The incidence rate for skin cancer has been steadily increasing throughout the world, leading to it being a serious issue. Diagnosis at an early stage has the potential to drastically reduce the harm caused by the disease, however, the traditional biopsy is a labor-intensive and invasive procedure. In addition, numerous rural communities do not have easy access to hospitals and do not prefer visiting one for what they feel might be a minor issue. Using machine learning and deep learning for skin cancer classification can increase accessibility and reduce the discomforting procedures involved in the traditional lesion detection process. These models can be wrapped in web or mobile apps and serve a greater population. In this paper, two such models are tested on the benchmark HAM10000 dataset of common skin lesions. They are Random Forest with Stratified K-Fold Validation, and MobileNetV2 (throughout the rest of the paper referred to as MobileNet). The MobileNet model was trained separately using both TensorFlow and PyTorch frameworks. A side-by-side comparison of both deep learning and machine learning models and a comparison of the same deep learning model on different frameworks for skin lesion diagnosis in a resource-constrained mobile environment has not been conducted before. The results indicate that each of these models fares better at different classification tasks. For greater overall recall, accuracy, and detection of malignant melanoma, the TensorFlow MobileNet was the better choice. However, for detecting noncancerous skin lesions, the PyTorch MobileNet proved to be better. Random Forest was the better algorithm when it came to having a low computational cost with moderate correctness.
Federated learning (FL) is a distributed learning method that offers medical institutes the prospect of collaboration in a global model while preserving the privacy of their patients. Although most medical centers conduct similar medical imaging tasks, their differences, such as specializations, number of patients, and devices, lead to distinctive data distributions. Data heterogeneity poses a challenge for FL and the personalization of the local models. In this work, we investigate an adaptive hierarchical clustering method for FL to produce intermediate semi-global models, so clients with similar data distribution have the chance of forming a more specialized model. Our method forms several clusters consisting of clients with the most similar data distributions; then, each cluster continues to train separately. Inside the cluster, we use meta-learning to improve the personalization of the participants' models. We compare the clustering approach with classical FedAvg and centralized training by evaluating our proposed methods on the HAM10k dataset for skin lesion classification with extreme heterogeneous data distribution. Our experiments demonstrate significant performance gain in heterogeneous distribution compared to standard FL methods in classification accuracy. Moreover, we show that the models converge faster if applied in clusters and outperform centralized training while using only a small subset of data.
Breast lesion detection in ultrasound is critical for breast cancer diagnosis. Existing methods mainly rely on individual 2D ultrasound images or combine unlabeled video and labeled 2D images to train models for breast lesion detection. In this paper, we first collect and annotate an ultrasound video dataset (188 videos) for breast lesion detection. Moreover, we propose a clip-level and video-level feature aggregated network (CVA-Net) for addressing breast lesion detection in ultrasound videos by aggregating video-level lesion classification features and clip-level temporal features. The clip-level temporal features encode local temporal information of ordered video frames and global temporal information of shuffled video frames. In our CVA-Net, an inter-video fusion module is devised to fuse local features from original video frames and global features from shuffled video frames, and an intra-video fusion module is devised to learn the temporal information among adjacent video frames. Moreover, we learn video-level features to classify the breast lesions of the original video as benign or malignant lesions to further enhance the final breast lesion detection performance in ultrasound videos. Experimental results on our annotated dataset demonstrate that our CVA-Net clearly outperforms state-of-the-art methods. The corresponding code and dataset are publicly available at \url{https://github.com/jhl-Det/CVA-Net}.
Recent years have witnessed a rapid development of automated methods for skin lesion diagnosis and classification. Due to an increasing deployment of such systems in clinics, it has become important to develop a more robust system towards various Out-of-Distribution(OOD) samples (unknown skin lesions and conditions). However, the current deep learning models trained for skin lesion classification tend to classify these OOD samples incorrectly into one of their learned skin lesion categories. To address this issue, we propose a simple yet strategic approach that improves the OOD detection performance while maintaining the multi-class classification accuracy for the known categories of skin lesion. To specify, this approach is built upon a realistic scenario of a long-tailed and fine-grained OOD detection task for skin lesion images. Through this approach, 1) First, we target the mixup amongst middle and tail classes to address the long-tail problem. 2) Later, we combine the above mixup strategy with prototype learning to address the fine-grained nature of the dataset. The unique contribution of this paper is two-fold, justified by extensive experiments. First, we present a realistic problem setting of OOD task for skin lesion. Second, we propose an approach to target the long-tailed and fine-grained aspects of the problem setting simultaneously to increase the OOD performance.
