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DMNet:Difference Minimization Network for Semi-supervised Segmentation in Medical Images Kang Fang and Wu-Jun Li) National Key Laboratory for Novel Software Technology, Department of Computer Science and Technology,Nanjing University, National Institute of Healthcare Data Science at Nanjing University,Nanjing,China fangk@lamda.nju.edu.cn,liwujun@nju.edu.cn Abstract.Semantic segmentation is an important task in medical image analysis.In general,training models with high performance needs a large amount of labeled data.However,collecting labeled data is typ- ically difficult,especially for medical images.Several semi-supervised methods have been proposed to use unlabeled data to facilitate learning. Most of these methods use a self-training framework,in which the model cannot be well trained if the pseudo masks predicted by the model itself are of low quality.Co-training is another widely used semi-supervised method in medical image segmentation.It uses two models and makes them learn from each other.All these methods are not end-to-end.In this paper,we propose a novel end-to-end approach,called difference minimization network (DMNet),for semi-supervised semantic segmen- tation.To use unlabeled data,DMNet adopts two decoder branches and minimizes the difference between soft masks generated by the two decoders.In this manner,each decoder can learn under the supervision of the other decoder,thus they can be improved at the same time.Also, to make the model generalize better,we force the model to generate low-entropy masks on unlabeled data so the decision boundary of model lies in low-density regions.Meanwhile,adversarial training strategy is adopted to learn a discriminator which can encourage the model to gen- erate more accurate masks.Experiments on a kidney tumor dataset and a brain tumor dataset show that our method can outperform the base- lines,including both supervised and semi-supervised ones,to achieve the best performance. Keywords:Semantic segmentation.Semi-supervised learning 1 Introduction Semantic segmentation is of great importance in medical image analysis,because it can help detect the location and size of anatomical structures and aid in mak- ing therapeutic schedule.With the development of deep learning,deep neural This work is supported by the NSFC-NRF Joint Research Project(No.61861146001) O Springer Nature Switzerland AG 2020 A.L.Martel et al.(Eds.):MICCAI 2020,LNCS 12261,pp.532-541,2020. https:/doi.org/10.1007/978-3-030-59710-8_52

DMNet: Difference Minimization Network for Semi-supervised Segmentation in Medical Images Kang Fang and Wu-Jun Li(B) National Key Laboratory for Novel Software Technology, Department of Computer Science and Technology, Nanjing University, National Institute of Healthcare Data Science at Nanjing University, Nanjing, China fangk@lamda.nju.edu.cn, liwujun@nju.edu.cn Abstract. Semantic segmentation is an important task in medical image analysis. In general, training models with high performance needs a large amount of labeled data. However, collecting labeled data is typ￾ically difficult, especially for medical images. Several semi-supervised methods have been proposed to use unlabeled data to facilitate learning. Most of these methods use a self-training framework, in which the model cannot be well trained if the pseudo masks predicted by the model itself are of low quality. Co-training is another widely used semi-supervised method in medical image segmentation. It uses two models and makes them learn from each other. All these methods are not end-to-end. In this paper, we propose a novel end-to-end approach, called difference minimization network (DMNet), for semi-supervised semantic segmen￾tation. To use unlabeled data, DMNet adopts two decoder branches and minimizes the difference between soft masks generated by the two decoders. In this manner, each decoder can learn under the supervision of the other decoder, thus they can be improved at the same time. Also, to make the model generalize better, we force the model to generate low-entropy masks on unlabeled data so the decision boundary of model lies in low-density regions. Meanwhile, adversarial training strategy is adopted to learn a discriminator which can encourage the model to gen￾erate more accurate masks. Experiments on a kidney tumor dataset and a brain tumor dataset show that our method can outperform the base￾lines, including both supervised and semi-supervised ones, to achieve the best performance. Keywords: Semantic segmentation · Semi-supervised learning 1 Introduction Semantic segmentation is of great importance in medical image analysis, because it can help detect the location and size of anatomical structures and aid in mak￾ing therapeutic schedule. With the development of deep learning, deep neural This work is supported by the NSFC-NRF Joint Research Project (No. 61861146001). c Springer Nature Switzerland AG 2020 A. L. Martel et al. (Eds.): MICCAI 2020, LNCS 12261, pp. 532–541, 2020. https://doi.org/10.1007/978-3-030-59710-8_52

