Despite the advances in automated medical image segmentation, AI models still underperform in various clinical settings, posing challenges for integration into real-world workflows. In this pre-registered prospective multicenter evaluation, we analyzed 20 state-of-the-art mandibular segmentation models across 19,218 segmentations of 1,000 clinically resampled CT/CBCT scans. Our results suggest that for a given model, segmentation accuracy can vary by up to 25% in Dice score as socio-technical factors such as voxel size, bone orientation, and patient conditions (e.g., osteosynthesis or pathology) shift from favorable to adverse. Higher sharpness, isotropic smaller voxels, and neutral orientation significantly improved results, while metallic osteosynthesis and anatomical complexity led to significant degradation. Our findings challenge the common view of AI models as “plug-and-play” tools and suggest evidence-based optimization recommendations for both clinicians and developers. This will in turn boost the integration of AI segmentation tools in routine healthcare.

We present Connected-Component (CC)-Metrics, a novel semantic segmentation evaluation protocol, targeted to align existing semantic segmentation metrics to a multi-instance detection scenario in which each connected component matters. We motivate this setup in the common medical scenario of semantic metastases segmentation in a full-body PET/CT. We show how existing semantic segmentation metrics suffer from a bias towards larger connected components contradicting the clinical assessment of scans in which tumor size and clinical relevance are uncorrelated. To rebalance existing segmentation metrics, we propose to evaluate them on a per-component basis thus giving each tumor the same weight irrespective of its size. To match predictions to ground-truth segments, we employ a proximity-based matching criterion, evaluating common metrics locally at the component of interest. Using this approach, we break free of biases introduced by large metastasis for overlap-based metrics such as Dice or Surface Dice. CC-Metrics also improves distance-based metrics such as Hausdorff Distances which are uninformative for small changes that do not influence the maximum or 95th percentile, and avoids pitfalls introduced by directly combining counting-based metrics with overlap-based metrics as it is done in Panoptic Quality.

In this paper, we explore the potential of visual in-context learning to enable a single model to handle multiple tasks and adapt to new tasks during test time without re-training. Unlike previous approaches, our focus is on training in-context learners to adapt to sequences of tasks, rather than individual tasks. Our goal is to solve complex tasks that involve multiple intermediate steps using a single model, allowing users to define entire vision pipelines flexibly at test time. To achieve this, we first examine the properties and limitations of visual in-context learning architectures, with a particular focus on the role of codebooks. We then introduce a novel method for training in-context learners using a synthetic compositional task generation engine. This engine bootstraps task sequences from arbitrary segmentation datasets, enabling the training of visual in-context learners for compositional tasks. Additionally, we investigate different masking-based training objectives to gather insights into how to train models better for solving complex, compositional tasks. Our exploration not only provides important insights especially for multi-modal medical task sequences but also highlights challenges that need to be addressed.

In this paper, we present a method for generating automated anatomy segmentation datasets using a sequential process that involves nnU-Net-based pseudo-labeling and anatomy-guided pseudo-label refinement. By combining various fragmented knowledge bases, we generate a dataset of whole-body CT scans with 142 voxel-level labels for 533 volumes providing comprehensive anatomical coverage. We validate its usefulness via Human expert evaluation and medical validity. This dataset enables the analysis of whole-body anatomy segmentation for cancer patients. Besides the DAP Atlas dataset, we release our trained anatomy segmentation models capable of predicting 142 anatomical structures on CT data.

