arXiv subjects

Yixing Huang

Publications and source records attributed to Yixing Huang.

At least 37 records · Page 2Linked to original sources

arXiv2024

Deep Learning for Cancer Prognosis Prediction Using Portrait Photos by StyleGAN Embedding

Survival prediction for cancer patients is critical for optimal treatment selection and patient management. Current patient survival prediction methods typically extract survival information from patients' clinical record data or biological and imaging data. In practice, experienced clinicians can have a preliminary assessment of patients' health status based on patients' observable physical appearances, which are mainly facial features. However, such assessment is highly subjective. In this work, the efficacy of objectively capturing and using prognostic information contained in conventional portrait photographs using deep learning for survival predication purposes is investigated for the first time. A pre-trained StyleGAN2 model is fine-tuned on a custom dataset of our cancer patients' photos to empower its generator with generative ability suitable for patients' photos. The StyleGAN2 is then used to embed the photographs to its highly expressive latent space. Utilizing the state-of-the-art survival analysis models and based on StyleGAN's latent space photo embeddings, this approach achieved a C-index of 0.677, which is notably higher than chance and evidencing the prognostic value embedded in simple 2D facial images. In addition, thanks to StyleGAN's interpretable latent space, our survival prediction model can be validated for relying on essential facial features, eliminating any biases from extraneous information like clothing or background. Moreover, a health attribute is obtained from regression coefficients, which has important potential value for patient care.

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arXiv2024

Multicenter Privacy-Preserving Model Training for Deep Learning Brain Metastases Autosegmentation

Objectives: This work aims to explore the impact of multicenter data heterogeneity on deep learning brain metastases (BM) autosegmentation performance, and assess the efficacy of an incremental transfer learning technique, namely learning without forgetting (LWF), to improve model generalizability without sharing raw data. Materials and methods: A total of six BM datasets from University Hospital Erlangen (UKER), University Hospital Zurich (USZ), Stanford, UCSF, NYU and BraTS Challenge 2023 on BM segmentation were used for this evaluation. First, the multicenter performance of a convolutional neural network (DeepMedic) for BM autosegmentation was established for exclusive single-center training and for training on pooled data, respectively. Subsequently bilateral collaboration was evaluated, where a UKER pretrained model is shared to another center for further training using transfer learning (TL) either with or without LWF. Results: For single-center training, average F1 scores of BM detection range from 0.625 (NYU) to 0.876 (UKER) on respective single-center test data. Mixed multicenter training notably improves F1 scores at Stanford and NYU, with negligible improvement at other centers. When the UKER pretrained model is applied to USZ, LWF achieves a higher average F1 score (0.839) than naive TL (0.570) and single-center training (0.688) on combined UKER and USZ test data. Naive TL improves sensitivity and contouring accuracy, but compromises precision. Conversely, LWF demonstrates commendable sensitivity, precision and contouring accuracy. When applied to Stanford, similar performance was observed. Conclusion: Data heterogeneity results in varying performance in BM autosegmentation, posing challenges to model generalizability. LWF is a promising approach to peer-to-peer privacy-preserving model training.

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arXiv2024

Generating Synthetic Computed Tomography for Radiotherapy: SynthRAD2023 Challenge Report

Radiation therapy plays a crucial role in cancer treatment, necessitating precise delivery of radiation to tumors while sparing healthy tissues over multiple days. Computed tomography (CT) is integral for treatment planning, offering electron density data crucial for accurate dose calculations. However, accurately representing patient anatomy is challenging, especially in adaptive radiotherapy, where CT is not acquired daily. Magnetic resonance imaging (MRI) provides superior soft-tissue contrast. Still, it lacks electron density information while cone beam CT (CBCT) lacks direct electron density calibration and is mainly used for patient positioning. Adopting MRI-only or CBCT-based adaptive radiotherapy eliminates the need for CT planning but presents challenges. Synthetic CT (sCT) generation techniques aim to address these challenges by using image synthesis to bridge the gap between MRI, CBCT, and CT. The SynthRAD2023 challenge was organized to compare synthetic CT generation methods using multi-center ground truth data from 1080 patients, divided into two tasks: 1) MRI-to-CT and 2) CBCT-to-CT. The evaluation included image similarity and dose-based metrics from proton and photon plans. The challenge attracted significant participation, with 617 registrations and 22/17 valid submissions for tasks 1/2. Top-performing teams achieved high structural similarity indices (>0.87/0.90) and gamma pass rates for photon (>98.1%/99.0%) and proton (>97.3%/97.0%) plans. However, no significant correlation was found between image similarity metrics and dose accuracy, emphasizing the need for dose evaluation when assessing the clinical applicability of sCT. SynthRAD2023 facilitated the investigation and benchmarking of sCT generation techniques, providing insights for developing MRI-only and CBCT-based adaptive radiotherapy.

