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Michael Fulham

Publications and source records attributed to Michael Fulham.

At least 19 recordsLinked to original sources

Heterogeneity-Aware Deep Learning for Tumour Classification from Multiparametric MRI

Intra-tumoural heterogeneity (ITH) reflects spatial variation in tumour biology and is an important determinant of tumour behaviour, prognosis, and treatment response. Radiomics and deep learning have shown promise for tumour classification from multiparametric MRI (mp-MRI), but radiomics relies on handcrafted features, while most deep learning methods use whole-tumour representations or manually defined sub-regions, limiting scalable modelling of tumour heterogeneity. We propose a Heterogeneity-Aware Deep Learning Classification (HA-DLC) framework that explicitly models imaging-derived tumour sub-regions for lesion-type diagnosis and molecular-status prediction. HA-DLC consists of: (1) a Heterogeneous Sub-region Generation (HSG) module that produces initial pseudo-labelled sub-regions via unsupervised clustering, followed by Cross-Patient Sub-region Alignment (CPSA), which maps cluster-derived regions to a shared label space using soft assignments; and (2) a Dual-Stream Feature Extraction (DSFE) module that integrates local heterogeneity-aware features with global tumour representations. Given the initial clustering masks, CPSA, segmentation, feature extraction, and classification are jointly optimized end-to-end using soft-target segmentation and classification objectives. We evaluate HA-DLC on the LLD-MMRI2023 liver lesion dataset and the RSNA-ASNR-MICCAI 2021 Radiogenomic Brain Tumour dataset. HA-DLC consistently outperforms state-of-the-art radiomics and deep learning baselines, demonstrating the value of cross-patient sub-region alignment and dual-stream heterogeneity modelling for tumour classification from mp-MRI.

cs.CV

MAISY: Motion-Aware Image SYnthesis for Medical Image Motion Correction

Patient motion during medical image acquisition causes blurring, ghosting, and distorts organs, which makes image interpretation challenging. Current state-of-the-art algorithms using Generative Adversarial Network (GAN)-based methods with their ability to learn the mappings between corrupted images and their ground truth via Structural Similarity Index Measure (SSIM) loss effectively generate motion-free images. However, we identified the following limitations: (i) they mainly focus on global structural characteristics and therefore overlook localized features that often carry critical pathological information, and (ii) the SSIM loss function struggles to handle images with varying pixel intensities, luminance factors, and variance. In this study, we propose Motion-Aware Image SYnthesis (MAISY) which initially characterize motion and then uses it for correction by: (a) leveraging the foundation model Segment Anything Model (SAM), to dynamically learn spatial patterns along anatomical boundaries where motion artifacts are most pronounced and, (b) introducing the Variance-Selective SSIM (VS-SSIM) loss which adaptively emphasizes spatial regions with high pixel variance to preserve essential anatomical details during artifact correction. Experiments on chest and head CT datasets demonstrate that our model outperformed the state-of-the-art counterparts, with Peak Signal-to-Noise Ratio (PSNR) increasing by 40%, SSIM by 10%, and Dice by 16%.

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Advancing Deformable Medical Image Registration with Multi-axis Cross-covariance Attention

Deformable image registration is a fundamental requirement for medical image analysis. Recently, transformers have been widely used in deep learning-based registration methods for their ability to capture long-range dependency via self-attention (SA). However, the high computation and memory loads of SA (growing quadratically with the spatial resolution) hinder transformers from processing subtle textural information in high-resolution image features, e.g., at the full and half image resolutions. This limits deformable registration as the high-resolution textural information is crucial for finding precise pixel-wise correspondence between subtle anatomical structures. Cross-covariance Attention (XCA), as a "transposed" version of SA that operates across feature channels, has complexity growing linearly with the spatial resolution, providing the feasibility of capturing long-range dependency among high-resolution image features. However, existing XCA-based transformers merely capture coarse global long-range dependency, which are unsuitable for deformable image registration relying primarily on fine-grained local correspondence. In this study, we propose to improve existing deep learning-based registration methods by embedding a new XCA mechanism. To this end, we design an XCA-based transformer block optimized for deformable medical image registration, named Multi-Axis XCA (MAXCA). Our MAXCA serves as a general network block that can be embedded into various registration network architectures. It can capture both global and local long-range dependency among high-resolution image features by applying regional and dilated XCA in parallel via a multi-axis design. Extensive experiments on two well-benchmarked inter-/intra-patient registration tasks with seven public medical datasets demonstrate that our MAXCA block enables state-of-the-art registration performance.

