Robust XAI techniques should ideally be simultaneously deterministic, model agnostic, and guaranteed to converge. We propose MULTIDIMENSIONAL PROBLEM AGNOSTIC EXPLAINABLE AI (MUPAX), a deterministic, model agnostic explainability technique, with guaranteed convergency. MUPAX measure theoretic formulation gives principled feature importance attribution through structured perturbation analysis that discovers inherent input patterns and eliminates spurious relationships. We evaluate MUPAX on an extensive range of data modalities and tasks: audio classification (1D), image classification (2D), volumetric medical image analysis (3D), and anatomical landmark detection, demonstrating dimension agnostic effectiveness. The rigorous convergence guarantees extend to any loss function and arbitrary dimensions, making MUPAX applicable to virtually any problem context for AI. By contrast with other XAI methods that typically decrease performance when masking, MUPAX not only preserves but actually enhances model accuracy by capturing only the most important patterns of the original data. Extensive benchmarking against the state of the XAI art demonstrates MUPAX ability to generate precise, consistent and understandable explanations, a crucial step towards explainable and trustworthy AI systems. The source code will be released upon publication.
Radiographic images are a cornerstone of medical diagnostics in orthopaedics, with anatomical landmark detection serving as a crucial intermediate step for information extraction. General-purpose foundational segmentation models, such as SAM (Segment Anything Model), do not support landmark segmentation out of the box and require prompts to function. However, in medical imaging, the prompts for landmarks are highly specific. Since SAM has not been trained to recognize such landmarks, it cannot generate accurate landmark segmentations for diagnostic purposes. Even MedSAM, a medically adapted variant of SAM, has been trained to identify larger anatomical structures, such as organs and their parts, and lacks the fine-grained precision required for orthopaedic pelvic landmarks. To address this limitation, we propose leveraging another general-purpose, non-foundational model: YOLO. YOLO excels in object detection and can provide bounding boxes that serve as input prompts for SAM. While YOLO is efficient at detection, it is significantly outperformed by SAM in segmenting complex structures. In combination, these two models form a reliable pipeline capable of segmenting not only a small pilot set of eight anatomical landmarks but also an expanded set of 72 landmarks and 16 regions with complex outlines, such as the femoral cortical bone and the pelvic inlet. By using YOLO-generated bounding boxes to guide SAM, we trained the hybrid model to accurately segment orthopaedic pelvic radiographs. Our results show that the proposed combination of YOLO and SAM yields excellent performance in detecting anatomical landmarks and intricate outlines in orthopaedic pelvic radiographs.
Anatomical landmark detection (ALD) from a medical image is crucial for a wide array of clinical applications. While existing methods achieve quite some success in ALD, they often struggle to balance global context with computational efficiency, particularly with high-resolution images, thereby leading to the rise of a natural question: where is the performance limit of ALD? In this paper, we aim to forge performant ALD by proposing a {\bf HY}brid {\bf ATT}ention {\bf Net}work (HYATT-Net) with the following designs: (i) A novel hybrid architecture that integrates CNNs and Transformers. Its core is the BiFormer module, utilizing Bi-Level Routing Attention for efficient attention to relevant image regions. This, combined with Attention Residual Module(ARM), enables precise local feature refinement guided by the global context. (ii) A Feature Fusion Correction Module that aggregates multi-scale features and thus mitigates a resolution loss. Deep supervision with a mean-square error loss on multi-resolution heatmaps optimizes the model. Experiments on five diverse datasets demonstrate state-of-the-art performance, surpassing existing methods in accuracy, robustness, and efficiency. The HYATT-Net provides a promising solution for accurate and efficient ALD in complex medical images. Our codes and data are already released at: \url{https://github.com/ECNUACRush/HYATT-Net}.
Automated detection of anatomical landmarks plays a crucial role in many diagnostic and surgical applications. Progresses in deep learning (DL) methods have resulted in significant performance enhancement in tasks related to anatomical landmark detection. While current research focuses on accurately localizing these landmarks in medical scans, the importance of inter-rater annotation variability in building DL models is often overlooked. Understanding how inter-rater variability impacts the performance and reliability of the resulting DL algorithms, which are crucial for clinical deployment, can inform the improvement of training data construction and boost DL models' outcomes. In this paper, we conducted a thorough study of different annotation-fusion strategies to preserve inter-rater variability in DL models for anatomical landmark detection, aiming to boost the performance and reliability of the resulting algorithms. Additionally, we explored the characteristics and reliability of four metrics, including a novel Weighted Coordinate Variance metric to quantify landmark detection uncertainty/inter-rater variability. Our research highlights the crucial connection between inter-rater variability, DL-models performances, and uncertainty, revealing how different approaches for multi-rater landmark annotation fusion can influence these factors.
