Daily Papers

In recent years, visually-rich document understanding has attracted increasing attention. Transformer-based pre-trained models have become the mainstream approach, yielding significant performance gains in this field. However, the self-attention mechanism's quadratic computational complexity hinders their efficiency and ability to process long documents. In this paper, we present DocMamba, a novel framework based on the state space model. It is designed to reduce computational complexity to linear while preserving global modeling capabilities. To further enhance its effectiveness in document processing, we introduce the Segment-First Bidirectional Scan (SFBS) to capture contiguous semantic information. Experimental results demonstrate that DocMamba achieves new state-of-the-art results on downstream datasets such as FUNSD, CORD, and SORIE, while significantly improving speed and reducing memory usage. Notably, experiments on the HRDoc confirm DocMamba's potential for length extrapolation. The code will be available online.

Point cloud sequences are commonly used to accurately detect 3D objects in applications such as autonomous driving. Current top-performing multi-frame detectors mostly follow a Detect-and-Fuse framework, which extracts features from each frame of the sequence and fuses them to detect the objects in the current frame. However, this inevitably leads to redundant computation since adjacent frames are highly correlated. In this paper, we propose an efficient Motion-guided Sequential Fusion (MSF) method, which exploits the continuity of object motion to mine useful sequential contexts for object detection in the current frame. We first generate 3D proposals on the current frame and propagate them to preceding frames based on the estimated velocities. The points-of-interest are then pooled from the sequence and encoded as proposal features. A novel Bidirectional Feature Aggregation (BiFA) module is further proposed to facilitate the interactions of proposal features across frames. Besides, we optimize the point cloud pooling by a voxel-based sampling technique so that millions of points can be processed in several milliseconds. The proposed MSF method achieves not only better efficiency than other multi-frame detectors but also leading accuracy, with 83.12% and 78.30% mAP on the LEVEL1 and LEVEL2 test sets of Waymo Open Dataset, respectively. Codes can be found at https://github.com/skyhehe123/MSF.

Efficient, reliable and reproducible target volume delineation is a key step in the effective planning of breast radiotherapy. However, post-operative breast target delineation is challenging as the contrast between the tumor bed volume (TBV) and normal breast tissue is relatively low in CT images. In this study, we propose to mimic the marker-guidance procedure in manual target delineation. We developed a saliency-based deep learning segmentation (SDL-Seg) algorithm for accurate TBV segmentation in post-operative breast irradiation. The SDL-Seg algorithm incorporates saliency information in the form of markers' location cues into a U-Net model. The design forces the model to encode the location-related features, which underscores regions with high saliency levels and suppresses low saliency regions. The saliency maps were generated by identifying markers on CT images. Markers' locations were then converted to probability maps using a distance-transformation coupled with a Gaussian filter. Subsequently, the CT images and the corresponding saliency maps formed a multi-channel input for the SDL-Seg network. Our in-house dataset was comprised of 145 prone CT images from 29 post-operative breast cancer patients, who received 5-fraction partial breast irradiation (PBI) regimen on GammaPod. The performance of the proposed method was compared against basic U-Net. Our model achieved mean (standard deviation) of 76.4 %, 6.76 mm, and 1.9 mm for DSC, HD95, and ASD respectively on the test set with computation time of below 11 seconds per one CT volume. SDL-Seg showed superior performance relative to basic U-Net for all the evaluation metrics while preserving low computation cost. The findings demonstrate that SDL-Seg is a promising approach for improving the efficiency and accuracy of the on-line treatment planning procedure of PBI, such as GammaPod based PBI.