Nuclei detection and segmentation in hematoxylin and eosin-stained (H&E) tissue images are important clinical tasks and crucial for a wide range of applications. However, it is a challenging task due to nuclei variances in staining and size, overlapping boundaries, and nuclei clustering. While convolutional neural networks have been extensively used for this task, we explore the potential of Transformer-based networks in combination with large scale pre-training in this domain. Therefore, we introduce a new method for automated instance segmentation of cell nuclei in digitized tissue samples using a deep learning architecture based on Vision Transformer called CellViT. CellViT is trained and evaluated on the PanNuke dataset, which is one of the most challenging nuclei instance segmentation datasets, consisting of nearly 200,000 annotated nuclei into 5 clinically important classes in 19 tissue types. We demonstrate the superiority of large-scale in-domain and out-of-domain pre-trained Vision Transformers by leveraging the recently published Segment Anything Model and a ViT-encoder pre-trained on 104 million histological image patches - achieving state-of-the-art nuclei detection and instance segmentation performance on the PanNuke dataset with a mean panoptic quality of 0.50 and an F1-detection score of 0.83. The code is publicly available at https://github.com/TIO-IKIM/CellViT.

A vast amount of images and pixel-wise annotations allowed our community to build scalable segmentation solutions for natural domains. However, the transfer to expert-driven domains like microscopy applications or medical healthcare remains difficult as domain experts are a critical factor due to their limited availability for providing pixel-wise annotations. To enable affordable segmentation solutions for such domains, we need training strategies which can simultaneously handle diverse annotation types and are not bound to costly pixel-wise annotations. In this work, we analyze existing training algorithms towards their flexibility for different annotation types and scalability to small annotation regimes. We conduct an extensive evaluation in the challenging domain of organelle segmentation and find that existing semi- and semi-weakly supervised training algorithms are not able to fully exploit diverse annotation types. Driven by our findings, we introduce Decoupled Semantic Prototypes (DSP) as a training method for semantic segmentation which enables learning from annotation types as diverse as image-level-, point-, bounding box-, and pixel-wise annotations and which leads to remarkable accuracy gains over existing solutions for semi-weakly segmentation.

Producing densely annotated data is a difficult and tedious task for medical imaging applications. To address this problem, we propose a novel approach to generate supervision for semi-supervised semantic segmentation. We argue that visually similar regions between labeled and unlabeled images likely contain the same semantics and therefore should share their label. Following this thought, we use a small number of labeled images as reference material and match pixels in an unlabeled image to the semantic of the best fitting pixel in a reference set. This way, we avoid pitfalls such as confirmation bias, common in purely prediction-based pseudo-labeling. Since our method does not require any architectural changes or accompanying networks, one can easily insert it into existing frameworks. We achieve the same performance as a standard fully supervised model on X-ray anatomy segmentation, albeit using 95% fewer labeled images. Aside from an in-depth analysis of different aspects of our proposed method, we further demonstrate the effectiveness of our reference-guided learning paradigm by comparing our approach against existing methods for retinal fluid segmentation with competitive performance as we improve upon recent work by up to 15% mean IoU.

Dimensionality reduction is crucial both for visualization and preprocessing high dimensional data for machine learning. We introduce a novel method based on a hierarchy built on 1-nearest neighbor graphs in the original space which is used to preserve the grouping properties of the data distribution on multiple levels. The core of the proposal is an optimization-free projection that is competitive with the latest versions of t-SNE and UMAP in performance and visualization quality while being an order of magnitude faster at run-time. Furthermore, its interpretable mechanics, the ability to project new data, and the natural separation of data clusters in visualizations make it a general purpose unsupervised dimension reduction technique. In the paper, we argue about the soundness of the proposed method and evaluate it on a diverse collection of datasets with sizes varying from 1 K to 11M samples and dimensions from 28 to 16K. We perform comparisons with other state-of-the-art methods on multiple metrics and target dimensions high-lighting its efficiency and performance. Code is available at https://github.com/koulakis/h-nne

