses. However, it usually suffers from a lack of high-quality datasets due to high annotation cost, inter-observer variability, human annotator error, and errors in computer-generated labels. Deep learning models trained on noisy labelled datasets are sensitive to the noise type and lead to less generalization on the unseen samples. To address this challenge, we propose a Robust Stochastic Knowledge Distillation (RoS-KD) framework which mimics the notion of learning a topic from multiple sources to ensure deterrence in learning noisy information. More specifically, RoS-KD learns a smooth, well-informed, and robust student manifold by distilling knowledge from multiple teachers trained on overlapping subsets of training data. Our extensive experiments on popular medical imaging classification tasks (cardiopulmonary disease and lesion classification) using real-world datasets, show the performance benefit of RoS-KD, its ability to distill knowledge from many popular large networks (ResNet-50, DenseNet-121, MobileNet-V2) in a comparatively small network, and its robustness to adversarial attacks (PGD, FSGM). More specifically, RoS-KD achieves >2% and >4% improvement on F1-score for lesion classification and cardiopulmonary disease classification tasks, respectively, when the underlying student is ResNet-18 against recent competitive knowledge distillation baseline. Additionally, on cardiopulmonary disease classification task, RoS-KD outperforms most of the SOTA baselines by ~1% gain in AUC score.
The early detection of skin cancer substantially improves the five-year survival rate of patients. It is often difficult to distinguish early malignant tumors from skin images, even by expert dermatologists. Therefore, several classification methods of dermatoscopic images have been proposed, but they have been found to be inadequate or defective for skin cancer detection, and often require a large amount of calculations. This study proposes an improved capsule network called FixCaps for dermoscopic image classification. FixCaps has a larger receptive field than CapsNets by applying a high-performance large-kernel at the bottom convolution layer whose kernel size is as large as 31×31 , in contrast to commonly used 9×9 . The convolutional block attention module was used to reduce the losses of spatial information caused by convolution and pooling. The group convolution was used to avoid model underfitting in the capsule layer. The network can improve the detection accuracy and reduce a great amount of calculations, compared with several existing methods. The experimental results showed that FixCaps is better than IRv2-SA for skin cancer diagnosis, which achieved an accuracy of 96.49% on the HAM10000 dataset.
In this paper, we focus on multi-task classification, where related classification tasks share the same label space and are learned simultaneously. In particular, we tackle a new setting, which is more realistic than currently addressed in the literature, where categories shift from training to test data. Hence, individual tasks do not contain complete training data for the categories in the test set. To generalize to such test data, it is crucial for individual tasks to leverage knowledge from related tasks. To this end, we propose learning an association graph to transfer knowledge among tasks for missing classes. We construct the association graph with nodes representing tasks, classes and instances, and encode the relationships among the nodes in the edges to guide their mutual knowledge transfer. By message passing on the association graph, our model enhances the categorical information of each instance, making it more discriminative. To avoid spurious correlations between task and class nodes in the graph, we introduce an assignment entropy maximization that encourages each class node to balance its edge weights. This enables all tasks to fully utilize the categorical information from related tasks. An extensive evaluation on three general benchmarks and a medical dataset for skin lesion classification reveals that our method consistently performs better than representative baselines.
Automatic classification of pigmented, non-pigmented, and depigmented non-melanocytic skin lesions have garnered lots of attention in recent years. However, imaging variations in skin texture, lesion shape, depigmentation contrast, lighting condition, etc. hinder robust feature extraction, affecting classification accuracy. In this paper, we propose a new deep neural network that exploits input data for robust feature extraction. Specifically, we analyze the convolutional network's behavior (field-of-view) to find the location of deep supervision for improved feature extraction. To achieve this, first, we perform activation mapping to generate an object mask, highlighting the input regions most critical for classification output generation. Then the network layer whose layer-wise effective receptive field matches the approximated object shape in the object mask is selected as our focus for deep supervision. Utilizing different types of convolutional feature extractors and classifiers on three melanoma detection datasets and two vitiligo detection datasets, we verify the effectiveness of our new method.