DMNet for Semi-supervised Segmentation 533 networks especially fully convolutional networks(FCN)[12]have shown promis- ing performance in segmenting both natural images and medial images.The models in these methods have millions of parameters to be optimized,thus a large amount of labeled data with pixel-level annotations is typically needed for training such models to achieve promising performance.However,it is generally difficult to collect a large amount of labeled data in medical image analysis.One main reason is that annotating medical images needs expertise knowledge but few experts have time for annotation.Another reason is that it is time-consuming to annotate medical images. Semi-supervised learning can utilize a large amount of unlabeled data to improve model performance.semiFCN [2]proposes a semi-supervised network- based approach for medical image segmentation.In semiFCN,a network is trained to predict pseudo masks.The predicted pseudo masks are then used to update the network in turn.ASDNet [14]trains a confidence network to select regions with high confidence in soft masks for updating the segmentation network.Zhou et al.[18]propose to jointly improve the performance of disease grading and lesion segmentation by semi-supervised learning with an attention mechanism.Souly et al.[17 use weakly labeled data and unlabeled data to train a generative adversarial network (GAN)[8],which can force real data to be close in feature space and thus cluster together.These methods all use a self-training framework,in which the model is updated using pseudo masks pre- dicted by the model itself.If the pseudo masks predicted by the model itself have low quality,the model will be updated using data with noise.On the other hand,co-training [4 uses two models and each model is updated using unla- beled data with pseudo masks predicted by the other model and labeled data with ground truth.In this manner,each model in co-training is supervised by the other model.So the two models can be improved in turn.Several methods [9,15] explore co-training in deep learning.But they are not end-to-end methods. In this paper,we propose a novel end-to-end approach,called difference minimization network(DMNet),for semi-supervised semantic segmentation in medical images.The contributions of our method can be listed as follows: DMNet is a semi-supervised segmentation model,which can be trained with a limited amount of labeled data and a large amount of unlabeled data. DMNet adopts the widely used encoder-decoder structure [1,7,16,but it has two decoder branches with a shared encoder.DMNet minimizes the difference between the soft masks predicted by the two decoders to utilize unlabeled data.Unlike co-training which is often not end-to-end,the two decoders in DMNet can be updated at the same time in an end-to-end way. -DMNet uses the sharpen [3 operation to force the model to generate pre- dictions with low entropy on unlabeled data,which can improve the model performance. DMNet adopts adversarial learning derived from GAN for further improve- ment. Experiments on a kidney tumor dataset and a brain tumor dataset show that our method can outperform other baselines to achieve the best performance

DMNet for Semi-supervised Segmentation 533 networks especially fully convolutional networks (FCN) [12] have shown promis￾ing performance in segmenting both natural images and medial images. The models in these methods have millions of parameters to be optimized, thus a large amount of labeled data with pixel-level annotations is typically needed for training such models to achieve promising performance. However, it is generally difficult to collect a large amount of labeled data in medical image analysis. One main reason is that annotating medical images needs expertise knowledge but few experts have time for annotation. Another reason is that it is time-consuming to annotate medical images. Semi-supervised learning can utilize a large amount of unlabeled data to improve model performance. semiFCN [2] proposes a semi-supervised network￾based approach for medical image segmentation. In semiFCN, a network is trained to predict pseudo masks. The predicted pseudo masks are then used to update the network in turn. ASDNet [14] trains a confidence network to select regions with high confidence in soft masks for updating the segmentation network. Zhou et al. [18] propose to jointly improve the performance of disease grading and lesion segmentation by semi-supervised learning with an attention mechanism. Souly et al. [17] use weakly labeled data and unlabeled data to train a generative adversarial network (GAN) [8], which can force real data to be close in feature space and thus cluster together. These methods all use a self-training framework, in which the model is updated using pseudo masks pre￾dicted by the model itself. If the pseudo masks predicted by the model itself have low quality, the model will be updated using data with noise. On the other hand, co-training [4] uses two models and each model is updated using unla￾beled data with pseudo masks predicted by the other model and labeled data with ground truth. In this manner, each model in co-training is supervised by the other model. So the two models can be improved in turn. Several methods [9,15] explore co-training in deep learning. But they are not end-to-end methods. In this paper, we propose a novel end-to-end approach, called difference minimization network (DMNet), for semi-supervised semantic segmentation in medical images. The contributions of our method can be listed as follows: – DMNet is a semi-supervised segmentation model, which can be trained with a limited amount of labeled data and a large amount of unlabeled data. – DMNet adopts the widely used encoder-decoder structure [1,7,16], but it has two decoder branches with a shared encoder. DMNet minimizes the difference between the soft masks predicted by the two decoders to utilize unlabeled data. Unlike co-training which is often not end-to-end, the two decoders in DMNet can be updated at the same time in an end-to-end way. – DMNet uses the sharpen [3] operation to force the model to generate pre￾dictions with low entropy on unlabeled data, which can improve the model performance. – DMNet adopts adversarial learning derived from GAN for further improve￾ment. – Experiments on a kidney tumor dataset and a brain tumor dataset show that our method can outperform other baselines to achieve the best performance