Anatomical landmark detection in medical images is essential for various clinical and research applications, including disease diagnosis and surgical planning. However, manual landmark annotation is time-consuming and requires significant expertise. Existing deep learning (DL) methods often require large amounts of well-annotated data, which are costly to acquire. In this paper, we introduce CABLD, a novel self-supervised DL framework for 3D brain landmark detection in unlabeled scans with varying contrasts by using only a single reference example. To achieve this, we employed an inter-subject landmark consistency loss with an image registration loss while introducing a 3D convolution-based contrast augmentation strategy to promote model generalization to new contrasts. Additionally, we utilize an adaptive mixed loss function to schedule the contributions of different sub-tasks for optimal outcomes. We demonstrate the proposed method with the intricate task of MRI-based 3D brain landmark detection. With comprehensive experiments on four diverse clinical and public datasets, including both T1w and T2w MRI scans at different MRI field strengths, we demonstrate that CABLD outperforms the state-of-the-art methods in terms of mean radial errors (MREs) and success detection rates (SDRs). Our framework provides a robust and accurate solution for anatomical landmark detection, reducing the need for extensively annotated datasets and generalizing well across different imaging contrasts. Our code will be publicly available at: https://github.com/HealthX-Lab/CABLD.
Breast cancer remains a leading cause of cancer-related deaths among women worldwide, with mammography screening as the most effective method for the early detection. Ensuring proper positioning in mammography is critical, as poor positioning can lead to diagnostic errors, increased patient stress, and higher costs due to recalls. Despite advancements in deep learning (DL) for breast cancer diagnostics, limited focus has been given to evaluating mammography positioning. This paper introduces a novel DL methodology to quantitatively assess mammogram positioning quality, specifically in mediolateral oblique (MLO) views using attention and coordinate convolution modules. Our method identifies key anatomical landmarks, such as the nipple and pectoralis muscle, and automatically draws a posterior nipple line (PNL), offering robust and inherently explainable alternative to well-known classification and regression-based approaches. We compare the performance of proposed methodology with various regression and classification-based models. The CoordAtt UNet model achieved the highest accuracy of 88.63% $\pm$ 2.84 and specificity of 90.25% $\pm$ 4.04, along with a noteworthy sensitivity of 86.04% $\pm$ 3.41. In landmark detection, the same model also recorded the lowest mean errors in key anatomical points and the smallest angular error of 2.42 degrees. Our results indicate that models incorporating attention mechanisms and CoordConv module increase the accuracy in classifying breast positioning quality and detecting anatomical landmarks. Furthermore, we make the labels and source codes available to the community to initiate an open research area for mammography, accessible at https://github.com/tanyelai/deep-breast-positioning.
Anatomical Landmark Detection is the process of identifying key areas of an image for clinical measurements. Each landmark is a single ground truth point labelled by a clinician. A machine learning model predicts the locus of a landmark as a probability region represented by a heatmap. Diffusion models have increased in popularity for generative modelling due to their high quality sampling and mode coverage, leading to their adoption in medical image processing for semantic segmentation. Diffusion modelling can be further adapted to learn a distribution over landmarks. The stochastic nature of diffusion models captures fluctuations in the landmark prediction, which we leverage by blurring into meaningful probability regions. In this paper, we reformulate automatic Anatomical Landmark Detection as a precise generative modelling task, producing a few-hot pixel heatmap. Our method achieves state-of-the-art MRE and comparable SDR performance with existing work.
One-shot detection of anatomical landmarks is gaining significant attention for its efficiency in using minimal labeled data to produce promising results. However, the success of current methods heavily relies on the employment of extensive unlabeled data to pre-train an effective feature extractor, which limits their applicability in scenarios where a substantial amount of unlabeled data is unavailable. In this paper, we propose the first foundation model-enabled one-shot landmark detection (FM-OSD) framework for accurate landmark detection in medical images by utilizing solely a single template image without any additional unlabeled data. Specifically, we use the frozen image encoder of visual foundation models as the feature extractor, and introduce dual-branch global and local feature decoders to increase the resolution of extracted features in a coarse to fine manner. The introduced feature decoders are efficiently trained with a distance-aware similarity learning loss to incorporate domain knowledge from the single template image. Moreover, a novel bidirectional matching strategy is developed to improve both robustness and accuracy of landmark detection in the case of scattered similarity map obtained by foundation models. We validate our method on two public anatomical landmark detection datasets. By using solely a single template image, our method demonstrates significant superiority over strong state-of-the-art one-shot landmark detection methods.
