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Marius George Linguraru

Publications and source records attributed to Marius George Linguraru.

At least 37 records · Page 2Linked to original sources

SelfFed: Self-Supervised Federated Learning for Data Heterogeneity and Label Scarcity in Medical Images

Self-supervised learning in the federated learning paradigm has been gaining a lot of interest both in industry and research due to the collaborative learning capability on unlabeled yet isolated data. However, self-supervised based federated learning strategies suffer from performance degradation due to label scarcity and diverse data distributions, i.e., data heterogeneity. In this paper, we propose the SelfFed framework for medical images to overcome data heterogeneity and label scarcity issues. The first phase of the SelfFed framework helps to overcome the data heterogeneity issue by leveraging the pre-training paradigm that performs augmentative modeling using Swin Transformer-based encoder in a decentralized manner. The label scarcity issue is addressed by fine-tuning paradigm that introduces a contrastive network and a novel aggregation strategy. We perform our experimental analysis on publicly available medical imaging datasets to show that SelfFed performs better when compared to existing baselines and works. Our method achieves a maximum improvement of 8.8% and 4.1% on Retina and COVID-FL datasets on non-IID datasets. Further, our proposed method outperforms existing baselines even when trained on a few (10%) labeled instances.

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Magnetic Resonance Imaging Feature-Based Subtyping and Model Ensemble for Enhanced Brain Tumor Segmentation

Accurate and automatic segmentation of brain tumors in multi-parametric magnetic resonance imaging (mpMRI) is essential for quantitative measurements, which play an increasingly important role in clinical diagnosis and prognosis. The International Brain Tumor Segmentation (BraTS) Challenge 2024 offers a unique benchmarking opportunity, including various types of brain tumors in both adult and pediatric populations, such as pediatric brain tumors (PED), meningiomas (MEN-RT) and brain metastases (MET), among others. Compared to previous editions, BraTS 2024 has implemented changes to substantially increase clinical relevance, such as refined tumor regions for evaluation. We propose a deep learning-based ensemble approach that integrates state-of-the-art segmentation models. Additionally, we introduce innovative, adaptive pre- and post-processing techniques that employ MRI-based radiomic analyses to differentiate tumor subtypes. Given the heterogeneous nature of the tumors present in the BraTS datasets, this approach enhances the precision and generalizability of segmentation models. On the final testing sets, our method achieved mean lesion-wise Dice similarity coefficients of 0.926, 0.801, and 0.688 for the whole tumor in PED, MEN-RT, and MET, respectively. These results demonstrate the effectiveness of our approach in improving segmentation performance and generalizability for various brain tumor types. The source code of our implementation is available at https://github.com/Precision-Medical-Imaging-Group/HOPE-Segmenter-Kids. Additionally, an open-source web-application is accessible at https://segmenter.hope4kids.io/ which uses the docker container aparida12/brats-peds-2024:v20240913 .

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Adult Glioma Segmentation in Sub-Saharan Africa using Transfer Learning on Stratified Finetuning Data

Gliomas, a kind of brain tumor characterized by high mortality, present substantial diagnostic challenges in low- and middle-income countries, particularly in Sub-Saharan Africa. This paper introduces a novel approach to glioma segmentation using transfer learning to address challenges in resource-limited regions with minimal and low-quality MRI data. We leverage pre-trained deep learning models, nnU-Net and MedNeXt, and apply a stratified fine-tuning strategy using the BraTS2023-Adult-Glioma and BraTS-Africa datasets. Our method exploits radiomic analysis to create stratified training folds, model training on a large brain tumor dataset, and transfer learning to the Sub-Saharan context. A weighted model ensembling strategy and adaptive post-processing are employed to enhance segmentation accuracy. The evaluation of our proposed method on unseen validation cases on the BraTS-Africa 2024 task resulted in lesion-wise mean Dice scores of 0.870, 0.865, and 0.926, for enhancing tumor, tumor core, and whole tumor regions and was ranked first for the challenge. Our approach highlights the ability of integrated machine-learning techniques to bridge the gap between the medical imaging capabilities of resource-limited countries and established developed regions. By tailoring our methods to a target population's specific needs and constraints, we aim to enhance diagnostic capabilities in isolated environments. Our findings underscore the importance of approaches like local data integration and stratification refinement to address healthcare disparities, ensure practical applicability, and enhance impact. A dockerized version of the BraTS-Africa 2024 winning algorithm is available at https://hub.docker.com/r/aparida12/brats-ssa-2024 .

