Medical image segmentation is crucial for healthcare, yet convolution-based methods like U-Net face limitations in modeling long-range dependencies. To address this, Transformers designed for sequence-to-sequence predictions have been integrated into medical image segmentation. However, a comprehensive understanding of Transformers' self-attention in U-Net components is lacking. TransUNet, first introduced in 2021, is widely recognized as one of the first models to integrate Transformer into medical image analysis. In this study, we present the versatile framework of TransUNet that encapsulates Transformers' self-attention into two key modules: (1) a Transformer encoder tokenizing image patches from a convolution neural network (CNN) feature map, facilitating global context extraction, and (2) a Transformer decoder refining candidate regions through cross-attention between proposals and U-Net features. These modules can be flexibly inserted into the U-Net backbone, resulting in three configurations: Encoder-only, Decoder-only, and Encoder+Decoder. TransUNet provides a library encompassing both 2D and 3D implementations, enabling users to easily tailor the chosen architecture. Our findings highlight the encoder's efficacy in modeling interactions among multiple abdominal organs and the decoder's strength in handling small targets like tumors. It excels in diverse medical applications, such as multi-organ segmentation, pancreatic tumor segmentation, and hepatic vessel segmentation. Notably, our TransUNet achieves a significant average Dice improvement of 1.06% and 4.30% for multi-organ segmentation and pancreatic tumor segmentation, respectively, when compared to the highly competitive nn-UNet, and surpasses the top-1 solution in the BrasTS2021 challenge. 2D/3D Code and models are available at https://github.com/Beckschen/TransUNet and https://github.com/Beckschen/TransUNet-3D, respectively.

Clusters of viral pneumonia occurrences over a short period may be a harbinger of an outbreak or pandemic. Rapid and accurate detection of viral pneumonia using chest X-rays can be of significant value for large-scale screening and epidemic prevention, particularly when other more sophisticated imaging modalities are not readily accessible. However, the emergence of novel mutated viruses causes a substantial dataset shift, which can greatly limit the performance of classification-based approaches. In this paper, we formulate the task of differentiating viral pneumonia from non-viral pneumonia and healthy controls into a one-class classification-based anomaly detection problem. We therefore propose the confidence-aware anomaly detection (CAAD) model, which consists of a shared feature extractor, an anomaly detection module, and a confidence prediction module. If the anomaly score produced by the anomaly detection module is large enough, or the confidence score estimated by the confidence prediction module is small enough, the input will be accepted as an anomaly case (i.e., viral pneumonia). The major advantage of our approach over binary classification is that we avoid modeling individual viral pneumonia classes explicitly and treat all known viral pneumonia cases as anomalies to improve the one-class model. The proposed model outperforms binary classification models on the clinical X-VIRAL dataset that contains 5,977 viral pneumonia (no COVID-19) cases, 37,393 non-viral pneumonia or healthy cases. Moreover, when directly testing on the X-COVID dataset that contains 106 COVID-19 cases and 107 normal controls without any fine-tuning, our model achieves an AUC of 83.61% and sensitivity of 71.70%, which is comparable to the performance of radiologists reported in the literature.

Automated skin lesion segmentation and classification are two most essential and related tasks in the computer-aided diagnosis of skin cancer. Despite their prevalence, deep learning models are usually designed for only one task, ignoring the potential benefits in jointly performing both tasks. In this paper, we propose the mutual bootstrapping deep convolutional neural networks (MB-DCNN) model for simultaneous skin lesion segmentation and classification. This model consists of a coarse segmentation network (coarse-SN), a mask-guided classification network (mask-CN), and an enhanced segmentation network (enhanced-SN). On one hand, the coarse-SN generates coarse lesion masks that provide a prior bootstrapping for mask-CN to help it locate and classify skin lesions accurately. On the other hand, the lesion localization maps produced by mask-CN are then fed into enhanced-SN, aiming to transfer the localization information learned by mask-CN to enhanced-SN for accurate lesion segmentation. In this way, both segmentation and classification networks mutually transfer knowledge between each other and facilitate each other in a bootstrapping way. Meanwhile, we also design a novel rank loss and jointly use it with the Dice loss in segmentation networks to address the issues caused by class imbalance and hard-easy pixel imbalance. We evaluate the proposed MB-DCNN model on the ISIC-2017 and PH2 datasets, and achieve a Jaccard index of 80.4% and 89.4% in skin lesion segmentation and an average AUC of 93.8% and 97.7% in skin lesion classification, which are superior to the performance of representative state-of-the-art skin lesion segmentation and classification methods. Our results suggest that it is possible to boost the performance of skin lesion segmentation and classification simultaneously via training a unified model to perform both tasks in a mutual bootstrapping way.