Recently, anatomical landmark detection has achieved great progresses on single-domain data, which usually assumes training and test sets are from the same domain. However, such an assumption is not always true in practice, which can cause significant performance drop due to domain shift. To tackle this problem, we propose a novel framework for anatomical landmark detection under the setting of unsupervised domain adaptation (UDA), which aims to transfer the knowledge from labeled source domain to unlabeled target domain. The framework leverages self-training and domain adversarial learning to address the domain gap during adaptation. Specifically, a self-training strategy is proposed to select reliable landmark-level pseudo-labels of target domain data with dynamic thresholds, which makes the adaptation more effective. Furthermore, a domain adversarial learning module is designed to handle the unaligned data distributions of two domains by learning domain-invariant features via adversarial training. Our experiments on cephalometric and lung landmark detection show the effectiveness of the method, which reduces the domain gap by a large margin and outperforms other UDA methods consistently. The code is available at https://github.com/jhb86253817/UDA_Med_Landmark.
Homologous anatomical landmarks between medical scans are instrumental in quantitative assessment of image registration quality in various clinical applications, such as MRI-ultrasound registration for tissue shift correction in ultrasound-guided brain tumor resection. While manually identified landmark pairs between MRI and ultrasound (US) have greatly facilitated the validation of different registration algorithms for the task, the procedure requires significant expertise, labor, and time, and can be prone to inter- and intra-rater inconsistency. So far, many traditional and machine learning approaches have been presented for anatomical landmark detection, but they primarily focus on mono-modal applications. Unfortunately, despite the clinical needs, inter-modal/contrast landmark detection has very rarely been attempted. Therefore, we propose a novel contrastive learning framework to detect corresponding landmarks between MRI and intra-operative US scans in neurosurgery. Specifically, two convolutional neural networks were trained jointly to encode image features in MRI and US scans to help match the US image patch that contain the corresponding landmarks in the MRI. We developed and validated the technique using the public RESECT database. With a mean landmark detection accuracy of 5.88+-4.79 mm against 18.78+-4.77 mm with SIFT features, the proposed method offers promising results for MRI-US landmark detection in neurosurgical applications for the first time.
Heatmap-based anatomical landmark detection is still facing two unresolved challenges: 1) inability to accurately evaluate the distribution of heatmap; 2) inability to effectively exploit global spatial structure information. To address the computational inability challenge, we propose a novel position-aware and sample-aware central loss. Specifically, our central loss can absorb position information, enabling accurate evaluation of the heatmap distribution. More advanced is that our central loss is sample-aware, which can adaptively distinguish easy and hard samples and make the model more focused on hard samples while solving the challenge of extreme imbalance between landmarks and non-landmarks. To address the challenge of ignoring structure information, a Coordinated Transformer, called CoorTransformer, is proposed, which establishes long-range dependencies under the guidance of landmark coordination information, making the attention more focused on the sparse landmarks while taking advantage of global spatial structure. Furthermore, CoorTransformer can speed up convergence, effectively avoiding the defect that Transformers have difficulty converging in sparse representation learning. Using the advanced CoorTransformer and central loss, we propose a generalized detection model that can handle various scenarios, inherently exploiting the underlying relationship between landmarks and incorporating rich structural knowledge around the target landmarks. We analyzed and evaluated CoorTransformer and central loss on three challenging landmark detection tasks. The experimental results show that our CoorTransformer outperforms state-of-the-art methods, and the central loss significantly improves the performance of the model with p-values< 0.05.
Heatmap-based methods play an important role in anatomical landmark detection. However, most current heatmap-based methods assume that the distributions of all landmarks are the same and the distribution of each landmark is isotropic, which may not be in line with reality. For example, the landmark on the jaw is more likely to be located along the edge and less likely to be located inside or outside the jaw. Manually annotating tends to follow similar rules, resulting in an anisotropic distribution for annotated landmarks, which represents the uncertainty in the annotation. To estimate the uncertainty, we propose a module named Pyramid Covariance Predictor to predict the covariance matrices of the target Gaussian distributions, which determine the distributions of landmarks and represent the uncertainty of landmark annotation. Specifically, the Pyramid Covariance Predictor utilizes the pyramid features extracted by the encoder of the backbone U-Net and predicts the Cholesky decomposition of the covariance matrix of the landmark location distribution. Experimental results show that the proposed Pyramid Covariance Predictor can accurately predict the distributions and improve the performance of anatomical landmark detection.