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The Brain Tumor Segmentation (BraTS-METS) Challenge 2023: Brain Metastasis Segmentation on Pre-treatment MRI

The translation of AI-generated brain metastases (BM) segmentation into clinical practice relies heavily on diverse, high-quality annotated medical imaging datasets. The BraTS-METS 2023 challenge has gained momentum for testing and benchmarking algorithms using rigorously annotated internationally compiled real-world datasets. This study presents the results of the segmentation challenge and characterizes the challenging cases that impacted the performance of the winning algorithms. Untreated brain metastases on standard anatomic MRI sequences (T1, T2, FLAIR, T1PG) from eight contributed international datasets were annotated in stepwise method: published UNET algorithms, student, neuroradiologist, final approver neuroradiologist. Segmentations were ranked based on lesion-wise Dice and Hausdorff distance (HD95) scores. False positives (FP) and false negatives (FN) were rigorously penalized, receiving a score of 0 for Dice and a fixed penalty of 374 for HD95. Eight datasets comprising 1303 studies were annotated, with 402 studies (3076 lesions) released on Synapse as publicly available datasets to challenge competitors. Additionally, 31 studies (139 lesions) were held out for validation, and 59 studies (218 lesions) were used for testing. Segmentation accuracy was measured as rank across subjects, with the winning team achieving a LesionWise mean score of 7.9. Common errors among the leading teams included false negatives for small lesions and misregistration of masks in space.The BraTS-METS 2023 challenge successfully curated well-annotated, diverse datasets and identified common errors, facilitating the translation of BM segmentation across varied clinical environments and providing personalized volumetric reports to patients undergoing BM treatment.

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The Brain Tumor Segmentation (BraTS) Challenge 2023: Brain MR Image Synthesis for Tumor Segmentation (BraSyn)

Automated brain tumor segmentation methods have become well-established and reached performance levels offering clear clinical utility. These methods typically rely on four input magnetic resonance imaging (MRI) modalities: T1-weighted images with and without contrast enhancement, T2-weighted images, and FLAIR images. However, some sequences are often missing in clinical practice due to time constraints or image artifacts, such as patient motion. Consequently, the ability to substitute missing modalities and gain segmentation performance is highly desirable and necessary for the broader adoption of these algorithms in the clinical routine. In this work, we present the establishment of the Brain MR Image Synthesis Benchmark (BraSyn) in conjunction with the Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2023. The primary objective of this challenge is to evaluate image synthesis methods that can realistically generate missing MRI modalities when multiple available images are provided. The ultimate aim is to facilitate automated brain tumor segmentation pipelines. The image dataset used in the benchmark is diverse and multi-modal, created through collaboration with various hospitals and research institutions.

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The Brain Tumor Segmentation (BraTS) Challenge: Local Synthesis of Healthy Brain Tissue via Inpainting

A myriad of algorithms for the automatic analysis of brain MR images is available to support clinicians in their decision-making. For brain tumor patients, the image acquisition time series typically starts with an already pathological scan. This poses problems, as many algorithms are designed to analyze healthy brains and provide no guarantee for images featuring lesions. Examples include, but are not limited to, algorithms for brain anatomy parcellation, tissue segmentation, and brain extraction. To solve this dilemma, we introduce the BraTS inpainting challenge. Here, the participants explore inpainting techniques to synthesize healthy brain scans from lesioned ones. The following manuscript contains the task formulation, dataset, and submission procedure. Later, it will be updated to summarize the findings of the challenge. The challenge is organized as part of the ASNR-BraTS MICCAI challenge.

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Model Ensemble for Brain Tumor Segmentation in Magnetic Resonance Imaging

Segmenting brain tumors in multi-parametric magnetic resonance imaging enables performing quantitative analysis in support of clinical trials and personalized patient care. This analysis provides the potential to impact clinical decision-making processes, including diagnosis and prognosis. In 2023, the well-established Brain Tumor Segmentation (BraTS) challenge presented a substantial expansion with eight tasks and 4,500 brain tumor cases. In this paper, we present a deep learning-based ensemble strategy that is evaluated for newly included tumor cases in three tasks: pediatric brain tumors (PED), intracranial meningioma (MEN), and brain metastases (MET). In particular, we ensemble outputs from state-of-the-art nnU-Net and Swin UNETR models on a region-wise basis. Furthermore, we implemented a targeted post-processing strategy based on a cross-validated threshold search to improve the segmentation results for tumor sub-regions. The evaluation of our proposed method on unseen test cases for the three tasks resulted in lesion-wise Dice scores for PED: 0.653, 0.809, 0.826; MEN: 0.876, 0.867, 0.849; and MET: 0.555, 0.6, 0.58; for the enhancing tumor, tumor core, and whole tumor, respectively. Our method was ranked first for PED, third for MEN, and fourth for MET, respectively.

