Accurate and complete segmentation of airways in chest CT images is essential for the quantitative assessment of lung diseases and the facilitation of pulmonary interventional procedures. Although deep learning has led to significant advancements in medical image segmentation, maintaining airway continuity remains particularly challenging. This difficulty arises primarily from the small and dispersed nature of airway structures, as well as class imbalance in CT scans. To address these challenges, we designed a Multi-scale Nested Residual U-Net (MNR-UNet), incorporating multi-scale inputs and Residual Multi-scale Modules (RMM) into a nested residual framework to enhance information flow, effectively capturing the intricate details of small airways and mitigating gradient vanishing. Building on this, we developed a three-stage segmentation pipeline to optimize the training of the MNR-UNet. The first two stages prioritize high accuracy and sensitivity, while the third stage focuses on repairing airway breakages to balance topological completeness and correctness. To further address class imbalance, we introduced a weighted Breakage-Aware Loss (wBAL) to heighten focus on challenging samples, penalizing breakages and thereby extending the length of the airway tree. Additionally, we proposed a hierarchical evaluation framework to offer more clinically meaningful analysis. Validation on both in-house and public datasets demonstrates that our approach achieves superior performance in detecting more accurate airway voxels and identifying additional branches, significantly improving airway topological completeness. The code will be released publicly following the publication of the paper.

Training fair machine learning models becomes more and more important. As many powerful models are trained by collaboration among multiple parties, each holding some sensitive data, it is natural to explore the feasibility of training fair models in federated learning so that the fairness of trained models, the data privacy of clients, and the collaboration between clients can be fully respected simultaneously. However, the task of training fair models in federated learning is challenging, since it is far from trivial to estimate the fairness of a model without knowing the private data of the participating parties, which is often constrained by privacy requirements in federated learning. In this paper, we first propose a federated estimation method to accurately estimate the fairness of a model without infringing the data privacy of any party. Then, we use the fairness estimation to formulate a novel problem of training fair models in federated learning. We develop FedFair, a well-designed federated learning framework, which can successfully train a fair model with high performance without data privacy infringement. Our extensive experiments on three real-world data sets demonstrate the excellent fair model training performance of our method.