Accurate anatomical landmark detection plays an increasingly vital role in medical image analysis. Although existing methods achieve satisfying performance, they are mostly based on CNN and specialized for a single domain say associated with a particular anatomical region. In this work, we propose a universal model for multi-domain landmark detection by taking advantage of transformer for modeling long dependencies and develop a domain-adaptive transformer model, named as DATR, which is trained on multiple mixed datasets from different anatomies and capable of detecting landmarks of any image from those anatomies. The proposed DATR exhibits three primary features: (i) It is the first universal model which introduces transformer as an encoder for multi-anatomy landmark detection; (ii) We design a domain-adaptive transformer for anatomy-aware landmark detection, which can be effectively extended to any other transformer network; (iii) Following previous studies, we employ a light-weighted guidance network, which encourages the transformer network to detect more accurate landmarks. We carry out experiments on three widely used X-ray datasets for landmark detection, which have 1,588 images and 62 landmarks in total, including three different anatomies (head, hand, and chest). Experimental results demonstrate that our proposed DATR achieves state-of-the-art performances by most metrics and behaves much better than any previous convolution-based models. The code will be released publicly.
Purpose: Mitral valve repair is a complex minimally invasive surgery of the heart valve. In this context, suture detection from endoscopic images is a highly relevant task that provides quantitative information to analyse suturing patterns, assess prosthetic configurations and produce augmented reality visualisations. Facial or anatomical landmark detection tasks typically contain a fixed number of landmarks, and use regression or fixed heatmap-based approaches to localize the landmarks. However in endoscopy, there are a varying number of sutures in every image, and the sutures may occur at any location in the annulus, as they are not semantically unique. Method: In this work, we formulate the suture detection task as a multi-instance deep heatmap regression problem, to identify entry and exit points of sutures. We extend our previous work, and introduce the novel use of a 2D Gaussian layer followed by a differentiable 2D spatial Soft-Argmax layer to function as a local non-maximum suppression. Results: We present extensive experiments with multiple heatmap distribution functions and two variants of the proposed model. In the intra-operative domain, Variant 1 showed a mean F1 of +0.0422 over the baseline. Similarly, in the simulator domain, Variant 1 showed a mean F1 of +0.0865 over the baseline. Conclusion: The proposed model shows an improvement over the baseline in the intra-operative and the simulator domains. The data is made publicly available within the scope of the MICCAI AdaptOR2021 Challenge https://adaptor2021.github.io/, and the code at https://github.com/Cardio-AI/suture-detection-pytorch/. DOI:10.1007/s11548-021-02523-w. The link to the open access article can be found here: https://link.springer.com/article/10.1007%2Fs11548-021-02523-w
Localization of anatomical landmarks is essential for clinical diagnosis, treatment planning, and research. In this paper, we propose a novel deep network, named feature aggregation and refinement network (FARNet), for the automatic detection of anatomical landmarks. To alleviate the problem of limited training data in the medical domain, our network adopts a deep network pre-trained on natural images as the backbone network and several popular networks have been compared. Our FARNet also includes a multi-scale feature aggregation module for multi-scale feature fusion and a feature refinement module for high-resolution heatmap regression. Coarse-to-fine supervisions are applied to the two modules to facilitate the end-to-end training. We further propose a novel loss function named Exponential Weighted Center loss for accurate heatmap regression, which focuses on the losses from the pixels near landmarks and suppresses the ones from far away. Our network has been evaluated on three publicly available anatomical landmark detection datasets, including cephalometric radiographs, hand radiographs, and spine radiographs, and achieves state-of-art performances on all three datasets. Code is available at: \url{https://github.com/JuvenileInWind/FARNet}
Fetal alcohol syndrome (FAS) caused by prenatal alcohol exposure can result in a series of cranio-facial anomalies, and behavioral and neurocognitive problems. Current diagnosis of FAS is typically done by identifying a set of facial characteristics, which are often obtained by manual examination. Anatomical landmark detection, which provides rich geometric information, is important to detect the presence of FAS associated facial anomalies. This imaging application is characterized by large variations in data appearance and limited availability of labeled data. Current deep learning-based heatmap regression methods designed for facial landmark detection in natural images assume availability of large datasets and are therefore not wellsuited for this application. To address this restriction, we develop a new regularized transfer learning approach that exploits the knowledge of a network learned on large facial recognition datasets. In contrast to standard transfer learning which focuses on adjusting the pre-trained weights, the proposed learning approach regularizes the model behavior. It explicitly reuses the rich visual semantics of a domain-similar source model on the target task data as an additional supervisory signal for regularizing landmark detection optimization. Specifically, we develop four regularization constraints for the proposed transfer learning, including constraining the feature outputs from classification and intermediate layers, as well as matching activation attention maps in both spatial and channel levels. Experimental evaluation on a collected clinical imaging dataset demonstrate that the proposed approach can effectively improve model generalizability under limited training samples, and is advantageous to other approaches in the literature.
