Due to a high heterogeneity in pose and size and to a limited number of available data, segmentation of pediatric images is challenging for deep learning methods. In this work, we propose a new CNN architecture that is pose and scale invariant thanks to the use of Spatial Transformer Network (STN). Our architecture is composed of three sequential modules that are estimated together during training: (i) a regression module to estimate a similarity matrix to normalize the input image to a reference one; (ii) a differentiable module to find the region of interest to segment; (iii) a segmentation module, based on the popular UNet architecture, to delineate the object. Unlike the original UNet, which strives to learn a complex mapping, including pose and scale variations, from a finite training dataset, our segmentation module learns a simpler mapping focusing on images with normalized pose and size. Furthermore, the use of an automatic bounding box detection through STN allows saving time and especially memory, while keeping similar performance. We test the proposed method in kidney and renal tumor segmentation on abdominal pediatric CT scanners. Results indicate that the estimated STN homogenization of size and pose accelerates the segmentation (25h), compared to standard data-augmentation (33h), while obtaining a similar quality for the kidney (88.01\% of Dice score) and improving the renal tumor delineation (from 85.52\% to 87.12\%).

The joint use of multiple imaging modalities for medical image segmentation has been widely studied in recent years. The fusion of information from different modalities has demonstrated to improve the segmentation accuracy, with respect to mono-modal segmentations, in several applications. However, acquiring multiple modalities is usually not possible in a clinical setting due to a limited number of physicians and scanners, and to limit costs and scan time. Most of the time, only one modality is acquired. In this paper, we propose KD-Net, a framework to transfer knowledge from a trained multi-modal network (teacher) to a mono-modal one (student). The proposed method is an adaptation of the generalized distillation framework where the student network is trained on a subset (1 modality) of the teacher's inputs (n modalities). We illustrate the effectiveness of the proposed framework in brain tumor segmentation with the BraTS 2018 dataset. Using different architectures, we show that the student network effectively learns from the teacher and always outperforms the baseline mono-modal network in terms of segmentation accuracy.