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Konstantinos Kamnitsas

Publications and source records attributed to Konstantinos Kamnitsas.

At least 37 records · Page 2Linked to original sources

Semi-Supervised Learning for Deep Causal Generative Models

Developing models that are capable of answering questions of the form "How would x change if y had been z?'" is fundamental to advancing medical image analysis. Training causal generative models that address such counterfactual questions, though, currently requires that all relevant variables have been observed and that the corresponding labels are available in the training data. However, clinical data may not have complete records for all patients and state of the art causal generative models are unable to take full advantage of this. We thus develop, for the first time, a semi-supervised deep causal generative model that exploits the causal relationships between variables to maximise the use of all available data. We explore this in the setting where each sample is either fully labelled or fully unlabelled, as well as the more clinically realistic case of having different labels missing for each sample. We leverage techniques from causal inference to infer missing values and subsequently generate realistic counterfactuals, even for samples with incomplete labels.

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An Organism Starts with a Single Pix-Cell: A Neural Cellular Diffusion for High-Resolution Image Synthesis

Generative modeling seeks to approximate the statistical properties of real data, enabling synthesis of new data that closely resembles the original distribution. Generative Adversarial Networks (GANs) and Denoising Diffusion Probabilistic Models (DDPMs) represent significant advancements in generative modeling, drawing inspiration from game theory and thermodynamics, respectively. Nevertheless, the exploration of generative modeling through the lens of biological evolution remains largely untapped. In this paper, we introduce a novel family of models termed Generative Cellular Automata (GeCA), inspired by the evolution of an organism from a single cell. GeCAs are evaluated as an effective augmentation tool for retinal disease classification across two imaging modalities: Fundus and Optical Coherence Tomography (OCT). In the context of OCT imaging, where data is scarce and the distribution of classes is inherently skewed, GeCA significantly boosts the performance of 11 different ophthalmological conditions, achieving a 12% increase in the average F1 score compared to conventional baselines. GeCAs outperform both diffusion methods that incorporate UNet or state-of-the art variants with transformer-based denoising models, under similar parameter constraints. Code is available at: https://github.com/xmed-lab/GeCA.

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IterMask2: Iterative Unsupervised Anomaly Segmentation via Spatial and Frequency Masking for Brain Lesions in MRI

Unsupervised anomaly segmentation approaches to pathology segmentation train a model on images of healthy subjects, that they define as the 'normal' data distribution. At inference, they aim to segment any pathologies in new images as 'anomalies', as they exhibit patterns that deviate from those in 'normal' training data. Prevailing methods follow the 'corrupt-and-reconstruct' paradigm. They intentionally corrupt an input image, reconstruct it to follow the learned 'normal' distribution, and subsequently segment anomalies based on reconstruction error. Corrupting an input image, however, inevitably leads to suboptimal reconstruction even of normal regions, causing false positives. To alleviate this, we propose a novel iterative spatial mask-refining strategy IterMask2. We iteratively mask areas of the image, reconstruct them, and update the mask based on reconstruction error. This iterative process progressively adds information about areas that are confidently normal as per the model. The increasing content guides reconstruction of nearby masked areas, improving reconstruction of normal tissue under these areas, reducing false positives. We also use high-frequency image content as an auxiliary input to provide additional structural information for masked areas. This further improves reconstruction error of normal in comparison to anomalous areas, facilitating segmentation of the latter. We conduct experiments on several brain lesion datasets and demonstrate effectiveness of our method. Code is available at: https://github.com/ZiyunLiang/IterMask2

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Feasibility and benefits of joint learning from MRI databases with different brain diseases and modalities for segmentation

