A Survey on Deep Learning in Medical Image Analysis

Geert Litjens, Thijs Kooi, Babak Ehteshami Bejnordi, Arnaud Arindra Adiyoso Setio · Medical Image Analysis / arXiv · 2017 · medicine · 10.1016/j.media.2017.07.005 · record litjens2017-medical-imaging-survey
tag layer · index · concepts · authors · עברית
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Other fields define these differently the same word, defined another way in another discipline
deep learning 11 fields · handcrafted features 2 fields · statistical-significance 2 fields · training data 2 fields · convolutional neural network 2 fields · reference standard 2 fields

Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 10 concept tags on this paper, 5 are grounded in a quoted sentence.
deep learning convolutional neural network medical imaging image segmentation computer-aided diagnosis reference standard label noise selective sampling within-class heterogeneity binary task THE SAME TECHNICAL PROBLEM IS REPORTED TO HAVE DIFFERENT SEVERITY IN TWO FIELDS, AND THE CONTRAST IS DRAWN EXPLICITLY: EVEN WHEN DATA IS ANNOTATED BY DOMAIN EXPERT, LABEL NOISE CAN BE A SIGNIFICANT LIMITING FACTOR - WHEREAS IN COMPUTER VISION THE NOISE IN THE LABELING OF IMAGES IS TYPICALLY RELATIVELY LOW. The word `label` names something with a different reliability depending on who produced it A REFERENCE STANDARD IS BUILT WITH CONSENSUS DELIBERATELY NOT FORCED, AND THE DISAGREEMENT THEN OUTNUMBERS THE AGREEMENT THREE TO ONE: nodules were annotated by four radiologists INDEPENDENTLY, the readers REVIEWED EACH OTHERS ANNOTATIONS BUT NO CONSENSUS WAS FORCED - and the number they DID NOT UNANIMOUSLY AGREE ON to be a nodule WAS THREE TIMES LARGER THAN THE NUMBER THEY DID FULLY AGREE ON THE CONSEQUENCE FOR ANYTHING TRAINED ON IT IS STATED, AND THE FIX IS AN OPEN PROBLEM: training a system on such data REQUIRES CAREFUL CONSIDERATION OF HOW TO DEAL WITH NOISE AND UNCERTAINTY IN THE REFERENCE STANDARD - one COULD THINK OF solutions like incorporating labeling uncertainty directly in the loss function, BUT THIS IS STILL AN OPEN CHALLENGE. The uncertainty is acknowledged and has nowhere to go A BINARY PRESENTATION OF THE TASK IS CALLED A GROSS SIMPLIFICATION, AND THE REASON IS HETEROGENEITY ON BOTH SIDES: classification is often presented as A BINARY TASK - normal versus abnormal, object versus background - HOWEVER THIS IS OFTEN A GROSS SIMPLIFICATION AS BOTH CLASSES CAN BE HIGHLY HETEROGENEOUS. Not one class hiding structure but both THE `NORMAL` CATEGORY IS SHOWN TO CONTAIN THINGS THAT ARE NOT NORMAL, INCLUDING ARTIFACTS OF THE INSTRUMENT: the normal category OFTEN CONSISTS OF COMPLETELY NORMAL TISSUE **BUT ALSO** several categories of BENIGN FINDINGS, WHICH CAN BE RARE, and MAY OCCASIONALLY INCLUDE A WIDE VARIETY OF IMAGING ARTIFACTS. The residual class is defined by what it is not, and collects the measurement's own failures THE PERFORMANCE PATTERN IS PREDICTED FROM THE CATEGORY'S STRUCTURE: systems end up GOOD AT EXCLUDING THE MOST COMMON NORMAL SUBCLASSES BUT FAIL MISERABLY ON SEVERAL