Deep learning-based patient re-identification is able to exploit the biometric nature of medical chest X-ray data.

With the rise and ever-increasing potential of deep learning techniques in recent years, publicly available medical datasets became a key factor to enable reproducible development of diagnostic algorithms in the medical domain. Medical data contains sensitive patient-related information and is therefore usually anonymized by removing patient identifiers, e.g., patient names before publication. To the best of our knowledge, we are the first to show that a well-trained deep learning system is able to recover the patient identity from chest X-ray data. We demonstrate this using the publicly available large-scale ChestX-ray14 dataset, a collection of 112,120 frontal-view chest X-ray images from 30,805 unique patients. Our verification system is able to identify whether two frontal chest X-ray images are from the same person with an AUC of 0.9940 and a classification accuracy of 95.55%. We further highlight that the proposed system is able to reveal the same person even ten and more years after the initial scan. When pursuing a retrieval approach, we observe an mAP@R of 0.9748 and a precision@1 of 0.9963. Furthermore, we achieve an AUC of up to 0.9870 and a precision@1 of up to 0.9444 when evaluating our trained networks on external datasets such as CheXpert and the COVID-19 Image Data Collection. Based on this high identification rate, a potential attacker may leak patient-related information and additionally cross-reference images to obtain more information. Thus, there is a great risk of sensitive content falling into unauthorized hands or being disseminated against the will of the concerned patients. Especially during the COVID-19 pandemic, numerous chest X-ray datasets have been published to advance research. Therefore, such data may be vulnerable to potential attacks by deep learning-based re-identification algorithms.

Cephalogram synthesis and landmark detection in dental cone-beam CT systems.

Due to the lack of a standardized 3D cephalometric analysis methodology, 2D cephalograms synthesized from 3D cone-beam computed tomography (CBCT) volumes are widely used for cephalometric analysis in dental CBCT systems. However, compared with conventional X-ray film based cephalograms, such synthetic cephalograms lack image contrast and resolution, which impairs cephalometric landmark identification. In addition, the increased radiation dose applied to acquire the scan for 3D reconstruction causes potential health risks. In this work, we propose a sigmoid-based intensity transform that uses the nonlinear optical property of X-ray films to increase image contrast of synthetic cephalograms from 3D volumes. To improve image resolution, super resolution deep learning techniques are investigated. For low dose purpose, the pixel-to-pixel generative adversarial network (pix2pixGAN) is proposed for 2D cephalogram synthesis directly from two cone-beam projections. For landmark detection in the synthetic cephalograms, an efficient automatic landmark detection method using the combination of LeNet-5 and ResNet50 is proposed. Our experiments demonstrate the efficacy of pix2pixGAN in 2D cephalogram synthesis, achieving an average peak signal-to-noise ratio (PSNR) value of 33.8 with reference to the cephalograms synthesized from 3D CBCT volumes. Pix2pixGAN also achieves the best performance in super resolution, achieving an average PSNR value of 32.5 without the introduction of checkerboard or jagging artifacts. Our proposed automatic landmark detection method achieves 86.7% successful detection rate in the 2 mm clinical acceptable range on the ISBI Test1 data, which is comparable to the state-of-the-art methods. The method trained on conventional cephalograms can be directly applied to landmark detection in the synthetic cephalograms, achieving 93.0% and 80.7% successful detection rate in 4 mm precision range for synthetic cephalograms from 3D volumes and 2D projections, respectively.

X-Ray Scatter Estimation Using Deep Splines.

X-ray scatter compensation is a very desirable technique in flat-panel X-ray imaging and cone-beam computed tomography. State-of-the-art U-net based scatter removal approaches yielded promising results. However, as there are no physics' constraints applied to the output of the U-Net, it cannot be ruled out that it yields spurious results. Unfortunately, in the context of medical imaging, those may be misleading and could lead to wrong conclusions. To overcome this problem, we propose to embed B-splines as a known operator into neural networks. This inherently constrains their predictions to well-behaved and smooth functions. In a study using synthetic head and thorax data as well as real thorax phantom data, we found that our approach performed on par with U-net when comparing both algorithms based on quantitative performance metrics. However, our approach not only reduces runtime and parameter complexity, but we also found it much more robust to unseen noise levels. While the U-net responded with visible artifacts, the proposed approach preserved the X-ray signal's frequency characteristics.