534 K.Fang and W.-J.Li 2 Notation We use X E RHxW to denote an image in the labeled training set,and YE 10,1]HxWxK to denote the corresponding ground-truth label which is encoded into a one-hot format.Here,K is the number of classes,H and W are the height and width of the image respectively.DMNet has two segmentation branches, and we denote the class probability maps generated by the two segmentation branches as Y(1),Y(2)ERHxWxK.Furthermore,we denote an unlabeled image asU∈rHxw.We use[1:N]to denote[l,2,…,MⅥ. 3 Method The framework of DMNet is shown in Fig.1,which is composed of a segmentation network with two decoder branches,a sharpen operation for unlabeled data and a discriminator for both labeled and unlabeled data.Each component will be described detailedly in the following subsections. For Unlabeled Data Segmentation Network Predicted 水 nput moge Sharpon 6 Shared Encoder Predicted Mask Discriminator 3 Fig.1.The framework of DMNet 3.1 Segmentation Network As shown in Fig.1,the segmentation network in DMNet adopts the widely used encoder-decoder architecture,which is composed of a shared encoder and two different decoders.By sharing an encoder,our segmentation network has some advantages.First,it can save GPU memory compared to the architecture in which two decoders use separate encoders.Second,since the encoder is shared by two decoders,it can be updated by the information from two decoders.Therefore

534 K. Fang and W.-J. Li 2 Notation We use X ∈ RH×W to denote an image in the labeled training set, and Y ∈ {0, 1}H×W×K to denote the corresponding ground-truth label which is encoded into a one-hot format. Here, K is the number of classes, H and W are the height and width of the image respectively. DMNet has two segmentation branches, and we denote the class probability maps generated by the two segmentation branches as Yˆ (1),Yˆ (2) ∈ RH×W×K. Furthermore, we denote an unlabeled image as U ∈ RH×W . We use [1 : N] to denote [1, 2, ··· , N]. 3 Method The framework of DMNet is shown in Fig. 1, which is composed of a segmentation network with two decoder branches, a sharpen operation for unlabeled data and a discriminator for both labeled and unlabeled data. Each component will be described detailedly in the following subsections. Fig. 1. The framework of DMNet 3.1 Segmentation Network As shown in Fig. 1, the segmentation network in DMNet adopts the widely used encoder-decoder architecture, which is composed of a shared encoder and two different decoders. By sharing an encoder, our segmentation network has some advantages. First, it can save GPU memory compared to the architecture in which two decoders use separate encoders. Second, since the encoder is shared by two decoders, it can be updated by the information from two decoders. Therefore

