Medical Image Computing and Computer-Assisted Intervention

The semantic image segmentation task consists of classifying each pixel of an image into an instance, where each instance corresponds to a class. This task is a part of the concept of scene understanding or better explaining the global context of an image. In the medical image analysis domain, image segmentation can be used for image-guided interventions, radiotherapy, or improved radiological diagnostics. In this review, we categorize the leading deep learning-based medical and non-medical image segmentation solutions into six main groups of deep architectural, data synthesis-based, loss function-based, sequenced models, weakly supervised, and multi-task methods and provide a comprehensive review of the contributions in each of these groups. Further, for each group, we analyze each variant of these groups and discuss the limitations of the current approaches and present potential future research directions for semantic image segmentation.

Deep semantic segmentation of natural and medical images: a review

Most recent semantic segmentation methods adopt a U-Net framework with an encoder-decoder architecture. It is still challenging for U-Net with a simple skip connection scheme to model the global multi-scale context: 1) Not each skip connection setting is effective due to the issue of incompatible feature sets of encoder and decoder stage, even some skip connection negatively influence the segmentation performance; 2) The original U-Net is worse than the one without any skip connection on some datasets. Based on our findings, we propose a new segmentation framework, named UCTransNet (with a proposed CTrans module in U-Net), from the channel perspective with attention mechanism. Specifically, the CTrans module is an alternate of the U-Net skip connections, which consists of a sub-module to conduct the multi-scale Channel Cross fusion with Transformer (named CCT) and a sub-module Channel-wise Cross-Attention (named CCA) to guide the fused multi-scale channel-wise information to effectively connect to the decoder features for eliminating the ambiguity. Hence, the proposed connection consisting of the CCT and CCA is able to replace the original skip connection to solve the semantic gaps for an accurate automatic medical image segmentation. The experimental results suggest that our UCTransNet produces more precise segmentation performance and achieves consistent improvements over the state-of-the-art for semantic segmentation across different datasets and conventional architectures involving transformer or U-shaped framework. Code: this https URL.

UCTransNet: Rethinking the Skip Connections in U-Net from a Channel-wise Perspective with Transformer.

Most recent semantic segmentation methods adopt a U-Net framework with an encoder-decoder architecture. It is still challenging for U-Net with a simple skip connection scheme to model the global multi-scale context: 1) Not each skip connection setting is effective due to the issue of incompatible feature sets of encoder and decoder stage, even some skip connection negatively influence the segmentation performance; 2) The original U-Net is worse than the one without any skip connection on some datasets. Based on our findings, we propose a new segmentation framework, named UCTransNet (with a proposed CTrans module in U-Net), from the channel perspective with attention mechanism. Specifically, the CTrans (Channel Transformer) module is an alternate of the U-Net skip connections, which consists of a sub-module to conduct the multi-scale Channel Cross fusion with Transformer (named CCT) and a sub-module Channel-wise Cross-Attention (named CCA) to guide the fused multi-scale channel-wise information to effectively connect to the decoder features for eliminating the ambiguity. Hence, the proposed connection consisting of the CCT and CCA is able to replace the original skip connection to solve the semantic gaps for an accurate automatic medical image segmentation. The experimental results suggest that our UCTransNet produces more precise segmentation performance and achieves consistent improvements over the state-of-the-art for semantic segmentation across different datasets and conventional architectures involving transformer or U-shaped framework. Code: https://github.com/McGregorWwww/UCTransNet. 

UCTransNet: Rethinking the Skip Connections in U-Net from a Channel-Wise Perspective with Transformer

The semantic image segmentation task consists of classifying each pixel of an image into an instance, where each instance corresponds to a class. This task is a part of the concept of scene understanding or better explaining the global context of an image. In the medical image analysis domain, image segmentation can be used for image-guided interventions, radiotherapy, or improved radiological diagnostics. In this review, we categorize the leading deep learning-based medical and non-medical image segmentation solutions into six main groups of deep architectural, data synthesis-based, loss function-based, sequenced models, weakly supervised, and multi-task methods and provide a comprehensive review of the contributions in each of these groups. Further, for each group, we analyze each variant of these groups and discuss the limitations of the current approaches and present potential future research directions for semantic image segmentation.

Deep Semantic Segmentation of Natural and Medical Images: A Review

Semantic segmentation of surgical instruments plays a crucial role in robot-assisted surgery. However, accurate segmentation of cataract surgical instruments is still a challenge due to specular reflection and class imbalance issues. In this paper, an attention-guided network is proposed to segment the cataract surgical instrument. A new attention module is designed to learn discriminative features and address the specular reflection issue. It captures global context and encodes semantic dependencies to emphasize key semantic features, boosting the feature representation. This attention module has very few parameters, which helps to save memory. Thus, it can be flexibly plugged into other networks. Besides, a hybrid loss is introduced to train our network for addressing the class imbalance issue, which merges cross entropy and logarithms of Dice loss. A new dataset named Cata7 is constructed to evaluate our network. To the best of our knowledge, this is the first cataract surgical instrument dataset for semantic segmentation. Based on this dataset, RAUNet achieves state-of-the-art performance 97.71$\%$ mean Dice and 95.62$\%$ mean IOU.

