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Alessa Hering

Publications and source records attributed to Alessa Hering.

30 records · Page 2Linked to original sources

CTARR: A fast and robust method for identifying anatomical regions on CT images via atlas registration

Medical image analysis tasks often focus on regions or structures located in a particular location within the patient's body. Often large parts of the image may not be of interest for the image analysis task. When using deep-learning based approaches, this causes an unnecessary increases the computational burden during inference and raises the chance of errors. In this paper, we introduce CTARR, a novel generic method for CT Anatomical Region Recognition. The method serves as a pre-processing step for any deep learning-based CT image analysis pipeline by automatically identifying the pre-defined anatomical region that is relevant for the follow-up task and removing the rest. It can be used in (i) image segmentation to prevent false positives in anatomically implausible regions and speeding up the inference, (ii) image classification to produce image crops that are consistent in their anatomical context, and (iii) image registration by serving as a fast pre-registration step. Our proposed method is based on atlas registration and provides a fast and robust way to crop any anatomical region encoded as one or multiple bounding box(es) from any unlabeled CT scan of the brain, chest, abdomen and/or pelvis. We demonstrate the utility and robustness of the proposed method in the context of medical image segmentation by evaluating it on six datasets of public segmentation challenges. The foreground voxels in the regions of interest are preserved in the vast majority of cases and tasks (97.45-100%) while taking only fractions of a seconds to compute (0.1-0.21s) on a deep learning workstation and greatly reducing the segmentation runtime (2.0-12.7x). Our code is available at https://github.com/ThomasBudd/ctarr.

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Improve Cross-Modality Segmentation by Treating T1-Weighted MRI Images as Inverted CT Scans

Computed tomography (CT) segmentation models often contain classes that are not currently supported by magnetic resonance imaging (MRI) segmentation models. In this study, we show that a simple image inversion technique can significantly improve the segmentation quality of CT segmentation models on MRI data. We demonstrate the feasibility for both a general multi-class and a specific renal carcinoma model for segmenting T1-weighted MRI images. Using this technique, we were able to localize and segment clear cell renal cell carcinoma in T1-weighted MRI scans, using a model that was trained on only CT data. Image inversion is straightforward to implement and does not require dedicated graphics processing units, thus providing a quick alternative to complex deep modality-transfer models. Our results demonstrate that existing CT models, including pathology models, might be transferable to the MRI domain with reasonable effort.

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Deformable MRI Sequence Registration for AI-based Prostate Cancer Diagnosis

The PI-CAI (Prostate Imaging: Cancer AI) challenge led to expert-level diagnostic algorithms for clinically significant prostate cancer detection. The algorithms receive biparametric MRI scans as input, which consist of T2-weighted and diffusion-weighted scans. These scans can be misaligned due to multiple factors in the scanning process. Image registration can alleviate this issue by predicting the deformation between the sequences. We investigate the effect of image registration on the diagnostic performance of AI-based prostate cancer diagnosis. First, the image registration algorithm, developed in MeVisLab, is analyzed using a dataset with paired lesion annotations. Second, the effect on diagnosis is evaluated by comparing case-level cancer diagnosis performance between using the original dataset, rigidly aligned diffusion-weighted scans, or deformably aligned diffusion-weighted scans. Rigid registration showed no improvement. Deformable registration demonstrated a substantial improvement in lesion overlap (+10% median Dice score) and a positive yet non-significant improvement in diagnostic performance (+0.3% AUROC, p=0.18). Our investigation shows that a substantial improvement in lesion alignment does not directly lead to a significant improvement in diagnostic performance. Qualitative analysis indicated that jointly developing image registration methods and diagnostic AI algorithms could enhance diagnostic accuracy and patient outcomes.

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The Brain Tumor Sequence Registration (BraTS-Reg) Challenge: Establishing Correspondence Between Pre-Operative and Follow-up MRI Scans of Diffuse Glioma Patients