Colonoscopy is a standard imaging tool for visualizing the entire gastrointestinal (GI) tract of patients to capture lesion areas. However, it takes the clinicians excessive time to review a large number of images extracted from colonoscopy videos. Thus, automatic detection of biological anatomical landmarks within the colon is highly demanded, which can help reduce the burden of clinicians by providing guidance information for the locations of lesion areas. In this article, we propose a novel deep learning-based approach to detect biological anatomical landmarks in colonoscopy videos. First, raw colonoscopy video sequences are pre-processed to reject interference frames. Second, a ResNet-101 based network is used to detect three biological anatomical landmarks separately to obtain the intermediate detection results. Third, to achieve more reliable localization of the landmark periods within the whole video period, we propose to post-process the intermediate detection results by identifying the incorrectly predicted frames based on their temporal distribution and reassigning them back to the correct class. Finally, the average detection accuracy reaches 99.75\%. Meanwhile, the average IoU of 0.91 shows a high degree of similarity between our predicted landmark periods and ground truth. The experimental results demonstrate that our proposed model is capable of accurately detecting and localizing biological anatomical landmarks from colonoscopy videos.
Well-annotated medical images are costly and sometimes even impossible to acquire, hindering landmark detection accuracy to some extent. Semi-supervised learning alleviates the reliance on large-scale annotated data by exploiting the unlabeled data to understand the population structure of anatomical landmarks. The global shape constraint is the inherent property of anatomical landmarks that provides valuable guidance for more consistent pseudo labelling of the unlabeled data, which is ignored in the previously semi-supervised methods. In this paper, we propose a model-agnostic shape-regulated self-training framework for semi-supervised landmark detection by fully considering the global shape constraint. Specifically, to ensure pseudo labels are reliable and consistent, a PCA-based shape model adjusts pseudo labels and eliminate abnormal ones. A novel Region Attention loss to make the network automatically focus on the structure consistent regions around pseudo labels. Extensive experiments show that our approach outperforms other semi-supervised methods and achieves notable improvement on three medical image datasets. Moreover, our framework is flexible and can be used as a plug-and-play module integrated into most supervised methods to improve performance further.
Automatic and accurate detection of anatomical landmarks is an essential operation in medical image analysis with a multitude of applications. Recent deep learning methods have improved results by directly encoding the appearance of the captured anatomy with the likelihood maps (i.e., heatmaps). However, most current solutions overlook another essence of heatmap regression, the objective metric for regressing target heatmaps and rely on hand-crafted heuristics to set the target precision, thus being usually cumbersome and task-specific. In this paper, we propose a novel learning-to-learn framework for landmark detection to optimize the neural network and the target precision simultaneously. The pivot of this work is to leverage the reinforcement learning (RL) framework to search objective metrics for regressing multiple heatmaps dynamically during the training process, thus avoiding setting problem-specific target precision. We also introduce an early-stop strategy for active termination of the RL agent's interaction that adapts the optimal precision for separate targets considering exploration-exploitation tradeoffs. This approach shows better stability in training and improved localization accuracy in inference. Extensive experimental results on two different applications of landmark localization: 1) our in-house prenatal ultrasound (US) dataset and 2) the publicly available dataset of cephalometric X-Ray landmark detection, demonstrate the effectiveness of our proposed method. Our proposed framework is general and shows the potential to improve the efficiency of anatomical landmark detection.
Detecting anatomical landmarks in medical images plays an essential role in understanding the anatomy and planning automated processing. In recent years, a variety of deep neural network methods have been developed to detect landmarks automatically. However, all of those methods are unary in the sense that a highly specialized network is trained for a single task say associated with a particular anatomical region. In this work, for the first time, we investigate the idea of "You Only Learn Once (YOLO)" and develop a universal anatomical landmark detection model to realize multiple landmark detection tasks with end-to-end training based on mixed datasets. The model consists of a local network and a global network: The local network is built upon the idea of universal U-Net to learn multi-domain local features and the global network is a parallelly-duplicated sequential of dilated convolutions that extract global features to further disambiguate the landmark locations. It is worth mentioning that the new model design requires much fewer parameters than models with standard convolutions to train. We evaluate our YOLO model on three X-ray datasets of 1,588 images on the head, hand, and chest, collectively contributing 62 landmarks. The experimental results show that our proposed universal model behaves largely better than any previous models trained on multiple datasets. It even beats the performance of the model that is trained separately for every single dataset. The code is available at https://github.com/MIRACLE-Center/YOLO_Universal_Anatomical_Landmark_Detection