Medical image analysis (MedIA) has become an essential tool in medicine and healthcare, aiding in disease diagnosis, prognosis, and treatment planning, and recent successes in deep learning (DL) have made significant contributions to its advances. However, deploying DL models for MedIAin real-world situations remains challenging due to their failure to generalize across the distributional gap between training and testing samples—a problem known as domain shift. Researchers have dedicated their efforts to developing various DL methods to adapt and perform robustly on unknown and out-of-distribution (OOD) data distributions. This article comprehensively reviews domain generalization (DG) studies specifically tailored for MedIA. We provide a holistic view of how DG techniques interact within the broader MedIAsystem, going beyond methodologies to consider the operational implications on the entire MedIAworkflow. Specifically, we categorize DG methods into data-level, feature-level, model-level, and analysis-level methods. We show how those methods can be used in various stages of the MedIAworkflow with DL equipped from data acquisition to model prediction and analysis. Furthermore, we critically analyze the strengths and weaknesses of various methods, unveiling future research opportunities.

In recent years, deep learning-based feature representation methods have shown a promising impact on electroencephalography (EEG)-based brain-computer interface (BCI). Nonetheless, owing to high intra- and inter-subject variabilities, many studies on decoding EEG were designed in a subject-specific manner by using calibration samples, with no concern of its practical use, hampered by time-consuming steps and a large data requirement. To this end, recent studies adopted a transfer learning strategy, especially domain adaptation techniques. Among those, we have witnessed the potential of adversarial learning-based transfer learning in BCIs. In the meantime, it is known that adversarial learning-based domain adaptation methods are prone to negative transfer that disrupts learning generalized feature representations, applicable to diverse domains, for example, subjects or sessions in BCIs. In this article, we propose a novel framework that learns class-relevant and subject-invariant feature representations in an information-theoretic manner, without using adversarial learning. To be specific, we devise two operational components in a deep network that explicitly estimate mutual information between feature representations: 1) to decompose features in an intermediate layer into class-relevant and class-irrelevant ones and 2) to enrich class-discriminative feature representation. On two large EEG datasets, we validated the effectiveness of our proposed framework by comparing with several comparative methods in performance. Furthermore, we conducted rigorous analyses by performing an ablation study in regard to the components in our network, explaining our model's decision on input EEG signals via layer-wise relevance propagation, and visualizing the distribution of learned features via t-SNE.

Ahn Y, et al. Korean J Radiol. 2020 Aug;21(8):987-997. https://doi.org/10.3348/kjr.2020.0237

Existing studies on disease diagnostic models focus either on diagnostic model learning for performance improvement or on the visual explanation of a trained diagnostic model. We propose a novel learn-explain-reinforce (LEAR) framework that unifies diagnostic model learning, visual explanation generation (explanation unit), and trained diagnostic model reinforcement (reinforcement unit) guided by the visual explanation. For the visual explanation, we generate a counterfactual map that transforms an input sample to be identified as an intended target label. For example, a counterfactual map can localize hypothetical abnormalities within a normal brain image that may cause it to be diagnosed with Alzheimer's disease (AD). We believe that the generated counterfactual maps represent data-driven knowledge about a target task, i.e., AD diagnosis using structural MRI, which can be a vital source of information to reinforce the generalization of the trained diagnostic model. To this end, we devise an attention-based feature refinement module with the guidance of the counterfactual maps. The explanation and reinforcement units are reciprocal and can be operated iteratively. Our proposed approach was validated via qualitative and quantitative analysis on the ADNI dataset. Its comprehensibility and fidelity were demonstrated through ablation studies and comparisons with existing methods.