Automatic analysis of colonoscopy images has been an active field of research motivated by the importance of early detection of precancerous polyps. However, detecting polyps during the live examination can be challenging due to various factors such as variation of skills and experience among the endoscopists, lack of attentiveness, and fatigue leading to a high polyp miss-rate. Therefore, there is a need for an automated system that can flag missed polyps during the examination and improve patient care. Deep learning has emerged as a promising solution to this challenge as it can assist endoscopists in detecting and classifying overlooked polyps and abnormalities in real time, improving the accuracy of diagnosis and enhancing treatment. In addition to the algorithm’s accuracy, transparency and interpretability are crucial to explaining the whys and hows of the algorithm’s prediction. Further, conclusions based on incorrect decisions may be fatal, especially in medicine. Despite these pitfalls, most algorithms are developed in private data, closed source, or proprietary software, and methods lack reproducibility. Therefore, to promote the development of efficient and transparent methods, we have organized the “Medico automatic polyp segmentation (Medico 2020)” and “MedAI: Transparency in Medical Image Segmentation (MedAI 2021)” competitions. The Medico 2020 challenge received submissions from 17 teams, while the MedAI 2021 challenge also gathered submissions from another 17 distinct teams in the following year. We present a comprehensive summary and analyze each contribution, highlight the strength of the best-performing methods, and discuss the possibility of clinical translations of such methods into the clinic. Our analysis revealed that the participants improved dice coefficient metrics from 0.8607 in 2020 to 0.8993 in 2021 despite adding diverse and challenging frames (containing irregular, smaller, sessile, or flat polyps), which are frequently missed during a routine clinical examination. For the instrument segmentation task, the best team obtained a mean Intersection over union metric of 0.9364. For the transparency task, a multi-disciplinary team, including expert gastroenterologists, accessed each submission and evaluated the team based on open-source practices, failure case analysis, ablation studies, usability and understandability of evaluations to gain a deeper understanding of the models’ credibility for clinical deployment. The best team obtained a final transparency score of 21 out of 25. Through the comprehensive analysis of the challenge, we not only highlight the advancements in polyp and surgical instrument segmentation but also encourage subjective evaluation for building more transparent and understandable AI-based colonoscopy systems. Moreover, we discuss the need for multi-center and out-of-distribution testing to address the current limitations of the methods to reduce the cancer burden and improve patient care. • We present a detailed analysis of the Medico 2020 and MedAI 2021 challenges that are aimed at advancing automated polyp and instrument segmentation in colonoscopy for early colorectal cancer diagnosis by using novel deep learning methods. • To the best of our knowledge, MedAI 2021 is the first challenge to evaluate the transparency in both GI endoscopy and colonoscopy. Through the challenge, we invited the participants to list package dependencies and architecture code (with instructions for building, compiling, and training) and share trained model weights in a standardized format. Additionally, we invited participants to include the code for model evaluation and provide repository licensing information to enable others to use the code and the trained model responsibly. Moreover, we asked the participants to explain model predictions using intermediate heatmaps, perform ablation studies, conduct a thorough failure analysis, and share their code for reproducing the results. Finally, we performed a subjective evaluation by including an expert gastroenterologist in the group and gave the final transparency score based on the usefulness and understandability of the results. Our initiative aims to promote transparency in AI research and foster the development of reliable, interpretable, and trustworthy algorithms for use in medical image segmentation. • We provide a comparative analysis of the 34 proposed methods in both challenges (3 subtasks), covering small details of each team in the form of Tables, qualitative and quantitative results (failure analysis), and an in-depth analysis of the findings. • We explore trust, safety, interpretability, transparency, and generalizability issues and provide future strategies to overcome the current limitations of developed algorithms.

