We propose a method for automatic segmentation of individual muscles from a clinical CT. The method uses Bayesian convolutional neural networks with the U-Net architecture, using Monte Carlo dropout that infers an uncertainty metric in addition to the segmentation label. We evaluated the performance of the proposed method using two data sets: 20 fully annotated CTs of the hip and thigh regions and 18 partially annotated CTs that are publicly available from The Cancer Imaging Archive (TCIA) database. The experiments showed a Dice coefficient (DC) of 0.891 + - 0.016 (mean + - std) and an average symmetric surface distance (ASD) of 0.994 + - 0.230 mm over 19 muscles in the set of 20 CTs. These results were statistically significant improvements compared to the state-of-the-art hierarchical multi-atlas method which resulted in 0.845 + - 0.031 DC and 1.556 + - 0.444 mm ASD. We evaluated validity of the uncertainty metric in the multi-class organ segmentation problem and demonstrated a correlation between the pixels with high uncertainty and the segmentation failure. One application of the uncertainty metric in active-learning is demonstrated, and the proposed query pixel selection method considerably reduced the manual annotation cost for expanding the training data set. The proposed method allows an accurate patient-specific analysis of individual muscle shapes in a clinical routine. This would open up various applications including personalization of biomechanical simulation and quantitative evaluation of muscle atrophy.
Deep neural nets with a large number of parameters are very powerful machine learning systems. However, overfitting is a serious problem in such networks. Large networks are also slow to use, making it difficult to deal with overfitting by combining the predictions of many different large neural nets at test time. Dropout is a technique for addressing this problem. The key idea is to randomly drop units (along with their connections) from the neural network during training. This prevents units from co-adapting too much. During training, dropout samples from an exponential number of different "thinned" networks. At test time, it is easy to approximate the effect of averaging the predictions of all these thinned networks by simply using a single unthinned network that has smaller weights. This significantly reduces overfitting and gives major improvements over other regularization methods. We show that dropout improves the performance of neural networks on supervised learning tasks in vision, speech recognition, document classification and computational biology, obtaining state-of-the-art results on many benchmark data sets. Image segmentation is a fundamental problem in biomedical image analysis. Recent advances in deep learning have achieved promising results on many biomedical image segmentation benchmarks. However, due to large variations in biomedical images (different modalities, image settings, objects, noise, etc.), to utilize deep learning on a new application, it usually needs a new set of training data. This can incur a great deal of annotation effort and cost, because only biomedical experts can annotate effectively, and often there are too many instances in images (e.g., cells) to annotate. In this paper, we aim to address the following question: With limited effort (e.g., time) for annotation, what instances should be annotated in order to attain the best performance? We present a deep active learning framework that combines fully convolutional network (FCN) and active learning to significantly reduce annotation effort by making judicious suggestions on the most effective annotation areas. We utilize uncertainty and similarity information provided by FCN and formulate a generalized version of the maximum set cover problem to determine the most representative and uncertain areas for annotation. Extensive experiments using the 2015 MICCAI Gland Challenge dataset and a lymph node ultrasound image segmentation dataset show that, using annotation suggestions by our method, state-of-the-art segmentation performance can be achieved by using only 50 of training data. There are two major types of uncertainty one can model. Aleatoric uncertainty captures noise inherent in the observations. On the other hand, epistemic uncertainty accounts for uncertainty in the model - uncertainty which can be explained away given enough data. Traditionally it has been difficult to model epistemic uncertainty in computer vision, but with new Bayesian deep learning tools this is now possible. We study the benefits of modeling epistemic vs. aleatoric uncertainty in Bayesian deep learning models for vision tasks. For this we present a Bayesian deep learning framework combining input-dependent aleatoric uncertainty together with epistemic uncertainty. We study models under the framework with per-pixel semantic segmentation and depth regression tasks. Further, our explicit uncertainty formulation leads to new loss functions for these tasks, which can be interpreted as learned attenuation. This makes the loss more robust to noisy data, also giving new state-of-the-art results on segmentation and depth regression benchmarks. Deep learning (DL) networks have recently been shown to outperform other segmentation methods on various public, medical-image challenge datasets [3, 11, 16], especially for large pathologies. However, in the context of diseases such as Multiple Sclerosis (MS), monitoring all the focal lesions visible on MRI sequences, even very small ones, is essential for disease staging, prognosis, and evaluating treatment efficacy. Moreover, producing deterministic outputs hinders DL adoption into clinical routines. Uncertainty estimates for the predictions would permit subsequent revision by clinicians. We present the first exploration of multiple uncertainty estimates based on Monte Carlo (MC) dropout [4] in the context of deep networks for lesion detection and segmentation in medical images. Specifically, we