While deep learning based approaches have demonstrated expert-level performance in dermatological diagnosis tasks, they have also been shown to exhibit biases toward certain demographic attributes, particularly skin types (e.g., light versus dark), a fairness concern that must be addressed. We propose CIRCLe, a skin color invariant deep representation learning method for improving fairness in skin lesion classification. CIRCLe is trained to classify images by utilizing a regularization loss that encourages images with the same diagnosis but different skin types to have similar latent representations. Through extensive evaluation and ablation studies, we demonstrate CIRCLe's superior performance over the state-of-the-art when evaluated on 16k+ images spanning 6 Fitzpatrick skin types and 114 diseases, using classification accuracy, equal opportunity difference (for light versus dark groups), and normalized accuracy range, a new measure we propose to assess fairness on multiple skin type groups.
The Computer-aided Diagnosis or Detection (CAD) approach for skin lesion analysis is an emerging field of research that has the potential to alleviate the burden and cost of skin cancer screening. Researchers have recently indicated increasing interest in developing such CAD systems, with the intention of providing a user-friendly tool to dermatologists to reduce the challenges encountered or associated with manual inspection. This article aims to provide a comprehensive literature survey and review of a total of 594 publications (356 for skin lesion segmentation and 238 for skin lesion classification) published between 2011 and 2022. These articles are analyzed and summarized in a number of different ways to contribute vital information regarding the methods for the development of CAD systems. These ways include relevant and essential definitions and theories, input data (dataset utilization, preprocessing, augmentations, and fixing imbalance problems), method configuration (techniques, architectures, module frameworks, and losses), training tactics (hyperparameter settings), and evaluation criteria. We intend to investigate a variety of performance-enhancing approaches, including ensemble and post-processing. We also discuss these dimensions to reveal their current trends based on utilization frequencies. In addition, we highlight the primary difficulties associated with evaluating skin lesion segmentation and classification systems using minimal datasets, as well as the potential solutions to these difficulties. Findings, recommendations, and trends are disclosed to inform future research on developing an automated and robust CAD system for skin lesion analysis.
Deep learning models have achieved great success in automating skin lesion diagnosis. However, the ethnic disparity in these models' predictions, where lesions on darker skin types are usually underrepresented and have lower diagnosis accuracy, receives little attention. In this paper, we propose FairDisCo, a disentanglement deep learning framework with contrastive learning that utilizes an additional network branch to remove sensitive attributes, i.e. skin-type information from representations for fairness and another contrastive branch to enhance feature extraction. We compare FairDisCo to three fairness methods, namely, resampling, reweighting, and attribute-aware, on two newly released skin lesion datasets with different skin types: Fitzpatrick17k and Diverse Dermatology Images (DDI). We adapt two fairness-based metrics DPM and EOM for our multiple classes and sensitive attributes task, highlighting the skin-type bias in skin lesion classification. Extensive experimental evaluation demonstrates the effectiveness of FairDisCo, with fairer and superior performance on skin lesion classification tasks.
In the development of technology, there are increasing cases of brain disease, there are more treatments proposed and achieved a positive result. However, with Brain-Lesion, the early diagnoses can improve the possibility for successful treatment and can help patients recuperate better. From this reason, Brain-Lesion is one of the controversial topics in medical images analysis nowadays. With the improvement of the architecture, there is a variety of methods that are proposed and achieve competitive scores. In this paper, we proposed a technique that uses efficient-net for 3D images, especially the Efficient-net B0 for Brain-Lesion classification task solution, and achieve the competitive score. Moreover, we also proposed the method to use Multiscale-EfficientNet to classify the slices of the MRI data
Large, annotated datasets are not widely available in medical image analysis due to the prohibitive time, costs, and challenges associated with labelling large datasets. Unlabelled datasets are easier to obtain, and in many contexts, it would be feasible for an expert to provide labels for a small subset of images. This work presents an information-theoretic active learning framework that guides the optimal selection of images from the unlabelled pool to be labeled based on maximizing the expected information gain (EIG) on an evaluation dataset. Experiments are performed on two different medical image classification datasets: multi-class diabetic retinopathy disease scale classification and multi-class skin lesion classification. Results indicate that by adapting EIG to account for class-imbalances, our proposed Adapted Expected Information Gain (AEIG) outperforms several popular baselines including the diversity based CoreSet and uncertainty based maximum entropy sampling. Specifically, AEIG achieves ~95% of overall performance with only 19% of the training data, while other active learning approaches require around 25%. We show that, by careful design choices, our model can be integrated into existing deep learning classifiers.