Models for segmentation of brain lesions in multi-modal MRI are commonly trained for a specific pathology using a single database with a predefined set of MRI modalities, determined by a protocol for the specific disease. This work explores the following open questions: Is it feasible to train a model using multiple databases that contain varying sets of MRI modalities and annotations for different brain pathologies? Will this joint learning benefit performance on the sets of modalities and pathologies available during training? Will it enable analysis of new databases with different sets of modalities and pathologies? We develop and compare different methods and show that promising results can be achieved with appropriate, simple and practical alterations to the model and training framework. We experiment with 7 databases containing 5 types of brain pathologies and different sets of MRI modalities. Results demonstrate, for the first time, that joint training on multi-modal MRI databases with different brain pathologies and sets of modalities is feasible and offers practical benefits. It enables a single model to segment pathologies encountered during training in diverse sets of modalities, while facilitating segmentation of new types of pathologies such as via follow-up fine-tuning. The insights this study provides into the potential and limitations of this paradigm should prove useful for guiding future advances in the direction. Code and pretrained models: https://github.com/WenTXuL/MultiUnet

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As Firm As Their Foundations: Can open-sourced foundation models be used to create adversarial examples for downstream tasks?

Foundation models pre-trained on web-scale vision-language data, such as CLIP, are widely used as cornerstones of powerful machine learning systems. While pre-training offers clear advantages for downstream learning, it also endows downstream models with shared adversarial vulnerabilities that can be easily identified through the open-sourced foundation model. In this work, we expose such vulnerabilities in CLIP's downstream models and show that foundation models can serve as a basis for attacking their downstream systems. In particular, we propose a simple yet effective adversarial attack strategy termed Patch Representation Misalignment (PRM). Solely based on open-sourced CLIP vision encoders, this method produces adversaries that simultaneously fool more than 20 downstream models spanning 4 common vision-language tasks (semantic segmentation, object detection, image captioning and visual question-answering). Our findings highlight the concerning safety risks introduced by the extensive usage of public foundational models in the development of downstream systems, calling for extra caution in these scenarios.

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Examining Modality Incongruity in Multimodal Federated Learning for Medical Vision and Language-based Disease Detection

Multimodal Federated Learning (MMFL) utilizes multiple modalities in each client to build a more powerful Federated Learning (FL) model than its unimodal counterpart. However, the impact of missing modality in different clients, also called modality incongruity, has been greatly overlooked. This paper, for the first time, analyses the impact of modality incongruity and reveals its connection with data heterogeneity across participating clients. We particularly inspect whether incongruent MMFL with unimodal and multimodal clients is more beneficial than unimodal FL. Furthermore, we examine three potential routes of addressing this issue. Firstly, we study the effectiveness of various self-attention mechanisms towards incongruity-agnostic information fusion in MMFL. Secondly, we introduce a modality imputation network (MIN) pre-trained in a multimodal client for modality translation in unimodal clients and investigate its potential towards mitigating the missing modality problem. Thirdly, we assess the capability of client-level and server-level regularization techniques towards mitigating modality incongruity effects. Experiments are conducted under several MMFL settings on two publicly available real-world datasets, MIMIC-CXR and Open-I, with Chest X-Ray and radiology reports.

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Modality Cycles with Masked Conditional Diffusion for Unsupervised Anomaly Segmentation in MRI

Unsupervised anomaly segmentation aims to detect patterns that are distinct from any patterns processed during training, commonly called abnormal or out-of-distribution patterns, without providing any associated manual segmentations. Since anomalies during deployment can lead to model failure, detecting the anomaly can enhance the reliability of models, which is valuable in high-risk domains like medical imaging. This paper introduces Masked Modality Cycles with Conditional Diffusion (MMCCD), a method that enables segmentation of anomalies across diverse patterns in multimodal MRI. The method is based on two fundamental ideas. First, we propose the use of cyclic modality translation as a mechanism for enabling abnormality detection. Image-translation models learn tissue-specific modality mappings, which are characteristic of tissue physiology. Thus, these learned mappings fail to translate tissues or image patterns that have never been encountered during training, and the error enables their segmentation. Furthermore, we combine image translation with a masked conditional diffusion model, which attempts to `imagine' what tissue exists under a masked area, further exposing unknown patterns as the generative model fails to recreate them. We evaluate our method on a proxy task by training on healthy-looking slices of BraTS2021 multi-modality MRIs and testing on slices with tumors. We show that our method compares favorably to previous unsupervised approaches based on image reconstruction and denoising with autoencoders and diffusion models.