Despite substantial advances, single-image super-resolution (SISR) is always in a dilemma to reconstruct high-quality images with limited information from one input image, especially in realistic scenarios. In this paper, we establish a large-scale real-world burst super-resolution dataset, i.e., RealBSR, to explore the faithful reconstruction of image details from multiple frames. Furthermore, we introduce a Federated Burst Affinity network (FBAnet) to investigate non-trivial pixel-wise displacements among images under real-world image degradation. Specifically, rather than using pixel-wise alignment, our FBAnet employs a simple homography alignment from a structural geometry aspect and a Federated Affinity Fusion (FAF) strategy to aggregate the complementary information among frames. Those fused informative representations are fed to a Transformer-based module of burst representation decoding. Besides, we have conducted extensive experiments on two versions of our datasets, i.e., RealBSR-RAW and RealBSR-RGB. Experimental results demonstrate that our FBAnet outperforms existing state-of-the-art burst SR methods and also achieves visually-pleasant SR image predictions with model details. Our dataset, codes, and models are publicly available at https://github.com/yjsunnn/FBANet.

3D semantic segmentation on multi-scan large-scale point clouds plays an important role in autonomous systems. Unlike the single-scan-based semantic segmentation task, this task requires distinguishing the motion states of points in addition to their semantic categories. However, methods designed for single-scan-based segmentation tasks perform poorly on the multi-scan task due to the lacking of an effective way to integrate temporal information. We propose MarS3D, a plug-and-play motion-aware module for semantic segmentation on multi-scan 3D point clouds. This module can be flexibly combined with single-scan models to allow them to have multi-scan perception abilities. The model encompasses two key designs: the Cross-Frame Feature Embedding module for enriching representation learning and the Motion-Aware Feature Learning module for enhancing motion awareness. Extensive experiments show that MarS3D can improve the performance of the baseline model by a large margin. The code is available at https://github.com/CVMI-Lab/MarS3D.

Background. Fully automatic analysis of myocardial perfusion MRI datasets enables rapid and objective reporting of stress/rest studies in patients with suspected ischemic heart disease. Developing deep learning techniques that can analyze multi-center datasets despite limited training data and variations in software and hardware is an ongoing challenge. Methods. Datasets from 3 medical centers acquired at 3T (n = 150 subjects) were included: an internal dataset (inD; n = 95) and two external datasets (exDs; n = 55) used for evaluating the robustness of the trained deep neural network (DNN) models against differences in pulse sequence (exD-1) and scanner vendor (exD-2). A subset of inD (n = 85) was used for training/validation of a pool of DNNs for segmentation, all using the same spatiotemporal U-Net architecture and hyperparameters but with different parameter initializations. We employed a space-time sliding-patch analysis approach that automatically yields a pixel-wise "uncertainty map" as a byproduct of the segmentation process. In our approach, a given test case is segmented by all members of the DNN pool and the resulting uncertainty maps are leveraged to automatically select the "best" one among the pool of solutions. Results. The proposed DAUGS analysis approach performed similarly to the established approach on the internal dataset (p = n.s.) whereas it significantly outperformed on the external datasets (p < 0.005 for exD-1 and exD-2). Moreover, the number of image series with "failed" segmentation was significantly lower for the proposed vs. the established approach (4.3% vs. 17.1%, p < 0.0005). Conclusions. The proposed DAUGS analysis approach has the potential to improve the robustness of deep learning methods for segmentation of multi-center stress perfusion datasets with variations in the choice of pulse sequence, site location or scanner vendor.

Backward Filtering Forward Guiding (BFFG) is a bidirectional algorithm proposed in Mider et al. [2021] and studied more in depth in a general setting in Van der Meulen and Schauer [2022]. In category theory, optics have been proposed for modelling systems with bidirectional data flow. We connect BFFG with optics and prove that different ways of composing the building blocks of BFFG correspond to equivalent optics.

Training data for video segmentation are expensive to annotate. This impedes extensions of end-to-end algorithms to new video segmentation tasks, especially in large-vocabulary settings. To 'track anything' without training on video data for every individual task, we develop a decoupled video segmentation approach (DEVA), composed of task-specific image-level segmentation and class/task-agnostic bi-directional temporal propagation. Due to this design, we only need an image-level model for the target task (which is cheaper to train) and a universal temporal propagation model which is trained once and generalizes across tasks. To effectively combine these two modules, we use bi-directional propagation for (semi-)online fusion of segmentation hypotheses from different frames to generate a coherent segmentation. We show that this decoupled formulation compares favorably to end-to-end approaches in several data-scarce tasks including large-vocabulary video panoptic segmentation, open-world video segmentation, referring video segmentation, and unsupervised video object segmentation. Code is available at: https://hkchengrex.github.io/Tracking-Anything-with-DEVA