It is generally believed that the human visual system is biased towards the recognition of shapes rather than textures. This assumption has led to a growing body of work aiming to align deep models' decision-making processes with the fundamental properties of human vision. The reliance on shape features is primarily expected to improve the robustness of these models under covariate shift. In this paper, we revisit the significance of shape-biases for the classification of skin lesion images. Our analysis shows that different skin lesion datasets exhibit varying biases towards individual image features. Interestingly, despite deep feature extractors being inclined towards learning entangled features for skin lesion classification, individual features can still be decoded from this entangled representation. This indicates that these features are still represented in the learnt embedding spaces of the models, but not used for classification. In addition, the spectral analysis of different datasets shows that in contrast to common visual recognition, dermoscopic skin lesion classification, by nature, is reliant on complex feature combinations beyond shape-bias. As a natural consequence, shifting away from the prevalent desire of shape-biasing models can even improve skin lesion classifiers in some cases.
The elasticity of soft tissues has been widely considered as a characteristic property to differentiate between healthy and vicious tissues and, therefore, motivated several elasticity imaging modalities, such as Ultrasound Elastography, Magnetic Resonance Elastography, and Optical Coherence Elastography. This paper proposes an alternative approach of modeling the elasticity using Computed Tomography (CT) imaging modality for model-based feature extraction machine learning (ML) differentiation of lesions. The model describes a dynamic non-rigid (or elastic) deformation in differential manifold to mimic the soft tissues elasticity under wave fluctuation in vivo. Based on the model, three local deformation invariants are constructed by two tensors defined by the first and second order derivatives from the CT images and used to generate elastic feature maps after normalization via a novel signal suppression method. The model-based elastic image features are extracted from the feature maps and fed to machine learning to perform lesion classifications. Two pathologically proven image datasets of colon polyps (44 malignant and 43 benign) and lung nodules (46 malignant and 20 benign) were used to evaluate the proposed model-based lesion classification. The outcomes of this modeling approach reached the score of area under the curve of the receiver operating characteristics of 94.2 % for the polyps and 87.4 % for the nodules, resulting in an average gain of 5 % to 30 % over ten existing state-of-the-art lesion classification methods. The gains by modeling tissue elasticity for ML differentiation of lesions are striking, indicating the great potential of exploring the modeling strategy to other tissue properties for ML differentiation of lesions.
Ultrasonography is an important routine examination for breast cancer diagnosis, due to its non-invasive, radiation-free and low-cost properties. However, the diagnostic accuracy of breast cancer is still limited due to its inherent limitations. It would be a tremendous success if we can precisely diagnose breast cancer by breast ultrasound images (BUS). Many learning-based computer-aided diagnostic methods have been proposed to achieve breast cancer diagnosis/lesion classification. However, most of them require a pre-define ROI and then classify the lesion inside the ROI. Conventional classification backbones, such as VGG16 and ResNet50, can achieve promising classification results with no ROI requirement. But these models lack interpretability, thus restricting their use in clinical practice. In this study, we propose a novel ROI-free model for breast cancer diagnosis in ultrasound images with interpretable feature representations. We leverage the anatomical prior knowledge that malignant and benign tumors have different spatial relationships between different tissue layers, and propose a HoVer-Transformer to formulate this prior knowledge. The proposed HoVer-Trans block extracts the inter- and intra-layer spatial information horizontally and vertically. We conduct and release an open dataset GDPH&SYSUCC for breast cancer diagnosis in BUS. The proposed model is evaluated in three datasets by comparing with four CNN-based models and two vision transformer models via five-fold cross validation. It achieves state-of-the-art classification performance with the best model interpretability. In the meanwhile, our proposed model outperforms two senior sonographers on the breast cancer diagnosis when only one BUS image is given.
