The lack of explainability of deep learning models limits the adoption of such models in clinical practice. Prototype-based models can provide inherent explainable predictions, but these have predominantly been designed for classification tasks, despite many important tasks in medical imaging being continuous regression problems. Therefore, in this work, we present ExPeRT: an explainable prototype-based model specifically designed for regression tasks. Our proposed model makes a sample prediction from the distances to a set of learned prototypes in latent space, using a weighted mean of prototype labels. The distances in latent space are regularized to be relative to label differences, and each of the prototypes can be visualized as a sample from the training set. The image-level distances are further constructed from patch-level distances, in which the patches of both images are structurally matched using optimal transport. This thus provides an example-based explanation with patch-level detail at inference time. We demonstrate our proposed model for brain age prediction on two imaging datasets: adult MR and fetal ultrasound. Our approach achieved state-of-the-art prediction performance while providing insight into the model’s reasoning process.

Since the rise of deep learning, new medical segmentation methods have rapidly been proposed with extremely promising results, often reporting marginal improvements on the previous state-of-the-art (SOTA) method. However, on visual inspection errors are often revealed, such as topological mistakes (e.g. holes or folds), that are not detected using traditional evaluation metrics. Incorrect topology can often lead to errors in clinically required downstream image processing tasks. Therefore, there is a need for new methods to focus on ensuring segmentations are topologically correct. In this work, we present TEDS-Net: a segmentation network that preserves anatomical topology whilst maintaining segmentation performance that is competitive with SOTA baselines. Further, we show how current SOTA segmentation methods can introduce problematic topological errors. TEDS-Net achieves anatomically plausible segmentation by using learnt topology-preserving fields to deform a prior. Traditionally, topology-preserving fields are described in the continuous domain and begin to break down when working in the discrete domain. Here, we introduce additional modifications that more strictly enforce topology preservation. We illustrate our method on an open-source medical heart dataset, performing both single and multi-structure segmentation, and show that the generated fields contain no folding voxels, which corresponds to full topology preservation on individual structures whilst vastly outperforming the other baselines on overall scene topology. The code is available at: https://github.com/mwyburd/TEDS-Net.

Three-dimensional (3D) ultrasound imaging has contributed to our understanding of fetal developmental processes by providing rich contextual information of the inherently 3D anatomies. However, its use is limited in clinical settings, due to the high purchasing costs and limited diagnostic practicality. Freehand 2D ultrasound imaging, in contrast, is routinely used in standard obstetric exams, but inherently lacks a 3D representation of the anatomies, which limits its potential for more advanced assessment. Such full representations are challenging to recover even with external tracking devices due to internal fetal movement which is independent from the operator-led trajectory of the probe. Capitalizing on the flexibility offered by freehand 2D ultrasound acquisition, we propose ImplicitVol to reconstruct 3D volumes from non-sensor-tracked 2D ultrasound sweeps. Conventionally, reconstructions are performed on a discrete voxel grid. We, however, employ a deep neural network to represent, for the first time, the reconstructed volume as an implicit function. Specifically, ImplicitVol takes a set of 2D images as input, predicts their locations in 3D space, jointly refines the inferred locations, and learns a full volumetric reconstruction. When testing natively-acquired and volume-sampled 2D ultrasound video sequences collected from different manufacturers, the 3D volumes reconstructed by ImplicitVol show significantly better visual and semantic quality than the existing interpolation-based reconstruction approaches. The inherent continuity of implicit representation also enables ImplicitVol to reconstruct the volume to arbitrarily high resolutions. As formulated, ImplicitVol has the potential to integrate seamlessly into the clinical workflow, while providing richer information for diagnosis and evaluation of the developing brain.

To represent the biological variability of clinical neuroimaging populations, it is vital to be able to combine data across scanners and studies. However, different MRI scanners produce images with different characteristics, resulting in a domain shift known as the ‘harmonisation problem’. Additionally, neuroimaging data is inherently personal in nature, leading to data privacy concerns when sharing the data. To overcome these barriers, we propose an Unsupervised Source-Free Domain Adaptation (SFDA) method, SFHarmony. Through modelling the imaging features as a Gaussian Mixture Model and minimising an adapted Bhattacharyya distance between the source and target features, we can create a model that performs well for the target data whilst having a shared feature representation across the data domains, without needing access to the source data for adaptation or target labels. We demonstrate the performance of our method on simulated and real domain shifts, showing that the approach is applicable to classification, segmentation and regression tasks, requiring no changes to the algorithm. Our method outperforms existing SFDA approaches across a range of realistic data scenarios, demonstrating the potential utility of our approach for MRI harmonisation and general SFDA problems. Our code is available at https://github.com/nkdinsdale/SFHarmony.

