Accurate classification of white blood cells in peripheral blood is essential for diagnosing hematological diseases. Due to constantly evolving clinical settings, data sources, and disease classifications, it is necessary to update machine learning classification models regularly for practical real-world use. Such models significantly benefit from sequentially learning from incoming data streams without forgetting previously acquired knowledge. However, models can suffer from catastrophic forgetting, causing a drop in performance on previous tasks when fine-tuned on new data. Here, we propose a rehearsal-based continual learning approach for class incremental and domain incremental scenarios in white blood cell classification. To choose representative samples from previous tasks, we employ exemplar set selection based on the model's predictions. This involves selecting the most confident samples and the most challenging samples identified through uncertainty estimation of the model. We thoroughly evaluated our proposed approach on three white blood cell classification datasets that differ in color, resolution, and class composition, including scenarios where new domains or new classes are introduced to the model with every task. We also test a long class incremental experiment with both new domains and new classes. Our results demonstrate that our approach outperforms established baselines in continual learning, including existing iCaRL and EWC methods for classifying white blood cells in cross-domain environments.

Measuring cross-sectional areas in ultrasound images is a standard tool to evaluate disease progress or treatment response. Often addressed today with supervised deep-learning segmentation approaches, existing solutions highly depend upon the quality of experts' annotations. However, the annotation quality in ultrasound is anisotropic and position-variant due to the inherent physical imaging principles, including attenuation, shadows, and missing boundaries, commonly exacerbated with depth. This work proposes a novel approach that guides ultrasound segmentation networks to account for sonographers' uncertainties and generate predictions with variability similar to the experts. We claim that realistic variability can reduce overconfident predictions and improve physicians' acceptance of deep-learning cross-sectional segmentation solutions. Our method provides CM's certainty for each pixel for minimal computational overhead as it can be precalculated directly from the image. We show that there is a correlation between low values in the confidence maps and expert's label uncertainty. Therefore, we propose to give the confidence maps as additional information to the networks. We study the effect of the proposed use of ultrasound CMs in combination with four state-of-the-art neural networks and in two configurations: as a second input channel and as part of the loss. We evaluate our method on 3D ultrasound datasets of the thyroid and lower limb muscles. Our results show ultrasound CMs increase the Dice score, improve the Hausdorff and Average Surface Distances, and decrease the number of isolated pixel predictions. Furthermore, our findings suggest that ultrasound CMs improve the penalization of uncertain areas in the ground truth data, thereby improving problematic interpolations. Our code and example data will be made public at https://github.com/IFL-CAMP/Confidence-segmentation.

While state-of-the-art monocular depth estimation approaches achieve impressive results in ideal settings, they are highly unreliable under challenging illumination and weather conditions, such as at nighttime or in the presence of rain. In this paper, we uncover these safety-critical issues and tackle them with md4all: a simple and effective solution that works reliably under both adverse and ideal conditions, as well as for different types of learning supervision. We achieve this by exploiting the efficacy of existing methods under perfect settings. Therefore, we provide valid training signals independently of what is in the input. First, we generate a set of complex samples corresponding to the normal training ones. Then, we train the model by guiding its self- or full-supervision by feeding the generated samples and computing the standard losses on the corresponding original images. Doing so enables a single model to recover information across diverse conditions without modifications at inference time. Extensive experiments on two challenging public datasets, namely nuScenes and Oxford RobotCar, demonstrate the effectiveness of our techniques, outperforming prior works by a large margin in both standard and challenging conditions. Source code and data are available at: https://md4all.github.io.

Panoptic segmentation methods assign a known class to each pixel given in input. Even for state-of-the-art approaches, this inevitably enforces decisions that systematically lead to wrong predictions for objects outside the training categories. However, robustness against out-of-distribution samples and corner cases is crucial in safety-critical settings to avoid dangerous consequences. Since real-world datasets cannot contain enough data points to adequately sample the long tail of the underlying distribution, models must be able to deal with unseen and unknown scenarios as well. Previous methods targeted this by re-identifying already-seen unlabeled objects. In this work, we propose the necessary step to extend segmentation with a new setting which we term holistic segmentation. Holistic segmentation aims to identify and separate objects of unseen, unknown categories into instances without any prior knowledge about them while performing panoptic segmentation of known classes. We tackle this new problem with U3HS, which finds unknowns as highly uncertain regions and clusters their corresponding instance-aware embeddings into individual objects. By doing so, for the first time in panoptic segmentation with unknown objects, our U3HS is trained without unknown categories, reducing assumptions and leaving the settings as unconstrained as in real-life scenarios. Extensive experiments on public data from MS COCO, Cityscapes, and Lost&Found demonstrate the effectiveness of U3HS for this new, challenging, and assumptions-free setting called holistic segmentation. Project page: https://holisticseg.github.io.