FSS(Few-shot segmentation) aims to segment a target class using a small number of labeled images (support set). To extract the information relevant to target class, a dominant approach in best performing FSS methods removes background features using a support mask. We observe that this feature excision through a limiting support mask introduces an information bottleneck in several challenging FSS cases, e.g., for small targets and/or inaccurate target boundaries. To this end, we present a novel method (MSI), which maximizes the support-set information by exploiting two complementary sources of features to generate super correlation maps. We validate the effectiveness of our approach by instantiating it into three recent and strong FSS methods. Experimental results on several publicly available FSS benchmarks show that our proposed method consistently improves the performance by visible margins and leads to faster convergence. Our code and models will be publicly released.

This work introduces a new framework, ProtoSAM, for one-shot medical image segmentation. It combines the use of prototypical networks, known for few-shot segmentation, with SAM - a natural image foundation model. The method proposed creates an initial coarse segmentation mask using the ALPnet prototypical network, augmented with a DINOv2 encoder. Following the extraction of an initial mask, prompts are extracted, such as points and bounding boxes, which are then input into the Segment Anything Model (SAM). State-of-the-art results are shown on several medical image datasets and demonstrate automated segmentation capabilities using a single image example (one shot) with no need for fine-tuning of the foundation model. Our code is available at: https://github.com/levayz/ProtoSAM

Segment Anything Model (SAM) has gained significant attention because of its ability to segment a variety of objects in images given a prompt. The recently developed SAM 2 has extended this ability to video inputs. This opens an opportunity to apply SAM to 3D images, one of the fundamental tasks in the medical imaging field. In this paper, we provide an extensive evaluation of SAM 2's ability to segment both 2D and 3D medical images. We collect 18 medical imaging datasets, including common 3D modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) as well as 2D modalities such as X-ray and ultrasound. We consider two evaluation pipelines of SAM 2: (1) multi-frame 3D segmentation, where prompts are provided to one or multiple slice(s) selected from the volume, and (2) single-frame 2D segmentation, where prompts are provided to each slice. The former is only applicable to 3D modalities, while the latter applies to both 2D and 3D modalities. We learn that SAM 2 exhibits similar performance as SAM under single-frame 2D segmentation, and has variable performance under multi-frame 3D segmentation depending on the choices of slices to annotate, the direction of the propagation, the predictions utilized during the propagation, etc.

The detailed images produced by Magnetic Resonance Imaging (MRI) provide life-critical information for the diagnosis and treatment of prostate cancer. To provide standardized acquisition, interpretation and usage of the complex MRI images, the PI-RADS v2 guideline was proposed. An automated segmentation following the guideline facilitates consistent and precise lesion detection, staging and treatment. The guideline recommends a division of the prostate into four zones, PZ (peripheral zone), TZ (transition zone), DPU (distal prostatic urethra) and AFS (anterior fibromuscular stroma). Not every zone shares a boundary with the others and is present in every slice. Further, the representations captured by a single model might not suffice for all zones. This motivated us to design a dual-branch convolutional neural network (CNN), where each branch captures the representations of the connected zones separately. Further, the representations from different branches act complementary to each other at the second stage of training, where they are fine-tuned through an unsupervised loss. The loss penalises the difference in predictions from the two branches for the same class. We also incorporate multi-task learning in our framework to further improve the segmentation accuracy. The proposed approach improves the segmentation accuracy of the baseline (mean absolute symmetric distance) by 7.56%, 11.00%, 58.43% and 19.67% for PZ, TZ, DPU and AFS zones respectively.