RARE ONES. A single accuracy figure over a heterogeneous class hides exactly the failures that matter, and the shape of the class predicts the shape of the failure THE CORRECT FIX IS NAMED AND DECLINED ON COST, IN ONE SENTENCE: a STRAIGHTFORWARD SOLUTION would be to turn the system into a MULTI-CLASS one by providing DETAILED ANNOTATIONS OF ALL POSSIBLE SUBCLASSES - OBVIOUSLY THIS AGAIN COMPOUNDS THE ISSUE OF LIMITED AVAILABILITY OF EXPERT TIME FOR ANNOTATING AND IS THEREFORE OFTEN SIMPLY NOT FEASIBLE. The right answer is known and unaffordable THE WORKAROUNDS ARE REPORTED TO FAIL FOR THE SAME REASON THE PROBLEM EXISTS: strategies that incorporate intelligence in the training process - selective sampling, hard negative mining - TYPICALLY FAIL WHEN THERE IS SUBSTANTIAL NOISE IN THE REFERENCE STANDARD - and ADDITIONAL METHODS FOR DEALING WITH WITHIN-CLASS HETEROGENEITY WOULD BE HIGHLY WELCOME. The noise in the labels defeats the corrections for the labels A STAIN IS OFFERED AS A SUBSTITUTE FOR EXPERTISE: in histopathology one can sometimes use SPECIFIC IMMUNOHISTOCHEMICAL STAINS to highlight regions of interest, REDUCING THE NEED FOR EXPERT EXPERIENCE - and non-expert labels can be leveraged VIA CROWD-SOURCING. Two ways to replace a judgement: a reagent and a crowd A BENCHMARK IS REPORTED TO HAVE SATURATED, SO THAT IMPROVEMENTS CAN NO LONGER BE ATTRIBUTED: since 2014 the performance on the benchmark HAS SATURATED and IT IS DIFFICULT TO ASSESS WHETHER THE SMALL INCREASES IN PERFORMANCE CAN REALLY BE ATTRIBUTED TO 'BETTER' AND MORE SOPHISTICATED ARCHITECTURES. The scare quotes on `better` are the paper's, and the measuring instrument has stopped discriminating A PERFORMANCE CRITERION IS DECLARED INSUFFICIENT AND SUPPLEMENTED BY AN ARTICULATION CRITERION, JUSTIFIED BY LEGAL ACCOUNTABILITY: these methods have often been described as BLACK BOXES, and especially in medicine WHERE ACCOUNTABILITY IS IMPORTANT AND CAN HAVE SERIOUS LEGAL CONSEQUENCES, IT IS OFTEN NOT ENOUGH TO HAVE A GOOD PREDICTION SYSTEM - the system ALSO HAS TO BE ABLE TO ARTICULATE ITSELF in a certain way. What counts as success acquires a second component from outside the field A SURVEY DE-DUPLICATES ITS OWN POPULATION BY A JUDGEMENT IT NEVER DEFINES, AND SUPPLIES A WORKED EXAMPLE INSTEAD OF A CRITERION: when largely overlapping work had been reported in multiple publications, ONLY THE PUBLICATION DEEMED MOST IMPORTANT WAS INCLUDED - A TYPICAL EXAMPLE HERE WAS ARXIV PREPRINTS THAT WERE SUBSEQUENTLY PUBLISHED, or conference contributions later expanded into journal papers. What `most important` means is stated nowhere, the survey's whole 308-paper population rests on it, and the example is doing the work a definition would have done convolutional networks medical image analysis image classification segmentation object detection feature extraction pattern recognition supervised GOFAI handcrafted features feature learning training data decision boundary discriminant features imaging tasks Bayesian regression regression model statistical-significance review