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arXiv2024

Comprehensive Multimodal Deep Learning Survival Prediction Enabled by a Transformer Architecture: A Multicenter Study in Glioblastoma

Background: This research aims to improve glioblastoma survival prediction by integrating MR images, clinical and molecular-pathologic data in a transformer-based deep learning model, addressing data heterogeneity and performance generalizability. Method: We propose and evaluate a transformer-based non-linear and non-proportional survival prediction model. The model employs self-supervised learning techniques to effectively encode the high-dimensional MRI input for integration with non-imaging data using cross-attention. To demonstrate model generalizability, the model is assessed with the time-dependent concordance index (Cdt) in two training setups using three independent public test sets: UPenn-GBM, UCSF-PDGM, and RHUH-GBM, each comprising 378, 366, and 36 cases, respectively. Results: The proposed transformer model achieved promising performance for imaging as well as non-imaging data, effectively integrating both modalities for enhanced performance (UPenn-GBM test-set, imaging Cdt 0.645, multimodal Cdt 0.707) while outperforming state-of-the-art late-fusion 3D-CNN-based models. Consistent performance was observed across the three independent multicenter test sets with Cdt values of 0.707 (UPenn-GBM, internal test set), 0.672 (UCSF-PDGM, first external test set) and 0.618 (RHUH-GBM, second external test set). The model achieved significant discrimination between patients with favorable and unfavorable survival for all three datasets (logrank p 1.9\times{10}^{-8}, 9.7\times{10}^{-3}, and 1.2\times{10}^{-2}). Conclusions: The proposed transformer-based survival prediction model integrates complementary information from diverse input modalities, contributing to improved glioblastoma survival prediction compared to state-of-the-art methods. Consistent performance was observed across institutions supporting model generalizability.

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arXiv2024

EAGLE: An Edge-Aware Gradient Localization Enhanced Loss for CT Image Reconstruction

Computed Tomography (CT) image reconstruction is crucial for accurate diagnosis and deep learning approaches have demonstrated significant potential in improving reconstruction quality. However, the choice of loss function profoundly affects the reconstructed images. Traditional mean squared error loss often produces blurry images lacking fine details, while alternatives designed to improve may introduce structural artifacts or other undesirable effects. To address these limitations, we propose Eagle-Loss, a novel loss function designed to enhance the visual quality of CT image reconstructions. Eagle-Loss applies spectral analysis of localized features within gradient changes to enhance sharpness and well-defined edges. We evaluated Eagle-Loss on two public datasets across low-dose CT reconstruction and CT field-of-view extension tasks. Our results show that Eagle-Loss consistently improves the visual quality of reconstructed images, surpassing state-of-the-art methods across various network architectures. Code and data are available at \url{https://github.com/sypsyp97/Eagle_Loss}.

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arXiv2024

Exploring Epipolar Consistency Conditions for Rigid Motion Compensation in In-vivo X-ray Microscopy

Intravital X-ray microscopy (XRM) in preclinical mouse models is of vital importance for the identification of microscopic structural pathological changes in the bone which are characteristic of osteoporosis. The complexity of this method stems from the requirement for high-quality 3D reconstructions of the murine bones. However, respiratory motion and muscle relaxation lead to inconsistencies in the projection data which result in artifacts in uncompensated reconstructions. Motion compensation using epipolar consistency conditions (ECC) has previously shown good performance in clinical CT settings. Here, we explore whether such algorithms are suitable for correcting motion-corrupted XRM data. Different rigid motion patterns are simulated and the quality of the motion-compensated reconstructions is assessed. The method is able to restore microscopic features for out-of-plane motion, but artifacts remain for more realistic motion patterns including all six degrees of freedom of rigid motion. Therefore, ECC is valuable for the initial alignment of the projection data followed by further fine-tuning of motion parameters using a reconstruction-based method.