Registration of longitudinal brain MRI scans containing pathologies is challenging due to dramatic changes in tissue appearance. Although there has been progress in developing general-purpose medical image registration techniques, they have not yet attained the requisite precision and reliability for this task, highlighting its inherent complexity. Here we describe the Brain Tumor Sequence Registration (BraTS-Reg) challenge, as the first public benchmark environment for deformable registration algorithms focusing on estimating correspondences between pre-operative and follow-up scans of the same patient diagnosed with a diffuse brain glioma. The BraTS-Reg data comprise de-identified multi-institutional multi-parametric MRI (mpMRI) scans, curated for size and resolution according to a canonical anatomical template, and divided into training, validation, and testing sets. Clinical experts annotated ground truth (GT) landmark points of anatomical locations distinct across the temporal domain. Quantitative evaluation and ranking were based on the Median Euclidean Error (MEE), Robustness, and the determinant of the Jacobian of the displacement field. The top-ranked methodologies yielded similar performance across all evaluation metrics and shared several methodological commonalities, including pre-alignment, deep neural networks, inverse consistency analysis, and test-time instance optimization per-case basis as a post-processing step. The top-ranked method attained the MEE at or below that of the inter-rater variability for approximately 60% of the evaluated landmarks, underscoring the scope for further accuracy and robustness improvements, especially relative to human experts. The aim of BraTS-Reg is to continue to serve as an active resource for research, with the data and online evaluation tools accessible at https://bratsreg.github.io/.

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Biomedical image analysis competitions: The state of current participation practice

The number of international benchmarking competitions is steadily increasing in various fields of machine learning (ML) research and practice. So far, however, little is known about the common practice as well as bottlenecks faced by the community in tackling the research questions posed. To shed light on the status quo of algorithm development in the specific field of biomedical imaging analysis, we designed an international survey that was issued to all participants of challenges conducted in conjunction with the IEEE ISBI 2021 and MICCAI 2021 conferences (80 competitions in total). The survey covered participants' expertise and working environments, their chosen strategies, as well as algorithm characteristics. A median of 72% challenge participants took part in the survey. According to our results, knowledge exchange was the primary incentive (70%) for participation, while the reception of prize money played only a minor role (16%). While a median of 80 working hours was spent on method development, a large portion of participants stated that they did not have enough time for method development (32%). 25% perceived the infrastructure to be a bottleneck. Overall, 94% of all solutions were deep learning-based. Of these, 84% were based on standard architectures. 43% of the respondents reported that the data samples (e.g., images) were too large to be processed at once. This was most commonly addressed by patch-based training (69%), downsampling (37%), and solving 3D analysis tasks as a series of 2D tasks. K-fold cross-validation on the training set was performed by only 37% of the participants and only 50% of the participants performed ensembling based on multiple identical models (61%) or heterogeneous models (39%). 48% of the respondents applied postprocessing steps.

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Why is the winner the best?

International benchmarking competitions have become fundamental for the comparative performance assessment of image analysis methods. However, little attention has been given to investigating what can be learnt from these competitions. Do they really generate scientific progress? What are common and successful participation strategies? What makes a solution superior to a competing method? To address this gap in the literature, we performed a multi-center study with all 80 competitions that were conducted in the scope of IEEE ISBI 2021 and MICCAI 2021. Statistical analyses performed based on comprehensive descriptions of the submitted algorithms linked to their rank as well as the underlying participation strategies revealed common characteristics of winning solutions. These typically include the use of multi-task learning (63%) and/or multi-stage pipelines (61%), and a focus on augmentation (100%), image preprocessing (97%), data curation (79%), and postprocessing (66%). The "typical" lead of a winning team is a computer scientist with a doctoral degree, five years of experience in biomedical image analysis, and four years of experience in deep learning. Two core general development strategies stood out for highly-ranked teams: the reflection of the metrics in the method design and the focus on analyzing and handling failure cases. According to the organizers, 43% of the winning algorithms exceeded the state of the art but only 11% completely solved the respective domain problem. The insights of our study could help researchers (1) improve algorithm development strategies when approaching new problems, and (2) focus on open research questions revealed by this work.

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Learn2Reg: comprehensive multi-task medical image registration challenge, dataset and evaluation in the era of deep learning

