Lung cancer has been one of the major threats across the world with the highest mortalities. Computer-aided detection (CAD) can help in early detection and thus can help increase the survival rate. Accurate lung parenchyma segmentation (to include the juxta-pleural nodules) and lung nodule segmentation, the primary symptom of lung cancer, play a crucial role in the overall accuracy of the Lung CAD pipeline. Lung nodule segmentation is quite challenging because of the diverse nodule types and other inhibit structures present within the lung lobes. Traditional machine/deep learning methods suffer from generalization and robustness. Recent Vision Language Models/Foundation Models perform well on the anatomical level, but they suffer on fine-grained segmentation tasks, and their semi-automatic nature limits their effectiveness in real-time clinical scenarios. In this paper, we propose a novel method for accurate 3D segmentation of lung parenchyma and lung nodules. The proposed architecture is an attention-based network with residual blocks at each encoder-decoder state. Max pooling is replaced by strided convolutions at the encoder, and trilinear interpolation is replaced by transposed convolutions at the decoder to maximize the number of learnable parameters. Dilated convolutions at each encoder-decoder stage allow the model to capture the larger context without increasing computational costs. The proposed method has been evaluated extensively on one of the largest publicly available datasets, namely LUNA16, and is compared with recent notable work in the domain using standard performance metrics like Dice score, IOU, etc. It can be seen from the results that the proposed method achieves better performance than state-of-the-art methods. The source code, datasets, and pre-processed data can be accessed using the link: https://github.com/EMeRALDsNRPU/Attention-Based-3D-ResUNet.
This study explores the application of various deep learning models for the segmentation of lung nodules using LIDC- IDRI. Unlike traditional approaches that utilize the full dataset, our work emphasizes the efficacy of training models on a filtered subset of 356 samples. Novel configurations, including attention mechanisms and advanced preprocessing strategies, were em- ployed to optimize segmentation accuracy. Among the models evaluated, the DPLinkNet50 with a Channel Attention Bridge and ResNet backbone demonstrated the highest performance with a Dice score of 0.86 and percision 0.88, significantly outper- forming conventional architectures. This work underscores the potential of leveraging data efficiency and tailored architectures in achieving robust segmentation performance, paving the way for improved computer-aided diagnosis in clinical settings.
In the U.S., lung cancer is the second major cause of death. Early detection of suspicious lung nodules is crucial for patient treatment planning, management, and improving outcomes. Many approaches for lung nodule segmentation and volumetric analysis have been proposed, but few have looked at longitudinal changes in total lung tumor burden. In this work, we trained two 3D models (nnUNet) with and without anatomical priors to automatically segment lung lesions and quantified total lesion burden for each patient. The 3D model without priors significantly outperformed ($p < .001$) the model trained with anatomy priors. For detecting clinically significant lesions $>$ 1cm, a precision of 71.3\%, sensitivity of 68.4\%, and F1-score of 69.8\% was achieved. For segmentation, a Dice score of 77.1 $\pm$ 20.3 and Hausdorff distance error of 11.7 $\pm$ 24.1 mm was obtained. The median lesion burden was 6.4 cc (IQR: 2.1, 18.1) and the median volume difference between manual and automated measurements was 0.02 cc (IQR: -2.8, 1.2). Agreements were also evaluated with linear regression and Bland-Altman plots. The proposed approach can produce a personalized evaluation of the total tumor burden for a patient and facilitate interval change tracking over time.