Medical image segmentation aims to delineate the anatomical or pathological structures of interest, playing a crucial role in clinical diagnosis. A substantial amount of high-quality annotated data is crucial for constructing high-precision deep segmentation models. However, medical annotation is highly cumbersome and time-consuming, especially for medical videos or 3D volumes, due to the huge labeling space and poor inter-frame consistency. Recently, a fundamental task named Moving Object Segmentation (MOS) has made significant advancements in natural images. Its objective is to delineate moving objects from the background within image sequences, requiring only minimal annotations. In this paper, we propose the first foundation model, named iMOS, for MOS in medical images. Extensive experiments on a large multi-modal medical dataset validate the effectiveness of the proposed iMOS. Specifically, with the annotation of only a small number of images in the sequence, iMOS can achieve satisfactory tracking and segmentation performance of moving objects throughout the entire sequence in bi-directions. We hope that the proposed iMOS can help accelerate the annotation speed of experts, and boost the development of medical foundation models.

Although LiDAR semantic segmentation advances rapidly, state-of-the-art methods often incorporate specifically designed inductive bias derived from benchmarks originating from mechanical spinning LiDAR. This can limit model generalizability to other kinds of LiDAR technologies and make hyperparameter tuning more complex. To tackle these issues, we propose a generalized framework to accommodate various types of LiDAR prevalent in the market by replacing window-attention with our sparse focal point modulation. Our SFPNet is capable of extracting multi-level contexts and dynamically aggregating them using a gate mechanism. By implementing a channel-wise information query, features that incorporate both local and global contexts are encoded. We also introduce a novel large-scale hybrid-solid LiDAR semantic segmentation dataset for robotic applications. SFPNet demonstrates competitive performance on conventional benchmarks derived from mechanical spinning LiDAR, while achieving state-of-the-art results on benchmark derived from solid-state LiDAR. Additionally, it outperforms existing methods on our novel dataset sourced from hybrid-solid LiDAR. Code and dataset are available at https://github.com/Cavendish518/SFPNet and https://www.semanticindustry.top.

Medical images and radiology reports are crucial for diagnosing medical conditions, highlighting the importance of quantitative analysis for clinical decision-making. However, the diversity and cross-source heterogeneity of these data challenge the generalizability of current data-mining methods. Multimodal large language models (MLLMs) have recently transformed many domains, significantly affecting the medical field. Notably, Gemini-Vision-series (Gemini) and GPT-4-series (GPT-4) models have epitomized a paradigm shift in Artificial General Intelligence (AGI) for computer vision, showcasing their potential in the biomedical domain. In this study, we evaluated the performance of the Gemini, GPT-4, and 4 popular large models for an exhaustive evaluation across 14 medical imaging datasets, including 5 medical imaging categories (dermatology, radiology, dentistry, ophthalmology, and endoscopy), and 3 radiology report datasets. The investigated tasks encompass disease classification, lesion segmentation, anatomical localization, disease diagnosis, report generation, and lesion detection. Our experimental results demonstrated that Gemini-series models excelled in report generation and lesion detection but faces challenges in disease classification and anatomical localization. Conversely, GPT-series models exhibited proficiency in lesion segmentation and anatomical localization but encountered difficulties in disease diagnosis and lesion detection. Additionally, both the Gemini series and GPT series contain models that have demonstrated commendable generation efficiency. While both models hold promise in reducing physician workload, alleviating pressure on limited healthcare resources, and fostering collaboration between clinical practitioners and artificial intelligence technologies, substantial enhancements and comprehensive validations remain imperative before clinical deployment.