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Language-guided Medical Image Segmentation with Target-informed Multi-level Contrastive Alignments

Medical image segmentation is a fundamental task in numerous medical engineering applications. Recently, language-guided segmentation has shown promise in medical scenarios where textual clinical reports are readily available as semantic guidance. Clinical reports contain diagnostic information provided by clinicians, which can provide auxiliary textual semantics to guide segmentation. However, existing language-guided segmentation methods neglect the inherent pattern gaps between image and text modalities, resulting in sub-optimal visual-language integration. Contrastive learning is a well-recognized approach to align image-text patterns, but it has not been optimized for bridging the pattern gaps in medical language-guided segmentation that relies primarily on medical image details to characterize the underlying disease/targets. Current contrastive alignment techniques typically align high-level global semantics without involving low-level localized target information, and thus cannot deliver fine-grained textual guidance on crucial image details. In this study, we propose a Target-informed Multi-level Contrastive Alignment framework (TMCA) to bridge image-text pattern gaps for medical language-guided segmentation. TMCA enables target-informed image-text alignments and fine-grained textual guidance by introducing: (i) a target-sensitive semantic distance module that utilizes target information for more granular image-text alignment modeling, (ii) a multi-level contrastive alignment strategy that directs fine-grained textual guidance to multi-scale image details, and (iii) a language-guided target enhancement module that reinforces attention to critical image regions based on the aligned image-text patterns. Extensive experiments on four public benchmark datasets demonstrate that TMCA enabled superior performance over state-of-the-art language-guided medical image segmentation methods.

cs.CV

Hyper-Fusion Network for Semi-Automatic Segmentation of Skin Lesions

Automatic skin lesion segmentation methods based on fully convolutional networks (FCNs) are regarded as the state-of-the-art for accuracy. When there are, however, insufficient training data to cover all the variations in skin lesions, where lesions from different patients may have major differences in size/shape/texture, these methods failed to segment the lesions that have image characteristics, which are less common in the training datasets. FCN-based semi-automatic segmentation methods, which fuse user-inputs with high-level semantic image features derived from FCNs offer an ideal complement to overcome limitations of automatic segmentation methods. These semi-automatic methods rely on the automated state-of-the-art FCNs coupled with user-inputs for refinements, and therefore being able to tackle challenging skin lesions. However, there are a limited number of FCN-based semi-automatic segmentation methods and all these methods focused on early-fusion, where the first few convolutional layers are used to fuse image features and user-inputs and then derive fused image features for segmentation. For early-fusion based methods, because the user-input information can be lost after the first few convolutional layers, consequently, the user-input information will have limited guidance and constraint in segmenting the challenging skin lesions with inhomogeneous textures and fuzzy boundaries. Hence, in this work, we introduce a hyper-fusion network (HFN) to fuse the extracted user-inputs and image features over multiple stages. We separately extract complementary features which then allows for an iterative use of user-inputs along all the fusion stages to refine the segmentation. We evaluated our HFN on ISIC 2017, ISIC 2016 and PH2 datasets, and our results show that the HFN is more accurate and generalizable than the state-of-the-art methods.

cs.CV

Enhancing medical vision-language contrastive learning via inter-matching relation modelling

Medical image representations can be learned through medical vision-language contrastive learning (mVLCL) where medical imaging reports are used as weak supervision through image-text alignment. These learned image representations can be transferred to and benefit various downstream medical vision tasks such as disease classification and segmentation. Recent mVLCL methods attempt to align image sub-regions and the report keywords as local-matchings. However, these methods aggregate all local-matchings via simple pooling operations while ignoring the inherent relations between them. These methods therefore fail to reason between local-matchings that are semantically related, e.g., local-matchings that correspond to the disease word and the location word (semantic-relations), and also fail to differentiate such clinically important local-matchings from others that correspond to less meaningful words, e.g., conjunction words (importance-relations). Hence, we propose a mVLCL method that models the inter-matching relations between local-matchings via a relation-enhanced contrastive learning framework (RECLF). In RECLF, we introduce a semantic-relation reasoning module (SRM) and an importance-relation reasoning module (IRM) to enable more fine-grained report supervision for image representation learning. We evaluated our method using six public benchmark datasets on four downstream tasks, including segmentation, zero-shot classification, linear classification, and cross-modal retrieval. Our results demonstrated the superiority of our RECLF over the state-of-the-art mVLCL methods with consistent improvements across single-modal and cross-modal tasks. These results suggest that our RECLF, by modelling the inter-matching relations, can learn improved medical image representations with better generalization capabilities.