Deep Learning has the ability to train on datasets created from videos. This facility makes deep learning algorithms suitable for detecting distinct objects in large sets of frames, particularly for delineating anomalies like precancerous lesions during surveillance colonoscopies of the large bowel. However, capturing subtle, diffuse characteristics in these videos’ frames can be a challenge. This paper presents a deep learning system that uses colour channel separation and recombination of images to improve the performance of an object detection model, to tackle this challenge. Using a dataset from surveillance colonoscopy videos to find precancerous and cancerous lesions in IBD patients, individual colour channels of RGB images in the dataset are separated and recombined to form different datasets which are later used to train YOLOv8x models. The object detection model that is trained and tested with only the blue channel component of the images in the dataset performs better and gives more accurate predictions than the object detection model that is trained and tested with the datasets containing the green and/or the red channel images, as well as the dataset containing the original RGB images.

AI-based colon polyp detection systems have received much attention, and several products and prototypes report good results. In silico verification is a crucial step when developing such systems, but very few compare human versus AI performance. This paper, therefore, describes methods and results for an in silico test of an AI model with two different versions for polyp detection in colonoscopy and compares them to the performance of endoscopist doctors who reviewed the same colonoscopy video clips. The two versions have different thresholds for false positive rate reduction. Our models perform polyp detection within the range of the endoscopists' performance, although faster, showing a potential for use in a clinical setting. For the AI and the endoscopists alike, the results show a trade-off between high sensitivity and high specificity; to achieve perfect detection, one will also get abundance of false positives. This can cause alarm fatigue in a clinical setting.

Early identification of a polyp in the lower gas-trointestinal (GI) tract can lead to prevention of life-threatening colorectal cancer. Developing computer-aided diagnosis (CAD) systems to detect polyps can improve detection accuracy and efficiency and save the time of the domain experts called endoscopists. Lack of annotated data is a common challenge when building CAD systems. Generating synthetic medical data is an active research area to overcome the problem of having relatively few true positive cases in the medical domain. To be able to efficiently train machine learning (ML) models, which are the core of CAD systems, a considerable amount of data should be used. In this respect, we propose the PolypConnect pipeline, which can convert non-polyp images into polyp images to increase the size of training datasets for training. We present the whole pipeline with quantitative and qualitative evaluations involving endoscopists. The polyp segmentation model trained using synthetic data, and real data shows a 5.1% improvement of mean intersection over union (mIOU), compared to the model trained only using real data. The codes of all the experiments are available on GitHub to reproduce the results.

Deep learning in gastrointestinal endoscopy can assist to improve clinical performance and be helpful to assess lesions more accurately. To this extent, semantic segmentation methods that can perform automated real-time delineation of a region-of-interest, e.g., boundary identification of cancer or pre-cancerous lesions, can benefit both diagnosis and interventions. However, accurate and real-time segmentation of endoscopic images is extremely challenging due to its high operator dependence and high-definition image quality. To utilize automated methods in clinical settings, it is crucial to design lightweight models with low latency such that they can be integrated with low-end endoscope hardware devices. In this work, we propose NanoNet, a novel architecture for the segmentation of video capsule endoscopy and colonoscopy images. Our proposed architecture allows real-time performance and has higher segmentation accuracy compared to other more complex ones. We use video capsule endoscopy and standard colonoscopy datasets with polyps, and a dataset consisting of endoscopy biopsies and surgical instruments, to evaluate the effectiveness of our approach. Our experiments demonstrate the increased performance of our architecture in terms of a trade-off between model complexity, speed, model parameters, and metric performances. Moreover, the resulting models' size is relatively tiny, with only nearly 36,000 parameters compared to traditional deep learning approaches having millions of parameters.