Model-based reconstruction employing the time separation technique (TST) was found to improve dynamic perfusion imaging of the liver using C-arm cone-beam computed tomography (CBCT). To apply TST using prior knowledge extracted from CT perfusion data, the liver should be accurately segmented from the CT scans. Reconstructions of primary and model-based CBCT data need to be segmented for proper visualisation and interpretation of perfusion maps. This research proposes Turbolift learning, which trains a modified version of the multi-scale Attention UNet on different liver segmentation tasks serially, following the order of the trainings CT, CBCT, CBCT TST - making the previous trainings act as pre-training stages for the subsequent ones - addressing the problem of limited number of datasets for training. For the final task of liver segmentation from CBCT TST, the proposed method achieved an overall Dice scores of 0.874pm0.031 and 0.905pm0.007 in 6-fold and 4-fold cross-validation experiments, respectively - securing statistically significant improvements over the model, which was trained only for that task. Experiments revealed that Turbolift not only improves the overall performance of the model but also makes it robust against artefacts originating from the embolisation materials and truncation artefacts. Additionally, in-depth analyses confirmed the order of the segmentation tasks. This paper shows the potential of segmenting the liver from CT, CBCT, and CBCT TST, learning from the available limited training data, which can possibly be used in the future for the visualisation and evaluation of the perfusion maps for the treatment evaluation of liver diseases.

We introduce a novel bilateral reference framework (BiRefNet) for high-resolution dichotomous image segmentation (DIS). It comprises two essential components: the localization module (LM) and the reconstruction module (RM) with our proposed bilateral reference (BiRef). The LM aids in object localization using global semantic information. Within the RM, we utilize BiRef for the reconstruction process, where hierarchical patches of images provide the source reference and gradient maps serve as the target reference. These components collaborate to generate the final predicted maps. We also introduce auxiliary gradient supervision to enhance focus on regions with finer details. Furthermore, we outline practical training strategies tailored for DIS to improve map quality and training process. To validate the general applicability of our approach, we conduct extensive experiments on four tasks to evince that BiRefNet exhibits remarkable performance, outperforming task-specific cutting-edge methods across all benchmarks. Our codes are available at https://github.com/ZhengPeng7/BiRefNet.

Few-Shot Video Object Segmentation (FSVOS) aims to segment objects in a query video with the same category defined by a few annotated support images. However, this task was seldom explored. In this work, based on IPMT, a state-of-the-art few-shot image segmentation method that combines external support guidance information with adaptive query guidance cues, we propose to leverage multi-grained temporal guidance information for handling the temporal correlation nature of video data. We decompose the query video information into a clip prototype and a memory prototype for capturing local and long-term internal temporal guidance, respectively. Frame prototypes are further used for each frame independently to handle fine-grained adaptive guidance and enable bidirectional clip-frame prototype communication. To reduce the influence of noisy memory, we propose to leverage the structural similarity relation among different predicted regions and the support for selecting reliable memory frames. Furthermore, a new segmentation loss is also proposed to enhance the category discriminability of the learned prototypes. Experimental results demonstrate that our proposed video IPMT model significantly outperforms previous models on two benchmark datasets. Code is available at https://github.com/nankepan/VIPMT.

Breast cancer is one of the most common causes of death among women worldwide. Early detection helps in reducing the number of deaths. Automated 3D Breast Ultrasound (ABUS) is a newer approach for breast screening, which has many advantages over handheld mammography such as safety, speed, and higher detection rate of breast cancer. Tumor detection, segmentation, and classification are key components in the analysis of medical images, especially challenging in the context of 3D ABUS due to the significant variability in tumor size and shape, unclear tumor boundaries, and a low signal-to-noise ratio. The lack of publicly accessible, well-labeled ABUS datasets further hinders the advancement of systems for breast tumor analysis. Addressing this gap, we have organized the inaugural Tumor Detection, Segmentation, and Classification Challenge on Automated 3D Breast Ultrasound 2023 (TDSC-ABUS2023). This initiative aims to spearhead research in this field and create a definitive benchmark for tasks associated with 3D ABUS image analysis. In this paper, we summarize the top-performing algorithms from the challenge and provide critical analysis for ABUS image examination. We offer the TDSC-ABUS challenge as an open-access platform at https://tdsc-abus2023.grand-challenge.org/ to benchmark and inspire future developments in algorithmic research.