A major challenge in applying deep learning to medical imaging is the paucity of annotated data. This study demonstrates that synthetic colonoscopy images generated by Generative Adversarial Network (GAN) inversion can be used as training data to improve the lesion classification performance of deep learning models. This approach inverts pairs of images with the same label to a semantically rich & disentangled latent space and manipulates latent representations to produce new synthetic images with the same label. We perform image modality translation (style transfer) between white light and narrowband imaging (NBI). We also generate realistic-looking synthetic lesion images by interpolating between original training images to increase the variety of lesion shapes in the training dataset. We show that these approaches outperform comparative colonoscopy data augmentation techniques without the need to re-train multiple generative models. This approach also leverages information from datasets that may not have been designed for the specific colonoscopy downstream task. E.g. using a bowel prep grading dataset for a polyp classification task. Our experiments show this approach can perform multiple colonoscopy data augmentations, which improve the downstream polyp classification performance over baseline and comparison methods by up to 6%.
Most of the medical tasks naturally exhibit a long-tailed distribution due to the complex patient-level conditions and the existence of rare diseases. Existing long-tailed learning methods usually treat each class equally to re-balance the long-tailed distribution. However, considering that some challenging classes may present diverse intra-class distributions, re-balancing all classes equally may lead to a significant performance drop. To address this, in this paper, we propose a curriculum learning-based framework called Flexible Sampling for the long-tailed skin lesion classification task. Specifically, we initially sample a subset of training data as anchor points based on the individual class prototypes. Then, these anchor points are used to pre-train an inference model to evaluate the per-class learning difficulty. Finally, we use a curriculum sampling module to dynamically query new samples from the rest training samples with the learning difficulty-aware sampling probability. We evaluated our model against several state-of-the-art methods on the ISIC dataset. The results with two long-tailed settings have demonstrated the superiority of our proposed training strategy, which achieves a new benchmark for long-tailed skin lesion classification.
A major prerequisite for the application of machine learning models in clinical decision making is trust and interpretability. Current explainability studies in the neuroimaging community have mostly focused on explaining individual decisions of trained models, e.g. obtained by a convolutional neural network (CNN). Using attribution methods such as layer-wise relevance propagation or SHAP heatmaps can be created that highlight which regions of an input are more relevant for the decision than others. While this allows the detection of potential data set biases and can be used as a guide for a human expert, it does not allow an understanding of the underlying principles the model has learned. In this study, we instead show, to the best of our knowledge, for the first time results using feature visualization of neuroimaging CNNs. Particularly, we have trained CNNs for different tasks including sex classification and artificial lesion classification based on structural magnetic resonance imaging (MRI) data. We have then iteratively generated images that maximally activate specific neurons, in order to visualize the patterns they respond to. To improve the visualizations we compared several regularization strategies. The resulting images reveal the learned concepts of the artificial lesions, including their shapes, but remain hard to interpret for abstract features in the sex classification task.
Skin cancer is one of the most common types of malignancy, affecting a large population and causing a heavy economic burden worldwide. Over the last few years, computer-aided diagnosis has been rapidly developed and make great progress in healthcare and medical practices due to the advances in artificial intelligence. However, most studies in skin cancer detection keep pursuing high prediction accuracies without considering the limitation of computing resources on portable devices. In this case, knowledge distillation (KD) has been proven as an efficient tool to help improve the adaptability of lightweight models under limited resources, meanwhile keeping a high-level representation capability. To bridge the gap, this study specifically proposes a novel method, termed SSD-KD, that unifies diverse knowledge into a generic KD framework for skin diseases classification. Our method models an intra-instance relational feature representation and integrates it with existing KD research. A dual relational knowledge distillation architecture is self-supervisedly trained while the weighted softened outputs are also exploited to enable the student model to capture richer knowledge from the teacher model. To demonstrate the effectiveness of our method, we conduct experiments on ISIC 2019, a large-scale open-accessed benchmark of skin diseases dermoscopic images. Experiments show that our distilled lightweight model can achieve an accuracy as high as 85% for the classification tasks of 8 different skin diseases with minimal parameters and computing requirements. Ablation studies confirm the effectiveness of our intra- and inter-instance relational knowledge integration strategy. Compared with state-of-the-art knowledge distillation techniques, the proposed method demonstrates improved performances for multi-diseases classification on the large-scale dermoscopy database.