develop a 3D MS lesion segmentation CNN, augmented to provide four different voxel-based uncertainty measures based on MC dropout. We train the network on a proprietary, large-scale, multi-site, multi-scanner, clinical MS dataset, and compute lesion-wise uncertainties by accumulating evidence from voxel-wise uncertainties within detected lesions. We analyze the performance of voxel-based segmentation and lesion-level detection by choosing operating points based on the uncertainty. Empirical evidence suggests that uncertainty measures consistently allow us to choose superior operating points compared only using the network’s sigmoid output as a probability. When integrating computational tools, such as automatic segmentation, into clinical practice, it is of utmost importance to be able to assess the level of accuracy on new data and, in particular, to detect when an automatic method fails. However, this is difficult to achieve due to the absence of ground truth. Segmentation accuracy on clinical data might be different from what is found through cross validation, because validation data are often used during incremental method development, which can lead to overfitting and unrealistic performance expectations. Before deployment, performance is quantified using different metrics, for which the predicted segmentation is compared with a reference segmentation, often obtained manually by an expert. But little is known about the real performance after deployment when a reference is unavailable. In this paper, we introduce the concept of reverse classification accuracy (RCA) as a framework for predicting the performance of a segmentation method on new data. In RCA, we take the predicted segmentation from a new image to train a reverse classifier, which is evaluated on a set of reference images with available ground truth. The hypothesis is that if the predicted segmentation is of good quality, then the reverse classifier will perform well on at least some of the reference images. We validate our approach on multi-organ segmentation with different classifiers and segmentation methods. Our results indicate that it is indeed possible to predict the quality of individual segmentations, in the absence of ground truth. Thus, RCA is ideal for integration into automatic processing pipelines in clinical routine and as a part of large-scale image analysis studies. Deep learning tools have gained tremendous attention in applied machine learning. However such tools for regression and classification do not capture model uncertainty. In comparison, Bayesian models offer a mathematically grounded framework to reason about model uncertainty, but usually come with a prohibitive computational cost. In this paper we develop a new theoretical framework casting dropout training in deep neural networks (NNs) as approximate Bayesian inference in deep Gaussian processes. A direct result of this theory gives us tools to model uncertainty with dropout NNs - extracting information from existing models that has been thrown away so far. This mitigates the problem of representing uncertainty in deep learning without sacrificing either computational complexity or test accuracy. We perform an extensive study of the properties of dropout's uncertainty. Various network architectures and nonlinearities are assessed on tasks of regression and classification, using MNIST as an example. We show a considerable improvement in predictive log-likelihood and RMSE compared to existing state-of-the-art methods, and finish by using dropout's uncertainty in deep reinforcement learning.  With the recent breakthrough success of machine learning based solutions for automatic image annotation, the availability of reference image annotations for algorithm training is one of the major bottlenecks in medical image segmentation and many other fields. Crowdsourcing has evolved as a valuable option for annotating large amounts of data while sparing the resources of experts, yet, segmentation of objects from scratch is relatively time-consuming and typically requires an initialization of the contour. The purpose of this paper is to investigate whether the concept of crowd-algorithm collaboration can be used to simultaneously (1) speed up crowd annotation and (2) improve algorithm performance based on the feedback of the crowd. Our contribution in this context is two-fold: Using benchmarking data from the MICCAI 2015 endoscopic vision challenge we show that atlas forests extended by a novel superpixel-based confidence measure are well-suited for medical instrument segmentation in laparoscopic video data. We further demonstrate that the new algorithm and the crowd can mutually benefit from each other in a collaborative annotation process. Our method can be adapted to various applications and thus holds high potential to be used for large-scale low-cost data annotation. Automated medical image segmentation, specifically using deep learning, has shown outstanding performance in semantic segmentation tasks. However, these methods rarely quantify their uncertainty, which may lead to errors in downstream analysis. In this work we propose to use Bayesian neural networks to quantify uncertainty within the domain of semantic segmentation. We also propose a method to convert voxel-wise segmentation uncertainty into volumetric uncertainty, and calibrate the accuracy and reliability of confidence intervals of derived measurements. When applied to a tumour volume estimation application, we demonstrate that by using such modelling of uncertainty, deep learning systems can be made to report volume estimates with well-calibrated error-bars, making them safer for clinical use. We also show that the uncertainty estimates extrapolate to unseen data, and that the confidence intervals are robust in the presence of artificial noise. This could be used to provide a form of quality control and quality assurance, and may permit further adoption of deep learning tools in the clinic.