Despite advances with deep learning (DL), automated airway segmentation from chest CT scans continues to face challenges in segmentation quality and generalization across cohorts. To address these, we propose integrating Curriculum Learning (CL) into airway segmentation networks, distributing the training set into batches according to ad-hoc complexity scores derived from CT scans and corresponding ground-truth tree features. We specifically investigate few-shot domain adaptation, targeting scenarios where manual annotation of a full fine-tuning dataset is prohibitively expensive. Results are reported on two large open-cohorts (ATM22 and AIIB23) with high performance using CL for full training (Source domain) and few-shot fine-tuning (Target domain), but with also some insights on potential detrimental effects if using a classic Bootstrapping scoring function or if not using proper scan sequencing.

The lack of large annotated datasets in medical imaging is an intrinsic burden for supervised Deep Learning (DL) segmentation models. Few-shot learning approaches are cost-effective solutions to transfer pre-trained models using only limited annotated data. However, such methods can be prone to overfitting due to limited data diversity especially when segmenting complex, diverse, and sparse tubular structures like airways. Furthermore, crafting informative image representations has played a crucial role in medical imaging, enabling discriminative enhancement of anatomical details. In this paper, we initially train a data-driven sparsification module to enhance airways efficiently in lung CT scans. We then incorporate these sparse representations in a standard supervised segmentation pipeline as a pretraining step to enhance the performance of the DL models. Results presented on the ATM public challenge cohort show the effectiveness of using sparse priors in pre-training, leading to segmentation Dice score increase by 1% to 10% in full-scale and few-shot learning scenarios, respectively.

Robust segmentation is critical for deriving quantitative measures from large-scale, multi-center, and longitudinal medical scans. Manually annotating medical scans, however, is expensive and labor-intensive and may not always be available in every domain. Unsupervised domain adaptation (UDA) is a well-studied technique that alleviates this label-scarcity problem by leveraging available labels from another domain. In this study, we introduce Masked Autoencoding and Pseudo-Labeling Segmentation (MAPSeg), a $\textbf{unified}$ UDA framework with great versatility and superior performance for heterogeneous and volumetric medical image segmentation. To the best of our knowledge, this is the first study that systematically reviews and develops a framework to tackle four different domain shifts in medical image segmentation. More importantly, MAPSeg is the first framework that can be applied to $\textbf{centralized}$, $\textbf{federated}$, and $\textbf{test-time}$ UDA while maintaining comparable performance. We compare MAPSeg with previous state-of-the-art methods on a private infant brain MRI dataset and a public cardiac CT-MRI dataset, and MAPSeg outperforms others by a large margin (10.5 Dice improvement on the private MRI dataset and 5.7 on the public CT-MRI dataset). MAPSeg poses great practical value and can be applied to real-world problems. Our code and pretrained model will be available later.

Deep learning (DL) models have provided state-of-the-art performance in various medical imaging benchmarking challenges, including the Brain Tumor Segmentation (BraTS) challenges. However, the task of focal pathology multi-compartment segmentation (e.g., tumor and lesion sub-regions) is particularly challenging, and potential errors hinder translating DL models into clinical workflows. Quantifying the reliability of DL model predictions in the form of uncertainties could enable clinical review of the most uncertain regions, thereby building trust and paving the way toward clinical translation. Several uncertainty estimation methods have recently been introduced for DL medical image segmentation tasks. Developing scores to evaluate and compare the performance of uncertainty measures will assist the end-user in making more informed decisions. In this study, we explore and evaluate a score developed during the BraTS 2019 and BraTS 2020 task on uncertainty quantification (QU-BraTS) and designed to assess and rank uncertainty estimates for brain tumor multi-compartment segmentation. This score (1) rewards uncertainty estimates that produce high confidence in correct assertions and those that assign low confidence levels at incorrect assertions, and (2) penalizes uncertainty measures that lead to a higher percentage of under-confident correct assertions. We further benchmark the segmentation uncertainties generated by 14 independent participating teams of QU-BraTS 2020, all of which also participated in the main BraTS segmentation task. Overall, our findings confirm the importance and complementary value that uncertainty estimates provide to segmentation algorithms, highlighting the need for uncertainty quantification in medical image analyses.

Unsupervised learning-based medical image registration approaches have witnessed rapid development in recent years. We propose to revisit a commonly ignored while simple and well-established principle: recursive refinement of deformation vector fields across scales. We introduce a recursive refinement network (RRN) for unsupervised medical image registration, to extract multi-scale features, construct normalized local cost correlation volume and recursively refine volumetric deformation vector fields. RRN achieves state of the art performance for 3D registration of expiratory-inspiratory pairs of CT lung scans. On DirLab COPDGene dataset, RRN returns an average Target Registration Error (TRE) of 0.83 mm, which corresponds to a 13% error reduction from the best result presented in the leaderboard. In addition to comparison with conventional methods, RRN leads to 89% error reduction compared to deep-learning-based peer approaches.

Chronic Pulmonary Aspergillosis (CPA) is a complex lung disease caused by infection with Aspergillus. Computed tomography (CT) images are frequently requested in patients with suspected and established disease, but the radiological signs on CT are difficult to quantify making accurate follow-up challenging. We propose a novel method to train Convolutional Neural Networks using only regional labels on the presence of pathological signs, to not only detect CPA, but also spatially localize pathological signs. We use average intensity projections within different ranges of Hounsfield-unit (HU) values, transforming input 3D CT scans into 2D RGB-like images. CNN architectures are trained for hierarchical tasks, leading to precise activation maps of pathological patterns. Results on a cohort of 352 subjects demonstrate high classification accuracy, localization precision and predictive power of 2 year survival. Such tool opens the way to CPA patient stratification and quantitative follow-up of CPA pathological signs, for patients under drug therapy.