We present RMA-Mamba, a novel architecture that advances the capabilities of vision state space models through a specialized reverse mamba attention module (RMA). The key innovation lies in RMA-Mamba's ability to capture long-range dependencies while maintaining precise local feature representation through its hierarchical processing pipeline. By integrating Vision Mamba (VMamba)'s efficient sequence modeling with RMA's targeted feature refinement, our architecture achieves superior feature learning across multiple scales. This dual-mechanism approach enables robust handling of complex morphological patterns while maintaining computational efficiency. We demonstrate RMA-Mamba's effectiveness in the challenging domain of pathological liver segmentation (from both CT and MRI), where traditional segmentation approaches often fail due to tissue variations. When evaluated on a newly introduced cirrhotic liver dataset (CirrMRI600+) of T2-weighted MRI scans, RMA-Mamba achieves the state-of-the-art performance with a Dice coefficient of 92.08%, mean IoU of 87.36%, and recall of 92.96%. The architecture's generalizability is further validated on the cancerous liver segmentation from CT scans (LiTS: Liver Tumor Segmentation dataset), yielding a Dice score of 92.9% and mIoU of 88.99%. Our code is available for public: https://github.com/JunZengz/RMAMamba.

We present an end-to-end deep learning framework for automated liver cirrhosis stage estimation from multi-sequence MRI. Cirrhosis is the severe scarring (fibrosis) of the liver and a common endpoint of various chronic liver diseases. Early diagnosis is vital to prevent complications such as decompensation and cancer, which significantly decreases life expectancy. However, diagnosing cirrhosis in its early stages is challenging, and patients often present with life-threatening complications. Our approach integrates multi-scale feature learning with sequence-specific attention mechanisms to capture subtle tissue variations across cirrhosis progression stages. Using CirrMRI600+, a large-scale publicly available dataset of 628 high-resolution MRI scans from 339 patients, we demonstrate state-of-the-art performance in three-stage cirrhosis classification. Our best model achieves 72.8% accuracy on T1W and 63.8% on T2W sequences, significantly outperforming traditional radiomics-based approaches. Through extensive ablation studies, we show that our architecture effectively learns stage-specific imaging biomarkers. We establish new benchmarks for automated cirrhosis staging and provide insights for developing clinically applicable deep learning systems. The source code will be available at https://github.com/JunZengz/CirrhosisStage.

Pulmonary Embolism (PE) is a serious cardiovascular condition that remains a leading cause of mortality and critical illness, underscoring the need for enhanced diagnostic strategies. Conventional clinical methods have limited success in predicting 30-day in-hospital mortality of PE patients. In this study, we present a new algorithm, called PEP-Net, for 30-day mortality prediction of PE patients based on the initial imaging data (CT) that opportunistically integrates a 3D Residual Network (3DResNet) with Extreme Gradient Boosting (XGBoost) algorithm with patient level binary labels without annotations of the emboli and its extent. Our proposed system offers a comprehensive prediction strategy by handling class imbalance problems, reducing overfitting via regularization, and reducing the prediction variance for more stable predictions. PEP-Net was tested in a cohort of 193 volumetric CT scans diagnosed with Acute PE, and it demonstrated a superior performance by significantly outperforming baseline models (76-78%) with an accuracy of 94.5% ( 0.3) and 94.0% ( 0.7) when the input image is either lung region (Lung-ROI) or heart region (Cardiac-ROI). Our results advance PE prognostics by using only initial imaging data, setting a new benchmark in the field. While purely deep learning models have become the go-to for many medical classification (diagnostic) tasks, combined ResNet and XGBoost models herein outperform sole deep learning models due to a potential reason for having lack of enough data.

We introduce FedEvPrompt, a federated learning approach that integrates principles of evidential deep learning, prompt tuning, and knowledge distillation for distributed skin lesion classification. FedEvPrompt leverages two sets of prompts: b-prompts (for low-level basic visual knowledge) and t-prompts (for task-specific knowledge) prepended to frozen pre-trained Vision Transformer (ViT) models trained in an evidential learning framework to maximize class evidences. Crucially, knowledge sharing across federation clients is achieved only through knowledge distillation on attention maps generated by the local ViT models, ensuring enhanced privacy preservation compared to traditional parameter or synthetic image sharing methodologies. FedEvPrompt is optimized within a round-based learning paradigm, where each round involves training local models followed by attention maps sharing with all federation clients. Experimental validation conducted in a real distributed setting, on the ISIC2019 dataset, demonstrates the superior performance of FedEvPrompt against baseline federated learning algorithms and knowledge distillation methods, without sharing model parameters. In conclusion, FedEvPrompt offers a promising approach for federated learning, effectively addressing challenges such as data heterogeneity, imbalance, privacy preservation, and knowledge sharing.

Accurate classification of Intraductal Papillary Mucinous Neoplasms (IPMN) is essential for identifying high-risk cases that require timely intervention. In this study, we develop a federated learning framework for multi-center IPMN classification utilizing a comprehensive pancreas MRI dataset. This dataset includes 653 T1-weighted and 656 T2-weighted MRI images, accompanied by corresponding IPMN risk scores from 7 leading medical institutions, making it the largest and most diverse dataset for IPMN classification to date. We assess the performance of DenseNet-121 in both centralized and federated settings for training on distributed data. Our results demonstrate that the federated learning approach achieves high classification accuracy comparable to centralized learning while ensuring data privacy across institutions. This work marks a significant advancement in collaborative IPMN classification, facilitating secure and high-accuracy model training across multiple centers.