Known Operator Learning Enables Constrained Projection Geometry Conversion: Parallel to Cone-Beam for Hybrid MR/X-Ray Imaging.

X-ray imaging is a wide-spread real-time imaging technique. Magnetic Resonance Imaging (MRI) offers a multitude of contrasts that offer improved guidance to interventionalists. As such simultaneous real-time acquisition and overlay would be highly favorable for image-guided interventions, e.g., in stroke therapy. One major obstacle in this setting is the fundamentally different acquisition geometry. MRI k -space sampling is associated with parallel projection geometry, while the X-ray acquisition results in perspective distorted projections. The classical rebinning methods to overcome this limitation inherently suffers from a loss of resolution. To counter this problem, we present a novel rebinning algorithm for parallel to cone-beam conversion. We derive a rebinning formula that is then used to find an appropriate deep neural network architecture. Following the known operator learning paradigm, the novel algorithm is mapped to a neural network with differentiable projection operators enabling data-driven learning of the remaining unknown operators. The evaluation aims in two directions: First, we give a profound analysis of the different hypotheses to the unknown operator and investigate the influence of numerical training data. Second, we evaluate the performance of the proposed method against the classical rebinning approach. We demonstrate that the derived network achieves better results than the baseline method and that such operators can be trained with simulated data without losing their generality making them applicable to real data without the need for retraining or transfer learning.

Multi-Modal Deep Guided Filtering for Comprehensible Medical Image Processing.

Deep learning-based image processing is capable of creating highly appealing results. However, it is still widely considered as a "blackbox" transformation. In medical imaging, this lack of comprehensibility of the results is a sensitive issue. The integration of known operators into the deep learning environment has proven to be advantageous for the comprehensibility and reliability of the computations. Consequently, we propose the use of the locally linear guided filter in combination with a learned guidance map for general purpose medical image processing. The output images are only processed by the guided filter while the guidance map can be trained to be task-optimal in an end-to-end fashion. We investigate the performance based on two popular tasks: image super resolution and denoising. The evaluation is conducted based on pairs of multi-modal magnetic resonance imaging and cross-modal computed tomography and magnetic resonance imaging datasets. For both tasks, the proposed approach is on par with state-of-the-art approaches. Additionally, we can show that the input image's content is almost unchanged after the processing which is not the case for conventional deep learning approaches. On top, the proposed pipeline offers increased robustness against degraded input as well as adversarial attacks.

A gentle introduction to deep learning in medical image processing.

This paper tries to give a gentle introduction to deep learning in medical image processing, proceeding from theoretical foundations to applications. We first discuss general reasons for the popularity of deep learning, including several major breakthroughs in computer science. Next, we start reviewing the fundamental basics of the perceptron and neural networks, along with some fundamental theory that is often omitted. Doing so allows us to understand the reasons for the rise of deep learning in many application domains. Obviously medical image processing is one of these areas which has been largely affected by this rapid progress, in particular in image detection and recognition, image segmentation, image registration, and computer-aided diagnosis. There are also recent trends in physical simulation, modeling, and reconstruction that have led to astonishing results. Yet, some of these approaches neglect prior knowledge and hence bear the risk of producing implausible results. These apparent weaknesses highlight current limitations of deep ()learning. However, we also briefly discuss promising approaches that might be able to resolve these problems in the future.

Technical Note: PYRO-NN: Python reconstruction operators in neural networks.