With the rapid development of artificial intelligence (AI), AI-assisted medical imaging analysis demonstrates remarkable performance in early lung cancer screening. However, the costly annotation process and privacy concerns limit the construction of large-scale medical datasets, hampering the further application of AI in healthcare. To address the data scarcity in lung cancer screening, we propose Lung-DDPM, a thoracic CT image synthesis approach that effectively generates high-fidelity 3D synthetic CT images, which prove helpful in downstream lung nodule segmentation tasks. Our method is based on semantic layout-guided denoising diffusion probabilistic models (DDPM), enabling anatomically reasonable, seamless, and consistent sample generation even from incomplete semantic layouts. Our results suggest that the proposed method outperforms other state-of-the-art (SOTA) generative models in image quality evaluation and downstream lung nodule segmentation tasks. Specifically, Lung-DDPM achieved superior performance on our large validation cohort, with a Fr\'echet inception distance (FID) of 0.0047, maximum mean discrepancy (MMD) of 0.0070, and mean squared error (MSE) of 0.0024. These results were 7.4$\times$, 3.1$\times$, and 29.5$\times$ better than the second-best competitors, respectively. Furthermore, the lung nodule segmentation model, trained on a dataset combining real and Lung-DDPM-generated synthetic samples, attained a dice coefficient (Dice) of 0.3914 and sensitivity of 0.4393. This represents 8.8\% and 18.6\% improvements in DICE and sensitivity compared to the model trained solely on real samples. The experimental results highlight Lung-DDPM's potential for a broader range of medical imaging applications, such as general tumor segmentation, cancer survival estimation, and risk prediction.
Lung cancer is an extremely lethal disease primarily due to its late-stage diagnosis and significant mortality rate, making it the major cause of cancer-related demises globally. Machine Learning (ML) and Convolution Neural network (CNN) based Deep Learning (DL) techniques are primarily used for precise segmentation and classification of cancerous nodules in the CT (Computed Tomography) or MRI images. This study introduces an innovative approach to lung nodule segmentation by utilizing the Segment Anything Model (SAM) combined with transfer learning techniques. Precise segmentation of lung nodules is crucial for the early detection of lung cancer. The proposed method leverages Bounding Box prompts and a vision transformer model to enhance segmentation performance, achieving high accuracy, Dice Similarity Coefficient (DSC) and Intersection over Union (IoU) metrics. The integration of SAM and Transfer Learning significantly improves Computer-Aided Detection (CAD) systems in medical imaging, particularly for lung cancer diagnosis. The findings demonstrate the proposed model effectiveness in precisely segmenting lung nodules from CT scans, underscoring its potential to advance early detection and improve patient care outcomes in lung cancer diagnosis. The results show SAM Model with transfer learning achieving a DSC of 97.08% and an IoU of 95.6%, for segmentation and accuracy of 96.71% for classification indicates that ,its performance is noteworthy compared to existing techniques.
The irregular and challenging characteristics of lung adenocarcinoma nodules in computed tomography (CT) images complicate staging diagnosis, making accurate segmentation critical for clinicians to extract detailed lesion information. In this study, we propose a segmentation model, S3TU-Net, which integrates multi-dimensional spatial connectors and a superpixel-based visual transformer. S3TU-Net is built on a multi-view CNN-Transformer hybrid architecture, incorporating superpixel algorithms, structured weighting, and spatial shifting techniques to achieve superior segmentation performance. The model leverages structured convolution blocks (DWF-Conv/D2BR-Conv) to extract multi-scale local features while mitigating overfitting. To enhance multi-scale feature fusion, we introduce the S2-MLP Link, integrating spatial shifting and attention mechanisms at the skip connections. Additionally, the residual-based superpixel visual transformer (RM-SViT) effectively merges global and local features by employing sparse correlation learning and multi-branch attention to capture long-range dependencies, with residual connections enhancing stability and computational efficiency. Experimental results on the LIDC-IDRI dataset demonstrate that S3TU-Net achieves a DSC, precision, and IoU of 89.04%, 90.73%, and 90.70%, respectively. Compared to recent methods, S3TU-Net improves DSC by 4.52% and sensitivity by 3.16%, with other metrics showing an approximate 2% increase. In addition to comparison and ablation studies, we validated the generalization ability of our model on the EPDB private dataset, achieving a DSC of 86.40%.