Gastrointestinal (GI) endoscopy has been an active field of research motivated by the large number of highly lethal GI cancers. Early GI cancer precursors are often missed during the endoscopic surveillance. The high missed rate of such abnormalities during endoscopy is thus a critical bottleneck. Lack of attentiveness due to tiring procedures, and requirement of training are few contributing factors. An automatic GI disease classification system can help reduce such risks by flagging suspicious frames and lesions. GI endoscopy consists of several multi-organ surveillance, therefore, there is need to develop methods that can generalize to various endoscopic findings. In this realm, we present a comprehensive analysis of the Medico GI challenges: Medical Multimedia Task at MediaEval 2017, Medico Multimedia Task at MediaEval 2018, and BioMedia ACM MM Grand Challenge 2019. These challenges are initiative to set-up a benchmark for different computer vision methods applied to the multi-class endoscopic images and promote to build new approaches that could reliably be used in clinics. We report the performance of 21 participating teams over a period of three consecutive years and provide a detailed analysis of the methods used by the participants, highlighting the challenges and shortcomings of the current approaches and dissect their credibility for the use in clinical settings. Our analysis revealed that the participants achieved an improvement on maximum Mathew correlation coefficient (MCC) from 82.68% in 2017 to 93.98% in 2018 and 95.20% in 2019 challenges, and a significant increase in computational speed over consecutive years.

Colonoscopy is considered the gold standard for detection of colorectal cancer and its precursors. Existing examination methods are, however, hampered by high overall miss-rate, and many abnormalities are left undetected. Computer-Aided Diagnosis systems based on advanced machine learning algorithms are touted as a game-changer that can identify regions in the colon overlooked by the physicians during endoscopic examinations, and help detect and characterize lesions. In previous work, we have proposed the ResUNet++ architecture and demonstrated that it produces more efficient results compared with its counterparts U-Net and ResUNet. In this paper, we demonstrate that further improvements to the overall prediction performance of the ResUNet++ architecture can be achieved by using Conditional Random Field (CRF) and Test-Time Augmentation (TTA). We have performed extensive evaluations and validated the improvements using six publicly available datasets: Kvasir-SEG, CVC-ClinicDB, CVC-ColonDB, ETIS-Larib Polyp DB, ASU-Mayo Clinic Colonoscopy Video Database, and CVC-VideoClinicDB. Moreover, we compare our proposed architecture and resulting model with other state-of-the-art methods. To explore the generalization capability of ResUNet++ on different publicly available polyp datasets, so that it could be used in a real-world setting, we performed an extensive cross-dataset evaluation. The experimental results show that applying CRF and TTA improves the performance on various polyp segmentation datasets both on the same dataset and cross-dataset. To check the model's performance on difficult to detect polyps, we selected, with the help of an expert gastroenterologist, 196 sessile or flat polyps that are less than ten millimeters in size. This additional data has been made available as a subset of Kvasir-SEG. Our approaches showed good results for flat or sessile and smaller polyps, which are known to be one of the major reasons for high polyp miss-rates. This is one of the significant strengths of our work and indicates that our methods should be investigated further for use in clinical practice.

Accurate computer-aided polyp detection and segmentation during colonoscopy examinations can help endoscopists resect abnormal tissue and thereby decrease chances of polyps growing into cancer. Towards developing a fully automated model for pixel-wise polyp segmentation, we propose ResUNet++, which is an improved ResUNet architecture for colonoscopic image segmentation. Our experimental evaluations show that the suggested architecture produces good segmentation results on publicly available datasets. Furthermore, ResUNet++ significantly outperforms U-Net and ResUNet, two key state-of-the-art deep learning architectures, by achieving high evaluation scores with a dice coefficient of 81.33%, and a mean Intersection over Union (mIoU) of 79.27% for the Kvasir-SEG dataset and a dice coefficient of 79.55%, and a mIoU of 79.62% with CVC-612 dataset.

The BioMedia 2019 ACM Multimedia Grand Challenge is the first in a series of competitions focusing on the use of multimedia for different medical use-cases. In this year's challenge, the participants are asked to develop efficient algorithms which automatically detect a variety of findings commonly identified in the gastrointestinal (GI) tract (a part of the human digestive system). The purpose of this task is to develop methods to aid medical doctors performing routine endoscopy inspections of the GI tract. In this paper, we give a detailed description of the four different tasks of this year's challenge, present the datasets used for training and testing, and discuss how each submission is evaluated both qualitatively and quantitatively.

