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Self-supervised pretraining followed by supervised fine-tuning has seen success in image recognition, especially when labeled examples are scarce, but has received limited attention in medical image analysis. This paper studies the effectiveness of self-supervised learning as a pretraining strategy for medical image classification. We conduct experiments on two distinct tasks: dermatology skin condition classification from digital camera images and multi-label chest X-ray classification, and demonstrate that self-supervised learning on ImageNet, followed by additional self-supervised learning on unlabeled domain-specific medical images significantly improves the accuracy of medical image classifiers. We introduce a novel Multi-Instance Contrastive Learning (MICLe) method that uses multiple images of the underlying pathology per patient case, when available, to construct more informative positive pairs for self-supervised learning. Combining our contributions, we achieve an improvement of 6.7% in top-1 accuracy and an improvement of 1.1% in mean AUC on dermatology and chest X-ray classification respectively, outperforming strong supervised baselines pretrained on ImageNet. In addition, we show that big self-supervised models are robust to distribution shift and can learn efficiently with a small number of labeled medical images.
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Supervised learning method requires a large volume of annotated datasets. Collecting such datasets is time-consuming and expensive. Until now, very few annotated COVID-19 imaging datasets are available. Although self-supervised learning enables us to bootstrap the training by exploiting unlabeled data, the generic self-supervised methods for natural images do not sufficiently incorporate the context. For medical images, a desirable method should be sensitive enough to detect deviation from normal-appearing tissue of each anatomical region; here, anatomy is the context. We introduce a novel approach with two levels of self-supervised representation learning objectives: one on the regional anatomical level and another on the patient-level. We use graph neural networks to incorporate the relationship between different anatomical regions. The structure of the graph is informed by anatomical correspondences between each patient and an anatomical atlas. In addition, the graph representation has the advantage of handling any arbitrarily sized image in full resolution. Experiments on large-scale Computer Tomography (CT) datasets of lung images show that our approach compares favorably to baseline methods that do not account for the context. We use the learnt embedding to quantify the clinical progression of COVID-19 and show that our method generalizes well to COVID-19 patients from different hospitals. Qualitative results suggest that our model can identify clinically relevant regions in the images.
Fetal brain magnetic resonance imaging (MRI) offers exquisite images of the developing brain but is not suitable for second-trimester anomaly screening, for which ultrasound (US) is employed. Although expert sonographers are adept at reading US images, MR images which closely resemble anatomical images are much easier for non-experts to interpret. Thus in this paper we propose to generate MR-like images directly from clinical US images. In medical image analysis such a capability is potentially useful as well, for instance for automatic US-MRI registration and fusion. The proposed model is end-to-end trainable and self-supervised without any external annotations. Specifically, based on an assumption that the US and MRI data share a similar anatomical latent space, we first utilise a network to extract the shared latent features, which are then used for MRI synthesis. Since paired data is unavailable for our study (and rare in practice), pixel-level constraints are infeasible to apply. We instead propose to enforce the distributions to be statistically indistinguishable, by adversarial learning in both the image domain and feature space. To regularise the anatomical structures between US and MRI during synthesis, we further propose an adversarial structural constraint. A new cross-modal attention technique is proposed to utilise non-local spatial information, by encouraging multi-modal knowledge fusion and propagation. We extend the approach to consider the case where 3D auxiliary information (e.g., 3D neighbours and a 3D location index) from volumetric data is also available, and show that this improves image synthesis. The proposed approach is evaluated quantitatively and qualitatively with comparison to real fetal MR images and other approaches to synthesis, demonstrating its feasibility of synthesising realistic MR images.
Magnetic Resonance Imaging (MRI) suffers from several artifacts, the most common of which are motion artifacts. These artifacts often yield images that are of non-diagnostic quality. To detect such artifacts, images are prospectively evaluated by experts for their diagnostic quality, which necessitates patient-revisits and rescans whenever non-diagnostic quality scans are encountered. This motivates the need to develop an automated framework capable of accessing medical image quality and detecting diagnostic and non-diagnostic images. In this paper, we explore several convolutional neural network-based frameworks for medical image quality assessment and investigate several challenges therein.
Image denoising is of great importance for medical imaging system, since it can improve image quality for disease diagnosis and downstream image analyses. In a variety of applications, dynamic imaging techniques are utilized to capture the time-varying features of the subject, where multiple images are acquired for the same subject at different time points. Although signal-to-noise ratio of each time frame is usually limited by the short acquisition time, the correlation among different time frames can be exploited to improve denoising results with shared information across time frames. With the success of neural networks in computer vision, supervised deep learning methods show prominent performance in single-image denoising, which rely on large datasets with clean-vs-noisy image pairs. Recently, several self-supervised deep denoising models have been proposed, achieving promising results without needing the pairwise ground truth of clean images. In the field of multi-image denoising, however, very few works have been done on extracting correlated information from multiple slices for denoising using self-supervised deep learning methods. In this work, we propose Deformed2Self, an end-to-end self-supervised deep learning framework for dynamic imaging denoising. It combines single-image and multi-image denoising to improve image quality and use a spatial transformer network to model motion between different slices. Further, it only requires a single noisy image with a few auxiliary observations at different time frames for training and inference. Evaluations on phantom and in vivo data with different noise statistics show that our method has comparable performance to other state-of-the-art unsupervised or self-supervised denoising methods and outperforms under high noise levels.
One paradigm for learning from few labeled examples while making best use of a large amount of unlabeled data is unsupervised pretraining followed by supervised fine-tuning. Although this paradigm uses unlabeled data in a task-agnostic way, in contrast to common approaches to semi-supervised learning for computer vision, we show that it is surprisingly effective for semi-supervised learning on ImageNet. A key ingredient of our approach is the use of big (deep and wide) networks during pretraining and fine-tuning. We find that, the fewer the labels, the more this approach (task-agnostic use of unlabeled data) benefits from a bigger network. After fine-tuning, the big network can be further improved and distilled into a much smaller one with little loss in classification accuracy by using the unlabeled examples for a second time, but in a task-specific way. The proposed semi-supervised learning algorithm can be summarized in three steps: unsupervised pretraining of a big ResNet model using SimCLRv2, supervised fine-tuning on a few labeled examples, and distillation with unlabeled examples for refining and transferring the task-specific knowledge. This procedure achieves 73.9% ImageNet top-1 accuracy with just 1% of the labels ($le$13 labeled images per class) using ResNet-50, a $10times$ improvement in label efficiency over the previous state-of-the-art. With 10% of labels, ResNet-50 trained with our method achieves 77.5% top-1 accuracy, outperforming standard supervised training with all of the labels.
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