RAUNet: Residual Attention U-Net for Semantic Segmentation of Cataract Surgical Instruments

Segmentation for tracking surgical instruments plays an important role in robot-assisted surgery. Segmentation of surgical instruments contributes to capturing accurate spatial information for tracking. In this paper, a novel network, Refined Attention Segmentation Network, is proposed to simultaneously segment surgical instruments and identify their categories. The U-shape network which is popular in segmentation is used. Different from previous work, an attention module is adopted to help the network focus on key regions, which can improve the segmentation accuracy. To solve the class imbalance problem, the weighted sum of the cross entropy loss and the logarithm of the Jaccard index is used as loss function. Furthermore, transfer learning is adopted in our network. The encoder is pre-trained on ImageNet. The dataset from the MICCAI EndoVis Challenge 2017 is used to evaluate our network. Based on this dataset, our network achieves state-of-the-art performance 94.65% mean Dice and 90.33% mean IOU.

RASNet: Segmentation for Tracking Surgical Instruments in Surgical Videos Using Refined Attention Segmentation Network

The real-time segmentation of surgical instruments plays a crucial role in robot-assisted surgery. However, it is still a challenging task to implement deep learning models to do real-time segmentation for surgical instruments due to their high computational costs and slow inference speed. In this paper, we propose an attention-guided lightweight network (LWANet), which can segment surgical instruments in real-time. LWANet adopts encoder-decoder architecture, where the encoder is the lightweight network MobileNetV2, and the decoder consists of depthwise separable convolution, attention fusion block, and transposed convolution. Depthwise separable convolution is used as the basic unit to construct the decoder, which can reduce the model size and computational costs. Attention fusion block captures global contexts and encodes semantic dependencies between channels to emphasize target regions, contributing to locating the surgical instrument. Transposed convolution is performed to upsample feature maps for acquiring refined edges. LWANet can segment surgical instruments in real-time while takes little computational costs. Based on 960x544 inputs, its inference speed can reach 39 fps with only 3.39 GFLOPs. Also, it has a small model size and the number of parameters is only 2.06 M. The proposed network is evaluated on two datasets. It achieves state-of-the- art performance 94.10% mean IOU on Cata7 and obtains a new record on EndoVis 2017 with a 4.10% increase on mean IOU.

Attention-Guided Lightweight Network for Real-Time Segmentation of Robotic Surgical Instruments

Semantic segmentation of surgical instruments plays a critical role in computer-assisted surgery. However, specular reflection and scale variation of instruments are likely to occur in the surgical environment, undesirably altering visual features of instruments, such as color and shape. These issues make semantic segmentation of surgical instruments more challenging. In this paper, a novel network, Pyramid Attention Aggregation Network, is proposed to aggregate multi-scale attentive features for surgical instruments. It contains two critical modules: Double Attention Module and Pyramid Upsampling Module. Specifically, the Double Attention Module includes two attention blocks (i.e., position attention block and channel attention block), which model semantic dependencies between positions and channels by capturing joint semantic information and global contexts, respectively. The attentive features generated by the Double Attention Module can distinguish target regions, contributing to solving the specular reflection issue. Moreover, the Pyramid Upsampling Module extracts local details and global contexts by aggregating multi-scale attentive features. It learns the shape and size features of surgical instruments in different receptive fields and thus addresses the scale variation issue. The proposed network achieves state-of-the-art performance on various datasets. It achieves a new record of 97.10% mean IOU on Cata7. Besides, it comes first in the MICCAI EndoVis Challenge 2017 with 9.90% increase on mean IOU.

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Pyramid Attention Aggregation Network for Semantic Segmentation of Surgical Instruments

Objective: Technical skill assessment plays an important role in the professional development of an interventionalist in percutaneous coronary intervention (PCI). However, most of the traditional assessment methods are time consuming and subjective. This paper aims to develop objective assessment techniques. Methods: In this study, a natural-behavior-based assessment framework is proposed to qualitatively and quantitatively assess technical skills in PCI. In vivo porcine studies were conducted to deliver a medical guidewire to two target coronaries of left circumflex arteries by six novice and four expert interventionalists. Simultaneously, four types of natural behaviors (i.e., hand motion, proximal force, muscle activity, and finger motion) were acquired from the subjects’ dominant hand and arm. The features extracted from the behaviors of different skill-level groups were compared using the Mann–Whitney U-test for effective behavior selection. The effective ones were further applied in the Gaussian-mixture-model-based qualitative assessment and Mahalanobis-distance-based quantitative assessment. Results: The qualitative assessment achieves an accuracy of 92% to distinguish the novice and expert attempts, which is significantly higher than that of using single guidewire motions. Furthermore, the quantitative assessment can assign objective and effective scores for all attempts, indicating high correlation ( $R$ $=$ 0.9225) to those obtained by traditional methods. Conclusion: The objective, effective, and comprehensive assessment of technical skills can be provided by qualitatively and quantitatively analyzing interventionalists’ natural behaviors in PCI. Significance: This paper suggests a novel approach for the technical skill assessment and the promising results demonstrate the great importance and effectiveness of the proposed method for promoting the development of objective assessment techniques.

Xiao-Hu Zhou

Papers

RAUNet: Residual Attention U-Net for Semantic Segmentation of Cataract Surgical Instruments

RASNet: Segmentation for Tracking Surgical Instruments in Surgical Videos Using Refined Attention Segmentation Network

Attention-Guided Lightweight Network for Real-Time Segmentation of Robotic Surgical Instruments

Pyramid Attention Aggregation Network for Semantic Segmentation of Surgical Instruments

Qualitative and Quantitative Assessment of Technical Skills in Percutaneous Coronary Intervention: In Vivo Porcine Studies