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relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
phenomenonphenomenonthe effect or regularity under study
sensesensesa distinct use of a term, quoted where the paper fixes it
transfertransfersa method or concept carried in from another field

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.1016/j.media.2017.07.005. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 2 · claim_type 1 · concepts 5 · content_tags 17 · controls 1 · limitations 7 · mechanisms 12 · method 1 · phenomenon 1 · senses 3 · transfers 1

This record holds no relations between concepts. A layer is empty when the tagger recorded nothing in it — which is not the same as the paper having nothing to record.

facettagfieldconf.whose words
claim_typeexistence
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claim_typethe paper's words
phenomenondeep learning in medical image analysis
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phenomenonthe paper's words
methodreview
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also in: review
methodthe paper's words
mechanismsmechanisms
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mechanisms[0]0.95the tagger's words
mechanismsmechanisms
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about this quote: THIS COPY MOVES TWO WORDS INTO THE QUOTE: the 'In this' after 'is' belongs at the start of the next sentence, before 'dataset pulmonary nodules'.
mechanisms[1]0.95the tagger's words
mechanismsmechanisms
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mechanisms[2]0.95the tagger's words
mechanismsmechanisms
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mechanisms[3]0.95the tagger's words
mechanismsmechanisms
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mechanisms[4]0.95the tagger's words
mechanismsmechanisms
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about this quote: RE-SLICED off a damage combination I had not seen before today and which NONE of my guards catch: the sentence reads "systems that are ex- 25 tremely good at excluding" - a line-break hyphen RETAINED (shape 11) with a PAGE NUMBER inserted at the break. The page-number guard needs a lowercase letter before the digit and finds "- "; the hyphen guards look for a fused or a surviving hyphen, not one with a number wedged into it. So the sentence's most important word is destroyed and every check passes. The span now starts after it.
mechanisms[5]0.85the tagger's words
mechanismsmechanisms
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mechanisms[6]0.95the tagger's words
mechanismsmechanisms
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mechanisms[7]0.95the tagger's words
mechanismsmechanisms
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mechanisms[8]0.95the tagger's words
mechanismsmechanisms
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mechanisms[9]0.95the tagger's words
mechanismsmechanisms
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mechanisms[10]0.95the tagger's words
mechanismsmechanisms
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about this quote: The span carries this file's surviving line-break hyphens - “publica- tions”, “contri- butions” - quoted verbatim, because a quote is the staged file's bytes. AND THE SPAN IS IN TEXT THAT WAS NOT STAGED UNTIL 2026-08-17: this record held 64% of its source and stopped mid-clause, so these sentences were never available to any earlier pass.
mechanisms[11]0.95the tagger's words
limitationsopen challenges and future-research directions remain in the field
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what this limits: the survey's own account of the field: it offers Quotation withheld rather than a settled picture
limitations[0]the tagger's words
limitationsThe survey deliberately excludes traditional (non-deep) feature-learning approaches applied to medical images.
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what this limits: any comparison between deep and traditional methods drawn from this survey: WE FOCUS PARTICULARLY ON SUCH DEEP MODELS, AND DO NOT INCLUDE THE MORE TRADITIONAL FEATURE LEARNING APPROACHES THAT HAVE BEEN APPLIED TO MEDICAL IMAGES
limitations[1]the tagger's words
limitationsCoverage has a hard cut-off date, so later work is not included.
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what this limits: every count and trend in the survey: THE LAST UPDATE TO THE INCLUDED PAPERS WAS ON FEBRUARY 1, 2017
limitations[2]the tagger's words
limitationsCompleteness of the literature search is an expectation rather than a guarantee.
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what this limits: the completeness of the literature search behind those counts: WE EXPECT THE SEARCH TERMS USED TO COVER MOST, IF NOT ALL, OF THE WORK INCORPORATING DEEP LEARNING METHODS
limitations[3]the tagger's words
limitationsOn a widely used dataset the disputed annotations outnumber the agreed ones three to one.
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about this quote: THIS COPY MOVES TWO WORDS INTO THE QUOTE: the 'In this' after 'is' belongs at the start of the next sentence, before 'dataset pulmonary nodules'. · what this limits: any accuracy reported on the LIDC-IDRI dataset: no consensus was forced between the four radiologists, and the number of nodules they did not unanimously agree on was three times larger than the number they did fully agree on
limitations[4]1.0the tagger's words
limitationsLabel noise is worse in this field than in the field the methods came from, and the survey says so.
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what this limits: any transfer of a computer-vision result to medical imaging: label noise can be a significant limiting factor even with domain-expert annotation, whereas in computer vision the labelling noise is typically relatively low
limitations[5]1.0the tagger's words
limitationsTraining on such data is stated to be an open problem, not a solved preprocessing step.