cs.CV

PET Synthesis via Self-supervised Adaptive Residual Estimation Generative Adversarial Network

Positron emission tomography (PET) is a widely used, highly sensitive molecular imaging in clinical diagnosis. There is interest in reducing the radiation exposure from PET but also maintaining adequate image quality. Recent methods using convolutional neural networks (CNNs) to generate synthesized high-quality PET images from low-dose counterparts have been reported to be state-of-the-art for low-to-high image recovery methods. However, these methods are prone to exhibiting discrepancies in texture and structure between synthesized and real images. Furthermore, the distribution shift between low-dose PET and standard PET has not been fully investigated. To address these issues, we developed a self-supervised adaptive residual estimation generative adversarial network (SS-AEGAN). We introduce (1) An adaptive residual estimation mapping mechanism, AE-Net, designed to dynamically rectify the preliminary synthesized PET images by taking the residual map between the low-dose PET and synthesized output as the input, and (2) A self-supervised pre-training strategy to enhance the feature representation of the coarse generator. Our experiments with a public benchmark dataset of total-body PET images show that SS-AEGAN consistently outperformed the state-of-the-art synthesis methods with various dose reduction factors.

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AutoFuse: Automatic Fusion Networks for Deformable Medical Image Registration

Deformable image registration aims to find a dense non-linear spatial correspondence between a pair of images, which is a crucial step for many medical tasks such as tumor growth monitoring and population analysis. Recently, Deep Neural Networks (DNNs) have been widely recognized for their ability to perform fast end-to-end registration. However, DNN-based registration needs to explore the spatial information of each image and fuse this information to characterize spatial correspondence. This raises an essential question: what is the optimal fusion strategy to characterize spatial correspondence? Existing fusion strategies (e.g., early fusion, late fusion) were empirically designed to fuse information by manually defined prior knowledge, which inevitably constrains the registration performance within the limits of empirical designs. In this study, we depart from existing empirically-designed fusion strategies and develop a data-driven fusion strategy for deformable image registration. To achieve this, we propose an Automatic Fusion network (AutoFuse) that provides flexibility to fuse information at many potential locations within the network. A Fusion Gate (FG) module is also proposed to control how to fuse information at each potential network location based on training data. Our AutoFuse can automatically optimize its fusion strategy during training and can be generalizable to both unsupervised registration (without any labels) and semi-supervised registration (with weak labels provided for partial training data). Extensive experiments on two well-benchmarked medical registration tasks (inter- and intra-patient registration) with eight public datasets show that our AutoFuse outperforms state-of-the-art unsupervised and semi-supervised registration methods.

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Merging-Diverging Hybrid Transformer Networks for Survival Prediction in Head and Neck Cancer

Survival prediction is crucial for cancer patients as it provides early prognostic information for treatment planning. Recently, deep survival models based on deep learning and medical images have shown promising performance for survival prediction. However, existing deep survival models are not well developed in utilizing multi-modality images (e.g., PET-CT) and in extracting region-specific information (e.g., the prognostic information in Primary Tumor (PT) and Metastatic Lymph Node (MLN) regions). In view of this, we propose a merging-diverging learning framework for survival prediction from multi-modality images. This framework has a merging encoder to fuse multi-modality information and a diverging decoder to extract region-specific information. In the merging encoder, we propose a Hybrid Parallel Cross-Attention (HPCA) block to effectively fuse multi-modality features via parallel convolutional layers and cross-attention transformers. In the diverging decoder, we propose a Region-specific Attention Gate (RAG) block to screen out the features related to lesion regions. Our framework is demonstrated on survival prediction from PET-CT images in Head and Neck (H&N) cancer, by designing an X-shape merging-diverging hybrid transformer network (named XSurv). Our XSurv combines the complementary information in PET and CT images and extracts the region-specific prognostic information in PT and MLN regions. Extensive experiments on the public dataset of HEad and neCK TumOR segmentation and outcome prediction challenge (HECKTOR 2022) demonstrate that our XSurv outperforms state-of-the-art survival prediction methods.