DMNet for Semi-supervised Segmentation 535 it can learn better features from the difference between soft masks generated by two decoders,which can lead to better performance.This will be verified by our experimental results in Sect.4.The two decoders in DMNet use different architectures to introduce diversity.By adopting different architectures,the two decoders will not typically output exactly the same segmentation masks and they can learn from each other.By using labeled and unlabeled data in turn,DMNet can utilize unlabeled data adequately to improve segmentation performance. DMNet is a general framework,and any segmentation network with an encoder- decoder architecture,such as UNet [16],VNet [13],SegNet [1]and DeepLab v3+[7],can be used in DMNet.In this paper,we adopt UNet [16]and DeepLab v3+[7]for illustration.The shared encoder can extract latent representation with high-level semantic information of the input image.Then we use the ground truth to supervise the learning of segmentation network for labeled data while minimizing the difference between the masks generated by the two decoders to let them learn from each other for unlabeled data. We use Dice loss [13 to train our segmentation network on labeled data, which is defined as follows: Ldice(Y),Y②),Y;0) 2∑从1W1五wk9k where Yh.w,k=1 when the pixel at position (h,w)belongs to class k,and other values inis set to be.is the probability that the pixel at position (h,w)belongs to class k predicted by the segmentation branch i.0s is the parameter of the segmentation network. The loss function used for unlabeled data is described in Sect.3.3. 3.2 Sharpen Operation Given an unlabeled data U,our segmentation network can generate soft masks Y(1)and Y(2).To make the predictions of the segmentation networks have low entropy or high confidence,we adopt the sharpen operation [3 to reduce the entropy of predictions on unlabeled data,which is defined as follows: Sharpen(Y0e,I))= (8cT ∑K1(Y9)/T h∈[1:H],w∈[1:W],T∈(0,1) where Y(i)is the soft mask predicted by decoder branch i and temperature T is a hyperparameter. 3.3 Difference Minimization for Semi-supervised Segmentation As described in Sect.3.1,two decoders can generate two masks on unlabeled data.If the two masks vary from each other,it means the model is unsure about the predictions and thus the model cannot generalize well.Therefore

DMNet for Semi-supervised Segmentation 535 it can learn better features from the difference between soft masks generated by two decoders, which can lead to better performance. This will be verified by our experimental results in Sect. 4. The two decoders in DMNet use different architectures to introduce diversity. By adopting different architectures, the two decoders will not typically output exactly the same segmentation masks and they can learn from each other. By using labeled and unlabeled data in turn, DMNet can utilize unlabeled data adequately to improve segmentation performance. DMNet is a general framework, and any segmentation network with an encoder￾decoder architecture, such as UNet [16], VNet [13], SegNet [1] and DeepLab v3+ [7], can be used in DMNet. In this paper, we adopt UNet [16] and DeepLab v3+ [7] for illustration. The shared encoder can extract latent representation with high-level semantic information of the input image. Then we use the ground truth to supervise the learning of segmentation network for labeled data while minimizing the difference between the masks generated by the two decoders to let them learn from each other for unlabeled data. We use Dice loss [13] to train our segmentation network on labeled data, which is defined as follows: Ldice(Yˆ (1),Yˆ (2),Y ; θs) = 2 i=1 1 − 1 K K k=1 2 H h=1 W w=1 Yh,w,kYˆ (i) h,w,k H h=1 W w=1(Yh,w,k + Yˆ (i) h,w,k)  , where Yh,w,k = 1 when the pixel at position (h, w) belongs to class k, and other values in Yh,w,k is set to be 0. Yˆ (i) h,w,k is the probability that the pixel at position (h, w) belongs to class k predicted by the segmentation branch i. θs is the parameter of the segmentation network. The loss function used for unlabeled data is described in Sect. 3.3. 3.2 Sharpen Operation Given an unlabeled data U, our segmentation network can generate soft masks Yˆ (1) and Yˆ (2). To make the predictions of the segmentation networks have low entropy or high confidence, we adopt the sharpen operation [3] to reduce the entropy of predictions on unlabeled data, which is defined as follows: Sharpen(Yˆ (i) h,w,c, T) = (Yˆ (i) h,w,c)1/T K i=1 (Yˆ (i) h,w,i)1/T ∀h ∈ [1 : H], w ∈ [1 : W], T ∈ (0, 1), where Yˆ (i) is the soft mask predicted by decoder branch i and temperature T is a hyperparameter. 3.3 Difference Minimization for Semi-supervised Segmentation As described in Sect. 3.1, two decoders can generate two masks on unlabeled data. If the two masks vary from each other, it means the model is unsure about the predictions and thus the model cannot generalize well. Therefore,