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what this limits: any system trained on a disputed reference standard: the authors state that handling noise and uncertainty in the reference standard requires careful consideration and that incorporating labelling uncertainty in the loss function is still an open challenge
limitations[6]1.0the tagger's words
transfersdeep convolutional networks, developed in computer vision, adopted as the methodology of choice for medical image analysis (classification, detection, segmentation)
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transfers[0]the tagger's words
controlspre-stated exclusion of papers not reporting results on medical image data or using only standard feed-forward networks with handcrafted features, plus de-duplication where the same work appeared in several publications
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eliminates: a survey padded by work that is not deep learning on medical images, and double-counting of one piece of work reported more than once · outcome (stated by the tagger, no quotation): held
controls[0]0.85the tagger's words
conceptsreference standard
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concepts[5]the paper's words
conceptslabel noise
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also in: label noise
concepts[6]the paper's words
conceptsselective sampling
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concepts[7]the paper's words
conceptswithin-class heterogeneity
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concepts[8]the paper's words
conceptsbinary task
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also in: binary task
concepts[9]the paper's words
sensesthe reference standard - AN ANNOTATION SET WITH ITS DISAGREEMENT LEFT IN: four radiologists annotated independently, reviewed each other, and NO CONSENSUS WAS FORCED, so what every accuracy on this dataset is measured against is a set whose disputed part is three times its agreed part - the standard is not a ground truth but a record of expert disagreement
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about this quote: THIS COPY MOVES TWO WORDS INTO THE QUOTE: the 'In this' after 'is' belongs at the start of the next sentence, before 'dataset pulmonary nodules'.
senses[0]1.0the tagger's words
senseslabel noise - A FIELD-RELATIVE QUANTITY: the survey contrasts medical imaging, where it can be a significant limiting factor even with domain-expert annotation, against computer vision, where it is typically relatively low - so the same word names a small nuisance in one literature and a limiting factor in the other, and the architectures move between them
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senses[1]1.0the tagger's words
sensesthe binary task - A STATED SIMPLIFICATION: normal versus abnormal is called a gross simplification because both classes are highly heterogeneous, which is why systems can excel on common normal subclasses and fail on rare ones; the two-class label is a choice about the data, not a property of it
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senses[2]1.0the tagger's words
claim_relationsbuilds-on → convolutional neural networks (deep learning)
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claim_relations[0]the tagger's words
claim_relationsextends → Shen et al. (2017), the earlier dedicated review of deep learning in medical image analysis
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claim_relations[1]the tagger's words
content_tags300 — papers summarized in the survey
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content_tags.quantities[0]the tagger's words
content_tags1970s-1990s — early rule-based image analysis period
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content_tags.quantities[1]the tagger's words
content_tags8 — clinical domains reviewed
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content_tags.quantities[2]the tagger's words
content_tagsconvolutional networks became the method of choice for medical images
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content_tags.findings[0]the tagger's words
content_tagsthe field shifted from human-designed to computer-trained systems
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content_tags.findings[1]the tagger's words
content_tagsmost surveyed contributions appeared in the last year
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content_tags.findings[2]the tagger's words
content_tagsthe next step is to let computers learn features automatically
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content_tags.findings[3]the tagger's words
content_tagstraining data
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also in: training data
content_tags.variables[0]the tagger's words
content_tagsdecision boundary
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content_tags.variables[1]the tagger's words
content_tagsdiscriminant features
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content_tags.variables[2]the tagger's words
content_tagsimaging tasks
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also in: imaging tasks
content_tags.variables[3]the tagger's words
content_tagsGOFAI
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also in: GOFAI
content_tags.definitions[0]the tagger's words
content_tagshandcrafted features
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content_tags.definitions[1]the tagger's words
content_tagsfeature learning
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content_tags.definitions[3]the tagger's words
content_tagsBayesian
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also in: Bayesian
content_tags.statistics[0]the tagger's words
content_tagsregression
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also in: regression
content_tags.statistics[1]the tagger's words
content_tagsstatistical-significance
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content_tags.statistics[2]the tagger's words

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