Federated learning is a promising direction to tackle the privacy issues related to sharing patients' sensitive data. Often, federated systems in the medical image analysis domain assume that the participating local clients are \textit{honest}. Several studies report mechanisms through which a set of malicious clients can be introduced that can poison the federated setup, hampering the performance of the global model. To overcome this, robust aggregation methods have been proposed that defend against those attacks. We observe that most of the state-of-the-art robust aggregation methods are heavily dependent on the distance between the parameters or gradients of malicious clients and benign clients, which makes them prone to local model poisoning attacks when the parameters or gradients of malicious and benign clients are close. Leveraging this, we introduce DISBELIEVE, a local model poisoning attack that creates malicious parameters or gradients such that their distance to benign clients' parameters or gradients is low respectively but at the same time their adverse effect on the global model's performance is high. Experiments on three publicly available medical image datasets demonstrate the efficacy of the proposed DISBELIEVE attack as it significantly lowers the performance of the state-of-the-art \textit{robust aggregation} methods for medical image analysis. Furthermore, compared to state-of-the-art local model poisoning attacks, DISBELIEVE attack is also effective on natural images where we observe a severe drop in classification performance of the global model for multi-class classification on benchmark dataset CIFAR-10.

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques.

Recent advancements in surgical computer vision applications have been driven by fully-supervised methods, primarily using only visual data. These methods rely on manually annotated surgical videos to predict a fixed set of object categories, limiting their generalizability to unseen surgical procedures and downstream tasks. In this work, we put forward the idea that the surgical video lectures available through open surgical e-learning platforms can provide effective supervisory signals for multi-modal representation learning without relying on manual annotations. We address the surgery-specific linguistic challenges present in surgical video lectures by employing multiple complementary automatic speech recognition systems to generate text transcriptions. We then present a novel method, SurgVLP - Surgical Vision Language Pre-training, for multi-modal representation learning. SurgVLP constructs a new contrastive learning objective to align video clip embeddings with the corresponding multiple text embeddings by bringing them together within a joint latent space. To effectively show the representation capability of the learned joint latent space, we introduce several vision-and-language tasks for surgery, such as text-based video retrieval, temporal activity grounding, and video captioning, as benchmarks for evaluation. We further demonstrate that without using any labeled ground truth, our approach can be employed for traditional vision-only surgical downstream tasks, such as surgical tool, phase, and triplet recognition. The code will be made available at https://github.com/CAMMA-public/SurgVLP

Statistical shape models (SSMs) are an established way to represent the anatomy of a population with various clinically relevant applications. However, they typically require domain expertise, and labor-intensive landmark annotations to construct. We address these shortcomings by proposing an unsupervised method that leverages deep geometric features and functional correspondences to simultaneously learn local and global shape structures across population anatomies. Our pipeline significantly improves unsupervised correspondence estimation for SSMs compared to baseline methods, even on highly irregular surface topologies. We demonstrate this for two different anatomical structures: the thyroid and a multi-chamber heart dataset. Furthermore, our method is robust enough to learn from noisy neural network predictions, potentially enabling scaling SSMs to larger patient populations without manual segmentation annotation.

Multimodal image registration is a challenging but essential step for numerous image-guided procedures. Most registration algorithms rely on the computation of complex, frequently non-differentiable similarity metrics to deal with the appearance discrepancy of anatomical structures between imaging modalities. Recent Machine Learning based approaches are limited to specific anatomy-modality combinations and do not generalize to new settings. We propose a generic framework for creating expressive cross-modal descriptors that enable fast deformable global registration. We achieve this by approximating existing metrics with a dot-product in the feature space of a small convolutional neural network (CNN) which is inherently differentiable can be trained without registered data. Our method is several orders of magnitude faster than local patch-based metrics and can be directly applied in clinical settings by replacing the similarity measure with the proposed one. Experiments on three different datasets demonstrate that our approach generalizes well beyond the training data, yielding a broad capture range even on unseen anatomies and modality pairs, without the need for specialized retraining. We make our training code and data publicly available.

Pre-training has shown success in different areas of machine learning, such as Computer Vision, Natural Language Processing (NLP), and medical imaging. However, it has not been fully explored for clinical data analysis. An immense amount of clinical records are recorded, but still, data and labels can be scarce for data collected in small hospitals or dealing with rare diseases. In such scenarios, pre-training on a larger set of unlabelled clinical data could improve performance. In this paper, we propose novel unsupervised pre-training techniques designed for heterogeneous, multi-modal clinical data for patient outcome prediction inspired by masked language modeling (MLM), by leveraging graph deep learning over population graphs. To this end, we further propose a graph-transformer-based network, designed to handle heterogeneous clinical data. By combining masking-based pre-training with a transformer-based network, we translate the success of masking-based pre-training in other domains to heterogeneous clinical data. We show the benefit of our pre-training method in a self-supervised and a transfer learning setting, utilizing three medical datasets TADPOLE, MIMIC-III, and a Sepsis Prediction Dataset. We find that our proposed pre-training methods help in modeling the data at a patient and population level and improve performance in different fine-tuning tasks on all datasets.