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arXiv2024

Two-View Topogram-Based Anatomy-Guided CT Reconstruction for Prospective Risk Minimization

To facilitate a prospective estimation of CT effective dose and risk minimization process, a prospective spatial dose estimation and the known anatomical structures are expected. To this end, a CT reconstruction method is required to reconstruct CT volumes from as few projections as possible, i.e. by using the topograms, with anatomical structures as correct as possible. In this work, an optimized CT reconstruction model based on a generative adversarial network (GAN) is proposed. The GAN is trained to reconstruct 3D volumes from an anterior-posterior and a lateral CT projection. To enhance anatomical structures, a pre-trained organ segmentation network and the 3D perceptual loss are applied during the training phase, so that the model can then generate both organ-enhanced CT volume and the organ segmentation mask. The proposed method can reconstruct CT volumes with PSNR of 26.49, RMSE of 196.17, and SSIM of 0.64, compared to 26.21, 201.55 and 0.63 using the baseline method. In terms of the anatomical structure, the proposed method effectively enhances the organ shape and boundary and allows for a straight-forward identification of the relevant anatomical structures. We note that conventional reconstruction metrics fail to indicate the enhancement of anatomical structures. In addition to such metrics, the evaluation is expanded with assessing the organ segmentation performance. The average organ dice of the proposed method is 0.71 compared with 0.63 in baseline model, indicating the enhancement of anatomical structures.

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arXiv2023

BPF Algorithms for Multiple Source-Translation Computed Tomography Reconstruction

Micro-computed tomography (micro-CT) is a widely used state-of-the-art instrument employed to study the morphological structures of objects in various fields. However, its small field-of-view (FOV) cannot meet the pressing demand for imaging relatively large objects at high spatial resolutions. Recently, we devised a novel scanning mode called multiple source translation CT (mSTCT) that effectively enlarges the FOV of the micro-CT and correspondingly developed a virtual projection-based filtered backprojection (V-FBP) algorithm for reconstruction. Although V-FBP skillfully solves the truncation problem in mSTCT, it requires densely sampled projections to arrive at high-resolution reconstruction, which reduces imaging efficiency. In this paper, we developed two backprojection-filtration (BPF)-based algorithms for mSTCT, i.e., S-BPF (derivatives along source) and D-BPF (derivatives along detector). D-BPF can achieve high-resolution reconstruction with fewer projections than V-FBP and S-BPF. Through simulated and real experiments conducted in this paper, we demonstrate that D-BPF can reduce source sampling by 75% compared with V-FBP at the same spatial resolution, which makes mSTCT more feasible in practice. Meanwhile, S-BPF can yield more stable results than D-BPF, which is similar to V-FBP.

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arXiv2023

A Survey of Incremental Transfer Learning: Combining Peer-to-Peer Federated Learning and Domain Incremental Learning for Multicenter Collaboration

Due to data privacy constraints, data sharing among multiple clinical centers is restricted, which impedes the development of high performance deep learning models from multicenter collaboration. Naive weight transfer methods share intermediate model weights without raw data and hence can bypass data privacy restrictions. However, performance drops are typically observed when the model is transferred from one center to the next because of the forgetting problem. Incremental transfer learning, which combines peer-to-peer federated learning and domain incremental learning, can overcome the data privacy issue and meanwhile preserve model performance by using continual learning techniques. In this work, a conventional domain/task incremental learning framework is adapted for incremental transfer learning. A comprehensive survey on the efficacy of different regularization-based continual learning methods for multicenter collaboration is performed. The influences of data heterogeneity, classifier head setting, network optimizer, model initialization, center order, and weight transfer type have been investigated thoroughly. Our framework is publicly accessible to the research community for further development.

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arXiv2023

OSNet & MNetO: Two Types of General Reconstruction Architectures for Linear Computed Tomography in Multi-Scenarios