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Non-iterative Coarse-to-fine Transformer Networks for Joint Affine and Deformable Image Registration

Image registration is a fundamental requirement for medical image analysis. Deep registration methods based on deep learning have been widely recognized for their capabilities to perform fast end-to-end registration. Many deep registration methods achieved state-of-the-art performance by performing coarse-to-fine registration, where multiple registration steps were iterated with cascaded networks. Recently, Non-Iterative Coarse-to-finE (NICE) registration methods have been proposed to perform coarse-to-fine registration in a single network and showed advantages in both registration accuracy and runtime. However, existing NICE registration methods mainly focus on deformable registration, while affine registration, a common prerequisite, is still reliant on time-consuming traditional optimization-based methods or extra affine registration networks. In addition, existing NICE registration methods are limited by the intrinsic locality of convolution operations. Transformers may address this limitation for their capabilities to capture long-range dependency, but the benefits of using transformers for NICE registration have not been explored. In this study, we propose a Non-Iterative Coarse-to-finE Transformer network (NICE-Trans) for image registration. Our NICE-Trans is the first deep registration method that (i) performs joint affine and deformable coarse-to-fine registration within a single network, and (ii) embeds transformers into a NICE registration framework to model long-range relevance between images. Extensive experiments with seven public datasets show that our NICE-Trans outperforms state-of-the-art registration methods on both registration accuracy and runtime.

cs.CV

AdaMSS: Adaptive Multi-Modality Segmentation-to-Survival Learning for Survival Outcome Prediction from PET/CT Images

Survival prediction is a major concern for cancer management. Deep survival models based on deep learning have been widely adopted to perform end-to-end survival prediction from medical images. Recent deep survival models achieved promising performance by jointly performing tumor segmentation with survival prediction, where the models were guided to extract tumor-related information through Multi-Task Learning (MTL). However, these deep survival models have difficulties in exploring out-of-tumor prognostic information. In addition, existing deep survival models are unable to effectively leverage multi-modality images. Empirically-designed fusion strategies were commonly adopted to fuse multi-modality information via task-specific manually-designed networks, thus limiting the adaptability to different scenarios. In this study, we propose an Adaptive Multi-modality Segmentation-to-Survival model (AdaMSS) for survival prediction from PET/CT images. Instead of adopting MTL, we propose a novel Segmentation-to-Survival Learning (SSL) strategy, where our AdaMSS is trained for tumor segmentation and survival prediction sequentially in two stages. This strategy enables the AdaMSS to focus on tumor regions in the first stage and gradually expand its focus to include other prognosis-related regions in the second stage. We also propose a data-driven strategy to fuse multi-modality information, which realizes adaptive optimization of fusion strategies based on training data during training. With the SSL and data-driven fusion strategies, our AdaMSS is designed as an adaptive model that can self-adapt its focus regions and fusion strategy for different training stages. Extensive experiments with two large clinical datasets show that our AdaMSS outperforms state-of-the-art survival prediction methods.

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Hyper-Connected Transformer Network for Multi-Modality PET-CT Segmentation

[18F]-Fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT) has become the imaging modality of choice for diagnosing many cancers. Co-learning complementary PET-CT imaging features is a fundamental requirement for automatic tumor segmentation and for developing computer aided cancer diagnosis systems. In this study, we propose a hyper-connected transformer (HCT) network that integrates a transformer network (TN) with a hyper connected fusion for multi-modality PET-CT images. The TN was leveraged for its ability to provide global dependencies in image feature learning, which was achieved by using image patch embeddings with a self-attention mechanism to capture image-wide contextual information. We extended the single-modality definition of TN with multiple TN based branches to separately extract image features. We also introduced a hyper connected fusion to fuse the contextual and complementary image features across multiple transformers in an iterative manner. Our results with two clinical datasets show that HCT achieved better performance in segmentation accuracy when compared to the existing methods.

