Domain shifts in medical image segmentation, particularly when data comes from different centers, pose significant challenges. Intra-center variability, such as differences in scanner models or imaging protocols, can cause domain shifts as large as, or even larger than, those between centers. To address this, we propose the "one image as one domain" (OIOD) hypothesis, which treats each image as a unique domain, enabling flexible and robust domain generalization. Based on this hypothesis, we develop a unified disentanglement-based domain generalization (UniDDG) framework, which simultaneously handles both multi-source and single-source domain generalization without requiring explicit domain labels. This approach simplifies training with a fixed architecture, independent of the number of source domains, reducing complexity and enhancing scalability. We decouple each input image into content representation and style code, then exchange and combine these within the batch for segmentation, reconstruction, and further disentanglement. By maintaining distinct style codes for each image, our model ensures thorough decoupling of content representations and style codes, improving domain invariance of the content representations. Additionally, we enhance generalization with expansion mask attention (EMA) for boundary preservation and style augmentation (SA) to simulate diverse image styles, improving robustness to domain shifts. Extensive experiments show that our method achieves Dice scores of 84.43% and 88.91% for multi-source to single-center and single-center generalization in optic disc and optic cup segmentation, respectively, and 86.96% and 88.56% for prostate segmentation, outperforming current state-of-the-art domain generalization methods, offering superior performance and adaptability across clinical settings.
Fundus image segmentation on unseen domains is challenging, especially for the over-parameterized deep models trained on the small medical datasets. To address this challenge, we propose a method named Adaptive Feature-fusion Neural Network (AFNN) for glaucoma segmentation on unseen domains, which mainly consists of three modules: domain adaptor, feature-fusion network, and self-supervised multi-task learning. Specifically, the domain adaptor helps the pretrained-model fast adapt from other image domains to the medical fundus image domain. Feature-fusion network and self-supervised multi-task learning for the encoder and decoder are introduced to improve the domain generalization ability. In addition, we also design the weighted-dice-loss to improve model performance on complex optic-cup segmentation tasks. Our proposed method achieves a competitive performance over existing fundus segmentation methods on four public glaucoma datasets.
The Segment Anything Model (SAM) gained significant success in natural image segmentation, and many methods have tried to fine-tune it to medical image segmentation. An efficient way to do so is by using Adapters, specialized modules that learn just a few parameters to tailor SAM specifically for medical images. However, unlike natural images, many tissues and lesions in medical images have blurry boundaries and may be ambiguous. Previous efforts to adapt SAM ignore this challenge and can only predict distinct segmentation. It may mislead clinicians or cause misdiagnosis, especially when encountering rare variants or situations with low model confidence. In this work, we propose a novel module called the Uncertainty-aware Adapter, which efficiently fine-tuning SAM for uncertainty-aware medical image segmentation. Utilizing a conditional variational autoencoder, we encoded stochastic samples to effectively represent the inherent uncertainty in medical imaging. We designed a new module on a standard adapter that utilizes a condition-based strategy to interact with samples to help SAM integrate uncertainty. We evaluated our method on two multi-annotated datasets with different modalities: LIDC-IDRI (lung abnormalities segmentation) and REFUGE2 (optic-cup segmentation). The experimental results show that the proposed model outperforms all the previous methods and achieves the new state-of-the-art (SOTA) on both benchmarks. We also demonstrated that our method can generate diverse segmentation hypotheses that are more realistic as well as heterogeneous.
Diffusion probabilistic model (DPM) recently becomes one of the hottest topic in computer vision. Its image generation application such as Imagen, Latent Diffusion Models and Stable Diffusion have shown impressive generation capabilities, which aroused extensive discussion in the community. Many recent studies also found it is useful in many other vision tasks, like image deblurring, super-resolution and anomaly detection. Inspired by the success of DPM, we propose the first DPM based model toward general medical image segmentation tasks, which we named MedSegDiff. In order to enhance the step-wise regional attention in DPM for the medical image segmentation, we propose dynamic conditional encoding, which establishes the state-adaptive conditions for each sampling step. We further propose Feature Frequency Parser (FF-Parser), to eliminate the negative effect of high-frequency noise component in this process. We verify MedSegDiff on three medical segmentation tasks with different image modalities, which are optic cup segmentation over fundus images, brain tumor segmentation over MRI images and thyroid nodule segmentation over ultrasound images. The experimental results show that MedSegDiff outperforms state-of-the-art (SOTA) methods with considerable performance gap, indicating the generalization and effectiveness of the proposed model. Our code is released at https://github.com/WuJunde/MedSegDiff.