Recently, linear computed tomography (LCT) systems have actively attracted attention. To weaken projection truncation and image the region of interest (ROI) for LCT, the backprojection filtration (BPF) algorithm is an effective solution. However, in BPF for LCT, it is difficult to achieve stable interior reconstruction, and for differentiated backprojection (DBP) images of LCT, multiple rotation-finite inversion of Hilbert transform (Hilbert filtering)-inverse rotation operations will blur the image. To satisfy multiple reconstruction scenarios for LCT, including interior ROI, complete object, and exterior region beyond field-of-view (FOV), and avoid the rotation operations of Hilbert filtering, we propose two types of reconstruction architectures. The first overlays multiple DBP images to obtain a complete DBP image, then uses a network to learn the overlying Hilbert filtering function, referred to as the Overlay-Single Network (OSNet). The second uses multiple networks to train different directional Hilbert filtering models for DBP images of multiple linear scannings, respectively, and then overlays the reconstructed results, i.e., Multiple Networks Overlaying (MNetO). In two architectures, we introduce a Swin Transformer (ST) block to the generator of pix2pixGAN to extract both local and global features from DBP images at the same time. We investigate two architectures from different networks, FOV sizes, pixel sizes, number of projections, geometric magnification, and processing time. Experimental results show that two architectures can both recover images. OSNet outperforms BPF in various scenarios. For the different networks, ST-pix2pixGAN is superior to pix2pixGAN and CycleGAN. MNetO exhibits a few artifacts due to the differences among the multiple models, but any one of its models is suitable for imaging the exterior edge in a certain direction.

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arXiv2023

Benchmarking ChatGPT-4 on ACR Radiation Oncology In-Training (TXIT) Exam and Red Journal Gray Zone Cases: Potentials and Challenges for AI-Assisted Medical Education and Decision Making in Radiation Oncology

The potential of large language models in medicine for education and decision making purposes has been demonstrated as they achieve decent scores on medical exams such as the United States Medical Licensing Exam (USMLE) and the MedQA exam. In this work, we evaluate the performance of ChatGPT-4 in the specialized field of radiation oncology using the 38th American College of Radiology (ACR) radiation oncology in-training (TXIT) exam and the 2022 Red Journal Gray Zone cases. For the TXIT exam, ChatGPT-3.5 and ChatGPT-4 have achieved the scores of 63.65% and 74.57%, respectively, highlighting the advantage of the latest ChatGPT-4 model. Based on the TXIT exam, ChatGPT-4's strong and weak areas in radiation oncology are identified to some extent. Specifically, ChatGPT-4 demonstrates better knowledge of statistics, CNS & eye, pediatrics, biology, and physics than knowledge of bone & soft tissue and gynecology, as per the ACR knowledge domain. Regarding clinical care paths, ChatGPT-4 performs better in diagnosis, prognosis, and toxicity than brachytherapy and dosimetry. It lacks proficiency in in-depth details of clinical trials. For the Gray Zone cases, ChatGPT-4 is able to suggest a personalized treatment approach to each case with high correctness and comprehensiveness. Importantly, it provides novel treatment aspects for many cases, which are not suggested by any human experts. Both evaluations demonstrate the potential of ChatGPT-4 in medical education for the general public and cancer patients, as well as the potential to aid clinical decision-making, while acknowledging its limitations in certain domains. Because of the risk of hallucination, facts provided by ChatGPT always need to be verified.

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arXiv2023

The Segment Anything foundation model achieves favorable brain tumor autosegmentation accuracy on MRI to support radiotherapy treatment planning

Background: Tumor segmentation in MRI is crucial in radiotherapy (RT) treatment planning for brain tumor patients. Segment anything (SA), a novel promptable foundation model for autosegmentation, has shown high accuracy for multiple segmentation tasks but was not evaluated on medical datasets yet. Methods: SA was evaluated in a point-to-mask task for glioma brain tumor autosegmentation on 16744 transversal slices from 369 MRI datasets (BraTS 2020). Up to 9 point prompts were placed per slice. Tumor core (enhancing tumor + necrotic core) was segmented on contrast-enhanced T1w sequences. Out of the 3 masks predicted by SA, accuracy was evaluated for the mask with the highest calculated IoU (oracle mask) and with highest model predicted IoU (suggested mask). In addition to assessing SA on whole MRI slices, SA was also evaluated on images cropped to the tumor (max. 3D extent + 2 cm). Results: Mean best IoU (mbIoU) using oracle mask on full MRI slices was 0.762 (IQR 0.713-0.917). Best 2D mask was achieved after a mean of 6.6 point prompts (IQR 5-9). Segmentation accuracy was significantly better for high- compared to low-grade glioma cases (mbIoU 0.789 vs. 0.668). Accuracy was worse using MRI slices cropped to the tumor (mbIoU 0.759) and was much worse using suggested mask (full slices 0.572). For all experiments, accuracy was low on peripheral slices with few tumor voxels (mbIoU, <300: 0.537 vs. >=300: 0.841). Stacking best oracle segmentations from full axial MRI slices, mean 3D DSC for tumor core was 0.872, which was improved to 0.919 by combining axial, sagittal and coronal masks. Conclusions: The Segment Anything foundation model, while trained on photos, can achieve high zero-shot accuracy for glioma brain tumor segmentation on MRI slices. The results suggest that Segment Anything can accelerate and facilitate RT treatment planning, when properly integrated in a clinical application.

