In multi-sequence Magnetic Resonance Imaging (MRI), the accurate segmentation of the kidney and tumor based on traditional supervised methods typically necessitates detailed annotation for each sequence, which is both time-consuming and labor-intensive. Unsupervised Domain Adaptation (UDA) methods can effectively mitigate inter-domain differences by aligning cross-modal features, thereby reducing the annotation burden. However, most existing UDA methods are limited to one-to-one domain adaptation, which tends to be inefficient and resourceintensive when faced with multi-target domain transfer tasks. To address this challenge, we propose a novel and efficient One-to-Multiple Progressive Style Transfer Unsupervised Domain-Adaptive (PSTUDA) framework for kidney and tumor segmentation in multi-sequence MRI. Specifically, we develop a multi-level style dictionary to explicitly store the style information of each target domain at various stages, which alleviates the burden of a single generator in a multi-target transfer task and enables effective decoupling of content and style. Concurrently, we employ multiple cascading style fusion modules that utilize point-wise instance normalization to progressively recombine content and style features, which enhances cross-modal alignment and structural consistency. Experiments conducted on the private MSKT and public KiTS19 datasets demonstrate the superiority of the proposed PSTUDA over comparative methods in multi-sequence kidney and tumor segmentation. The average Dice Similarity Coefficients are increased by at least 1.8% and 3.9%, respectively. Impressively, our PSTUDA not only significantly reduces the floating-point computation by approximately 72% but also reduces the number of model parameters by about 50%, bringing higher efficiency and feasibility to practical clinical applications.

Autonomous robotic systems hold potential for improving renal tumor resection accuracy and patient outcomes. We present a fluorescence-guided robotic system capable of planning and executing incision paths around exophytic renal tumors with a clinically relevant resection margin. Leveraging point cloud observations, the system handles irregular tumor shapes and distinguishes healthy from tumorous tissue based on near-infrared imaging, akin to indocyanine green staining in partial nephrectomy. Tissue-mimicking phantoms are crucial for the development of autonomous robotic surgical systems for interventions where acquiring ex-vivo animal tissue is infeasible, such as cancer of the kidney and renal pelvis. To this end, we propose novel hydrogel-based kidney phantoms with exophytic tumors that mimic the physical and visual behavior of tissue, and are compatible with electrosurgical instruments, a common limitation of silicone-based phantoms. In contrast to previous hydrogel phantoms, we mix the material with near-infrared dye to enable fluorescence-guided tumor segmentation. Autonomous real-world robotic experiments validate our system and phantoms, achieving an average margin accuracy of 1.44 mm in a completion time of 69 sec.

-- T o track tumors during surgery, information from preoperative CT scans is used to determine their position. However, as the surgeon operates, the tumor may be deformed which presents a major hurdle for accurately resecting the tumor, and can lead to surgical inaccuracy, increased operation time, and excessive margins. This issue is particularly pronounced in robot-assisted partial nephrectomy (RAPN), where the kidney undergoes significant deformations during operation. T oward addressing this, we introduce a occupancy network-based method for the localization of tumors within kidney phantoms undergoing deformations at interactive speeds. We validate our method by introducing a 3D hydrogel kidney phantom embedded with exophytic and endophytic renal tumors. It closely mimics real tissue mechanics to simulate kidney deformation during in vivo surgery, providing excellent contrast and clear delineation of tumor margins to enable automatic threshold-based segmentation. Our findings indicate that the proposed method can localize tumors in moderately deforming kidneys with a margin of 6mm to 10mm, while providing essential volumetric 3D information at over 60Hz. This capability directly enables downstream tasks such as robotic resection. Kidney cancer is one of the most common forms of cancer in the US, with over 65,000 new patients being diagnosed every year, leading to over 15,000 deaths [1]. The standard treatment for localized small renal masses has shifted from radical nephrectomy (complete kidney removal) toward the more minimally invasive approach of partial nephrectomy (removal of the tumor, retaining partial kidney function). One of the main challenges during tumor removal is ensuring the resection of adequate tumor margins. This work has been submitted to the IEEE for possible publication.