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On the use of Mahalanobis distance for out-of-distribution detection with neural networks for medical imaging

Implementing neural networks for clinical use in medical applications necessitates the ability for the network to detect when input data differs significantly from the training data, with the aim of preventing unreliable predictions. The community has developed several methods for out-of-distribution (OOD) detection, within which distance-based approaches - such as Mahalanobis distance - have shown potential. This paper challenges the prevailing community understanding that there is an optimal layer, or combination of layers, of a neural network for applying Mahalanobis distance for detection of any OOD pattern. Using synthetic artefacts to emulate OOD patterns, this paper shows the optimum layer to apply Mahalanobis distance changes with the type of OOD pattern, showing there is no one-fits-all solution. This paper also shows that separating this OOD detector into multiple detectors at different depths of the network can enhance the robustness for detecting different OOD patterns. These insights were validated on real-world OOD tasks, training models on CheXpert chest X-rays with no support devices, then using scans with unseen pacemakers (we manually labelled 50% of CheXpert for this research) and unseen sex as OOD cases. The results inform best-practices for the use of Mahalanobis distance for OOD detection. The manually annotated pacemaker labels and the project's code are available at: https://github.com/HarryAnthony/Mahalanobis-OOD-detection.

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Post-Deployment Adaptation with Access to Source Data via Federated Learning and Source-Target Remote Gradient Alignment

Deployment of Deep Neural Networks in medical imaging is hindered by distribution shift between training data and data processed after deployment, causing performance degradation. Post-Deployment Adaptation (PDA) addresses this by tailoring a pre-trained, deployed model to the target data distribution using limited labelled or entirely unlabelled target data, while assuming no access to source training data as they cannot be deployed with the model due to privacy concerns and their large size. This makes reliable adaptation challenging due to limited learning signal. This paper challenges this assumption and introduces FedPDA, a novel adaptation framework that brings the utility of learning from remote data from Federated Learning into PDA. FedPDA enables a deployed model to obtain information from source data via remote gradient exchange, while aiming to optimize the model specifically for the target domain. Tailored for FedPDA, we introduce a novel optimization method StarAlign (Source-Target Remote Gradient Alignment) that aligns gradients between source-target domain pairs by maximizing their inner product, to facilitate learning a target-specific model. We demonstrate the method's effectiveness using multi-center databases for the tasks of cancer metastases detection and skin lesion classification, where our method compares favourably to previous work. Code is available at: https://github.com/FelixWag/StarAlign

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Joint Optimization of Class-Specific Training- and Test-Time Data Augmentation in Segmentation

This paper presents an effective and general data augmentation framework for medical image segmentation. We adopt a computationally efficient and data-efficient gradient-based meta-learning scheme to explicitly align the distribution of training and validation data which is used as a proxy for unseen test data. We improve the current data augmentation strategies with two core designs. First, we learn class-specific training-time data augmentation (TRA) effectively increasing the heterogeneity within the training subsets and tackling the class imbalance common in segmentation. Second, we jointly optimize TRA and test-time data augmentation (TEA), which are closely connected as both aim to align the training and test data distribution but were so far considered separately in previous works. We demonstrate the effectiveness of our method on four medical image segmentation tasks across different scenarios with two state-of-the-art segmentation models, DeepMedic and nnU-Net. Extensive experimentation shows that the proposed data augmentation framework can significantly and consistently improve the segmentation performance when compared to existing solutions. Code is publicly available.