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arXiv2023

Deep learning for automatic head and neck lymph node level delineation provides expert-level accuracy

Background: Deep learning (DL)-based head and neck lymph node level (HN_LNL) autodelineation is of high relevance to radiotherapy research and clinical treatment planning but still underinvestigated in academic literature. Methods: An expert-delineated cohort of 35 planning CTs was used for training of an nnU-net 3D-fullres/2D-ensemble model for autosegmentation of 20 different HN_LNL. A second cohort acquired at the same institution later in time served as the test set (n=20). In a completely blinded evaluation, 3 clinical experts rated the quality of DL autosegmentations in a head-to-head comparison with expert-created contours. For a subgroup of 10 cases, intraobserver variability was compared to the average DL autosegmentation accuracy on the original and recontoured set of expert segmentations. A postprocessing step to adjust craniocaudal boundaries of level autosegmentations to the CT slice plane was introduced and the effect on geometric accuracy and expert rating was investigated. Results: Blinded expert ratings for DL segmentations and expert-created contours were not significantly different. DL segmentations with slice plane adjustment were rated numerically higher (mean, 81.0 vs. 79.6,p=0.185) and DL segmentations without slice plane adjustment were rated numerically lower (77.2 vs. 79.6,p=0.167) than manually drawn contours. DL segmentations with CT slice plane adjustment were rated significantly better than DL contours without slice plane adjustment (81.0 vs. 77.2,p=0.004). Geometric accuracy of DL segmentations was not different from intraobserver variability (mean, 0.76 vs. 0.77, p=0.307). Conclusions: We show that a nnU-net 3D-fullres/2D-ensemble model can be used for highly accurate autodelineation of HN_LNL using only a limited training dataset that is ideally suited for large-scale standardized autodelineation of HN_LNL in the research setting.

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arXiv2023

Risk Classification of Brain Metastases via Radiomics, Delta-Radiomics and Machine Learning

Stereotactic radiotherapy (SRT) is one of the most important treatment for patients with brain metastases (BM). Conventionally, following SRT patients are monitored by serial imaging and receive salvage treatments in case of significant tumor growth. We hypothesized that using radiomics and machine learning (ML), metastases at high risk for subsequent progression could be identified during follow-up prior to the onset of significant tumor growth, enabling personalized follow-up intervals and early selection for salvage treatment. All experiments are performed on a dataset from clinical routine of the Radiation Oncology department of the University Hospital Erlangen (UKER). The classification is realized via the maximum-relevance minimal-redundancy (MRMR) technique and support vector machines (SVM). The pipeline leads to a classification with a mean area under the curve (AUC) score of 0.83 in internal cross-validation and allows a division of the cohort into two subcohorts that differ significantly in their median time to progression (low-risk metastasis (LRM): 17.3 months, high-risk metastasis (HRM): 9.6 months, p < 0.01). The classification performance is especially enhanced by the analysis of medical images from different points in time (AUC 0.53 -> AUC 0.74). The results indicate that risk stratification of BM based on radiomics and machine learning during post-SRT follow-up is possible with good accuracy and should be further pursued to personalize and improve post-SRT follow-up.

cs.CV↗

arXiv2023

Learning Perspective Deformation in X-Ray Transmission Imaging

In cone-beam X-ray transmission imaging, perspective deformation causes difficulty in direct, accurate geometric assessments of anatomical structures. In this work, the perspective deformation correction problem is formulated and addressed in a framework using two complementary (180°) views. The complementary view setting provides a practical way to identify perspectively deformed structures by assessing the deviation between the two views. It also provides bounding information and reduces uncertainty for learning perspective deformation. Two representative networks Pix2pixGAN and TransU-Net for correcting perspective deformation are investigated. Experiments on numerical bead phantom data demonstrate the advantage of complementary views over orthogonal views or a single view. They show that Pix2pixGAN as a fully convolutional network achieves better performance in polar space than Cartesian space, while TransU-Net as a transformer-based hybrid network achieves comparable performance in Cartesian space to polar space. Further study demonstrates that the trained model has certain tolerance to geometric inaccuracy within calibration accuracy. The efficacy of the proposed framework on synthetic projection images from patients' chest and head data as well as real cadaver CBCT projection data and its robustness in the presence of bulky metal implants and surgical screws indicate the promising aspects of future real applications.