Neural networks, in the context of deep learning, show much promise in becoming an important tool with the purpose assisting medical doctors in disease detection during patient examinations. However, the current state of deep learning is something of a "black box", making it very difficult to understand what internal processes lead to a given result. This is not only true for non-technical users but among experts as well. This lack of understanding has led to hesitation in the implementation of these methods among mission-critical fields, with many putting interpretability in front of actual performance. Motivated by increasing the acceptance and trust of these methods, and to make qualified decisions, we present a system that allows for the partial opening of this black box. This includes an investigation on what the neural network sees when making a prediction, to both, improve algorithmic understanding, and to gain intuition into what pre-processing steps may lead to better image classification performance. Furthermore, a significant part of a medical expert's time is spent preparing reports after medical examinations, and if we already have a system for dissecting the analysis done by the network, the same tool can be used for automatic examination documentation through content suggestions. In this paper, we present a system that can look into the layers of a deep neural network and present the network's decision in a way that that medical doctors may understand. Furthermore, we present and discuss how this information can possibly be used for automatic reporting. Our initial results are very promising.

Video analysis including classification, segmentation or tagging is one of the most challenging but also interesting topics multimedia research currently try to tackle. This is often related to videos from surveillance cameras or social media. In the last years, also medical institutions produce more and more video and image content. Some areas of medical image analysis, like radiology or brain scans, are well covered, but there is a much broader potential of medical multimedia content analysis. For example, in colonoscopy, 20% of polyps are missed or incompletely removed on average. Thus, automatic detection to support medical experts can be useful. In this paper, we present and evaluate several machine learning-based approaches for real-time polyp detection for live colonoscopy. We propose pixel-wise localization and frame-wise detection methods which include both handcrafted and deep learning based approaches. The experimental results demonstrate the capability of analyzing multimedia content in real clinical settings, the possible improvements in the work flow and the potential improved detection rates for medical experts.

The interest in neural networks has increased significantly, and the application of this type of machine learning is vast, ranging from natural image classification to medical image segmentation. However, many users of neural networks tend to use them as a black box tool. They do not access all of the possible variations, nor take into account the respective classification accuracies and costs. In our work, we focus on multiclass image classification, and in this research, we shed light on the trade-offs between systems using a single multiclass classification and multiple binary classifiers, respectively. We have tested these classifiers on several modern neural network architectures, including DenseNet, Inception v3, Inception ResNet v2, Xception, NASNet and MobileNet. We have compared several aspects of the performance of these architectures during training and testing using both classification styles in terms of classification speed and several classification accuracy metrics. Here, we present the results from experiments on a total of 99 networks: 11 multiclass and 88 individual binary networks, for an 8-class classification of medical images. In short, using multiple binary classification networks resulted in a more robust model (less variance) for the task at hand. However, on average, such a multi-network style performed the classification 7.6 times slower compared to a single network multiclass implementation. These collective findings show that both approaches can be applied to modern neural network structures. Several binary networks can often give more robust and increased classification accuracy, but at the cost of classification speed and resources consumption.

Automatic detection of diseases is a growing field of interest, and machine learning in form of deep learning neural networks are frequently explored as a potential tool for the medical video analysis. To both improve the "black box"-understanding and assist in the administrative duties of writing an examination report, we release an automated multimedia reporting software dissecting the neural network to learn the intermediate analysis steps, i.e., we are adding a new level of understanding and explainability by looking into the deep learning algorithms decision processes. The presented open-source software can be used for easy retrieval and reuse of data for automatic report generation, comparisons, teaching and research. As an example, we use live colonoscopy as a use case which is the gold standard examination of the large bowel, commonly performed for clinical and screening purposes. The added information has potentially a large value, and reuse of the data for the automatic reporting may potentially save the doctors large amounts of time.

In the future, medical doctors will to an increasing degree be assisted by deep learning neural networks for disease detection during examinations of patients. In order to make qualified decisions, the black box of deep learning must be opened to increase the understanding of the reasoning behind the decision of the machine learning system. Furthermore, preparing reports after the examinations is a significant part of a doctors work-day, but if we already have a system dissecting the neural network for understanding, the same tool can be used for automatic report generation. In this demo, we describe a system that analyses medical videos from the gastrointestinal tract. Our system dissects the Tensorflow-based neural network to provide insights into the analysis and uses the resulting classification and rationale behind the classification to automatically generate an examination report for the patient's medical journal.