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D-Rax: Domain-specific Radiologic assistant leveraging multi-modal data and eXpert model predictions

Large vision language models (VLMs) have progressed incredibly from research to applicability for general-purpose use cases. LLaVA-Med, a pioneering large language and vision assistant for biomedicine, can perform multi-modal biomedical image and data analysis to provide a natural language interface for radiologists. While it is highly generalizable and works with multi-modal data, it is currently limited by well-known challenges that exist in the large language model space. Hallucinations and imprecision in responses can lead to misdiagnosis which currently hinder the clinical adaptability of VLMs. To create precise, user-friendly models in healthcare, we propose D-Rax -- a domain-specific, conversational, radiologic assistance tool that can be used to gain insights about a particular radiologic image. In this study, we enhance the conversational analysis of chest X-ray (CXR) images to support radiological reporting, offering comprehensive insights from medical imaging and aiding in the formulation of accurate diagnosis. D-Rax is achieved by fine-tuning the LLaVA-Med architecture on our curated enhanced instruction-following data, comprising of images, instructions, as well as disease diagnosis and demographic predictions derived from MIMIC-CXR imaging data, CXR-related visual question answer (VQA) pairs, and predictive outcomes from multiple expert AI models. We observe statistically significant improvement in responses when evaluated for both open and close-ended conversations. Leveraging the power of state-of-the-art diagnostic models combined with VLMs, D-Rax empowers clinicians to interact with medical images using natural language, which could potentially streamline their decision-making process, enhance diagnostic accuracy, and conserve their time.

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The Brain Tumor Segmentation in Pediatrics (BraTS-PEDs) Challenge: Focus on Pediatrics (CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs)

Pediatric tumors of the central nervous system are the most common cause of cancer-related death in children. The five-year survival rate for high-grade gliomas in children is less than 20%. Due to their rarity, the diagnosis of these entities is often delayed, their treatment is mainly based on historic treatment concepts, and clinical trials require multi-institutional collaborations. Here we present the CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs challenge, focused on pediatric brain tumors with data acquired across multiple international consortia dedicated to pediatric neuro-oncology and clinical trials. The CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs challenge brings together clinicians and AI/imaging scientists to lead to faster development of automated segmentation techniques that could benefit clinical trials, and ultimately the care of children with brain tumors.

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FUTURE-AI: International consensus guideline for trustworthy and deployable artificial intelligence in healthcare

Despite major advances in artificial intelligence (AI) for medicine and healthcare, the deployment and adoption of AI technologies remain limited in real-world clinical practice. In recent years, concerns have been raised about the technical, clinical, ethical and legal risks associated with medical AI. To increase real world adoption, it is essential that medical AI tools are trusted and accepted by patients, clinicians, health organisations and authorities. This work describes the FUTURE-AI guideline as the first international consensus framework for guiding the development and deployment of trustworthy AI tools in healthcare. The FUTURE-AI consortium was founded in 2021 and currently comprises 118 inter-disciplinary experts from 51 countries representing all continents, including AI scientists, clinicians, ethicists, and social scientists. Over a two-year period, the consortium defined guiding principles and best practices for trustworthy AI through an iterative process comprising an in-depth literature review, a modified Delphi survey, and online consensus meetings. The FUTURE-AI framework was established based on 6 guiding principles for trustworthy AI in healthcare, i.e. Fairness, Universality, Traceability, Usability, Robustness and Explainability. Through consensus, a set of 28 best practices were defined, addressing technical, clinical, legal and socio-ethical dimensions. The recommendations cover the entire lifecycle of medical AI, from design, development and validation to regulation, deployment, and monitoring. FUTURE-AI is a risk-informed, assumption-free guideline which provides a structured approach for constructing medical AI tools that will be trusted, deployed and adopted in real-world practice. Researchers are encouraged to take the recommendations into account in proof-of-concept stages to facilitate future translation towards clinical practice of medical AI.