Medical imaging is a cornerstone of therapy and diagnosis in modern medicine. However, the choice of imaging modality for a particular theranostic task typically involves trade-offs between the feasibility of using a particular modality (e.g., short wait times, low cost, fast acquisition, reduced radiation/invasiveness) and the expected performance on a clinical task (e.g., diagnostic accuracy, efficacy of treatment planning and guidance). In this work, we aim to apply the knowledge learned from the less feasible but better-performing (superior) modality to guide the utilization of the more-feasible yet under-performing (inferior) modality and steer it towards improved performance. We focus on the application of deep learning for image-based diagnosis. We develop a light-weight guidance model that leverages the latent representation learned from the superior modality, when training a model that consumes only the inferior modality. We examine the advantages of our method in the context of two clinical applications: multi-task skin lesion classification from clinical and dermoscopic images and brain tumor classification from multi-sequence magnetic resonance imaging (MRI) and histopathology images. For both these scenarios we show a boost in diagnostic performance of the inferior modality without requiring the superior modality. Furthermore, in the case of brain tumor classification, our method outperforms the model trained on the superior modality while producing comparable results to the model that uses both modalities during inference.
Convolutional neural networks (CNNs) have achieved great success in skin lesion classification. A balanced dataset is required to train a good model. However, due to the appearance of different skin lesions in practice, severe or even deadliest skin lesion types (e.g., melanoma) naturally have quite small amount represented in a dataset. In that, classification performance degradation occurs widely, it is significantly important to have CNNs that work well on class imbalanced skin lesion image dataset. In this paper, we propose SuperCon, a two-stage training strategy to overcome the class imbalance problem on skin lesion classification. It contains two stages: (i) representation training that tries to learn a feature representation that closely aligned among intra-classes and distantly apart from inter-classes, and (ii) classifier fine-tuning that aims to learn a classifier that correctly predict the label based on the learnt representations. In the experimental evaluation, extensive comparisons have been made among our approach and other existing approaches on skin lesion benchmark datasets. The results show that our two-stage training strategy effectively addresses the class imbalance classification problem, and significantly improves existing works in terms of F1-score and AUC score, resulting in state-of-the-art performance.
Convolutional Neural Networks have demonstrated human-level performance in the classification of melanoma and other skin lesions, but evident performance disparities between differing skin tones should be addressed before widespread deployment. In this work, we propose an efficient yet effective algorithm for automatically labelling the skin tone of lesion images, and use this to annotate the benchmark ISIC dataset. We subsequently use these automated labels as the target for two leading bias unlearning techniques towards mitigating skin tone bias. Our experimental results provide evidence that our skin tone detection algorithm outperforms existing solutions and that unlearning skin tone may improve generalisation and can reduce the performance disparity between melanoma detection in lighter and darker skin tones.
State-of-the-art deep learning approaches for skin lesion recognition often require pretraining on larger and more varied datasets, to overcome the generalization limitations derived from the reduced size of the skin lesion imaging datasets. ImageNet is often used as the pretraining dataset, but its transferring potential is hindered by the domain gap between the source dataset and the target dermatoscopic scenario. In this work, we introduce a novel pretraining approach that sequentially trains a series of Self-Supervised Learning pretext tasks and only requires the unlabeled skin lesion imaging data. We present a simple methodology to establish an ordering that defines a pretext task curriculum. For the multi-class skin lesion classification problem, and ISIC-2019 dataset, we provide experimental evidence showing that: i) a model pretrained by a curriculum of pretext tasks outperforms models pretrained by individual pretext tasks, and ii) a model pretrained by the optimal pretext task curriculum outperforms a model pretrained on ImageNet. We demonstrate that this performance gain is related to the fact that the curriculum of pretext tasks better focuses the attention of the final model on the skin lesion. Beyond performance improvement, this strategy allows for a large reduction in the training time with respect to ImageNet pretraining, which is especially advantageous for network architectures tailored for a specific problem.
Recent advances in automated skin cancer diagnosis have yielded performance on par with board-certified dermatologists. However, these approaches formulated skin cancer diagnosis as a simple classification task, dismissing the potential benefit from lesion segmentation. We argue that an accurate lesion segmentation can supplement the classification task with additive lesion information, such as asymmetry, border, intensity, and physical size; in turn, a faithful lesion classification can support the segmentation task with discriminant lesion features. To this end, this paper proposes a new multi-task framework, named MT-TransUNet, which is capable of segmenting and classifying skin lesions collaboratively by mediating multi-task tokens in Transformers. Furthermore, we have introduced dual-task and attended region consistency losses to take advantage of those images without pixel-level annotation, ensuring the model's robustness when it encounters the same image with an account of augmentation. Our MT-TransUNet exceeds the previous state of the art for lesion segmentation and classification tasks in ISIC-2017 and PH2; more importantly, it preserves compelling computational efficiency regarding model parameters (48M~vs.~130M) and inference speed (0.17s~vs.~2.02s per image). Code will be available at https://github.com/JingyeChen/MT-TransUNet.