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Context Label Learning: Improving Background Class Representations in Semantic Segmentation

Background samples provide key contextual information for segmenting regions of interest (ROIs). However, they always cover a diverse set of structures, causing difficulties for the segmentation model to learn good decision boundaries with high sensitivity and precision. The issue concerns the highly heterogeneous nature of the background class, resulting in multi-modal distributions. Empirically, we find that neural networks trained with heterogeneous background struggle to map the corresponding contextual samples to compact clusters in feature space. As a result, the distribution over background logit activations may shift across the decision boundary, leading to systematic over-segmentation across different datasets and tasks. In this study, we propose context label learning (CoLab) to improve the context representations by decomposing the background class into several subclasses. Specifically, we train an auxiliary network as a task generator, along with the primary segmentation model, to automatically generate context labels that positively affect the ROI segmentation accuracy. Extensive experiments are conducted on several challenging segmentation tasks and datasets. The results demonstrate that CoLab can guide the segmentation model to map the logits of background samples away from the decision boundary, resulting in significantly improved segmentation accuracy. Code is available.

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Estimating Model Performance under Domain Shifts with Class-Specific Confidence Scores

Machine learning models are typically deployed in a test setting that differs from the training setting, potentially leading to decreased model performance because of domain shift. If we could estimate the performance that a pre-trained model would achieve on data from a specific deployment setting, for example a certain clinic, we could judge whether the model could safely be deployed or if its performance degrades unacceptably on the specific data. Existing approaches estimate this based on the confidence of predictions made on unlabeled test data from the deployment's domain. We find existing methods struggle with data that present class imbalance, because the methods used to calibrate confidence do not account for bias induced by class imbalance, consequently failing to estimate class-wise accuracy. Here, we introduce class-wise calibration within the framework of performance estimation for imbalanced datasets. Specifically, we derive class-specific modifications of state-of-the-art confidence-based model evaluation methods including temperature scaling (TS), difference of confidences (DoC), and average thresholded confidence (ATC). We also extend the methods to estimate Dice similarity coefficient (DSC) in image segmentation. We conduct experiments on four tasks and find the proposed modifications consistently improve the estimation accuracy for imbalanced datasets. Our methods improve accuracy estimation by 18\% in classification under natural domain shifts, and double the estimation accuracy on segmentation tasks, when compared with prior methods.

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Distributional Gaussian Processes Layers for Out-of-Distribution Detection

Machine learning models deployed on medical imaging tasks must be equipped with out-of-distribution detection capabilities in order to avoid erroneous predictions. It is unsure whether out-of-distribution detection models reliant on deep neural networks are suitable for detecting domain shifts in medical imaging. Gaussian Processes can reliably separate in-distribution data points from out-of-distribution data points via their mathematical construction. Hence, we propose a parameter efficient Bayesian layer for hierarchical convolutional Gaussian Processes that incorporates Gaussian Processes operating in Wasserstein-2 space to reliably propagate uncertainty. This directly replaces convolving Gaussian Processes with a distance-preserving affine operator on distributions. Our experiments on brain tissue-segmentation show that the resulting architecture approaches the performance of well-established deterministic segmentation algorithms (U-Net), which has not been achieved with previous hierarchical Gaussian Processes. Moreover, by applying the same segmentation model to out-of-distribution data (i.e., images with pathology such as brain tumors), we show that our uncertainty estimates result in out-of-distribution detection that outperforms the capabilities of previous Bayesian networks and reconstruction-based approaches that learn normative distributions. To facilitate future work our code is publicly available.