Medical image segmentation is important for computer-aided diagnosis. Good segmentation demands the model to see the big picture and fine details simultaneously, i.e., to learn image features that incorporate large context while keep high spatial resolutions. To approach this goal, the most widely used methods -- U-Net and variants, extract and fuse multi-scale features. However, the fused features still have small "effective receptive fields" with a focus on local image cues, limiting their performance. In this work, we propose Segtran, an alternative segmentation framework based on transformers, which have unlimited "effective receptive fields" even at high feature resolutions. The core of Segtran is a novel Squeeze-and-Expansion transformer: a squeezed attention block regularizes the self attention of transformers, and an expansion block learns diversified representations. Additionally, we propose a new positional encoding scheme for transformers, imposing a continuity inductive bias for images. Experiments were performed on 2D and 3D medical image segmentation tasks: optic disc/cup segmentation in fundus images (REFUGE'20 challenge), polyp segmentation in colonoscopy images, and brain tumor segmentation in MRI scans (BraTS'19 challenge). Compared with representative existing methods, Segtran consistently achieved the highest segmentation accuracy, and exhibited good cross-domain generalization capabilities. The source code of Segtran is released at https://github.com/askerlee/segtran.
Scarcity of large publicly available retinal fundus image datasets for automated glaucoma detection has been the bottleneck for successful application of artificial intelligence towards practical Computer-Aided Diagnosis (CAD). A few small datasets that are available for research community usually suffer from impractical image capturing conditions and stringent inclusion criteria. These shortcomings in already limited choice of existing datasets make it challenging to mature a CAD system so that it can perform in real-world environment. In this paper we present a large publicly available retinal fundus image dataset for glaucoma classification called G1020. The dataset is curated by conforming to standard practices in routine ophthalmology and it is expected to serve as standard benchmark dataset for glaucoma detection. This database consists of 1020 high resolution colour fundus images and provides ground truth annotations for glaucoma diagnosis, optic disc and optic cup segmentation, vertical cup-to-disc ratio, size of neuroretinal rim in inferior, superior, nasal and temporal quadrants, and bounding box location for optic disc. We also report baseline results by conducting extensive experiments for automated glaucoma diagnosis and segmentation of optic disc and optic cup.
Retinal fundus photographs have been used in the diagnosis of many ocular diseases such as glaucoma, pathological myopia, age-related macular degeneration and diabetic retinopathy. With the development of computer science, computer aided diagnosis has been developed to process and analyse the retinal images automatically. One of the challenges in the analysis is that the quality of the retinal image is often degraded. For example, a cataract in human lens will attenuate the retinal image, just as a cloudy camera lens which reduces the quality of a photograph. It often obscures the details in the retinal images and posts challenges in retinal image processing and analysing tasks. In this paper, we approximate the degradation of the retinal images as a combination of human-lens attenuation and scattering. A novel structure-preserving guided retinal image filtering (SGRIF) is then proposed to restore images based on the attenuation and scattering model. The proposed SGRIF consists of a step of global structure transferring and a step of global edge-preserving smoothing. Our results show that the proposed SGRIF method is able to improve the contrast of retinal images, measured by histogram flatness measure, histogram spread and variability of local luminosity. In addition, we further explored the benefits of SGRIF for subsequent retinal image processing and analysing tasks. In the two applications of deep learning based optic cup segmentation and sparse learning based cup-to-disc ratio (CDR) computation, our results show that we are able to achieve more accurate optic cup segmentation and CDR measurements from images processed by SGRIF.