Foundation models for interactive segmentation in 2D natural images and videos have sparked significant interest in building 3D foundation models for medical imaging. However, the domain gaps and clinical use cases for 3D medical imaging require a dedicated model that diverges from existing 2D solutions. Specifically, such foundation models should support a full workflow that can actually reduce human effort. Treating 3D medical images as sequences of 2D slices and reusing interactive 2D foundation models seems straightforward, but 2D annotation is too time-consuming for 3D tasks. Moreover, for large cohort analysis, it’s the highly accurate automatic segmentation models that reduce the most human effort. However, these models lack support for interactive corrections and lack zero-shot ability for novel structures, which is a key feature of "foundation". While reusing pre-trained 2D backbones in 3D enhances zero-shot potential, their performance on complex 3D structures still lags behind leading 3D models. To address these issues, we present VISTA3D, Versatile Imaging SegmenTation and Annotation model, that targets to solve all these challenges and requirements with one unified foundation model. VISTA3D is built on top of the well-established 3D segmentation pipeline, and it is the first model to achieve state-of-the-art performance in both 3D automatic (supporting 127 classes) and 3D interactive segmentation, even when compared with top 3D expert models on large and diverse benchmarks. Additionally, VISTA3D’s 3D interactive design allows efficient human correction, and a novel 3D supervoxel method that distills 2D pre-trained backbones grants VISTA3D top 3D zero-shot performance. We believe the model, recipe, and insights represent a promising step towards a clinically useful 3D foundation model. Code and weights are publicly available at https://github.com/Project-MONAI/VISTA.

Generalist vision language models (VLMs) have made significant strides in computer vision, but they fall short in specialized fields like healthcare, where expert knowledge is essential. Current large multimodal models like Gemini and GPT-4o are insufficient for medical tasks due to their reliance on memorized internet knowledge rather than the nuanced expertise required in healthcare. Meanwhile, existing medical VLMs (e.g. Med-Gemini) often lack expert consultation as part of their design, and many rely on outdated, static datasets that were not created with modern, large deep learning models in mind. VLMs are usually trained in three stages: vision pre-training, vision-language pre-training, and instruction fine-tuning (IFT). IFT has been typically applied using a mixture of generic and healthcare data. In contrast, we propose that for medical VLMs, a fourth stage of specialized IFT is necessary, which focuses on medical data and includes information from domain expert models. Domain expert models developed for medical use are crucial because they are specifically trained for certain clinical tasks, e.g. to detect tumors and classify abnormalities through segmentation and classification, which learn fine-grained features of medical data−features that are often too intricate for a VLM to capture effectively. This paper introduces a new framework, VILA-M3, for medical VLMs that utilizes domain knowledge via expert models. We argue that generic VLM architectures alone are not viable for real-world clinical applications and on-demand usage of domain-specialized expert model knowledge is critical for advancing AI in healthcare. Through our experiments, we show an improved state-of-the-art (SOTA) performance with an average improvement of ~9% over the prior SOTA model Med-Gemini and ~6% over models trained on the specific tasks. Our approach emphasizes the importance of domain expertise in creating precise, reliable VLMs for medical applications.

Segmentation is a critical step in analyzing the developing human fetal brain. There have been vast improvements in automatic segmentation methods in the past several years, and the Fetal Brain Tissue Annotation (FeTA) Challenge 2021 helped to establish an excellent standard of fetal brain segmentation. However, FeTA 2021 was a single center study, limiting real-world clinical applicability and acceptance. The multi-center FeTA Challenge 2022 focused on advancing the generalizability of fetal brain segmentation algorithms for magnetic resonance imaging (MRI). In FeTA 2022, the training dataset contained images and corresponding manually annotated multi-class labels from two imaging centers, and the testing data contained images from these two centers as well as two additional unseen centers. The multi-center data included different MR scanners, imaging parameters, and fetal brain super-resolution algorithms applied. 16 teams participated and 17 algorithms were evaluated. Here, the challenge results are presented, focusing on the generalizability of the submissions. Both in- and out-of-domain, the white matter and ventricles were segmented with the highest accuracy (Top Dice scores: 0.89, 0.87 respectively), while the most challenging structure remains the grey matter (Top Dice score: 0.75) due to anatomical complexity. The top 5 average Dices scores ranged from 0.81-0.82, the top 5 average percentile Hausdorff distance values ranged from 2.3-2.5mm, and the top 5 volumetric similarity scores ranged from 0.90-0.92. The FeTA Challenge 2022 was able to successfully evaluate and advance generalizability of multi-class fetal brain tissue segmentation algorithms for MRI and it continues to benchmark new algorithms.