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arXiv2022

Metal-conscious Embedding for CBCT Projection Inpainting

The existence of metallic implants in projection images for cone-beam computed tomography (CBCT) introduces undesired artifacts which degrade the quality of reconstructed images. In order to reduce metal artifacts, projection inpainting is an essential step in many metal artifact reduction algorithms. In this work, a hybrid network combining the shift window (Swin) vision transformer (ViT) and a convolutional neural network is proposed as a baseline network for the inpainting task. To incorporate metal information for the Swin ViT-based encoder, metal-conscious self-embedding and neighborhood-embedding methods are investigated. Both methods have improved the performance of the baseline network. Furthermore, by choosing appropriate window size, the model with neighborhood-embedding could achieve the lowest mean absolute error of 0.079 in metal regions and the highest peak signal-to-noise ratio of 42.346 in CBCT projections. At the end, the efficiency of metal-conscious embedding on both simulated and real cadaver CBCT data has been demonstrated, where the inpainting capability of the baseline network has been enhanced.

cs.CV↗

arXiv2022

Continual Learning for Peer-to-Peer Federated Learning: A Study on Automated Brain Metastasis Identification

Due to data privacy constraints, data sharing among multiple centers is restricted. Continual learning, as one approach to peer-to-peer federated learning, can promote multicenter collaboration on deep learning algorithm development by sharing intermediate models instead of training data. This work aims to investigate the feasibility of continual learning for multicenter collaboration on an exemplary application of brain metastasis identification using DeepMedic. 920 T1 MRI contrast enhanced volumes are split to simulate multicenter collaboration scenarios. A continual learning algorithm, synaptic intelligence (SI), is applied to preserve important model weights for training one center after another. In a bilateral collaboration scenario, continual learning with SI achieves a sensitivity of 0.917, and naive continual learning without SI achieves a sensitivity of 0.906, while two models trained on internal data solely without continual learning achieve sensitivity of 0.853 and 0.831 only. In a seven-center multilateral collaboration scenario, the models trained on internal datasets (100 volumes each center) without continual learning obtain a mean sensitivity value of 0.699. With single-visit continual learning (i.e., the shared model visits each center only once during training), the sensitivity is improved to 0.788 and 0.849 without SI and with SI, respectively. With iterative continual learning (i.e., the shared model revisits each center multiple times during training), the sensitivity is further improved to 0.914, which is identical to the sensitivity using mixed data for training. Our experiments demonstrate that continual learning can improve brain metastasis identification performance for centers with limited data. This study demonstrates the feasibility of applying continual learning for peer-to-peer federated learning in multicenter collaboration.

cs.LG↗

arXiv2022

Deep learning for brain metastasis detection and segmentation in longitudinal MRI data

Brain metastases occur frequently in patients with metastatic cancer. Early and accurate detection of brain metastases is very essential for treatment planning and prognosis in radiation therapy. To improve brain metastasis detection performance with deep learning, a custom detection loss called volume-level sensitivity-specificity (VSS) is proposed, which rates individual metastasis detection sensitivity and specificity in (sub-)volume levels. As sensitivity and precision are always a trade-off in a metastasis level, either a high sensitivity or a high precision can be achieved by adjusting the weights in the VSS loss without decline in dice score coefficient for segmented metastases. To reduce metastasis-like structures being detected as false positive metastases, a temporal prior volume is proposed as an additional input of DeepMedic. The modified network is called DeepMedic+ for distinction. Our proposed VSS loss improves the sensitivity of brain metastasis detection for DeepMedic, increasing the sensitivity from 85.3% to 97.5%. Alternatively, it improves the precision from 69.1% to 98.7%. Comparing DeepMedic+ with DeepMedic with the same VSS loss, 44.4% of the false positive metastases are reduced in the high sensitivity model and the precision reaches 99.6% for the high specificity model. The mean dice coefficient for all metastases is about 0.81. With the ensemble of the high sensitivity and high specificity models, on average only 1.5 false positive metastases per patient needs further check, while the majority of true positive metastases are confirmed. The ensemble learning is able to distinguish high confidence true positive metastases from metastases candidates that require special expert review or further follow-up, being particularly well-fit to the requirements of expert support in real clinical practice.

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