536 K.Fang and W.-J.Li we minimize the difference between the two masks to make the two decoders generate consistent masks on the same unlabeled data.In other words,the two decoders can learn under the supervision of each other. More specifically,given an unlabeled data U,the two decoder branches can generate two probability masks Y(1)and Y(2)which are processed by the sharpen operation.Since dice loss can measure the similarity of two segmenta- tion masks and the loss can be backpropogated through two terms,we extend dice loss to the unlabeled setting and get the corresponding loss Lsemi as follows: 152"8k LmW:a)=1-下三gk+9 From the definition of Lsemi,we can see that the two decoders can be updated by minimizing the difference between the masks they generate. 3.4 Discriminator In DMNet,we also adopt adversarial learning to learn a discriminator.Unlike the original discriminator in GAN which discriminates whether an image is generated or is real,our discriminator adopts a fully convolutional network (FCN).The FCN discriminator is composed of three convolutional layers whose stride is 2 for downsampling and three corresponding upsampling layers.Each convolutional layer is followed by a ReLU layer.It can discriminate whether a region or some pixels are predicted or from ground truth. Adversarial Loss for Discriminator.The objective function of discriminator can be written as follows: Ldis(),(2),Y:0d)=Lbce(D(Y()),0:0d)+Lbce(D(Y(2)),0;0a) +Lbce(D(Y),1;0d), where 0d is the parameter of the discriminator D().1 and 0 are tensors filled with 1 or 0 respectively,with the same size as that of the outputs of D().The term Lbce(D(Y),1)in Ldis(Y(1),Y(2),Y;0a)is used only when the input data is labeled and is ignored when the input data is unlabeled data.Loce is defined as follows: HW H W Lie(A,B:)=-∑∑B.log.-∑∑Il-Baw)log-Ahl h=1w=1 h=1w=1 where 6 is the parameter of A. Adversarial Loss for Segmentation Network.In the adversarial learning scheme,the segmentation network tries to fool the discriminator.Hence,there is an adversarial loss Lade for segmentation network to learn consistent features: Ladm(O:9s)=Lbce(D(Y),1:0g)+Lbce(D(Y②),1;0g)

536 K. Fang and W.-J. Li we minimize the difference between the two masks to make the two decoders generate consistent masks on the same unlabeled data. In other words, the two decoders can learn under the supervision of each other. More specifically, given an unlabeled data U, the two decoder branches can generate two probability masks Yˆ (1) and Yˆ (2) which are processed by the sharpen operation. Since dice loss can measure the similarity of two segmenta￾tion masks and the loss can be backpropogated through two terms, we extend dice loss to the unlabeled setting and get the corresponding loss Lsemi as follows: Lsemi(U; θs)=1 − 1 K K k=1 2 H h=1 W w=1 Yˆ (1) h,w,kYˆ (2) h,w,k H h=1 W w=1(Yˆ (1) h,w,k + Yˆ (2) h,w,k) . From the definition of Lsemi, we can see that the two decoders can be updated by minimizing the difference between the masks they generate. 3.4 Discriminator In DMNet, we also adopt adversarial learning to learn a discriminator. Unlike the original discriminator in GAN which discriminates whether an image is generated or is real, our discriminator adopts a fully convolutional network (FCN). The FCN discriminator is composed of three convolutional layers whose stride is 2 for downsampling and three corresponding upsampling layers. Each convolutional layer is followed by a ReLU layer. It can discriminate whether a region or some pixels are predicted or from ground truth. Adversarial Loss for Discriminator. The objective function of discriminator can be written as follows: Ldis(Yˆ (1),Yˆ (2),Y ; θd) = Lbce(D(Yˆ (1)), 0; θd) + Lbce(D(Yˆ (2)), 0; θd) + Lbce(D(Y ), 1; θd), where θd is the parameter of the discriminator D(·). 1 and 0 are tensors filled with 1 or 0 respectively, with the same size as that of the outputs of D(·). The term Lbce(D(Y ), 1) in Ldis(Yˆ (1),Yˆ (2),Y ; θd) is used only when the input data is labeled and is ignored when the input data is unlabeled data. Lbce is defined as follows: Lbce(A, B; θ) = − H h=1 W w=1 Bh,w log Ah,w − H h=1 W w=1 [(1 − Bh,w) log(1 − Ah,w)], where θ is the parameter of A. Adversarial Loss for Segmentation Network. In the adversarial learning scheme, the segmentation network tries to fool the discriminator. Hence, there is an adversarial loss Ladv for segmentation network to learn consistent features: Ladv(O; θs) = Lbce(D(Yˆ (1)), 1; θs) + Lbce(D(Yˆ (2)), 1; θs),

