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Deep reinforcement learning (DRL) augments the reinforcement learning framework, which learns a sequence of actions that maximizes the expected reward, with the representative power of deep neural networks. Recent works have demonstrated the great potential of DRL in medicine and healthcare. This paper presents a literature review of DRL in medical imaging. We start with a comprehensive tutorial of DRL, including the latest model-free and model-based algorithms. We then cover existing DRL applications for medical imaging, which are roughly divided into three main categories: (I) parametric medical image analysis tasks including landmark detection, object/lesion detection, registration, and view plane localization; (ii) solving optimization tasks including hyperparameter tuning, selecting augmentation strategies, and neural architecture search; and (iii) miscellaneous applications including surgical gesture segmentation, personalized mobile health intervention, and computational model personalization. The paper concludes with discussions of future perspectives. 

Deep learning holds a great promise of revolutionizing healthcare and medicine. Unfortunately, various inference attack models demonstrated that deep learning puts sensitive patient information at risk. The high capacity of deep neural networks is the main reason behind the privacy loss. In particular, patient information in the training data can be unintentionally memorized by a deep network. Adversarial parties can extract that information given the ability to access or query the network. In this paper, we propose a novel privacy-preserving mechanism for training deep neural networks. Our approach adds decaying Gaussian noise to the gradients at every training iteration. This is in contrast to the mainstream approach adopted by Google's TensorFlow Privacy, which employs the same noise scale in each step of the whole training process. Compared to existing methods, our proposed approach provides an explicit closed-form mathematical expression to approximately estimate the privacy loss. It is easy to compute and can be useful when the users would like to decide proper training time, noise scale, and sampling ratio during the planning phase. We provide extensive experimental results using one real-world medical dataset (chest radiographs from the CheXpert dataset) to validate the effectiveness of the proposed approach. The proposed differential privacy based deep learning model achieves significantly higher classification accuracy over the existing methods with the same privacy budget. 

Computer-aided diagnosis (CAD) systems must constantly cope with the perpetual changes in data distribution caused by different sensing technologies, imaging protocols, and patient populations. Adapting these systems to new domains often requires significant amounts of labeled data for re-training. This process is labor-intensive and time-consuming. We propose a memory-augmented capsule network for the rapid adaptation of CAD models to new domains. It consists of a capsule network that is meant to extract feature embeddings from some high-dimensional input, and a memory-augmented task network meant to exploit its stored knowledge from the target domains. Our network is able to efficiently adapt to unseen domains using only a few annotated samples. We evaluate our method using a large-scale public lung nodule dataset (LUNA), coupled with our own collected lung nodules and incidental lung nodules datasets. When trained on the LUNA dataset, our network requires only 30 additional samples from our collected lung nodule and incidental lung nodule datasets to achieve clinically relevant performance (0.925 and 0.891 area under receiving operating characteristic curves (AUROC), respectively). This result is equivalent to using two orders of magnitude less labeled training data while achieving the same performance. We further evaluate our method by introducing heavy noise, artifacts, and adversarial attacks. Under these severe conditions, our network’s AUROC remains above 0.7 while the performance of state-of-the-art approaches reduce to chance level 

The novelty detection models learn a decision boundary around multiple categories of a given dataset. This helps such models in detecting any novel classes encountered during testing. However, in many cases, the test data distribution can be different from that of the training data. For such cases, the novelty detection models risk detecting a known class as novel due to the dataset distribution shift. This scenario is often ignored while working with novelty detection. To this end, we consider the problem of multiple class novelty detection under dataset distribution shift to improve the novelty detection performance. Firstly, we discuss the problem setting in detail and show how it affects the performance of current novelty detection methods. Secondly, we show that one could improve those novelty detection methods with a simple integration of domain adversarial loss. Finally, we propose a method which brings together the techniques from novelty detection and domain adaptation to improve generalization of multiple class novelty detection on different domains. We evaluate the proposed method on digits and object recognition datasets and show that it provides improvements over the baseline methods. 