Analysis of medical videos for detection of abnormalities and diseases requires both high precision and recall, but also real-time processing for live feedback and scalability for massive screening of entire populations. Existing work on this field does not provide the necessary combination of retrieval accuracy and performance.; [email protected] this paper, a multimedia system is presented where the aim is to tackle automatic analysis of videos from the human gastrointestinal (GI) tract. The system includes the whole pipeline from data collection, processing and analysis, to visualization. The system combines filters using machine learning, image recognition and extraction of global and local image features. Furthermore, it is built in a modular way so that it can easily be extended. At the same time, it is developed for efficient processing in order to provide real-time feedback to the doctors. Our experimental evaluation proves that our system has detection and localisation accuracy at least as good as existing systems for polyp detection, it is capable of detecting a wider range of diseases, it can analyze video in real-time, and it has a low resource consumption for scalability.

Automatic detection of diseases by use of computers is an important, but still unexplored field of research. Such innovations may improve medical practice and refine health care systems all over the world. However, datasets containing medical images are hardly available, making reproducibility and comparison of approaches almost impossible. In this paper, we present KVASIR, a dataset containing images from inside the gastrointestinal (GI) tract. The collection of images are classified into three important anatomical landmarks and three clinically significant findings. In addition, it contains two categories of images related to endoscopic polyp removal. Sorting and annotation of the dataset is performed by medical doctors (experienced endoscopists). In this respect, KVASIR is important for research on both single- and multi-disease computer aided detection. By providing it, we invite and enable multimedia researcher into the medical domain of detection and retrieval.

Bowel preparation (cleansing) is considered to be a key precondition for successful colonoscopy (endoscopic examination of the bowel). The degree of bowel cleansing directly affects the possibility to detect diseases and may influence decisions on screening and follow-up examination intervals. An accurate assessment of bowel preparation quality is therefore important. Despite the use of reliable and validated bowel preparation scales, the grading may vary from one doctor to another. An objective and automated assessment of bowel cleansing would contribute to reduce such inequalities and optimize use of medical resources. This would also be a valuable feature for automatic endoscopy reporting in the future. In this paper, we present Nerthus, a dataset containing videos from inside the gastrointestinal (GI) tract, showing different degrees of bowel cleansing. By providing this dataset, we invite multimedia researchers to contribute in the medical field by making systems automatically evaluate the quality of bowel cleansing for colonoscopy. Such innovations would probably contribute to improve the medical field of GI endoscopy.

Analysis of medical videos from the human gastrointestinal (GI) tract for detection and localization of abnormalities like lesions and diseases requires both high precision and recall. Additionally, it is important to support efficient, real-time processing for live feedback during (i) standard colonoscopies and (ii) scalability for massive population-based screening, which we conjecture can be done using a wireless video capsule endoscope (camera-pill). Existing related work in this field does neither provide the necessary combination of accuracy and performance for detecting multiple classes of abnormalities simultaneously nor for particular disease localization tasks. In this paper, a complete end-to-end multimedia system is presented where the aim is to tackle automatic analysis of GI tract videos. The system includes an entire pipeline ranging from data collection, processing and analysis, to visualization. The system combines deep learning neural networks, information retrieval, and analysis of global and local image features in order to implement multi-class classification, detection and localization. Furthermore, it is built in a modular way, so that it can be easily extended to deal with other types of abnormalities. Simultaneously, the system is developed for efficient processing in order to provide real-time feedback to the doctors and for scalability reasons when potentially applied for massive population-based algorithmic screenings in the future. Initial experiments show that our system has multi-class detection accuracy and polyp localization precision at least as good as state-of-the-art systems, and provides additional novelty in terms of real-time performance, low resource consumption and ability to extend with support for new classes of diseases.