In-utero fetal MRI is emerging as an important tool in the diagnosis and analysis of the developing human brain. Automatic segmentation of the developing fetal brain is a vital step in the quantitative analysis of prenatal neurodevelopment both in the research and clinical context. However, manual segmentation of cerebral structures is time-consuming and prone to error and inter-observer variability. Therefore, we organized the Fetal Tissue Annotation (FeTA) Challenge in 2021 in order to encourage the development of automatic segmentation algorithms on an international level. The challenge utilized FeTA Dataset, an open dataset of fetal brain MRI reconstructions segmented into seven different tissues (external cerebrospinal fluid, gray matter, white matter, ventricles, cerebellum, brainstem, deep gray matter). 20 international teams participated in this challenge, submitting a total of 21 algorithms for evaluation. In this paper, we provide a detailed analysis of the results from both a technical and clinical perspective. All participants relied on deep learning methods, mainly U-Nets, with some variability present in the network architecture, optimization, and image pre- and post-processing. The majority of teams used existing medical imaging deep learning frameworks. The main differences between the submissions were the fine tuning done during training, and the specific pre- and post-processing steps performed. The challenge results showed that almost all submissions performed similarly. Four of the top five teams used ensemble learning methods. However, one team's algorithm performed significantly superior to the other submissions, and consisted of an asymmetrical U-Net network architecture. This paper provides a first of its kind benchmark for future automatic multi-tissue segmentation algorithms for the developing human brain in utero.

Federated learning (FL) allows the collaborative training of AI models without needing to share raw data. This capability makes it especially interesting for healthcare applications where patient and data privacy is of utmost concern. However, recent works on the inversion of deep neural networks from model gradients raised concerns about the security of FL in preventing the leakage of training data. In this work, we show that these attacks presented in the literature are impractical in FL use-cases where the clients' training involves updating the Batch Normalization (BN) statistics and provide a new baseline attack that works for such scenarios. Furthermore, we present new ways to measure and visualize potential data leakage in FL. Our work is a step towards establishing reproducible methods of measuring data leakage in FL and could help determine the optimal tradeoffs between privacy-preserving techniques, such as differential privacy, and model accuracy based on quantifiable metrics.

Semantic segmentation of 3D medical images is a challenging task due to the high variability of the shape and pattern of objects (such as organs or tumors). Given the recent success of deep learning in medical image segmentation, Neural Architecture Search (NAS) has been introduced to find high-performance 3D segmentation network architectures. However, because of the massive computational requirements of 3D data and the discrete optimization nature of architecture search, previous NAS methods require a long search time or necessary continuous relaxation, and commonly lead to sub-optimal network architectures. While one-shot NAS can potentially address these disadvantages, its application in the segmentation domain has not been well studied in the expansive multi-scale multi-path search space. To enable one-shot NAS for medical image segmentation, our method, named HyperSegNAS, introduces a HyperNet to assist super-net training by incorporating architecture topology information. Such a HyperNet can be removed once the super-net is trained and introduces no overhead during architecture search. We show that HyperSegNAS yields better performing and more intuitive architectures compared to the previous state-of-the-art (SOTA) segmentation networks; furthermore, it can quickly and accurately find good architecture candidates under different computing constraints. Our method is evaluated on public datasets from the Medical Segmentation Decathlon (MSD) challenge, and achieves SOTA performances.

Fully Convolutional Neural Networks (FCNNs) with contracting and expanding paths have shown prominence for the majority of medical image segmentation applications since the past decade. In FCNNs, the encoder plays an integral role by learning both global and local features and contextual representations which can be utilized for semantic output prediction by the decoder. Despite their success, the locality of convolutional layers in FCNNs, limits the capability of learning long-range spatial dependencies. Inspired by the recent success of transformers for Natural Language Processing (NLP) in long-range sequence learning, we reformulate the task of volumetric (3D) medical image segmentation as a sequence-to-sequence prediction problem. We introduce a novel architecture, dubbed as UNEt TRansformers (UNETR), that utilizes a transformer as the encoder to learn sequence representations of the input volume and effectively capture the global multi-scale information, while also following the successful "U-shaped" network design for the encoder and decoder. The transformer encoder is directly connected to a decoder via skip connections at different resolutions to compute the final semantic segmentation output. We have validated the performance of our method on the Multi Atlas Labeling Beyond The Cranial Vault (BTCV) dataset for multi-organ segmentation and the Medical Segmentation Decathlon (MSD) dataset for brain tumor and spleen segmentation tasks. Our benchmarks demonstrate new state-of-the-art performance on the BTCV leaderboard.

Lesion segmentation in medical imaging has been an important topic in clinical research. Researchers have proposed various detection and segmentation algorithms to address this task. Recently, deep learning-based approaches have significantly improved the performance over conventional methods. However, most state-of-the-art deep learning methods require the manual design of multiple network components and training strategies. In this paper, we propose a new automated machine learning algorithm, T-AutoML, which not only searches for the best neural architecture, but also finds the best combination of hyper-parameters and data augmentation strategies simultaneously. The proposed method utilizes the modern transformer model, which is introduced to adapt to the dynamic length of the search space embedding and can significantly improve the ability of the search. We validate T-AutoML on several large-scale public lesion segmentation data-sets and achieve state-of-the-art performance.