Structured Visual Content (SVC) such as graphs, flow charts, or the like are used by authors to illustrate various concepts. While such depictions allow the average reader to better understand the contents, images containing SVCs are typically not machine-readable. This, in turn, not only hinders automated knowledge aggregation, but also the perception of displayed information for visually impaired people. In this work, we propose a synthetic dataset, containing SVCs in the form of images as well as ground truths. We show the usage of this dataset by an application that automatically extracts a graph representation from an SVC image. This is done by training a model via common supervised learning methods. As there currently exist no large-scale public datasets for the detailed analysis of SVC, we propose the Synthetic SVC (SSVC) dataset comprising 12,000 images with respective bounding box annotations and detailed graph representations. Our dataset enables the development of strong models for the interpretation of SVCs while skipping the time-consuming dense data annotation.We evaluate our model on both synthetic and manually annotated data and show the transferability of synthetic to real via various metrics, given the presented application. Here, we evaluate that this proof of concept is possible to some extend and lay down a solid baseline for this task. We discuss the limitations of our approach for further improvements. Our utilized metrics can be used as a tool for future comparisons in this domain. To enable further research on this task, the dataset is publicly available at https://bit.ly/3jN1pJJ.

Visual recognition inside the vehicle cabin leads to safer driving and more intuitive human-vehicle interaction but such systems face substantial obstacles as they need to capture different granularities of driver behaviour while dealing with highly limited body visibility and changing illumination. Multimodal recognition mitigates a number of such issues: prediction outcomes of different sensors complement each other due to different modality-specific strengths and weaknesses. While several late fusion methods have been considered in previously published frameworks, they constantly feature different architecture backbones and building blocks making it very hard to isolate the role of the chosen late fusion strategy itself.This paper presents an empirical evaluation of different paradigms for decision-level late fusion in video-based driver observation. We compare seven different mechanisms for joining the results of single-modal classifiers which have been both popular, (e.g. score averaging) and not yet considered (e.g. rank-level fusion) in the context of driver observation evaluating them based on different criteria and benchmark settings. This is the first systematic study of strategies for fusing outcomes of multimodal predictors inside the vehicles, conducted with the goal to provide guidance for fusion scheme selection.

Pixel-wise segmentation is one of the most data and an-notation hungry tasks in our field. Providing representative and accurate annotations is often mission-critical especially for challenging medical applications. In this paper, we propose a semi-weakly supervised segmentation algorithm to overcome this barrier. Our approach is based on a new formulation of deep supervision and student-teacher model and allows for easy integration of different supervision signals. In contrast to previous work, we show that care has to be taken how deep supervision is integrated in lower layers and we present multi-label deep supervision as the most important secret ingredient for success. With our novel training regime for segmentation that flexibly makes use of images that are either fully labeled, marked with bounding boxes, just global labels, or not at all, we are able to cut the requirement for expensive labels by 94.22% – narrowing the gap to the best fully supervised baseline to only 5% mean IoU. Our approach is validated by extensive experiments on retinal fluid segmentation and we provide an in-depth analysis of the anticipated effect each annotation type can have in boosting segmentation performance.

Recognizing Activities of Daily Living (ADL) is a vital process for intelligent assistive robots, but collecting large annotated datasets requires time-consuming temporal labeling and raises privacy concerns, e.g., if the data is collected in a real household. In this work, we explore the concept of constructing training examples for ADL recognition by playing life simulation video games and introduce the SIMS4ACTION dataset created with the popular commercial game THE SIMS 4. We build SIMS4ACTION by specifically executing actions-of-interest in a "top-down" manner, while the gaming circumstances allow us to freely switch between environments, camera angles and subject appearances. While ADL recognition on gaming data is interesting from the theoretical perspective, the key challenge arises from transferring it to the real-world applications, such as smart-homes or assistive robotics. To meet this requirement, SIMS4ACTION is accompanied with a GAMING→REAL benchmark, where the models are evaluated on real videos derived from an existing ADL dataset. We integrate two modern algorithms for video-based activity recognition in our framework, revealing the value of life simulation video games as an inexpensive and far less intrusive source of training data. However, our results also indicate that tasks involving a mixture of gaming and real data are challenging, opening a new research direction. We will make our dataset publicly available at https://github.com/aroitberg/sims4action.