Semi-supervised learning (SSL) has achieved notable progress in medical image segmentation. To achieve effective SSL, a model needs to be able to efficiently learn from limited labeled data and effectively exploit knowledge from abundant unlabeled data. Recent developments in visual foundation models, such as the Segment Anything Model (SAM), have demonstrated remarkable adaptability with improved sample efficiency. To seamlessly harness foundation models in SSL, we propose a SAM-driven cross prompting framework with adaptive sampling and prompt consistency for semi-supervised medical image segmentation, named CPAC-SAM. Our method employs SAM's unique prompt design and innovates a cross prompting strategy within a dual-branch framework to automatically generate prompts and supervision across two decoder branches, enabling effective learning from both scarce labeled and valuable unlabeled data. To ensure the quality of prompts for unlabeled data and provide meaningful supervision in the cross prompting scheme, we propose an innovative prototype-guided grid sampling strategy with adaptive intervals to simultaneously improve the reliability of the prompt selection area and ensure both adequate prompt density and complete target coverage. We further design a novel prompt consistency regularization to reduce SAM's prompt sensitivity and to enhance the output invariance under different prompts. We validate our method on five medical image segmentation tasks, encompassing both 2D and 3D scenarios. The extensive experiments with different labeled-data ratios and modalities demonstrate the superiority of our proposed method over the state-of-the-art SSL methods, with more than 4.1% and 3.8% Dice improvement on the breast cancer segmentation task and left atrium segmentation task, respectively. Our code is available at: https://github.com/JuzhengMiao/CPAC-SAM.

Image segmentation achieves significant improvements with deep neural networks at the premise of a large scale of labeled training data, which is laborious to assure in medical image tasks. Recently, semi-supervised learning (SSL) has shown great potential in medical image segmentation. However, the influence of the learning target quality for unlabeled data is usually neglected in these SSL methods. Therefore, this study proposes a novel self-correcting co-training scheme to learn a better target that is more similar to ground-truth labels from collaborative network outputs. Our work has three-fold highlights. First, we advance the learning target generation as a learning task, improving the learning confidence for unannotated data with a self-correcting module. Second, we impose a structure constraint to encourage the shape similarity further between the improved learning target and the collaborative network outputs. Finally, we propose an innovative pixel-wise contrastive learning loss to boost the representation capacity under the guidance of an improved learning target, thus exploring unlabeled data more efficiently with the awareness of semantic context. We have extensively evaluated our method with the state-of-the-art semi-supervised approaches on four public-available datasets, including the ACDC dataset, M&Ms dataset, Pancreas-CT dataset, and Task_07 CT dataset. The experimental results with different labeled-data ratios show our proposed method's superiority over other existing methods, demonstrating its effectiveness in semi-supervised medical image segmentation.

Semi-supervised learning (SSL) has recently demonstrated great success in medical image segmentation, significantly enhancing data efficiency with limited annotations. However, despite its empirical benefits, there are still concerns in the literature about the theoretical foundation and explanation of semi-supervised segmentation. To explore this problem, this study first proposes a novel causal diagram to provide a theoretical foundation for the mainstream semi-supervised segmentation methods. Our causal diagram takes two additional intermediate variables into account, which are neglected in previous work. Drawing from this proposed causal diagram, we then introduce a causality-inspired SSL approach on top of co-training frameworks called CauSSL, to improve SSL for medical image segmentation. Specifically, we first point out the importance of algorithmic independence between two networks or branches in SSL, which is often overlooked in the literature. We then propose a novel statistical quantification of the uncomputable algorithmic independence and further enhance the independence via a min-max optimization process. Our method can be flexibly incorporated into different existing SSL methods to improve their performance. Our method has been evaluated on three challenging medical image segmentation tasks using both 2D and 3D network architectures and has shown consistent improvements over state-of-the-art methods. Our code is publicly available at: https://github.com/JuzhengMiao/CauSSL.

The automatic and dependable identification of colonic disease subtypes by colonoscopy is crucial. Once successful, it will facilitate clinically more in-depth disease staging analysis and the formulation of more tailored treatment plans. However, inter-class confusion and brightness imbalance are major obstacles to colon disease subtyping. Notably, the Fourier-based image spectrum, with its distinctive frequency features and brightness insensitivity, offers a potential solution. To effectively leverage its advantages to address the existing challenges, this article proposes a framework capable of thorough learning in the frequency domain based on four core designs: the position consistency module, the high-frequency self-supervised module, the complex number arithmetic model, and the feature anti-aliasing module. The position consistency module enables the generation of spectra that preserve local and positional information while compressing the spectral data range to improve training stability. Through band masking and supervision, the high-frequency autoencoder module guides the network to learn useful frequency features selectively. The proposed complex number arithmetic model allows direct spectral training while avoiding the loss of phase information caused by current general-purpose real-valued operations. The feature anti-aliasing module embeds filters in the model to prevent spectral aliasing caused by down-sampling and improve performance. Experiments are performed on the collected five-class dataset, which contains 4591 colorectal endoscopic images. The outcomes show that our proposed method produces state-of-the-art results with an accuracy rate of 89.82%.

Automatic and accurate detection of anatomical landmarks is an essential operation in medical image analysis with a multitude of applications. Recent deep learning methods have improved results by directly encoding the appearance of the captured anatomy with the likelihood maps (i.e., heatmaps). However, most current solutions overlook another essence of heatmap regression, the objective metric for regressing target heatmaps and rely on hand-crafted heuristics to set the target precision, thus being usually cumbersome and task-specific. In this paper, we propose a novel learning-to-learn framework for landmark detection to optimize the neural network and the target precision simultaneously. The pivot of this work is to leverage the reinforcement learning (RL) framework to search objective metrics for regressing multiple heatmaps dynamically during the training process, thus avoiding setting problem-specific target precision. We also introduce an early-stop strategy for active termination of the RL agent's interaction that adapts the optimal precision for separate targets considering exploration-exploitation tradeoffs. This approach shows better stability in training and improved localization accuracy in inference. Extensive experimental results on two different applications of landmark localization: 1) our in-house prenatal ultrasound (US) dataset and 2) the publicly available dataset of cephalometric X-Ray landmark detection, demonstrate the effectiveness of our proposed method. Our proposed framework is general and shows the potential to improve the efficiency of anatomical landmark detection.