Capsule Networks (CapsNets) have demonstrated to be a promising alternative to Convolutional Neural Networks (CNNs). However, they often fall short of state-of-the-art accuracies on large-scale high-dimensional datasets. We propose a Detail-Oriented Capsule Network (DECAPS) that combines the strength of CapsNets with several novel techniques to boost its classification accuracies. First, DECAPS uses an Inverted Dynamic Routing (IDR) mechanism to group lowerlevel capsules into heads before sending them to higher-level capsules. This strategy enables capsules to selectively attend to small but informative details within the data which may be lost during pooling operations in CNNs. Second, DECAPS employs a Peekaboo training procedure, which encourages the network to focus on fine-grained information through a second-level attention scheme. Finally, the distillation process improves the robustness of DECAPS by averaging over the original and attended image region predictions. We provide extensive experiments on the CheXpert and RSNA Pneumonia datasets to validate the effectiveness of DECAPS. Our networks achieve state-of-the-art accuracies not only in classification (increasing the average area under ROC curves from 87.24% to 92.82% on the CheXpert dataset) but also in the weaklysupervised localization of diseased areas (increasing average precision from 41.7% to 80% for the RSNA Pneumonia detection dataset). 

The classification of Antibody Mediated Rejection (AMR) in kidney transplant remains challenging even for experienced nephropathologists; this is partly because histological tissue stain analysis is often characterized by low inter-observer agreement and poor reproducibility. One of the implicated causes for inter-observer disagreement is the variability of tissue stain quality between (and within) pathology labs, coupled with the gradual fading of archival sections. Variations in stain colors and intensities can make tissue evaluation difficult for pathologists, ultimately affecting their ability to describe relevant morphological features. Being able to accurately predict the AMR status based on kidney histology images is crucial for improving patient treatment and care. We propose a novel pipeline to build robust deep neural networks for AMR classification based on StyPath, a histological data augmentation technique that leverages a light weight style-transfer algorithm as a means to reduce sample-specific bias. Each image was generated in 1.84 ± 0.03 s using a single GTX TITAN V gpu and pytorch, making it faster than other popular histological data augmentation techniques. We evaluated our model using a Monte Carlo (MC) estimate of Bayesian performance and generate an epistemic measure of uncertainty to compare both the baseline and StyPath augmented models. We also generated Grad-CAM representations of the results which were assessed by an experienced nephropathologist; we used this qualitative analysis to elucidate on the assumptions being made by each model. Our results imply that our style-transfer augmentation technique improves histological classification performance (reducing error from 14.8% to 11.5%) and generalization ability. 

Deep Neural Networks (or DNNs) must constantly cope with distribution changes in the input data when the task of interest or the data collection protocol changes. Retraining a network from scratch to combat this issue poses a significant cost. Meta-learning aims to deliver an adaptive model that is sensitive to these underlying distribution changes, but requires many tasks during the meta-training process. In this paper, we propose a tAsk-auGmented actIve meta-LEarning (AGILE) method to efficiently adapt DNNs to new tasks by using a small number of training examples. AGILE combines a meta-learning algorithm with a novel task augmentation technique which we use to generate an initial adaptive model. It then uses Bayesian dropout uncertainty estimates to actively select the most difficult samples when updating the model to a new task. This allows AGILE to learn with fewer tasks and a few informative samples, achieving high performance with a limited dataset. We perform our experiments using the brain cell classification task and compare the results to a plain meta-learning model trained from scratch. We show that the proposed task-augmented meta-learning framework can learn to classify new cell types after a single gradient step with a limited number of training samples. We show that active learning with Bayesian uncertainty can further improve the performance when the number of training samples is extremely small. Using only 1% of the training data and a single update step, we achieved 90% accuracy on the new cell type classification task, a 50% points improvement over a state-of-the-art meta-learning algorithm.