DMNet for Semi-supervised Segmentation 537 where O denotes either a labeled image or an unlabeled image,F(1)and Y(2) are the corresponding masks predicted by the two decoder branches in the seg- mentation network. 3.5 Total Loss Based on the above results,the loss function for the segmentation network can be written as follows: Ls=Ldice+入1Ladw+入2 Lsemi, where Ai and A2 are two balance parameters.By integrating the discriminator, the objective of DMNet can be written as follows: L mintLs Ldis). 0s,0a 4 Experiments We adopt two real datasets to evaluate DMNet and other baselines,including supervised baselines and semi-supervised baselines. 4.1 Dataset and Evaluation Metric We conduct our experiments on the KiTS19!dataset and BraTS182 dataset. KiTS19 dataset is a kidney tumor dataset.It contains 210 labeled 3D computed tomography (CT)images for training and validation,and 90 CT images whose annotation is not published for testing.In our experiments,we use the 210 CT images with annotation to verify the effectiveness of our DMNet. BraTS18 dataset is a brain tumor dataset.It contains 385 labeled 3D MRI scans and each MRI scan has four modalities(T1,T1 contrast-enhanced,T2 and FLAIR).We use T1,Tl contrast-enhanced and T2 modality to form a three- channel input.This dataset divides the brain tumor into four categories:whole tumor,tumor core,enhancing tumor structures and cystic/necrotic components. In our experiments,we combine these four categories so there are two classes in our experiment:tumor and background. For each patient in KiTS19 and BraTS18,we choose one slice with its ground- truth label as a labeled image,and choose two slices as unlabeled images by discarding their labels.We split all labeled data into three subsets for training, validation and testing according to the proportion of 7:1:2.The unlabeled data is used for training only.Training data,validation data and testing data have no patient-level overlap to make sure that our model has never seen slices from validation patient or testing patient during training. Mean Intersection over Union (mloU)[11]can measure the similarity of any two shapes and is widely used in semantic segmentation.We also adopt mloU as the evaluation metric. 1 https://kits19.grand-challenge.org/. 2 https://www.med.upenn.edu/sbia/brats2018.html

DMNet for Semi-supervised Segmentation 537 where O denotes either a labeled image or an unlabeled image, Yˆ (1) and Yˆ (2) are the corresponding masks predicted by the two decoder branches in the seg￾mentation network. 3.5 Total Loss Based on the above results, the loss function for the segmentation network can be written as follows: LS = Ldice + λ1Ladv + λ2Lsemi, where λ1 and λ2 are two balance parameters. By integrating the discriminator, the objective of DMNet can be written as follows: L = min θs,θd {LS + Ldis}. 4 Experiments We adopt two real datasets to evaluate DMNet and other baselines, including supervised baselines and semi-supervised baselines. 4.1 Dataset and Evaluation Metric We conduct our experiments on the KiTS191 dataset and BraTS182 dataset. KiTS19 dataset is a kidney tumor dataset. It contains 210 labeled 3D computed tomography (CT) images for training and validation, and 90 CT images whose annotation is not published for testing. In our experiments, we use the 210 CT images with annotation to verify the effectiveness of our DMNet. BraTS18 dataset is a brain tumor dataset. It contains 385 labeled 3D MRI scans and each MRI scan has four modalities (T1, T1 contrast-enhanced, T2 and FLAIR). We use T1, T1 contrast-enhanced and T2 modality to form a three￾channel input. This dataset divides the brain tumor into four categories: whole tumor, tumor core, enhancing tumor structures and cystic/necrotic components. In our experiments, we combine these four categories so there are two classes in our experiment: tumor and background. For each patient in KiTS19 and BraTS18, we choose one slice with its ground￾truth label as a labeled image, and choose two slices as unlabeled images by discarding their labels. We split all labeled data into three subsets for training, validation and testing according to the proportion of 7:1:2. The unlabeled data is used for training only. Training data, validation data and testing data have no patient-level overlap to make sure that our model has never seen slices from validation patient or testing patient during training. Mean Intersection over Union (mIoU) [11] can measure the similarity of any two shapes and is widely used in semantic segmentation. We also adopt mIoU as the evaluation metric. 1 https://kits19.grand-challenge.org/. 2 https://www.med.upenn.edu/sbia/brats2018.html