Lung cancer ranks as one of the leading causes of cancer diagnosis and is the foremost cause of cancer-related mortality worldwide. The early detection of lung nodules plays a pivotal role in improving outcomes for patients, as it enables timely and effective treatment interventions. The segmentation of lung nodules plays a critical role in aiding physicians in distinguishing between malignant and benign lesions. However, this task remains challenging due to the substantial variation in the shapes and sizes of lung nodules, and their frequent proximity to lung tissues, which complicates clear delineation. In this study, we introduce a novel model for segmenting lung nodules in computed tomography (CT) images, leveraging a deep learning framework that integrates segmentation and classification processes. This model is distinguished by its use of feature combination blocks, which facilitate the sharing of information between the segmentation and classification components. Additionally, we employ the classification outcomes as priors to refine the size estimation of the predicted nodules, integrating these with a spatial regularization technique to enhance precision. Furthermore, recognizing the challenges posed by limited training datasets, we have developed an optimal transfer learning strategy that freezes certain layers to further improve performance. The results show that our proposed model can capture the target nodules more accurately compared to other commonly used models. By applying transfer learning, the performance can be further improved, achieving a sensitivity score of 0.885 and a Dice score of 0.814.
The scarcity of publicly available medical imaging data limits the development of effective AI models. This work proposes a memory-efficient patch-wise denoising diffusion probabilistic model (DDPM) for generating synthetic medical images, focusing on CT scans with lung nodules. Our approach generates high-utility synthetic images with nodule segmentation while efficiently managing memory constraints, enabling the creation of training datasets. We evaluate the method in two scenarios: training a segmentation model exclusively on synthetic data, and augmenting real-world training data with synthetic images. In the first case, models trained solely on synthetic data achieve Dice scores comparable to those trained on real-world data benchmarks. In the second case, augmenting real-world data with synthetic images significantly improves segmentation performance. The generated images demonstrate their potential to enhance medical image datasets in scenarios with limited real-world data.
Capsule networks (CapsNets) were introduced to address convolutional neural networks limitations, learning object-centric representations that are more robust, pose-aware, and interpretable. They organize neurons into groups called capsules, where each capsule encodes the instantiation parameters of an object or one of its parts. Moreover, a routing algorithm connects capsules in different layers, thereby capturing hierarchical part-whole relationships in the data. This thesis investigates the intriguing aspects of CapsNets and focuses on three key questions to unlock their full potential. First, we explore the effectiveness of the routing algorithm, particularly in small-sized networks. We propose a novel method that anneals the number of routing iterations during training, enhancing performance in architectures with fewer parameters. Secondly, we investigate methods to extract more effective first-layer capsules, also known as primary capsules. By exploiting pruned backbones, we aim to improve computational efficiency by reducing the number of capsules while achieving high generalization. This approach reduces CapsNets memory requirements and computational effort. Third, we explore part-relationship learning in CapsNets. Through extensive research, we demonstrate that capsules with low entropy can extract more concise and discriminative part-whole relationships compared to traditional capsule networks, even with reasonable network sizes. Lastly, we showcase how CapsNets can be utilized in real-world applications, including autonomous localization of unmanned aerial vehicles, quaternion-based rotations prediction in synthetic datasets, and lung nodule segmentation in biomedical imaging. The findings presented in this thesis contribute to a deeper understanding of CapsNets and highlight their potential to address complex computer vision challenges.
In view of the recent paradigm shift in deep AI based image processing methods, medical image processing has advanced considerably. In this study, we propose a novel deep neural network (DNN), entitled InceptNet, in the scope of medical image processing, for early disease detection and segmentation of medical images in order to enhance precision and performance. We also investigate the interaction of users with the InceptNet application to present a comprehensive application including the background processes, and foreground interactions with users. Fast InceptNet is shaped by the prominent Unet architecture, and it seizes the power of an Inception module to be fast and cost effective while aiming to approximate an optimal local sparse structure. Adding Inception modules with various parallel kernel sizes can improve the network's ability to capture the variations in the scaled regions of interest. To experiment, the model is tested on four benchmark datasets, including retina blood vessel segmentation, lung nodule segmentation, skin lesion segmentation, and breast cancer cell detection. The improvement was more significant on images with small scale structures. The proposed method improved the accuracy from 0.9531, 0.8900, 0.9872, and 0.9881 to 0.9555, 0.9510, 0.9945, and 0.9945 on the mentioned datasets, respectively, which show outperforming of the proposed method over the previous works. Furthermore, by exploring the procedure from start to end, individuals who have utilized a trial edition of InceptNet, in the form of a complete application, are presented with thirteen multiple choice questions in order to assess the proposed method. The outcomes are evaluated through the means of Human Computer Interaction.