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Lung-CADex: Fully automatic Zero-Shot Detection and Classification of Lung Nodules in Thoracic CT Images

Lung cancer has been one of the major threats to human life for decades. Computer-aided diagnosis can help with early lung nodul detection and facilitate subsequent nodule characterization. Large Visual Language models (VLMs) have been found effective for multiple downstream medical tasks that rely on both imaging and text data. However, lesion level detection and subsequent diagnosis using VLMs have not been explored yet. We propose CADe, for segmenting lung nodules in a zero-shot manner using a variant of the Segment Anything Model called MedSAM. CADe trains on a prompt suite on input computed tomography (CT) scans by using the CLIP text encoder through prefix tuning. We also propose, CADx, a method for the nodule characterization as benign/malignant by making a gallery of radiomic features and aligning image-feature pairs through contrastive learning. Training and validation of CADe and CADx have been done using one of the largest publicly available datasets, called LIDC. To check the generalization ability of the model, it is also evaluated on a challenging dataset, LUNGx. Our experimental results show that the proposed methods achieve a sensitivity of 0.86 compared to 0.76 that of other fully supervised methods.The source code, datasets and pre-processed data can be accessed using the link:

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The 2024 Brain Tumor Segmentation (BraTS) Challenge: Glioma Segmentation on Post-treatment MRI

Gliomas are the most common malignant primary brain tumors in adults and one of the deadliest types of cancer. There are many challenges in treatment and monitoring due to the genetic diversity and high intrinsic heterogeneity in appearance, shape, histology, and treatment response. Treatments include surgery, radiation, and systemic therapies, with magnetic resonance imaging (MRI) playing a key role in treatment planning and post-treatment longitudinal assessment. The 2024 Brain Tumor Segmentation (BraTS) challenge on post-treatment glioma MRI will provide a community standard and benchmark for state-of-the-art automated segmentation models based on the largest expert-annotated post-treatment glioma MRI dataset. Challenge competitors will develop automated segmentation models to predict four distinct tumor sub-regions consisting of enhancing tissue (ET), surrounding non-enhancing T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity (SNFH), non-enhancing tumor core (NETC), and resection cavity (RC). Models will be evaluated on separate validation and test datasets using standardized performance metrics utilized across the BraTS 2024 cluster of challenges, including lesion-wise Dice Similarity Coefficient and Hausdorff Distance. Models developed during this challenge will advance the field of automated MRI segmentation and contribute to their integration into clinical practice, ultimately enhancing patient care.

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The Brain Tumor Segmentation (BraTS) Challenge 2023: Focus on Pediatrics (CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs)

Pediatric tumors of the central nervous system are the most common cause of cancer-related death in children. The five-year survival rate for high-grade gliomas in children is less than 20\%. Due to their rarity, the diagnosis of these entities is often delayed, their treatment is mainly based on historic treatment concepts, and clinical trials require multi-institutional collaborations. The MICCAI Brain Tumor Segmentation (BraTS) Challenge is a landmark community benchmark event with a successful history of 12 years of resource creation for the segmentation and analysis of adult glioma. Here we present the CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs 2023 challenge, which represents the first BraTS challenge focused on pediatric brain tumors with data acquired across multiple international consortia dedicated to pediatric neuro-oncology and clinical trials. The BraTS-PEDs 2023 challenge focuses on benchmarking the development of volumentric segmentation algorithms for pediatric brain glioma through standardized quantitative performance evaluation metrics utilized across the BraTS 2023 cluster of challenges. Models gaining knowledge from the BraTS-PEDs multi-parametric structural MRI (mpMRI) training data will be evaluated on separate validation and unseen test mpMRI dataof high-grade pediatric glioma. The CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs 2023 challenge brings together clinicians and AI/imaging scientists to lead to faster development of automated segmentation techniques that could benefit clinical trials, and ultimately the care of children with brain tumors.

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A multi-institutional pediatric dataset of clinical radiology MRIs by the Children's Brain Tumor Network

Pediatric brain and spinal cancers remain the leading cause of cancer-related death in children. Advancements in clinical decision-support in pediatric neuro-oncology utilizing the wealth of radiology imaging data collected through standard care, however, has significantly lagged other domains. Such data is ripe for use with predictive analytics such as artificial intelligence (AI) methods, which require large datasets. To address this unmet need, we provide a multi-institutional, large-scale pediatric dataset of 23,101 multi-parametric MRI exams acquired through routine care for 1,526 brain tumor patients, as part of the Children's Brain Tumor Network. This includes longitudinal MRIs across various cancer diagnoses, with associated patient-level clinical information, digital pathology slides, as well as tissue genotype and omics data. To facilitate downstream analysis, treatment-naïve images for 370 subjects were processed and released through the NCI Childhood Cancer Data Initiative via the Cancer Data Service. Through ongoing efforts to continuously build these imaging repositories, our aim is to accelerate discovery and translational AI models with real-world data, to ultimately empower precision medicine for children.

