Early tumor detection save lives. Each year, more than 300 million computed tomography (CT) scans are performed worldwide, offering a vast opportunity for effective cancer screening. However, detecting small or early-stage tumors on these CT scans remains challenging, even for experts. Artificial intelligence (AI) models can assist by highlighting suspicious regions, but training such models typically requires extensive tumor masks--detailed, voxel-wise outlines of tumors manually drawn by radiologists. Drawing these masks is costly, requiring years of effort and millions of dollars. In contrast, nearly every CT scan in clinical practice is already accompanied by medical reports describing the tumor's size, number, appearance, and sometimes, pathology results--information that is rich, abundant, and often underutilized for AI training. We introduce R-Super, which trains AI to segment tumors that match their descriptions in medical reports. This approach scales AI training with large collections of readily available medical reports, substantially reducing the need for manually drawn tumor masks. When trained on 101,654 reports, AI models achieved performance comparable to those trained on 723 masks. Combining reports and masks further improved sensitivity by +13% and specificity by +8%, surpassing radiologists in detecting five of the seven tumor types. Notably, R-Super enabled segmentation of tumors in the spleen, gallbladder, prostate, bladder, uterus, and esophagus, for which no public masks or AI models previously existed. This study challenges the long-held belief that large-scale, labor-intensive tumor mask creation is indispensable, establishing a scalable and accessible path toward early detection across diverse tumor types. We plan to release our trained models, code, and dataset at https://github.com/MrGiovanni/R-Super

The absence of adequately sufficient expert-level tumor annotations hinders the effectiveness of supervised learning based opportunistic cancer screening on medical imaging. Clinical reports (that are rich in descriptive textual details) can offer a "free lunch'' supervision information and provide tumor location as a type of weak label to cope with screening tasks, thus saving human labeling workloads, if properly leveraged. However, predicting cancer only using such weak labels can be very changeling since tumors are usually presented in small anatomical regions compared to the whole 3D medical scans. Weakly semi-supervised learning (WSSL) utilizes a limited set of voxel-level tumor annotations and incorporates alongside a substantial number of medical images that have only off-the-shelf clinical reports, which may strike a good balance between minimizing expert annotation workload and optimizing screening efficacy. In this paper, we propose a novel text-guided learning method to achieve highly accurate cancer detection results. Through integrating diagnostic and tumor location text prompts into the text encoder of a vision-language model (VLM), optimization of weakly supervised learning can be effectively performed in the latent space of VLM, thereby enhancing the stability of training. Our approach can leverage clinical knowledge by large-scale pre-trained VLM to enhance generalization ability, and produce reliable pseudo tumor masks to improve cancer detection. Our extensive quantitative experimental results on a large-scale cancer dataset, including 1,651 unique patients, validate that our approach can reduce human annotation efforts by at least 70% while maintaining comparable cancer detection accuracy to competing fully supervised methods (AUC value 0.961 versus 0.966).

Medical image registration is a critical task that estimates the spatial correspondence between pairs of images. However, current traditional and deep-learning-based methods rely on similarity measures to generate a deforming field, which often results in disproportionate volume changes in dissimilar regions, especially in tumor regions. These changes can significantly alter the tumor size and underlying anatomy, which limits the practical use of image registration in clinical diagnosis. To address this issue, we have formulated image registration with tumors as a constraint problem that preserves tumor volumes while maximizing image similarity in other normal regions. Our proposed strategy involves a two-stage process. In the first stage, we use similarity-based registration to identify potential tumor regions by their volume change, generating a soft tumor mask accordingly. In the second stage, we propose a volume-preserving registration with a novel adaptive volume-preserving loss that penalizes the change in size adaptively based on the masks calculated from the previous stage. Our approach balances image similarity and volume preservation in different regions, i.e., normal and tumor regions, by using soft tumor masks to adjust the imposition of volume-preserving loss on each one. This ensures that the tumor volume is preserved during the registration process. We have evaluated our strategy on various datasets and network architectures, demonstrating that our method successfully preserves the tumor volume while achieving comparable registration results with state-of-the-art methods. Our codes is available at: \url{https://dddraxxx.github.io/Volume-Preserving-Registration/}.

Data augmentation is classically used to improve the overall performance of deep learning models. It is, however, challenging in the case of medical applications, and in particular for multiparametric datasets. For example, traditional geometric transformations used in several applications to generate synthetic images can modify in a non-realistic manner the patients' anatomy. Therefore, dedicated image generation techniques are necessary in the medical field to, for example, mimic a given pathology realistically. This paper introduces a new data augmentation architecture that generates synthetic multiparametric (T1 arterial, T1 portal, and T2) magnetic resonance images (MRI) of massive macrotrabecular subtype hepatocellular carcinoma with their corresponding tumor masks through a generative deep learning approach. The proposed architecture creates liver tumor masks and abdominal edges used as input in a Pix2Pix network for synthetic data creation. The method's efficiency is demonstrated by training it on a limited multiparametric dataset of MRI triplets from $89$ patients with liver lesions to generate $1,000$ synthetic triplets and their corresponding liver tumor masks. The resulting Frechet Inception Distance score was $86.55$. The proposed approach was among the winners of the 2021 data augmentation challenge organized by the French Society of Radiology.

Instead of using current deep-learning segmentation models (like the UNet and variants), we approach the segmentation problem using trained Convolutional Neural Network (CNN) classifiers, which automatically extract important features from classified targets for image classification. Those extracted features can be visualized and formed heatmaps using Gradient-weighted Class Activation Mapping (Grad-CAM). This study tested whether the heatmaps could be used to segment the classified targets. We also proposed an evaluation method for the heatmaps; that is, to re-train the CNN classifier using images filtered by heatmaps and examine its performance. We used the mean-Dice coefficient to evaluate segmentation results. Results from our experiments show that heatmaps can locate and segment partial tumor areas. But only use of the heatmaps from CNN classifiers may not be an optimal approach for segmentation. In addition, we have verified that the predictions of CNN classifiers mainly depend on tumor areas, and dark regions in Grad-CAM's heatmaps also contribute to classification.