Driven by the latest trend towards self-supervised learning (SSL), the paradigm of "pretraining-then-finetuning" has been extensively explored to enhance the performance of clinical applications with limited annotations. Previous literature on model finetuning has mainly focused on regularization terms and specific policy models, while the misalignment of channels between source and target models has not received sufficient attention. In this work, we revisited the dynamics of batch normalization (BN) layers and observed that the trainable affine parameters of BN serve as sensitive indicators of domain information. Therefore, Affine Collaborative Normalization (AC-Norm) is proposed for finetuning, which dynamically recalibrates the channels in the target model according to the cross-domain channel-wise correlations without adding extra parameters. Based on a single-step backpropagation, AC-Norm can also be utilized to measure the transferability of pretrained models. We evaluated AC-Norm against the vanilla finetuning and state-of-the-art fine-tuning methods on transferring diverse pretrained models to the diabetic retinopathy grade classification, retinal vessel segmentation, CT lung nodule segmentation/classification, CT liver-tumor segmentation and MRI cardiac segmentation tasks. Extensive experiments demonstrate that AC-Norm unanimously outperforms the vanilla finetuning by up to 4% improvement, even under significant domain shifts where the state-of-the-art methods bring no gains. We also prove the capability of AC-Norm in fast transferability estimation. Our code is available at https://github.com/EndoluminalSurgicalVision-IMR/ACNorm.
Lung cancer is the leading cause of cancer death and early diagnosis is associated with a positive prognosis. Chest X-ray (CXR) provides an inexpensive imaging mode for lung cancer diagnosis. Suspicious nodules are difficult to distinguish from vascular and bone structures using CXR. Computer vision has previously been proposed to assist human radiologists in this task, however, leading studies use down-sampled images and computationally expensive methods with unproven generalization. Instead, this study localizes lung nodules using efficient encoder-decoder neural networks that process full resolution images to avoid any signal loss resulting from down-sampling. Encoder-decoder networks are trained and tested using the JSRT lung nodule dataset. The networks are used to localize lung nodules from an independent external CXR dataset. Sensitivity and false positive rates are measured using an automated framework to eliminate any observer subjectivity. These experiments allow for the determination of the optimal network depth, image resolution and pre-processing pipeline for generalized lung nodule localization. We find that nodule localization is influenced by subtlety, with more subtle nodules being detected in earlier training epochs. Therefore, we propose a novel self-ensemble model from three consecutive epochs centered on the validation optimum. This ensemble achieved a sensitivity of 85% in 10-fold internal testing with false positives of 8 per image. A sensitivity of 81% is achieved at a false positive rate of 6 following morphological false positive reduction. This result is comparable to more computationally complex systems based on linear and spatial filtering, but with a sub-second inference time that is faster than other methods. The proposed algorithm achieved excellent generalization results against an external dataset with sensitivity of 77% at a false positive rate of 7.6.
Uncertainty quantification in medical images has become an essential addition to segmentation models for practical application in the real world. Although there are valuable developments in accurate uncertainty quantification methods using 2D images and slices of 3D volumes, in clinical practice, the complete 3D volumes (such as CT and MRI scans) are used to evaluate and plan the medical procedure. As a result, the existing 2D methods miss the rich 3D spatial information when resolving the uncertainty. A popular approach for quantifying the ambiguity in the data is to learn a distribution over the possible hypotheses. In recent work, this ambiguity has been modeled to be strictly Gaussian. Normalizing Flows (NFs) are capable of modelling more complex distributions and thus, better fit the embedding space of the data. To this end, we have developed a 3D probabilistic segmentation framework augmented with NFs, to enable capturing the distributions of various complexity. To test the proposed approach, we evaluate the model on the LIDC-IDRI dataset for lung nodule segmentation and quantify the aleatoric uncertainty introduced by the multi-annotator setting and inherent ambiguity in the CT data. Following this approach, we are the first to present a 3D Squared Generalized Energy Distance (GED) of 0.401 and a high 0.468 Hungarian-matched 3D IoU. The obtained results reveal the value in capturing the 3D uncertainty, using a flexible posterior distribution augmented with a Normalizing Flow. Finally, we present the aleatoric uncertainty in a visual manner with the aim to provide clinicians with additional insight into data ambiguity and facilitating more informed decision-making.