Holistic medical multimedia systems covering end-to-end functionality from data collection to aided diagnosis are highly needed, but rare. In many hospitals, the potential value of multimedia data collected through routine examinations is not recognized. Moreover, the availability of the data is limited, as the health care personnel may not have direct access to stored data. However, medical specialists interact with multimedia content daily through their everyday work and have an increasing interest in finding ways to use it to facilitate their work processes. In this article, we present a novel, holistic multimedia system aiming to tackle automatic analysis of video from gastrointestinal (GI) endoscopy. The proposed system comprises the whole pipeline, including data collection, processing, analysis, and visualization. It combines filters using machine learning, image recognition, and extraction of global and local image features. The novelty is primarily in this holistic approach and its real-time performance, where we automate a complete algorithmic GI screening process. We built the system in a modular way to make it easily extendable to analyze various abnormalities, and we made it efficient in order to run in real time. The conducted experimental evaluation proves that the detection and localization accuracy are comparable or even better than existing systems, but it is by far leading in terms of real-time performance and efficient resource consumption.

The process of finding diseases and abnormalities during live medical examinations has for a long time depended mostly on the medical personnel, with a limited amount of computer support. However, computer-based medical systems are currently emerging in domains like endoscopies of the gastrointestinal (GI) tract. In this context, we aim for a system that enables automatic analysis of endoscopy videos, where one use case is live computer-assisted endoscopy that increases disease-and abnormality-detection rates. In this paper, a system that tackles live automatic analysis of endoscopy videos is presented with a particular focus on the system's ability to perform in real time. The presented system utilizes different parts of a heterogeneous architecture and can be used for automatic analysis of high-definition colonoscopy videos (and a fully automated analysis of video from capsular endoscopy devices). We describe our implementation and report the system performance of our GPU-based processing framework. The experimental results show real-time stream processing and low resource consumption, and a detection precision and recall level at least as good as existing related work.

Health care has a long history of adopting technology to save lives and improve the quality of living. Visual information is frequently applied for disease detection and assessment, and the established fields of computer vision and medical imaging provide essential tools. It is, however, a misconception that disease detection and assessment are provided exclusively by these fields and that they provide the solution for all challenges. Integration and analysis of data from several sources, real-time processing, and the assessment of usefulness for end-users are core competences of the multimedia community and are required for the successful improvement of health care systems. We have conducted initial investigations into two use cases surrounding diseases of the gastrointestinal (GI) tract, where the detection of abnormalities provides the largest chance of successful treatment if the initial observation of disease indicators occurs before the patient notices any symptoms. Although such detection is typically provided visually by applying an endoscope, we are facing a multitude of new multimedia challenges that differ between use cases. In real-time assistance for colonoscopy, we combine sensor information about camera position and direction to aid in detecting, investigate means for providing support to doctors in unobtrusive ways, and assist in reporting. In the area of large-scale capsular endoscopy, we investigate questions of scalability, performance and energy efficiency for the recording phase, and combine video summarization and retrieval questions for analysis.

In this paper, we present a demo that utilizes Device Lending via PCI Express (PCIe) in the context of a multi-auditory environment. Device Lending is a transparent, low-latency cross-machine PCIe device sharing mechanism without any the need for implementing application-specific distribution mechanisms. As workload, we use a computer-aided diagnosis system that is used to automatically find polyps and mark them for medical doctors during a colonoscopy. We choose this scenario because one of the main requirements is to perform the analysis in real-time. The demonstration consists of a setup of two computers that demonstrates how Device Lending can be used to improve performance, as well as its effect of providing the performance needed for real-time feedback. We also present a performance evaluation that shows its real-time capabilities of it.

In this paper, we present the computer-aided diagnosis part of the EIR system [9], which can support medical experts in the task of detecting diseases and anatomical landmarks in the gastrointestinal (GI) system. This includes automatic detection of important findings in colonoscopy videos and marking them for the doctors. EIR is designed in a modular way so that it can easily be extended for other diseases. For this demonstration, we will focus on polyp detection, as our system is trained with the ASU-Mayo Clinic polyp database [5].