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Transductive image segmentation: Self-training and effect of uncertainty estimation

Semi-supervised learning (SSL) uses unlabeled data during training to learn better models. Previous studies on SSL for medical image segmentation focused mostly on improving model generalization to unseen data. In some applications, however, our primary interest is not generalization but to obtain optimal predictions on a specific unlabeled database that is fully available during model development. Examples include population studies for extracting imaging phenotypes. This work investigates an often overlooked aspect of SSL, transduction. It focuses on the quality of predictions made on the unlabeled data of interest when they are included for optimization during training, rather than improving generalization. We focus on the self-training framework and explore its potential for transduction. We analyze it through the lens of Information Gain and reveal that learning benefits from the use of calibrated or under-confident models. Our extensive experiments on a large MRI database for multi-class segmentation of traumatic brain lesions shows promising results when comparing transductive with inductive predictions. We believe this study will inspire further research on transductive learning, a well-suited paradigm for medical image analysis.

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Learning from Partially Overlapping Labels: Image Segmentation under Annotation Shift

Scarcity of high quality annotated images remains a limiting factor for training accurate image segmentation models. While more and more annotated datasets become publicly available, the number of samples in each individual database is often small. Combining different databases to create larger amounts of training data is appealing yet challenging due to the heterogeneity as a result of differences in data acquisition and annotation processes, often yielding incompatible or even conflicting information. In this paper, we investigate and propose several strategies for learning from partially overlapping labels in the context of abdominal organ segmentation. We find that combining a semi-supervised approach with an adaptive cross entropy loss can successfully exploit heterogeneously annotated data and substantially improve segmentation accuracy compared to baseline and alternative approaches.

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Confidence-based Out-of-Distribution Detection: A Comparative Study and Analysis

Image classification models deployed in the real world may receive inputs outside the intended data distribution. For critical applications such as clinical decision making, it is important that a model can detect such out-of-distribution (OOD) inputs and express its uncertainty. In this work, we assess the capability of various state-of-the-art approaches for confidence-based OOD detection through a comparative study and in-depth analysis. First, we leverage a computer vision benchmark to reproduce and compare multiple OOD detection methods. We then evaluate their capabilities on the challenging task of disease classification using chest X-rays. Our study shows that high performance in a computer vision task does not directly translate to accuracy in a medical imaging task. We analyse factors that affect performance of the methods between the two tasks. Our results provide useful insights for developing the next generation of OOD detection methods.

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Distributional Gaussian Process Layers for Outlier Detection in Image Segmentation

We propose a parameter efficient Bayesian layer for hierarchical convolutional Gaussian Processes that incorporates Gaussian Processes operating in Wasserstein-2 space to reliably propagate uncertainty. This directly replaces convolving Gaussian Processes with a distance-preserving affine operator on distributions. Our experiments on brain tissue-segmentation show that the resulting architecture approaches the performance of well-established deterministic segmentation algorithms (U-Net), which has never been achieved with previous hierarchical Gaussian Processes. Moreover, by applying the same segmentation model to out-of-distribution data (i.e., images with pathology such as brain tumors), we show that our uncertainty estimates result in out-of-distribution detection that outperforms the capabilities of previous Bayesian networks and reconstruction-based approaches that learn normative distributions.

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Analyzing Overfitting under Class Imbalance in Neural Networks for Image Segmentation

Class imbalance poses a challenge for developing unbiased, accurate predictive models. In particular, in image segmentation neural networks may overfit to the foreground samples from small structures, which are often heavily under-represented in the training set, leading to poor generalization. In this study, we provide new insights on the problem of overfitting under class imbalance by inspecting the network behavior. We find empirically that when training with limited data and strong class imbalance, at test time the distribution of logit activations may shift across the decision boundary, while samples of the well-represented class seem unaffected. This bias leads to a systematic under-segmentation of small structures. This phenomenon is consistently observed for different databases, tasks and network architectures. To tackle this problem, we introduce new asymmetric variants of popular loss functions and regularization techniques including a large margin loss, focal loss, adversarial training, mixup and data augmentation, which are explicitly designed to counter logit shift of the under-represented classes. Extensive experiments are conducted on several challenging segmentation tasks. Our results demonstrate that the proposed modifications to the objective function can lead to significantly improved segmentation accuracy compared to baselines and alternative approaches.

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