Acquisition of high quality manual annotations is vital for the development of segmentation algorithms. However, to create them we require a substantial amount of expert time and knowledge. Large numbers of labels are required to train convolutional neural networks due to the vast number of parameters that must be learned in the optimisation process. Here, we develop the STAMP algorithm to allow the simultaneous training and pruning of a UNet architecture for medical image segmentation with targeted channelwise dropout to make the network robust to the pruning. We demonstrate the technique across segmentation tasks and imaging modalities. It is then shown that, through online pruning, we are able to train networks to have much higher performance than the equivalent standard UNet models while reducing their size by more than 85% in terms of parameters. This has the potential to allow networks to be directly trained on datasets where very low numbers of labels are available.

Convolutional Neural Networks (CNNs), which are currently state-of-the-art for most image analysis tasks, are ill suited to leveraging the key benefits of ultrasound imaging - specifically, ultrasound's portability and real-time capabilities. CNNs have large memory footprints, which obstructs their implementation on mobile devices, and require numerous floating point operations, which results in slow CPU inference times. In this paper, we propose three approaches to training efficient CNNs that can operate in real-time on a CPU (catering to the clinical setting), with a low memory footprint, for minimal compromise in accuracy. We first demonstrate the power of 'thin' CNNs, with very few feature channels, for fast medical image segmentation. We then leverage separable convolutions to further speed up inference, reduce parameter count and facilitate mobile deployment. Lastly, we propose a novel knowledge distillation technique to boost the accuracy of light-weight models, while maintaining inference speed-up. For a negligible sacrifice in test set Dice performance on the challenging ultrasound analysis task of nerve segmentation, our final proposed model processes images at 30fps on a CPU, which is 9× faster than the standard U-Net, while requiring 420× less space in memory.

Fetal brain magnetic resonance imaging (MRI) offers exquisite images of the developing brain but is not suitable for second-trimester anomaly screening, for which ultrasound (US) is employed. Although expert sonographers are adept at reading US images, MR images which closely resemble anatomical images are much easier for non-experts to interpret. Thus in this article we propose to generate MR-like images directly from clinical US images. In medical image analysis such a capability is potentially useful as well, for instance for automatic US-MRI registration and fusion. The proposed model is end-to-end trainable and self-supervised without any external annotations. Specifically, based on an assumption that the US and MRI data share a similar anatomical latent space, we first utilise a network to extract the shared latent features, which are then used for MRI synthesis. Since paired data is unavailable for our study (and rare in practice), pixel-level constraints are infeasible to apply. We instead propose to enforce the distributions to be statistically indistinguishable, by adversarial learning in both the image domain and feature space. To regularise the anatomical structures between US and MRI during synthesis, we further propose an adversarial structural constraint. A new cross-modal attention technique is proposed to utilise non-local spatial information, by encouraging multi-modal knowledge fusion and propagation. We extend the approach to consider the case where 3D auxiliary information (e.g., 3D neighbours and a 3D location index) from volumetric data is also available, and show that this improves image synthesis. The proposed approach is evaluated quantitatively and qualitatively with comparison to real fetal MR images and other approaches to synthesis, demonstrating its feasibility of synthesising realistic MR images.

We propose an automated framework for predicting gestational age (GA) and neurodevelopmental maturation of a fetus based on 3D ultrasound (US) brain image appearance. Our method capitalizes on age-related sonographic image patterns in conjunction with clinical measurements to develop, for the first time, a predictive age model which improves on the GA-prediction potential of US images. The framework benefits from a manifold surface representation of the fetal head which delineates the inner skull boundary and serves as a common coordinate system based on cranial position. This allows for fast and efficient sampling of anatomically-corresponding brain regions to achieve like-for-like structural comparison of different developmental stages. We develop bespoke features which capture neurosonographic patterns in 3D images, and using a regression forest classifier, we characterize structural brain development both spatially and temporally to capture the natural variation existing in a healthy population (N=447) over an age range of active brain maturation (18-34weeks). On a routine clinical dataset (N=187) our age prediction results strongly correlate with true GA (r=0.98,accurate within±6.10days), confirming the link between maturational progression and neurosonographic activity observable across gestation. Our model also outperforms current clinical methods by ±4.57 days in the third trimester-a period complicated by biological variations in the fetal population. Through feature selection, the model successfully identified the most age-discriminating anatomies over this age range as being the Sylvian fissure, cingulate, and callosal sulci.