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Mixed reality hologram slicer (mxdR-HS): a marker-less tangible user interface for interactive holographic volume visualization

Mixed reality head-mounted displays (mxdR-HMD) have the potential to visualize volumetric medical imaging data in holograms to provide a true sense of volumetric depth. An effective user interface, however, has yet to be thoroughly studied. Tangible user interfaces (TUIs) enable a tactile interaction with a hologram through an object. The object has physical properties indicating how it might be used with multiple degrees-of-freedom. We propose a TUI using a planar object (PO) for the holographic medical volume visualization and exploration. We refer to it as mxdR hologram slicer (mxdR-HS). Users can slice the hologram to examine particular regions of interest (ROIs) and intermix complementary data and annotations. The mxdR-HS introduces a novel real-time ad-hoc marker-less PO tracking method that works with any PO where corners are visible. The aim of mxdR-HS is to maintain minimum computational latency while preserving practical tracking accuracy to enable seamless TUI integration in the commercial mxdR-HMD, which has limited computational resources. We implemented the mxdR-HS on a commercial Microsoft HoloLens with a built-in depth camera. Our experimental results showed our mxdR-HS had a superior computational latency but marginally lower tracking accuracy than two marker-based tracking methods and resulted in enhanced computational latency and tracking accuracy than 10 marker-less tracking methods. Our mxdR-HS, in a medical environment, can be suggested as a visual guide to display complex volumetric medical imaging data.

cs.HC

Spatio-Temporal Dual-Stream Neural Network for Sequential Whole-Body PET Segmentation

Sequential whole-body 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) scans are regarded as the imaging modality of choice for the assessment of treatment response in the lymphomas because they detect treatment response when there may not be changes on anatomical imaging. Any computerized analysis of lymphomas in whole-body PET requires automatic segmentation of the studies so that sites of disease can be quantitatively monitored over time. State-of-the-art PET image segmentation methods are based on convolutional neural networks (CNNs) given their ability to leverage annotated datasets to derive high-level features about the disease process. Such methods, however, focus on PET images from a single time-point and discard information from other scans or are targeted towards specific organs and cannot cater for the multiple structures in whole-body PET images. In this study, we propose a spatio-temporal 'dual-stream' neural network (ST-DSNN) to segment sequential whole-body PET scans. Our ST-DSNN learns and accumulates image features from the PET images done over time. The accumulated image features are used to enhance the organs / structures that are consistent over time to allow easier identification of sites of active lymphoma. Our results show that our method outperforms the state-of-the-art PET image segmentation methods.

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Predicting Distant Metastases in Soft-Tissue Sarcomas from PET-CT scans using Constrained Hierarchical Multi-Modality Feature Learning

Distant metastases (DM) refer to the dissemination of tumors, usually, beyond the organ where the tumor originated. They are the leading cause of death in patients with soft-tissue sarcomas (STSs). Positron emission tomography-computed tomography (PET-CT) is regarded as the imaging modality of choice for the management of STSs. It is difficult to determine from imaging studies which STS patients will develop metastases. 'Radiomics' refers to the extraction and analysis of quantitative features from medical images and it has been employed to help identify such tumors. The state-of-the-art in radiomics is based on convolutional neural networks (CNNs). Most CNNs are designed for single-modality imaging data (CT or PET alone) and do not exploit the information embedded in PET-CT where there is a combination of an anatomical and functional imaging modality. Furthermore, most radiomic methods rely on manual input from imaging specialists for tumor delineation, definition and selection of radiomic features. This approach, however, may not be scalable to tumors with complex boundaries and where there are multiple other sites of disease. We outline a new 3D CNN to help predict DM in STS patients from PET-CT data. The 3D CNN uses a constrained feature learning module and a hierarchical multi-modality feature learning module that leverages the complementary information from the modalities to focus on semantically important regions. Our results on a public PET-CT dataset of STS patients show that multi-modal information improves the ability to identify those patients who develop DM. Further our method outperformed all other related state-of-the-art methods.