Accurate lung nodule segmentation is crucial for early-stage lung cancer diagnosis, as it can substantially enhance patient survival rates. Computed tomography (CT) images are widely employed for early diagnosis in lung nodule analysis. However, the heterogeneity of lung nodules, size diversity, and the complexity of the surrounding environment pose challenges for developing robust nodule segmentation methods. In this study, we propose an efficient end-to-end framework, the multi-encoder-based self-adaptive hard attention network (MESAHA-Net), for precise lung nodule segmentation in CT scans. MESAHA-Net comprises three encoding paths, an attention block, and a decoder block, facilitating the integration of three types of inputs: CT slice patches, forward and backward maximum intensity projection (MIP) images, and region of interest (ROI) masks encompassing the nodule. By employing a novel adaptive hard attention mechanism, MESAHA-Net iteratively performs slice-by-slice 2D segmentation of lung nodules, focusing on the nodule region in each slice to generate 3D volumetric segmentation of lung nodules. The proposed framework has been comprehensively evaluated on the LIDC-IDRI dataset, the largest publicly available dataset for lung nodule segmentation. The results demonstrate that our approach is highly robust for various lung nodule types, outperforming previous state-of-the-art techniques in terms of segmentation accuracy and computational complexity, rendering it suitable for real-time clinical implementation.
Radiologists possess diverse training and clinical experiences, leading to variations in the segmentation annotations of lung nodules and resulting in segmentation uncertainty.Conventional methods typically select a single annotation as the learning target or attempt to learn a latent space comprising multiple annotations. However, these approaches fail to leverage the valuable information inherent in the consensus and disagreements among the multiple annotations. In this paper, we propose an Uncertainty-Aware Attention Mechanism (UAAM) that utilizes consensus and disagreements among multiple annotations to facilitate better segmentation. To this end, we introduce the Multi-Confidence Mask (MCM), which combines a Low-Confidence (LC) Mask and a High-Confidence (HC) Mask.The LC mask indicates regions with low segmentation confidence, where radiologists may have different segmentation choices. Following UAAM, we further design an Uncertainty-Guide Multi-Confidence Segmentation Network (UGMCS-Net), which contains three modules: a Feature Extracting Module that captures a general feature of a lung nodule, an Uncertainty-Aware Module that produces three features for the the annotations' union, intersection, and annotation set, and an Intersection-Union Constraining Module that uses distances between the three features to balance the predictions of final segmentation and MCM. To comprehensively demonstrate the performance of our method, we propose a Complex Nodule Validation on LIDC-IDRI, which tests UGMCS-Net's segmentation performance on lung nodules that are difficult to segment using common methods. Experimental results demonstrate that our method can significantly improve the segmentation performance on nodules that are difficult to segment using conventional methods.
Since radiologists have different training and clinical experiences, they may provide various segmentation annotations for a lung nodule. Conventional studies choose a single annotation as the learning target by default, but they waste valuable information of consensus or disagreements ingrained in the multiple annotations. This paper proposes an Uncertainty-Guided Segmentation Network (UGS-Net), which learns the rich visual features from the regions that may cause segmentation uncertainty and contributes to a better segmentation result. With an Uncertainty-Aware Module, this network can provide a Multi-Confidence Mask (MCM), pointing out regions with different segmentation uncertainty levels. Moreover, this paper introduces a Feature-Aware Attention Module to enhance the learning of the nodule boundary and density differences. Experimental results show that our method can predict the nodule regions with different uncertainty levels and achieve superior performance in LIDC-IDRI dataset.