Automated and accurate 3D medical image segmentation plays an essential role in assisting medical professionals to evaluate disease progresses and make fast therapeutic schedules. Although deep convolutional neural networks (DCNNs) have widely applied to this task, the accuracy of these models still need to be further improved mainly due to their limited ability to 3D context perception. In this paper, we propose the 3D context residual network (ConResNet) for the accurate segmentation of 3D medical images. This model consists of an encoder, a segmentation decoder, and a context residual decoder. We design the context residual module and use it to bridge both decoders at each scale. Each context residual module contains both context residual mapping and context attention mapping, the formal aims to explicitly learn the inter-slice context information and the latter uses such context as a kind of attention to boost the segmentation accuracy. We evaluated this model on the MICCAI 2018 Brain Tumor Segmentation (BraTS) dataset and NIH Pancreas Segmentation (Pancreas-CT) dataset. Our results not only demonstrate the effectiveness of the proposed 3D context residual learning scheme but also indicate that the proposed ConResNet is more accurate than six top-ranking methods in brain tumor segmentation and seven top-ranking methods in pancreas segmentation.

The classification of medical images and illustrations from the biomedical literature is important for automated literature review, retrieval and mining. Although deep learning is effective for large-scale image classification, it may not be the optimal choice for this task as there is only a small training dataset. We propose a combined deep and handcrafted visual feature (CDHVF) based algorithm that uses features learned by three fine-tuned and pre-trained deep convolutional neural networks (DCNNs) and two handcrafted descriptors in a joint approach. We evaluated the CDHVF algorithm on the ImageCLEF 2016 Subfigure Classification dataset and it achieved an accuracy of 85.47%, which is higher than the best performance of other purely visual approaches listed in the challenge leaderboard. Our results indicate that handcrafted features complement the image representation learned by DCNNs on small training datasets and improve accuracy in certain medical image classification problems.

Medical image segmentation is an essential task in computer-aided diagnosis. Despite their prevalence and success, deep convolutional neural networks (DCNNs) still need to be improved to produce accurate and robust enough segmentation results for clinical use. In this paper, we propose a novel and generic framework called Segmentation-Emendation-reSegmentation-Verification (SESV) to improve the accuracy of existing DCNNs in medical image segmentation, instead of designing a more accurate segmentation model. Our idea is to predict the segmentation errors produced by an existing model and then correct them. Since predicting segmentation errors is challenging, we design two ways to tolerate the mistakes in the error prediction. First, rather than using a predicted segmentation error map to correct the segmentation mask directly, we only treat the error map as the prior that indicates the locations where segmentation errors are prone to occur, and then concatenate the error map with the image and segmentation mask as the input of a re-segmentation network. Second, we introduce a verification network to determine whether to accept or reject the refined mask produced by the re-segmentation network on a region-by-region basis. The experimental results on the CRAG, ISIC, and IDRiD datasets suggest that using our SESV framework can improve the accuracy of DeepLabv3+ substantially and achieve advanced performance in the segmentation of gland cells, skin lesions, and retinal microaneurysms. Consistent conclusions can also be drawn when using PSPNet, U-Net, and FPN as the segmentation network, respectively. Therefore, our SESV framework is capable of improving the accuracy of different DCNNs on different medical image segmentation tasks.