The domain gap caused mainly by variable medical image quality renders a major obstacle on the path between training a segmentation model in the lab and applying the trained model to unseen clinical data. To address this issue, domain generalization methods have been proposed, which however usually use static convolutions and are less flexible. In this paper, we propose a multi-source domain generalization model based on the domain and content adaptive convolution (DCAC) for the segmentation of medical images across different modalities. Specifically, we design the domain adaptive convolution (DAC) module and content adaptive convolution (CAC) module and incorporate both into an encoder-decoder backbone. In the DAC module, a dynamic convolutional head is conditioned on the predicted domain code of the input to make our model adapt to the unseen target domain. In the CAC module, a dynamic convolutional head is conditioned on the global image features to make our model adapt to the test image. We evaluated the DCAC model against the baseline and four state-of-the-art domain generalization methods on the prostate segmentation, COVID-19 lesion segmentation, and optic cup/optic disc segmentation tasks. Our results not only indicate that the proposed DCAC model outperforms all competing methods on each segmentation task but also demonstrate the effectiveness of the DAC and CAC modules. Code is available at https://git.io/DCAC.

Lung nodule malignancy prediction is an essential step in the early diagnosis of lung cancer. Besides the difficulties commonly discussed, the challenges of this task also come from the ambiguous labels provided by annotators, since deep learning models have in some cases been found to reproduce or amplify human biases. In this paper, we propose a multi-view 'divide-and-rule' (MV-DAR) model to learn from both reliable and ambiguous annotations for lung nodule malignancy prediction on chest CT scans. According to the consistency and reliability of their annotations, we divide nodules into three sets: a consistent and reliable set (CR-Set), an inconsistent set (IC-Set), and a low reliable set (LR-Set). The nodule in IC-Set is annotated by multiple radiologists inconsistently, and the nodule in LR-Set is annotated by only one radiologist. Although ambiguous, inconsistent labels tell which label(s) is consistently excluded by all annotators, and the unreliable labels of a cohort of nodules are largely correct from the statistical point of view. Hence, both IC-Set and LR-Set can be used to facilitate the training of MV-DAR. Our MV-DAR contains three DAR models to characterize a lung nodule from three orthographic views and is trained following a two-stage procedure. Each DAR consists of three networks with the same architecture, including a prediction network (Prd-Net), a counterfactual network (CF-Net), and a low reliable network (LR-Net), which are trained on CR-Set, IC-Set, and LR-Set respectively in the pretraining phase. In the fine-tuning phase, the image representation ability learned by CF-Net and LR-Net is transferred to Prd-Net by negative-attention module (NA-Module) and consistent-attention module (CA-Module), aiming to boost the prediction ability of Prd-Net. The MV-DAR model has been evaluated on the LIDC-IDRI dataset and LUNGx dataset. Our results indicate not only the effectiveness of the MV-DAR in learning from ambiguous labels but also its superiority over present noisy label-learning models in lung nodule malignancy prediction.