In recent years, the security of AI systems has drawn increasing research attention, especially in the medical imaging realm. To develop a secure medical image analysis (MIA) system, it is a must to study possible backdoor attacks (BAs), which can embed hidden malicious behaviors into the system. However, designing a unified BA method that can be applied to various MIA systems is challenging due to the diversity of imaging modalities (e.g., X-Ray, CT, and MRI) and analysis tasks (e.g., classification, detection, and segmentation). Most existing BA methods are designed to attack natural image classification models, which apply spatial triggers to training images and inevitably corrupt the semantics of poisoned pixels, leading to the failures of attacking dense prediction models. To address this issue, we propose a novel Frequency-Injection based Backdoor Attack method (FIBA) that is capable of delivering attacks in various MIA tasks. Specifically, FIBA leverages a trigger function in the frequency domain that can inject the low-frequency information of a trigger image into the poisoned image by linearly combining the spectral amplitude of both images. Since it preserves the semantics of the poisoned image pixels, FIBA can perform attacks on both classification and dense prediction models. Experiments on three benchmarks in MIA (i.e., ISIC-2019 for skin lesion classification, KiTS-19 for kidney tumor segmentation, and EAD-2019 for endoscopic artifact detection), validate the effectiveness of FIBA and its superiority over state-of-the-art methods in attacking MIA models as well as bypassing backdoor defense. Source code will be available at https://github.com/HazardFY/FIBA.
in healthcare. However, the existing AI model may be biased in its decision marking. The bias induced by data itself, such as collecting data in subgroups only, can be mitigated by including more diversified data. Distributed and collaborative learning is an approach to involve training models in massive, heterogeneous, and distributed data sources, also known as nodes. In this work, we target on examining the fairness issue in Swarm Learning (SL), a recent edge-computing based decentralized machine learning approach, which is designed for heterogeneous illnesses detection in precision medicine. SL has achieved high performance in clinical applications, but no attempt has been made to evaluate if SL can improve fairness. To address the problem, we present an empirical study by comparing the fairness among single (node) training, SL, centralized training. Specifically, we evaluate on large public available skin lesion dataset, which contains samples from various subgroups. The experiments demonstrate that SL does not exacerbate the fairness problem compared to centralized training and improves both performance and fairness compared to single training. However, there still exists biases in SL model and the implementation of SL is more complex than the alternative two strategies.
Deep learning has the potential to automate many clinically useful tasks in medical imaging. However translation of deep learning into clinical practice has been hindered by issues such as lack of the transparency and interpretability in these "black box" algorithms compared to traditional statistical methods. Specifically, many clinical deep learning models lack rigorous and robust techniques for conveying certainty (or lack thereof) in their predictions -- ultimately limiting their appeal for extensive use in medical decision-making. Furthermore, numerous demonstrations of algorithmic bias have increased hesitancy towards deployment of deep learning for clinical applications. To this end, we explore how conformal predictions can complement existing deep learning approaches by providing an intuitive way of expressing uncertainty while facilitating greater transparency to clinical users. In this paper, we conduct field interviews with radiologists to assess possible use-cases for conformal predictors. Using insights gathered from these interviews, we devise two clinical use-cases and empirically evaluate several methods of conformal predictions on a dermatology photography dataset for skin lesion classification. We show how to modify conformal predictions to be more adaptive to subgroup differences in patient skin tones through equalized coverage. Finally, we compare conformal prediction against measures of epistemic uncertainty.
Accurate breast lesion risk estimation can significantly reduce unnecessary biopsies and help doctors decide optimal treatment plans. Most existing computer-aided systems rely solely on mammogram features to classify breast lesions. While this approach is convenient, it does not fully exploit useful information in clinical reports to achieve the optimal performance. Would clinical features significantly improve breast lesion classification compared to using mammograms alone? How to handle missing clinical information caused by variation in medical practice? What is the best way to combine mammograms and clinical features? There is a compelling need for a systematic study to address these fundamental questions. This paper investigates several multimodal deep networks based on feature concatenation, cross-attention, and co-attention to combine mammograms and categorical clinical variables. We show that the proposed architectures significantly increase the lesion classification performance (average area under ROC curves from 0.89 to 0.94). We also evaluate the model when clinical variables are missing.