Introduction: Blood vessels can be non-invasively visualized from a digital fundus image (DFI). Several studies have shown an association between cardiovascular risk and vascular features obtained from DFI. Recent advances in computer vision and image segmentation enable automatising DFI blood vessel segmentation. There is a need for a resource that can automatically compute digital vasculature biomarkers (VBM) from these segmented DFI. Methods: In this paper, we introduce a Python Vasculature BioMarker toolbox, denoted PVBM. A total of 11 VBMs were implemented. In particular, we introduce new algorithmic methods to estimate tortuosity and branching angles. Using PVBM, and as a proof of usability, we analyze geometric vascular differences between glaucomatous patients and healthy controls. Results: We built a fully automated vasculature biomarker toolbox based on DFI segmentations and provided a proof of usability to characterize the vascular changes in glaucoma. For arterioles and venules, all biomarkers were significant and lower in glaucoma patients compared to healthy controls except for tortuosity, venular singularity length and venular branching angles. Conclusion: We have automated the computation of 11 VBMs from retinal blood vessel segmentation. The PVBM toolbox is made open source under a GNU GPL 3 license and is available on physiozoo.com (following publication).

We present a novel bird's-eye-view (BEV) detector with perspective supervision, which converges faster and better suits modern image backbones. Existing state-of-the-art BEV detectors are often tied to certain depth pre-trained backbones like VoVNet, hindering the synergy between booming image backbones and BEV detectors. To address this limitation, we prioritize easing the optimization of BEV detectors by introducing perspective space supervision. To this end, we propose a two-stage BEV detector, where proposals from the perspective head are fed into the bird's-eye-view head for final predictions. To evaluate the effectiveness of our model, we conduct extensive ablation studies focusing on the form of supervision and the generality of the proposed detector. The proposed method is verified with a wide spectrum of traditional and modern image backbones and achieves new SoTA results on the large-scale nuScenes dataset. The code shall be released soon.

Generating accurate 3D reconstructions from endoscopic video is a promising avenue for longitudinal radiation-free analysis of sinus anatomy and surgical outcomes. Several methods for monocular reconstruction have been proposed, yielding visually pleasant 3D anatomical structures by retrieving relative camera poses with structure-from-motion-type algorithms and fusion of monocular depth estimates. However, due to the complex properties of the underlying algorithms and endoscopic scenes, the reconstruction pipeline may perform poorly or fail unexpectedly. Further, acquiring medical data conveys additional challenges, presenting difficulties in quantitatively benchmarking these models, understanding failure cases, and identifying critical components that contribute to their precision. In this work, we perform a quantitative analysis of a self-supervised approach for sinus reconstruction using endoscopic sequences paired with optical tracking and high-resolution computed tomography acquired from nine ex-vivo specimens. Our results show that the generated reconstructions are in high agreement with the anatomy, yielding an average point-to-mesh error of 0.91 mm between reconstructions and CT segmentations. However, in a point-to-point matching scenario, relevant for endoscope tracking and navigation, we found average target registration errors of 6.58 mm. We identified that pose and depth estimation inaccuracies contribute equally to this error and that locally consistent sequences with shorter trajectories generate more accurate reconstructions. These results suggest that achieving global consistency between relative camera poses and estimated depths with the anatomy is essential. In doing so, we can ensure proper synergy between all components of the pipeline for improved reconstructions that will facilitate clinical application of this innovative technology.

Effectively discerning spatial-spectral dependencies in HSI denoising is crucial, but prevailing methods using convolution or transformers still face computational efficiency limitations. Recently, the emerging Selective State Space Model(Mamba) has risen with its nearly linear computational complexity in processing natural language sequences, which inspired us to explore its potential in handling long spectral sequences. In this paper, we propose HSIDMamba(HSDM), tailored to exploit the linear complexity for effectively capturing spatial-spectral dependencies in HSI denoising. In particular, HSDM comprises multiple Hyperspectral Continuous Scan Blocks, incorporating BCSM(Bidirectional Continuous Scanning Mechanism), scale residual, and spectral attention mechanisms to enhance the capture of long-range and local spatial-spectral information. BCSM strengthens spatial-spectral interactions by linking forward and backward scans and enhancing information from eight directions through SSM, significantly enhancing the perceptual capability of HSDM and improving denoising performance more effectively. Extensive evaluations against HSI denoising benchmarks validate the superior performance of HSDM, achieving state-of-the-art results in performance and surpassing the efficiency of the latest transformer architectures by 30%.