538 K.Fang and W.-J.Li 4.2 Implementation Detail We use Pytorch3 to implement DMNet on a workstation with an Intel(R)CPU E5-2620V4@2.1G of 8 cores,128G RAM and an NVIDIA (R)GPU TITAN Xp. Our encoder network is ResNet101 [10]and we use it for all experiments.In the training phase,we resize the input image to 224 x 224 for KiTS19 and 240 x 240 for BraTS18,and randomly flip it horizontally with a probability of 0.5.In the inference phase,we use the average result of two segmentation branches as the final result.We train our model from scratch using Adam algorithm.The initial learning rate for segmentation network and discriminator is set to be le-4 and le-5,respectively.The weight decay is set to be 5e-5.We train our model for 150 epochs and decrease the learning rate according to a poly scheme [6].In our experiment,B in poly is set to be 0.9.Without explicit statement,we set A and A2 to be 0.01 and 0.1 respectively and set temperature T to be 0.5. 4.3 Baselines Several semi-supervised methods are adopted as baselines for comparison.More specifically,we compare DMNet to semiFCN [2]and SDNet [5].semiFCN is a relatively early method in semi-supervised segmentation used for medical image analysis.SDNet is a state-of-the-art method in medical image segmentation.We carefully reimplement semiFCN and SDNet.We adopt ResNet101 as backbone for both methods for fair comparison. We also design several supervised counterparts of DMNet to demonstrate the usefulness of unlabeled data and design some semi-supervised counterparts to demonstrate the usefulness of each component of DMNet.Supervised DMNet without adu denotes a supervised variant which adopts only labeled data for training without adversarial learning.Supervised DMNet with adv denotes a supervised variant which adopts only labeled data for training but the adver- sarial learning is adopted.Both variants do not minimize the difference between two decoder branches.Separate DMNet denotes a semi-supervised variant which adopts two separate encoders.That's to say,Separate DMNet is composed of two separate encoder-decoder networks.DMNet_wo_adv_wo_sharpen denotes a semi- supervised variant which does not adopt the adversarial training strategy and sharpen operation.DMNet_wo_sharpen denotes a semi-supervised variant which does not adopt the sharpen operation on unlabeled data but adopts adversarial learning. 4.4 Comparison with Baselines We compare our DMNet to baselines,including semiFCN 2 and SDNet 5,on KiTS19 dataset and BraTS18 dataset.The results are shown in Table 1.From the results,we can see that our DMNet outperforms these methods and achieves the best results,when trained with different amount of labeled data.DMNet 3 https://pytorch.org/

538 K. Fang and W.-J. Li 4.2 Implementation Detail We use Pytorch3 to implement DMNet on a workstation with an Intel (R) CPU E5-2620V4@2.1G of 8 cores, 128G RAM and an NVIDIA (R) GPU TITAN Xp. Our encoder network is ResNet101 [10] and we use it for all experiments. In the training phase, we resize the input image to 224 × 224 for KiTS19 and 240 × 240 for BraTS18, and randomly flip it horizontally with a probability of 0.5. In the inference phase, we use the average result of two segmentation branches as the final result. We train our model from scratch using Adam algorithm. The initial learning rate for segmentation network and discriminator is set to be 1e-4 and 1e-5, respectively. The weight decay is set to be 5e-5. We train our model for 150 epochs and decrease the learning rate according to a poly scheme [6]. In our experiment, β in poly is set to be 0.9. Without explicit statement, we set λ1 and λ2 to be 0.01 and 0.1 respectively and set temperature T to be 0.5. 4.3 Baselines Several semi-supervised methods are adopted as baselines for comparison. More specifically, we compare DMNet to semiFCN [2] and SDNet [5]. semiFCN is a relatively early method in semi-supervised segmentation used for medical image analysis. SDNet is a state-of-the-art method in medical image segmentation. We carefully reimplement semiFCN and SDNet. We adopt ResNet101 as backbone for both methods for fair comparison. We also design several supervised counterparts of DMNet to demonstrate the usefulness of unlabeled data and design some semi-supervised counterparts to demonstrate the usefulness of each component of DMNet. Supervised DMNet without adv denotes a supervised variant which adopts only labeled data for training without adversarial learning. Supervised DMNet with adv denotes a supervised variant which adopts only labeled data for training but the adver￾sarial learning is adopted. Both variants do not minimize the difference between two decoder branches. Separate DMNet denotes a semi-supervised variant which adopts two separate encoders. That’s to say, Separate DMNet is composed of two separate encoder-decoder networks. DMNet wo adv wo sharpen denotes a semi￾supervised variant which does not adopt the adversarial training strategy and sharpen operation. DMNet wo sharpen denotes a semi-supervised variant which does not adopt the sharpen operation on unlabeled data but adopts adversarial learning. 4.4 Comparison with Baselines We compare our DMNet to baselines, including semiFCN [2] and SDNet [5], on KiTS19 dataset and BraTS18 dataset. The results are shown in Table 1. From the results, we can see that our DMNet outperforms these methods and achieves the best results, when trained with different amount of labeled data. DMNet 3 https://pytorch.org/