PURPOSE: Recently, several attempts were conducted to transfer deep learning to medical image reconstruction. An increasingly number of publications follow the concept of embedding the computed tomography (CT) reconstruction as a known operator into a neural network. However, most of the approaches presented lack an efficient CT reconstruction framework fully integrated into deep learning environments. As a result, many approaches use workarounds for mathematically unambiguously solvable problems. METHODS: PYRO-NN is a generalized framework to embed known operators into the prevalent deep learning framework Tensorflow. The current status includes state-of-the-art parallel-, fan-, and cone-beam projectors, and back-projectors accelerated with CUDA provided as Tensorflow layers. On top, the framework provides a high-level Python API to conduct FBP and iterative reconstruction experiments with data from real CT systems. RESULTS: The framework provides all necessary algorithms and tools to design end-to-end neural network pipelines with integrated CT reconstruction algorithms. The high-level Python API allows a simple use of the layers as known from Tensorflow. All algorithms and tools are referenced to a scientific publication and are compared to existing non-deep learning reconstruction frameworks. To demonstrate the capabilities of the layers, the framework comes with baseline experiments, which are described in the supplementary material. The framework is available as open-source software under the Apache 2.0 licence at https://github.com/csyben/PYRO-NN. CONCLUSIONS: PYRO-NN comes with the prevalent deep learning framework Tensorflow and allows to setup end-to-end trainable neural networks in the medical image reconstruction context. We believe that the framework will be a step toward reproducible research and give the medical physics community a toolkit to elevate medical image reconstruction with new deep learning techniques.

Projection-to-Projection Translation for Hybrid X-ray and Magnetic Resonance Imaging.

Hybrid X-ray and magnetic resonance (MR) imaging promises large potential in interventional medical imaging applications due to the broad variety of contrast of MRI combined with fast imaging of X-ray-based modalities. To fully utilize the potential of the vast amount of existing image enhancement techniques, the corresponding information from both modalities must be present in the same domain. For image-guided interventional procedures, X-ray fluoroscopy has proven to be the modality of choice. Synthesizing one modality from another in this case is an ill-posed problem due to ambiguous signal and overlapping structures in projective geometry. To take on these challenges, we present a learning-based solution to MR to X-ray projection-to-projection translation. We propose an image generator network that focuses on high representation capacity in higher resolution layers to allow for accurate synthesis of fine details in the projection images. Additionally, a weighting scheme in the loss computation that favors high-frequency structures is proposed to focus on the important details and contours in projection imaging. The proposed extensions prove valuable in generating X-ray projection images with natural appearance. Our approach achieves a deviation from the ground truth of only 6% and structural similarity measure of 0.913 ± 0.005. In particular the high frequency weighting assists in generating projection images with sharp appearance and reduces erroneously synthesized fine details.

Magnetic Resonance Fingerprinting Reconstruction Using Recurrent Neural Networks.

Magnetic Resonance Fingerprinting (MRF) is an imaging technique acquiring unique time signals for different tissues. Although the acquisition is highly accelerated, the reconstruction time remains a problem, as the state-of-the-art template matching compares every signal with a set of possible signals. To overcome this limitation, deep learning based approaches, e.g. Convolutional Neural Networks (CNNs) have been proposed. In this work, we investigate the applicability of Recurrent Neural Networks (RNNs) for this reconstruction problem, as the signals are correlated in time. Compared to previous methods based on CNNs, RNN models yield significantly improved results using in-vivo data.

Learning with Known Operators reduces Maximum Training Error Bounds.

We describe an approach for incorporating prior knowledge into machine learning algorithms. We aim at applications in physics and signal processing in which we know that certain operations must be embedded into the algorithm. Any operation that allows computation of a gradient or sub-gradient towards its inputs is suited for our framework. We derive a maximal error bound for deep nets that demonstrates that inclusion of prior knowledge results in its reduction. Furthermore, we also show experimentally that known operators reduce the number of free parameters. We apply this approach to various tasks ranging from CT image reconstruction over vessel segmentation to the derivation of previously unknown imaging algorithms. As such the concept is widely applicable for many researchers in physics, imaging, and signal processing. We assume that our analysis will support further investigation of known operators in other fields of physics, imaging, and signal processing.