Interactive segmentation aims to accurately segment target objects with minimal user interactions. However, current methods often fail to accurately separate target objects from the background, due to a limited understanding of order, the relative depth between objects in a scene. To address this issue, we propose OIS: order-aware interactive segmentation, where we explicitly encode the relative depth between objects into order maps. We introduce a novel order-aware attention, where the order maps seamlessly guide the user interactions (in the form of clicks) to attend to the image features. We further present an object-aware attention module to incorporate a strong object-level understanding to better differentiate objects with similar order. Our approach allows both dense and sparse integration of user clicks, enhancing both accuracy and efficiency as compared to prior works. Experimental results demonstrate that OIS achieves state-of-the-art performance, improving mIoU after one click by 7.61 on the HQSeg44K dataset and 1.32 on the DAVIS dataset as compared to the previous state-of-the-art SegNext, while also doubling inference speed compared to current leading methods. The project page is https://ukaukaaaa.github.io/projects/OIS/index.html

The 2024 Brain Tumor Segmentation Meningioma Radiotherapy (BraTS-MEN-RT) challenge aims to advance automated segmentation algorithms using the largest known multi-institutional dataset of radiotherapy planning brain MRIs with expert-annotated target labels for patients with intact or post-operative meningioma that underwent either conventional external beam radiotherapy or stereotactic radiosurgery. Each case includes a defaced 3D post-contrast T1-weighted radiotherapy planning MRI in its native acquisition space, accompanied by a single-label "target volume" representing the gross tumor volume (GTV) and any at-risk post-operative site. Target volume annotations adhere to established radiotherapy planning protocols, ensuring consistency across cases and institutions. For pre-operative meningiomas, the target volume encompasses the entire GTV and associated nodular dural tail, while for post-operative cases, it includes at-risk resection cavity margins as determined by the treating institution. Case annotations were reviewed and approved by expert neuroradiologists and radiation oncologists. Participating teams will develop, containerize, and evaluate automated segmentation models using this comprehensive dataset. Model performance will be assessed using the lesion-wise Dice Similarity Coefficient and the 95% Hausdorff distance. The top-performing teams will be recognized at the Medical Image Computing and Computer Assisted Intervention Conference in October 2024. BraTS-MEN-RT is expected to significantly advance automated radiotherapy planning by enabling precise tumor segmentation and facilitating tailored treatment, ultimately improving patient outcomes.

Central to the Transformer architectures' effectiveness is the self-attention mechanism, a function that maps queries, keys, and values into a high-dimensional vector space. However, training the attention weights of queries, keys, and values is non-trivial from a state of random initialization. In this paper, we propose two methods. (i) We first address the initialization problem of Vision Transformers by introducing a simple, yet highly innovative, initialization approach utilizing Discrete Cosine Transform (DCT) coefficients. Our proposed DCT-based attention initialization marks a significant gain compared to traditional initialization strategies; offering a robust foundation for the attention mechanism. Our experiments reveal that the DCT-based initialization enhances the accuracy of Vision Transformers in classification tasks. (ii) We also recognize that since DCT effectively decorrelates image information in the frequency domain, this decorrelation is useful for compression because it allows the quantization step to discard many of the higher-frequency components. Based on this observation, we propose a novel DCT-based compression technique for the attention function of Vision Transformers. Since high-frequency DCT coefficients usually correspond to noise, we truncate the high-frequency DCT components of the input patches. Our DCT-based compression reduces the size of weight matrices for queries, keys, and values. While maintaining the same level of accuracy, our DCT compressed Swin Transformers obtain a considerable decrease in the computational overhead.

Foundational models (FMs) have tremendous potential to revolutionize medical imaging. However, their deployment in real-world clinical settings demands extensive ethical considerations. This paper aims to highlight the ethical concerns related to FMs and propose a framework to guide their responsible development and implementation within medicine. We meticulously examine ethical issues such as privacy of patient data, bias mitigation, algorithmic transparency, explainability and accountability. The proposed framework is designed to prioritize patient welfare, mitigate potential risks, and foster trust in AI-assisted healthcare.

Magnetic field inhomogeneity correction remains a challenging task in MRI analysis. Most established techniques are designed for brain MRI by supposing that image intensities in the identical tissue follow a uniform distribution. Such an assumption cannot be easily applied to other organs, especially those that are small in size and heterogeneous in texture (large variations in intensity), such as the prostate. To address this problem, this paper proposes a probabilistic Hadamard U-Net (PHU-Net) for prostate MRI bias field correction. First, a novel Hadamard U-Net (HU-Net) is introduced to extract the low-frequency scalar field, multiplied by the original input to obtain the prototypical corrected image. HU-Net converts the input image from the time domain into the frequency domain via Hadamard transform. In the frequency domain, high-frequency components are eliminated using the trainable filter (scaling layer), hard-thresholding layer, and sparsity penalty. Next, a conditional variational autoencoder is used to encode possible bias field-corrected variants into a low-dimensional latent space. Random samples drawn from latent space are then incorporated with a prototypical corrected image to generate multiple plausible images. Experimental results demonstrate the effectiveness of PHU-Net in correcting bias-field in prostate MRI with a fast inference speed. It has also been shown that prostate MRI segmentation accuracy improves with the high-quality corrected images from PHU-Net. The code will be available in the final version of this manuscript.