Registration is a fundamental task in medical image analysis which can be applied to several tasks including image segmentation, intra-operative tracking, multi-modal image alignment, and motion analysis. Popular registration tools such as ANTs and NiftyReg optimize an objective function for each pair of images from scratch which is time-consuming for large images with complicated deformation. Facilitated by the rapid progress of deep learning, learning-based approaches such as VoxelMorph have been emerging for image registration. These approaches can achieve competitive performance in a fraction of a second on advanced GPUs. In this work, we construct a neural registration framework, called NeurReg, with a hybrid loss of displacement fields and data similarity, which substantially improves the current state-of-the-art of registrations. Within the framework, we simulate various transformations by a registration simulator which generates fixed image and displacement field ground truth for training. Furthermore, we design three segmentation frameworks based on the proposed registration framework: 1) atlas-based segmentation, 2) joint learning of both segmentation and registration tasks, and 3) multi-task learning with atlas-based segmentation as an intermediate feature. Extensive experimental results validate the effectiveness of the proposed NeurReg framework based on various metrics: the endpoint error (EPE) of the predicted displacement field, mean square error (MSE), normalized local cross-correlation (NLCC), mutual information (MI), Dice coefficient, uncertainty estimation, and the interpretability of the segmentation. The proposed NeurReg improves registration accuracy with fast inference speed, which can greatly accelerate related medical image analysis tasks.

Recent advances in deep learning for medical image segmentation demonstrate expert-level accuracy. However, application of these models in clinically realistic environments can result in poor generalization and decreased accuracy, mainly due to the domain shift across different hospitals, scanner vendors, imaging protocols, and patient populations etc. Common transfer learning and domain adaptation techniques are proposed to address this bottleneck. However, these solutions require data (and annotations) from the target domain to retrain the model, and is therefore restrictive in practice for widespread model deployment. Ideally, we wish to have a trained (locked) model that can work uniformly well across unseen domains without further training. In this paper, we propose a deep stacked transformation approach for domain generalization. Specifically, a series of n stacked transformations are applied to each image during network training. The underlying assumption is that the "expected" domain shift for a specific medical imaging modality could be simulated by applying extensive data augmentation on a single source domain, and consequently, a deep model trained on the augmented "big" data (BigAug) could generalize well on unseen domains. We exploit four surprisingly effective, but previously understudied, image-based characteristics for data augmentation to overcome the domain generalization problem. We train and evaluate the BigAug model (with n=9 transformations) on three different 3D segmentation tasks (prostate gland, left atrial, left ventricle) covering two medical imaging modalities (MRI and ultrasound) involving eight publicly available challenge datasets. The results show that when training on relatively small dataset (n = 10~32 volumes, depending on the size of the available datasets) from a single source domain: (i) BigAug models degrade an average of 11%(Dice score change) from source to unseen domain, substantially better than conventional augmentation (degrading 39%) and CycleGAN-based domain adaptation method (degrading 25%), (ii) BigAug is better than "shallower" stacked transforms (i.e. those with fewer transforms) on unseen domains and demonstrates modest improvement to conventional augmentation on the source domain, (iii) after training with BigAug on one source domain, performance on an unseen domain is similar to training a model from scratch on that domain when using the same number of training samples. When training on large datasets (n = 465 volumes) with BigAug, (iv) application to unseen domains reaches the performance of state-of-the-art fully supervised models that are trained and tested on their source domains. These findings establish a strong benchmark for the study of domain generalization in medical imaging, and can be generalized to the design of highly robust deep segmentation models for clinical deployment.

Point set registration is a key component in many computer vision tasks. The goal of point set registration is to assign correspondences between two sets of points and to recover the transformation that maps one point set to the other. Multiple factors, including an unknown nonrigid spatial transformation, large dimensionality of point set, noise, and outliers, make the point set registration a challenging problem. We introduce a probabilistic method, called the Coherent Point Drift (CPD) algorithm, for both rigid and nonrigid point set registration. We consider the alignment of two point sets as a probability density estimation problem. We fit the Gaussian mixture model (GMM) centroids (representing the first point set) to the data (the second point set) by maximizing the likelihood. We force the GMM centroids to move coherently as a group to preserve the topological structure of the point sets. In the rigid case, we impose the coherence constraint by reparameterization of GMM centroid locations with rigid parameters and derive a closed form solution of the maximization step of the EM algorithm in arbitrary dimensions. In the nonrigid case, we impose the coherence constraint by regularizing the displacement field and using the variational calculus to derive the optimal transformation. We also introduce a fast algorithm that reduces the method computation complexity to linear. We test the CPD algorithm for both rigid and nonrigid transformations in the presence of noise, outliers, and missing points, where CPD shows accurate results and outperforms current state-of-the-art methods.