Renal tumors, especially renal cell carcinoma (RCC), show significant heterogeneity, posing challenges for diagnosis using radiology images such as MRI, echocardiograms, and CT scans. U-Net based deep learning techniques are emerging as a promising approach for automated medical image segmentation for minimally invasive diagnosis of renal tumors. However, current techniques need further improvements in accuracy to become clinically useful to radiologists. In this study, we present an improved U-Net based model for end-to-end automated semantic segmentation of CT scan images to identify renal tumors. The model uses residual connections across convolution layers, integrates a multi-layer feature fusion (MFF) and cross-channel attention (CCA) within encoder blocks, and incorporates skip connections augmented with additional information derived using MFF and CCA. We evaluated our model on the KiTS19 dataset, which contains data from 210 patients. For kidney segmentation, our model achieves a Dice Similarity Coefficient (DSC) of 0.97 and a Jaccard index (JI) of 0.95. For renal tumor segmentation, our model achieves a DSC of 0.96 and a JI of 0.91. Based on a comparison of available DSC scores, our model outperforms the current leading models.

Multi-phase computed tomography (CT) has been widely used for the preoperative diagnosis of kidney cancer due to its non-invasive nature and ability to characterize renal lesions. However, since enhancement patterns of renal lesions across CT phases are different even for the same lesion type, the visual assessment by radiologists suffers from inter-observer variability in clinical practice. Although deep learning-based approaches have been recently explored for differential diagnosis of kidney cancer, they do not explicitly model the relationships between CT phases in the network design, limiting the diagnostic performance. In this paper, we propose a novel lesion-aware cross-phase attention network (LACPANet) that can effectively capture temporal dependencies of renal lesions across CT phases to accurately classify the lesions into five major pathological subtypes from time-series multi-phase CT images. We introduce a 3D inter-phase lesion-aware attention mechanism to learn effective 3D lesion features that are used to estimate attention weights describing the inter-phase relations of the enhancement patterns. We also present a multi-scale attention scheme to capture and aggregate temporal patterns of lesion features at different spatial scales for further improvement. Extensive experiments on multi-phase CT scans of kidney cancer patients from the collected dataset demonstrate that our LACPANet outperforms state-of-the-art approaches in diagnostic accuracy.

Background: Predictive biomarkers of treatment response are lacking for metastatic clearcell renal cell carcinoma (ccRCC), a tumor type that is treated with angiogenesis inhibitors, immune checkpoint inhibitors, mTOR inhibitors and a HIF2 inhibitor. The Angioscore, an RNA-based quantification of angiogenesis, is arguably the best candidate to predict anti-angiogenic (AA) response. However, the clinical adoption of transcriptomic assays faces several challenges including standardization, time delay, and high cost. Further, ccRCC tumors are highly heterogenous, and sampling multiple areas for sequencing is impractical. Approach: Here we present a novel deep learning (DL) approach to predict the Angioscore from ubiquitous histopathology slides. In order to overcome the lack of interpretability, one of the biggest limitations of typical DL models, our model produces a visual vascular network which is the basis of the model's prediction. To test its reliability, we applied this model to multiple cohorts including a clinical trial dataset. Results: Our model accurately predicts the RNA-based Angioscore on multiple independent cohorts (spearman correlations of 0.77 and 0.73). Further, the predictions help unravel meaningful biology such as association of angiogenesis with grade, stage, and driver mutation status. Finally, we find our model is able to predict response to AA therapy, in both a real-world cohort and the IMmotion150 clinical trial. The predictive power of our model vastly exceeds that of CD31, a marker of vasculature, and nearly rivals the performance (c-index 0.66 vs 0.67) of the ground truth RNA-based Angioscore at a fraction of the cost. Conclusion: By providing a robust yet interpretable prediction of the Angioscore from histopathology slides alone, our approach offers insights into angiogenesis biology and AA treatment response. Introduction: Patients with metastatic clear cell renal cell carcinoma (ccRCC) are treated with anti-angiogenic (AA) therapies (e.g., vascular endothelial growth factor tyrosine kinase inhibitors VEGF-TKIs), immune checkpoint inhibitors (ICI), mammalian target of rapamycin (mTOR) inhibitors and a hypoxia inducible factor (HIF)-2 inhibitor, either in combination or as monotherapy (1).

