How can we test AI performance? This question seems trivial, but it isn't. Standard benchmarks often have problems such as in-distribution and small-size test sets, oversimplified metrics, unfair comparisons, and short-term outcome pressure. As a consequence, good performance on standard benchmarks does not guarantee success in real-world scenarios. To address these problems, we present Touchstone, a large-scale collaborative segmentation benchmark of 9 types of abdominal organs. This benchmark is based on 5,195 training CT scans from 76 hospitals around the world and 5,903 testing CT scans from 11 additional hospitals. This diverse test set enhances the statistical significance of benchmark results and rigorously evaluates AI algorithms across various out-of-distribution scenarios. We invited 14 inventors of 19 AI algorithms to train their algorithms, while our team, as a third party, independently evaluated these algorithms on three test sets. In addition, we also evaluated pre-existing AI frameworks--which, differing from algorithms, are more flexible and can support different algorithms--including MONAI from NVIDIA, nnU-Net from DKFZ, and numerous other open-source frameworks. We are committed to expanding this benchmark to encourage more innovation of AI algorithms for the medical domain.

As a result of the rise of Transformer architectures in medical image analysis, specifically in the domain of medical image segmentation, a multitude of hybrid models have been created that merge the advantages of Convolutional Neural Networks (CNNs) and Transformers. These hybrid models have achieved notable success by significantly improving segmentation accuracy. Yet, this progress often comes at the cost of increased model complexity, both in terms of parameters and computational demand. Moreover, many of these models fail to consider the crucial interplay between spatial and channel features, which could further refine and improve segmentation outcomes. To address this, we introduce LHU-Net, a Light Hybrid U-Net architecture optimized for volumetric medical image segmentation. LHU-Net is meticulously designed to prioritize spatial feature analysis in its initial layers before shifting focus to channel-based features in its deeper layers, ensuring a comprehensive feature extraction process. Rigorous evaluation across five benchmark datasets - Synapse, LA, Pancreas, ACDC, and BRaTS 2018 - underscores LHU-Net's superior performance, showcasing its dual capacity for efficiency and accuracy. Notably, LHU-Net sets new performance benchmarks, such as attaining a Dice score of 92.66 on the ACDC dataset, while simultaneously reducing parameters by 85% and quartering the computational load compared to existing state-of-the-art models. Achieved without any reliance on pre-training, additional data, or model ensemble, LHU-Net's effectiveness is further evidenced by its state-of-the-art performance across all evaluated datasets, utilizing fewer than 11 million parameters. This achievement highlights that balancing computational efficiency with high accuracy in medical image segmentation is feasible. Our implementation of LHU-Net is freely accessible to the research community on GitHub.

Intrigued by the inherent ability of the human visual system to identify salient regions in complex scenes, attention mechanisms have been seamlessly integrated into various Computer Vision (CV) tasks. Building upon this paradigm, Vision Transformer (ViT) networks exploit attention mechanisms for improved efficiency. This review navigates the landscape of redesigned attention mechanisms within ViTs, aiming to enhance their performance. This paper provides a comprehensive exploration of techniques and insights for designing attention mechanisms, systematically reviewing recent literature in the field of CV. This survey begins with an introduction to the theoretical foundations and fundamental concepts underlying attention mechanisms. We then present a systematic taxonomy of various attention mechanisms within ViTs, employing redesigned approaches. A multi-perspective categorization is proposed based on their application, objectives, and the type of attention applied. The analysis includes an exploration of the novelty, strengths, weaknesses, and an in-depth evaluation of the different proposed strategies. This culminates in the development of taxonomies that highlight key properties and contributions. Finally, we gather the reviewed studies along with their available open-source implementations at our \href{https://github.com/mindflow-institue/Awesome-Attention-Mechanism-in-Medical-Imaging}{GitHub}\footnote{\url{https://github.com/xmindflow/Awesome-Attention-Mechanism-in-Medical-Imaging}}. We aim to regularly update it with the most recent relevant papers.

Convolutional neural networks (CNNs) have been the consensus for medical image segmentation tasks. However, they suffer from the limitation in modeling long-range dependencies and spatial correlations due to the nature of convolution operation. Although transformers were first developed to address this issue, they fail to capture low-level features. In contrast, it is demonstrated that both local and global features are crucial for dense prediction, such as segmenting in challenging contexts. In this paper, we propose HiFormer, a novel method that efficiently bridges a CNN and a transformer for medical image segmentation. Specifically, we design two multi-scale feature representations using the seminal Swin Transformer module and a CNN-based encoder. To secure a fine fusion of global and local features obtained from the two aforementioned representations, we propose a Double-Level Fusion (DLF) module in the skip connection of the encoder-decoder structure. Extensive experiments on various medical image segmentation datasets demonstrate the effectiveness of HiFormer over other CNN-based, transformer-based, and hybrid methods in terms of computational complexity, and quantitative and qualitative results. Our code is publicly available at: https://github.com/amirhossein-kz/HiFormer

Convolutional neural networks (CNNs) have been the de facto standard in a diverse set of computer vision tasks for many years. Especially, deep neural networks based on seminal architectures such as U-shaped models with skip-connections or atrous convolution with pyramid pooling have been tailored to a wide range of medical image analysis tasks. The main advantage of such architectures is that they are prone to detaining versatile local features. However, as a general consensus, CNNs fail to capture long-range dependencies and spatial correlations due to the intrinsic property of confined receptive field size of convolution operations. Alternatively, Transformer, profiting from global information modelling that stems from the self-attention mechanism, has recently attained remarkable performance in natural language processing and computer vision. Nevertheless, previous studies prove that both local and global features are critical for a deep model in dense prediction, such as segmenting complicated structures with disparate shapes and configurations. To this end, this paper proposes TransDeepLab, a novel DeepLab-like pure Transformer for medical image segmentation. Specifically, we exploit hierarchical Swin-Transformer with shifted windows to extend the DeepLabv3 and model the Atrous Spatial Pyramid Pooling (ASPP) module. A thorough search of the relevant literature yielded that we are the first to model the seminal DeepLab model with a pure Transformer-based model. Extensive experiments on various medical image segmentation tasks verify that our approach performs superior or on par with most contemporary works on an amalgamation of Vision Transformer and CNN-based methods, along with a significant reduction of model complexity. The codes and trained models are publicly available at https://github.com/rezazad68/transdeeplab

Labeling vertebral discs from MRI scans is important for the proper diagnosis of spinal related diseases, including multiple sclerosis, amyotrophic lateral sclerosis, degenerative cervical myelopathy and cancer. Automatic labeling of the vertebral discs in MRI data is a difficult task because of the similarity between discs and bone area, the variability in the geometry of the spine and surrounding tissues across individuals, and the variability across scans (manufacturers, pulse sequence, image contrast, resolution and artefacts). In previous studies, vertebral disc labeling is often done after a disc detection step and mostly fails when the localization algorithm misses discs or has false positive detection. In this work, we aim to mitigate this problem by reformulating the semantic vertebral disc labeling using the pose estimation technique. To do so, we propose a stacked hourglass network with multi-level attention mechanism to jointly learn intervertebral disc position and their skeleton structure. The proposed deep learning model takes into account the strength of semantic segmentation and pose estimation technique to handle the missing area and false positive detection. To further improve the performance of the proposed method, we propose a skeleton-based search space to reduce false positive detection. The proposed method evaluated on spine generic public multi-center dataset and demonstrated better performance comparing to previous work, on both T1w and T2w contrasts. The method is implemented in ivadomed (https://ivadomed.org).