Lung cancer is deadly cancer that causes millions of deaths every year around the world. Accurate lung nodule detection and segmentation in computed tomography (CT) images is the most important part of diagnosing lung cancer in the early stage. Most of the existing systems are semi-automated and need to manually select the lung and nodules regions to perform the segmentation task. To address these challenges, we proposed a fully automated end-to-end lung nodule detection and segmentation system based on a deep learning approach. In this paper, we used Optimized Faster R-CNN; a state-of-the-art detection model to detect the lung nodule regions in the CT scans. Furthermore, we proposed an attention-aware weight excitation U-Net, called AWEU-Net, for lung nodule segmentation and boundaries detection. To achieve more accurate nodule segmentation, in AWEU-Net, we proposed position attention-aware weight excitation (PAWE), and channel attention-aware weight excitation (CAWE) blocks to highlight the best aligned spatial and channel features in the input feature maps. The experimental results demonstrate that our proposed model yields a Dice score of 89.79% and 90.35%, and an intersection over union (IoU) of 82.34% and 83.21% on the publicly LUNA16 and LIDC-IDRI datasets, respectively.
Accurate lung lesion segmentation from Computed Tomography (CT) images is crucial to the analysis and diagnosis of lung diseases such as COVID-19 and lung cancer. However, the smallness and variety of lung nodules and the lack of high-quality labeling make the accurate lung nodule segmentation difficult. To address these issues, we first introduce a novel segmentation mask named Soft Mask which has richer and more accurate edge details description and better visualization and develop a universal automatic Soft Mask annotation pipeline to deal with different datasets correspondingly. Then, a novel Network with detailed representation transfer and Soft Mask supervision (DSNet) is proposed to process the input low-resolution images of lung nodules into high-quality segmentation results. Our DSNet contains a special Detail Representation Transfer Module (DRTM) for reconstructing the detailed representation to alleviate the small size of lung nodules images, and an adversarial training framework with Soft Mask for further improving the accuracy of segmentation. Extensive experiments validate that our DSNet outperforms other state-of-the-art methods for accurate lung nodule segmentation and has strong generalization ability in other accurate medical segmentation tasks with competitive results. Besides, we provide a new challenging lung nodules segmentation dataset for further studies.
Medical images are naturally associated with rich semantics about the human anatomy, reflected in an abundance of recurring anatomical patterns, offering unique potential to foster deep semantic representation learning and yield semantically more powerful models for different medical applications. But how exactly such strong yet free semantics embedded in medical images can be harnessed for self-supervised learning remains largely unexplored. To this end, we train deep models to learn semantically enriched visual representation by self-discovery, self-classification, and self-restoration of the anatomy underneath medical images, resulting in a semantics-enriched, general-purpose, pre-trained 3D model, named Semantic Genesis. We examine our Semantic Genesis with all the publicly-available pre-trained models, by either self-supervision or fully supervision, on the six distinct target tasks, covering both classification and segmentation in various medical modalities (i.e.,CT, MRI, and X-ray). Our extensive experiments demonstrate that Semantic Genesis significantly exceeds all of its 3D counterparts as well as the de facto ImageNet-based transfer learning in 2D. This performance is attributed to our novel self-supervised learning framework, encouraging deep models to learn compelling semantic representation from abundant anatomical patterns resulting from consistent anatomies embedded in medical images. Code and pre-trained Semantic Genesis are available at https://github.com/JLiangLab/SemanticGenesis .
Early diagnosis and analysis of lung cancer involve a precise and efficient lung nodule segmentation in computed tomography (CT) images. However, the anonymous shapes, visual features, and surroundings of the nodule in the CT image pose a challenging problem to the robust segmentation of the lung nodules. This article proposes U-Det, a resource-efficient model architecture, which is an end to end deep learning approach to solve the task at hand. It incorporates a Bi-FPN (bidirectional feature network) between the encoder and decoder. Furthermore, it uses Mish activation function and class weights of masks to enhance segmentation efficiency. The proposed model is extensively trained and evaluated on the publicly available LUNA-16 dataset consisting of 1186 lung nodules. The U-Det architecture outperforms the existing U-Net model with the Dice similarity coefficient (DSC) of 82.82% and achieves results comparable to human experts.