Identification of vessel structures of different sizes in biomedical images is crucial in the diagnosis of many neurodegenerative diseases. However, the sparsity of good-quality annotations of such images makes the task of vessel segmentation challenging. Deep learning offers an efficient way to segment vessels of different sizes by learning their high-level feature representations and the spatial continuity of such features across dimensions. Semi-supervised patch-based approaches have been effective in identifying small vessels of one to two voxels in diameter. This study focuses on improving the segmentation quality by considering the spatial correlation of the features using the Maximum Intensity Projection~(MIP) as an additional loss criterion. Two methods are proposed with the incorporation of MIPs of label segmentation on the single~(z-axis) and multiple perceivable axes of the 3D volume. The proposed MIP-based methods produce segmentations with improved vessel continuity, which is evident in visual examinations of ROIs. Patch-based training is improved by introducing an additional loss term, MIP loss, to penalise the predicted discontinuity of vessels. A training set of 14 volumes is selected from the StudyForrest dataset comprising of 18 7-Tesla 3D Time-of-Flight~(ToF) Magnetic Resonance Angiography (MRA) images. The generalisation performance of the method is evaluated using the other unseen volumes in the dataset. It is observed that the proposed method with multi-axes MIP loss produces better quality segmentations with a median Dice of 80.245 pm 0.129. Also, the method with single-axis MIP loss produces segmentations with a median Dice of 79.749 pm 0.109. Furthermore, a visual comparison of the ROIs in the predicted segmentation reveals a significant improvement in the continuity of the vessels when MIP loss is incorporated into training.

Real-world medical image segmentation has tremendous long-tailed complexity of objects, among which tail conditions correlate with relatively rare diseases and are clinically significant. A trustworthy medical AI algorithm should demonstrate its effectiveness on tail conditions to avoid clinically dangerous damage in these out-of-distribution (OOD) cases. In this paper, we adopt the concept of object queries in Mask Transformers to formulate semantic segmentation as a soft cluster assignment. The queries fit the feature-level cluster centers of inliers during training. Therefore, when performing inference on a medical image in real-world scenarios, the similarity between pixels and the queries detects and localizes OOD regions. We term this OOD localization as MaxQuery. Furthermore, the foregrounds of real-world medical images, whether OOD objects or inliers, are lesions. The difference between them is less than that between the foreground and background, possibly misleading the object queries to focus redundantly on the background. Thus, we propose a query-distribution (QD) loss to enforce clear boundaries between segmentation targets and other regions at the query level, improving the inlier segmentation and OOD indication. Our proposed framework is tested on two real-world segmentation tasks, i.e., segmentation of pancreatic and liver tumors, outperforming previous state-of-the-art algorithms by an average of 7.39% on AUROC, 14.69% on AUPR, and 13.79% on FPR95 for OOD localization. On the other hand, our framework improves the performance of inlier segmentation by an average of 5.27% DSC when compared with the leading baseline nnUNet.

Clinical monitoring of metastatic disease to the brain can be a laborious and time-consuming process, especially in cases involving multiple metastases when the assessment is performed manually. The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) guideline, which utilizes the unidimensional longest diameter, is commonly used in clinical and research settings to evaluate response to therapy in patients with brain metastases. However, accurate volumetric assessment of the lesion and surrounding peri-lesional edema holds significant importance in clinical decision-making and can greatly enhance outcome prediction. The unique challenge in performing segmentations of brain metastases lies in their common occurrence as small lesions. Detection and segmentation of lesions that are smaller than 10 mm in size has not demonstrated high accuracy in prior publications. The brain metastases challenge sets itself apart from previously conducted MICCAI challenges on glioma segmentation due to the significant variability in lesion size. Unlike gliomas, which tend to be larger on presentation scans, brain metastases exhibit a wide range of sizes and tend to include small lesions. We hope that the BraTS-METS dataset and challenge will advance the field of automated brain metastasis detection and segmentation.