Image registration is a fundamental medical image analysis task, and a wide variety of approaches have been proposed. However, only a few studies have comprehensively compared medical image registration approaches on a wide range of clinically relevant tasks. This limits the development of registration methods, the adoption of research advances into practice, and a fair benchmark across competing approaches. The Learn2Reg challenge addresses these limitations by providing a multi-task medical image registration data set for comprehensive characterisation of deformable registration algorithms. A continuous evaluation will be possible at https://learn2reg.grand-challenge.org. Learn2Reg covers a wide range of anatomies (brain, abdomen, and thorax), modalities (ultrasound, CT, MR), availability of annotations, as well as intra- and inter-patient registration evaluation. We established an easily accessible framework for training and validation of 3D registration methods, which enabled the compilation of results of over 65 individual method submissions from more than 20 unique teams. We used a complementary set of metrics, including robustness, accuracy, plausibility, and runtime, enabling unique insight into the current state-of-the-art of medical image registration. This paper describes datasets, tasks, evaluation methods and results of the challenge, as well as results of further analysis of transferability to new datasets, the importance of label supervision, and resulting bias. While no single approach worked best across all tasks, many methodological aspects could be identified that push the performance of medical image registration to new state-of-the-art performance. Furthermore, we demystified the common belief that conventional registration methods have to be much slower than deep-learning-based methods.

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CNN-based Lung CT Registration with Multiple Anatomical Constraints

Deep-learning-based registration methods emerged as a fast alternative to conventional registration methods. However, these methods often still cannot achieve the same performance as conventional registration methods because they are either limited to small deformation or they fail to handle a superposition of large and small deformations without producing implausible deformation fields with foldings inside. In this paper, we identify important strategies of conventional registration methods for lung registration and successfully developed the deep-learning counterpart. We employ a Gaussian-pyramid-based multilevel framework that can solve the image registration optimization in a coarse-to-fine fashion. Furthermore, we prevent foldings of the deformation field and restrict the determinant of the Jacobian to physiologically meaningful values by combining a volume change penalty with a curvature regularizer in the loss function. Keypoint correspondences are integrated to focus on the alignment of smaller structures. We perform an extensive evaluation to assess the accuracy, the robustness, the plausibility of the estimated deformation fields, and the transferability of our registration approach. We show that it achieves state-of-the-art results on the COPDGene dataset compared to conventional registration method with much shorter execution time. In our experiments on the DIRLab exhale to inhale lung registration, we demonstrate substantial improvements (TRE below $1.2$ mm) over other deep learning methods. Our algorithm is publicly available at https://grand-challenge.org/algorithms/deep-learning-based-ct-lung-registration/.

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Automatic segmentation of the pulmonary lobes with a 3D u-net and optimized loss function

Fully-automatic lung lobe segmentation is challenging due to anatomical variations, pathologies, and incomplete fissures. We trained a 3D u-net for pulmonary lobe segmentation on 49 mainly publically available datasets and introduced a weighted Dice loss function to emphasize the lobar boundaries. To validate the performance of the proposed method we compared the results to two other methods. The new loss function improved the mean distance to 1.46 mm (compared to 2.08 mm for simple loss function without weighting).

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mlVIRNET: Multilevel Variational Image Registration Network

We present a novel multilevel approach for deep learning based image registration. Recently published deep learning based registration methods have shown promising results for a wide range of tasks. However, these algorithms are still limited to relatively small deformations. Our method addresses this shortcoming by introducing a multilevel framework, which computes deformation fields on different scales, similar to conventional methods. Thereby, a coarse-level alignment is obtained first, which is subsequently improved on finer levels. We demonstrate our method on the complex task of inhale-to-exhale lung registration. We show that the use of a deep learning multilevel approach leads to significantly better registration results.

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Efficient Prealignment of CT Scans for Registration through a Bodypart Regressor

Convolutional neural networks have not only been applied for classification of voxels, objects, or images, for instance, but have also been proposed as a bodypart regressor. We pick up this underexplored idea and evaluate its value for registration: A CNN is trained to output the relative height within the human body in axial CT scans, and the resulting scores are used for quick alignment between different timepoints. Preliminary results confirm that this allows both fast and robust prealignment compared with iterative approaches.

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Enhancing Label-Driven Deep Deformable Image Registration with Local Distance Metrics for State-of-the-Art Cardiac Motion Tracking

While deep learning has achieved significant advances in accuracy for medical image segmentation, its benefits for deformable image registration have so far remained limited to reduced computation times. Previous work has either focused on replacing the iterative optimization of distance and smoothness terms with CNN-layers or using supervised approaches driven by labels. Our method is the first to combine the complementary strengths of global semantic information (represented by segmentation labels) and local distance metrics that help align surrounding structures. We demonstrate significant higher Dice scores (of 86.5\%) for deformable cardiac image registration compared to classic registration (79.0\%) as well as label-driven deep learning frameworks (83.4\%).

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