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Harmonization Across Imaging Locations(HAIL): One-Shot Learning for Brain MRI

For machine learning-based prognosis and diagnosis of rare diseases, such as pediatric brain tumors, it is necessary to gather medical imaging data from multiple clinical sites that may use different devices and protocols. Deep learning-driven harmonization of radiologic images relies on generative adversarial networks (GANs). However, GANs notoriously generate pseudo structures that do not exist in the original training data, a phenomenon known as "hallucination". To prevent hallucination in medical imaging, such as magnetic resonance images (MRI) of the brain, we propose a one-shot learning method where we utilize neural style transfer for harmonization. At test time, the method uses one image from a clinical site to generate an image that matches the intensity scale of the collaborating sites. Our approach combines learning a feature extractor, neural style transfer, and adaptive instance normalization. We further propose a novel strategy to evaluate the effectiveness of image harmonization approaches with evaluation metrics that both measure image style harmonization and assess the preservation of anatomical structures. Experimental results demonstrate the effectiveness of our method in preserving patient anatomy while adjusting the image intensities to a new clinical site. Our general harmonization model can be used on unseen data from new sites, making it a valuable tool for real-world medical applications and clinical trials.

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SPCXR: Self-supervised Pretraining using Chest X-rays Towards a Domain Specific Foundation Model

Chest X-rays (CXRs) are a widely used imaging modality for the diagnosis and prognosis of lung disease. The image analysis tasks vary. Examples include pathology detection and lung segmentation. There is a large body of work where machine learning algorithms are developed for specific tasks. A significant recent example is Coronavirus disease (covid-19) detection using CXR data. However, the traditional diagnostic tool design methods based on supervised learning are burdened by the need to provide training data annotation, which should be of good quality for better clinical outcomes. Here, we propose an alternative solution, a new self-supervised paradigm, where a general representation from CXRs is learned using a group-masked self-supervised framework. The pre-trained model is then fine-tuned for domain-specific tasks such as covid-19, pneumonia detection, and general health screening. We show that the same pre-training can be used for the lung segmentation task. Our proposed paradigm shows robust performance in multiple downstream tasks which demonstrates the success of the pre-training. Moreover, the performance of the pre-trained models on data with significant drift during test time proves the learning of a better generic representation. The methods are further validated by covid-19 detection in a unique small-scale pediatric data set. The performance gain in accuracy (~25%) is significant when compared to a supervised transformer-based method. This adds credence to the strength and reliability of our proposed framework and pre-training strategy.

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The ASNR-MICCAI Brain Tumor Segmentation (BraTS) Challenge 2023: Intracranial Meningioma

Meningiomas are the most common primary intracranial tumor in adults and can be associated with significant morbidity and mortality. Radiologists, neurosurgeons, neuro-oncologists, and radiation oncologists rely on multiparametric MRI (mpMRI) for diagnosis, treatment planning, and longitudinal treatment monitoring; yet automated, objective, and quantitative tools for non-invasive assessment of meningiomas on mpMRI are lacking. The BraTS meningioma 2023 challenge will provide a community standard and benchmark for state-of-the-art automated intracranial meningioma segmentation models based on the largest expert annotated multilabel meningioma mpMRI dataset to date. Challenge competitors will develop automated segmentation models to predict three distinct meningioma sub-regions on MRI including enhancing tumor, non-enhancing tumor core, and surrounding nonenhancing T2/FLAIR hyperintensity. Models will be evaluated on separate validation and held-out test datasets using standardized metrics utilized across the BraTS 2023 series of challenges including the Dice similarity coefficient and Hausdorff distance. The models developed during the course of this challenge will aid in incorporation of automated meningioma MRI segmentation into clinical practice, which will ultimately improve care of patients with meningioma.

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BabyNet: Reconstructing 3D faces of babies from uncalibrated photographs

We present a 3D face reconstruction system that aims at recovering the 3D facial geometry of babies from uncalibrated photographs, BabyNet. Since the 3D facial geometry of babies differs substantially from that of adults, baby-specific facial reconstruction systems are needed. BabyNet consists of two stages: 1) a 3D graph convolutional autoencoder learns a latent space of the baby 3D facial shape; and 2) a 2D encoder that maps photographs to the 3D latent space based on representative features extracted using transfer learning. In this way, using the pre-trained 3D decoder, we can recover a 3D face from 2D images. We evaluate BabyNet and show that 1) methods based on adult datasets cannot model the 3D facial geometry of babies, which proves the need for a baby-specific method, and 2) BabyNet outperforms classical model-fitting methods even when a baby-specific 3D morphable model, such as BabyFM, is used.

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