Deep learning is dramatically transforming the field of medical imaging and radiology, enabling the identification of pathologies in medical images, including computed tomography (CT) and X-ray scans. However, the performance of deep learning models, particularly in segmentation tasks, is often limited by the need for extensive annotated datasets. To address this challenge, the capabilities of weakly supervised semantic segmentation are explored through the lens of Explainable AI and the generation of counterfactual explanations. The scope of this research is development of a novel counterfactual inpainting approach (COIN) that flips the predicted classification label from abnormal to normal by using a generative model. For instance, if the classifier deems an input medical image X as abnormal, indicating the presence of a pathology, the generative model aims to inpaint the abnormal region, thus reversing the classifier's original prediction label. The approach enables us to produce precise segmentations for pathologies without depending on pre-existing segmentation masks. Crucially, image-level labels are utilized, which are substantially easier to acquire than creating detailed segmentation masks. The effectiveness of the method is demonstrated by segmenting synthetic targets and actual kidney tumors from CT images acquired from Tartu University Hospital in Estonia. The findings indicate that COIN greatly surpasses established attribution methods, such as RISE, ScoreCAM, and LayerCAM, as well as an alternative counterfactual explanation method introduced by Singla et al. This evidence suggests that COIN is a promising approach for semantic segmentation of tumors in CT images, and presents a step forward in making deep learning applications more accessible and effective in healthcare, where annotated data is scarce.

Multi-phase CT is widely adopted for the diagnosis of kidney cancer due to the complementary information among phases. However, the complete set of multi-phase CT is often not available in practical clinical applications. In recent years, there have been some studies to generate the missing modality image from the available data. Nevertheless, the generated images are not guaranteed to be effective for the diagnosis task. In this paper, we propose a unified framework for kidney cancer diagnosis with incomplete multi-phase CT, which simultaneously recovers missing CT images and classifies cancer subtypes using the completed set of images. The advantage of our framework is that it encourages a synthesis model to explicitly learn to generate missing CT phases that are helpful for classifying cancer subtypes. We further incorporate lesion segmentation network into our framework to exploit lesion-level features for effective cancer classification in the whole CT volumes. The proposed framework is based on fully 3D convolutional neural networks to jointly optimize both synthesis and classification of 3D CT volumes. Extensive experiments on both in-house and external datasets demonstrate the effectiveness of our framework for the diagnosis with incomplete data compared with state-of-the-art baselines. In particular, cancer subtype classification using the completed CT data by our method achieves higher performance than the classification using the given incomplete data.

This study introduces an automated pipeline for renal cancer (RC) detection in non-contrast computed tomography (NCCT). In the development of our pipeline, we test three detections models: a shape model, a 2D-, and a 3D axial-sample model. Training (n=1348) and testing (n=64) data were gathered from open sources (KiTS23, Abdomen1k, CT-ORG) and Cambridge University Hospital (CUH). Results from cross-validation and testing revealed that the 2D axial sample model had the highest small ($\leq$40mm diameter) RC detection area under the curve (AUC) of 0.804. Our pipeline achieves 61.9\% sensitivity and 92.7\% specificity for small kidney cancers on unseen test data. Our results are much more accurate than previous attempts to automatically detect small renal cancers in NCCT, the most likely imaging modality for RC screening. This pipeline offers a promising advance that may enable screening for kidney cancers.

Quantitative organ assessment is an essential step in automated abdominal disease diagnosis and treatment planning. Artificial intelligence (AI) has shown great potential to automatize this process. However, most existing AI algorithms rely on many expert annotations and lack a comprehensive evaluation of accuracy and efficiency in real-world multinational settings. To overcome these limitations, we organized the FLARE 2022 Challenge, the largest abdominal organ analysis challenge to date, to benchmark fast, low-resource, accurate, annotation-efficient, and generalized AI algorithms. We constructed an intercontinental and multinational dataset from more than 50 medical groups, including Computed Tomography (CT) scans with different races, diseases, phases, and manufacturers. We independently validated that a set of AI algorithms achieved a median Dice Similarity Coefficient (DSC) of 90.0% by using 50 labeled scans and 2000 unlabeled scans, which can significantly reduce annotation requirements. They also enabled automatic extraction of key organ biology features, which was labor-intensive with traditional manual measurements. This opens the potential to use unlabeled data to boost performance and alleviate annotation shortages for modern AI models. Abdominal organs are high cancer incidence areas, such as liver cancer, kidney cancer, pancreas cancer, and gastric cancer [1]. Computed Tomography (CT) scanning has been a major imaging technology for the diagnosis and treatment of abdominal cancer because it can yield important prognostic information with fast imaging speed for cancer patients, which has been recommended by many clinical treatment guidelines. In order to quantify abdominal organs, radiologists and clinicians need to manually delineate organ boundaries in each slice of the 3D CT scans [2], [3]. However, manual segmentation is time-consuming and inherently subjective with inter-and intra-expert variability.