Accurate definition of the similarity measure is a key component in image registration. Most commonly used intensity-based similarity measures rely on the assumptions of independence and stationarity of the intensities from pixel to pixel. Such measures cannot capture the complex interactions among the pixel intensities, and often result in less satisfactory registration performances, especially in the presence of spatially-varying intensity distortions. We propose a novel similarity measure that accounts for intensity nonstationarities and complex spatially-varying intensity distortions in mono-modal settings. We derive the similarity measure by analytically solving for the intensity correction field and its adaptive regularization. The final measure can be interpreted as one that favors a registration with minimum compression complexity of the residual image between the two registered images. One of the key advantages of the new similarity measure is its simplicity in terms of both computational complexity and implementation. This measure produces accurate registration results on both artificial and real-world problems that we have tested, and outperforms other state-of-the-art similarity measures in these cases.

Accurate definition of similarity measure is a key component in image registration. Most commonly used intensity-based similarity measures rely on the assumptions of independence and stationarity of the intensities from pixel to pixel. Such measures cannot capture the complex interactions among the pixel intensities, and often result in less satisfactory registration performances, especially in the presence of nonstationary intensity distortions. We propose a novel similarity measure that accounts for intensity non-stationarities and complex spatially-varying intensity distortions. We derive the similarity measure by analytically solving for the intensity correction field and its adaptive regularization. The final measure can be interpreted as one that favors a registration with minimum compression complexity of the residual image between the two registered images. This measure produces accurate registration results on both artificial and real-world problems that we have tested, whereas many other state-of-the-art similarity measures have failed to do so.

Active contours is a popular technique for image segmentation. However, active contour tend to converge to the closest local minimum of its energy function and often requires a close boundary initialization. We introduce a new approach that overcomes the close boundary initialization problem by reformulating the external energy term. We treat the active contour as a mean curve of the probability density function p(x). It moves to minimize the Kullback-Leibler (KL) divergence between p(x) and the probability density function derived from the image. KL divergence forces p(x) to “cover all image areas” and the uncovered areas are heavily penalized, which allows the active contour to go over the edges. Also we use deterministic annealing on the width of p(x) to implement a coarse-to-fine search strategy. In the limit, when the width of p(x) goes to zero, the KL divergence function converges to the conventional external energy term (which can be seen a special case) of active contours. Our method produces robust segmentation results from arbitrary initialization positions.

We introduce a novel probabilistic approach for non-parametric nonrigid image registration using generalized elastic nets, a model previously used for topographic maps. The idea of the algorithm is to adapt an elastic net (a constrained Gaussian mixture) in the spatial-intensity space of one image to fit the second image. The resulting net directly represents the correspondence between image pixels in a probabilistic way and recovers the underlying image deformation. We regularize the net with a differential prior and develop an efficient optimization algorithm using linear conjugate gradients. The nonparametric formulation allows for complex transformations having local deformation. The method is generally applicable to registering point sets of arbitrary features. The accuracy and effectiveness of the method are demonstrated on different medical image and point set registration examples with locally nonlinear underlying deformations.

Tracking of speckles in echocardiography enables the study of myocardium deformation, and thus can provide insights about heart structure and function. Most of the current methods are based on 2D speckle tracking, which suffers from errors due to through-plane decorrelation. Speckle tracking in 3D overcomes such limitation. However, 3D speckle tracking is a challenging problem due to relatively low spatial and temporal resolution of 3D echocardiography. To ensure accurate and robust tracking, high level spatial and temporal constraints need to be incorporated. In this paper, we introduce a novel method for speckle tracking in 3D echocardiography. Instead of tracking each speckle independently, we enforce a motion coherence constraint, in conjunction with a dynamic model for the speckles. This method is validated on in vivo porcine hearts, and is proved to be accurate and robust.

We introduce Coherent Point Drift (CPD), a novel probabilistic method for nonrigid registration of point sets. The registration is treated as a Maximum Likelihood (ML) estimation problem with motion coherence constraint over the velocity field such that one point set moves coherently to align with the second set. We formulate the motion coherence constraint and derive a solution of regularized ML estimation through the variational approach, which leads to an elegant kernel form. We also derive the EM algorithm for the penalized ML optimization with deterministic annealing. The CPD method simultaneously finds both the non-rigid transformation and the correspondence between two point sets without making any prior assumption of the transformation model except that of motion coherence. This method can estimate complex non-linear non-rigid transformations, and is shown to be accurate on 2D and 3D examples and robust in the presence of outliers and missing points.