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Graph-Based Intercategory and Intermodality Network for Multilabel Classification and Melanoma Diagnosis of Skin Lesions in Dermoscopy and Clinical Images

The identification of melanoma involves an integrated analysis of skin lesion images acquired using the clinical and dermoscopy modalities. Dermoscopic images provide a detailed view of the subsurface visual structures that supplement the macroscopic clinical images. Melanoma diagnosis is commonly based on the 7-point visual category checklist (7PC). The 7PC contains intrinsic relationships between categories that can aid classification, such as shared features, correlations, and the contributions of categories towards diagnosis. Manual classification is subjective and prone to intra- and interobserver variability. This presents an opportunity for automated methods to improve diagnosis. Current state-of-the-art methods focus on a single image modality and ignore information from the other, or do not fully leverage the complementary information from both modalities. Further, there is not a method to exploit the intercategory relationships in the 7PC. In this study, we address these issues by proposing a graph-based intercategory and intermodality network (GIIN) with two modules. A graph-based relational module (GRM) leverages intercategorical relations, intermodal relations, and prioritises the visual structure details from dermoscopy by encoding category representations in a graph network. The category embedding learning module (CELM) captures representations that are specialised for each category and support the GRM. We show that our modules are effective at enhancing classification performance using a public dataset of dermoscopy-clinical images, and show that our method outperforms the state-of-the-art at classifying the 7PC categories and diagnosis.

cs.CV

Enhancing Medical Image Registration via Appearance Adjustment Networks

Deformable image registration is fundamental for many medical image analyses. A key obstacle for accurate image registration lies in image appearance variations such as the variations in texture, intensities, and noise. These variations are readily apparent in medical images, especially in brain images where registration is frequently used. Recently, deep learning-based registration methods (DLRs), using deep neural networks, have shown computational efficiency that is several orders of magnitude faster than traditional optimization-based registration methods (ORs). DLRs rely on a globally optimized network that is trained with a set of training samples to achieve faster registration. DLRs tend, however, to disregard the target-pair-specific optimization inherent in ORs and thus have degraded adaptability to variations in testing samples. This limitation is severe for registering medical images with large appearance variations, especially since few existing DLRs explicitly take into account appearance variations. In this study, we propose an Appearance Adjustment Network (AAN) to enhance the adaptability of DLRs to appearance variations. Our AAN, when integrated into a DLR, provides appearance transformations to reduce the appearance variations during registration. In addition, we propose an anatomy-constrained loss function through which our AAN generates anatomy-preserving transformations. Our AAN has been purposely designed to be readily inserted into a wide range of DLRs and can be trained cooperatively in an unsupervised and end-to-end manner. We evaluated our AAN with three state-of-the-art DLRs on three well-established public datasets of 3D brain magnetic resonance imaging (MRI). The results show that our AAN consistently improved existing DLRs and outperformed state-of-the-art ORs on registration accuracy, while adding a fractional computational load to existing DLRs.

cs.CV

Attention-Enhanced Cross-Task Network for Analysing Multiple Attributes of Lung Nodules in CT

Accurate characterisation of visual attributes such as spiculation, lobulation, and calcification of lung nodules is critical in cancer management. The characterisation of these attributes is often subjective, which may lead to high inter- and intra-observer variability. Furthermore, lung nodules are often heterogeneous in the cross-sectional image slices of a 3D volume. Current state-of-the-art methods that score multiple attributes rely on deep learning-based multi-task learning (MTL) schemes. These methods, however, extract shared visual features across attributes and then examine each attribute without explicitly leveraging their inherent intercorrelations. Furthermore, current methods either treat each slice with equal importance without considering their relevance or heterogeneity, which limits performance. In this study, we address these challenges with a new convolutional neural network (CNN)-based MTL model that incorporates multiple attention-based learning modules to simultaneously score 9 visual attributes of lung nodules in computed tomography (CT) image volumes. Our model processes entire nodule volumes of arbitrary depth and uses a slice attention module to filter out irrelevant slices. We also introduce cross-attribute and attribute specialisation attention modules that learn an optimal amalgamation of meaningful representations to leverage relationships between attributes. We demonstrate that our model outperforms previous state-of-the-art methods at scoring attributes using the well-known public LIDC-IDRI dataset of pulmonary nodules from over 1,000 patients. Our model also performs competitively when repurposed for benign-malignant classification. Our attention modules also provide easy-to-interpret weights that offer insights into the predictions of the model.

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