DMNet for Semi-supervised Segmentation 539 has obvious advantage over other methods when the amount of labeled data is limited.When we use only 10%of the labeled data and all unlabeled data, DMNet can achieve 88.4%and 78.7%mloU on KiTS19 and BraTS18,which outperforms semiFCN by 12.3%and 15.1%,and outperforms SDNet by 5.2% and 3.6%,respectively. Table 1.mIoU on test set of KiTS19 and BraTS18 by different methods using 10%, 30%,50%and 100%of the labeled data KiTS19 BraTS18 10% 30% 50% 100% 10% 30% 50% 100% semiFCN [2]78.7% 84.4%86.7% 87.9% 68.4% 78.8% 77.9% 82.7% SDNet[5】 84.0% 85.9% 89.0% 89.9% 76.0% 80.2% 80.8% 82.9% DMNet 88.4% 89.9%90.2% 90.9% 78.7%85.0% 85.4% 87.0% 4.5 Ablation Study We also perform ablation study on BraTS18 to show the effectiveness of each component used in DMNet. Table 2 shows the results of Supervised DMNet without adu trained with 100% of the labeled data using different loss functions.From the results of Table 2,we can see that Dice loss can surpass the performance of cross entropy loss. Table 2.Comparison between different loss functions Loss function mIoU Cross entropy 81.1% Dice loss 84.5% Table 3 shows the results of DMNet and its variants introduced in Subsect.4.3. From the results of Separate DMNet,we can see that our architecture design, in which the two decoders share an encoder,has better performance than the architecture in which two decoders use separate encoders.Therefore,it proves that the architecture of DMNet has advantages.More specifically,it can save GPU memory and achieve better performance.Comparing the results between DMNet_wo_adv_wo_sharpen and DMNet_wo_sharpen,and the results between Supervised DMNet without adv and Supervised DMNet with adv,we can see that adversarial learning strategy can improve the performance whether in supervised setting or semi-supervised setting.From the results of DMNet_wo_sharpen and DMNet,we can see that the sharpen operation can benefit the learning on unla- beled data.Comparing the results of DMNet to those of supervised variants

DMNet for Semi-supervised Segmentation 539 has obvious advantage over other methods when the amount of labeled data is limited. When we use only 10% of the labeled data and all unlabeled data, DMNet can achieve 88.4% and 78.7% mIoU on KiTS19 and BraTS18, which outperforms semiFCN by 12.3% and 15.1%, and outperforms SDNet by 5.2% and 3.6%, respectively. Table 1. mIoU on test set of KiTS19 and BraTS18 by different methods using 10%, 30%, 50% and 100% of the labeled data KiTS19 BraTS18 10% 30% 50% 100% 10% 30% 50% 100% semiFCN [2] 78.7% 84.4% 86.7% 87.9% 68.4% 78.8% 77.9% 82.7% SDNet [5] 84.0% 85.9% 89.0% 89.9% 76.0% 80.2% 80.8% 82.9% DMNet 88.4% 89.9% 90.2% 90.9% 78.7% 85.0% 85.4% 87.0% 4.5 Ablation Study We also perform ablation study on BraTS18 to show the effectiveness of each component used in DMNet. Table 2 shows the results of Supervised DMNet without adv trained with 100% of the labeled data using different loss functions. From the results of Table 2, we can see that Dice loss can surpass the performance of cross entropy loss. Table 2. Comparison between different loss functions Loss function mIoU Cross entropy 81.1% Dice loss 84.5% Table 3 shows the results of DMNet and its variants introduced in Subsect. 4.3. From the results of Separate DMNet, we can see that our architecture design, in which the two decoders share an encoder, has better performance than the architecture in which two decoders use separate encoders. Therefore, it proves that the architecture of DMNet has advantages. More specifically, it can save GPU memory and achieve better performance. Comparing the results between DMNet wo adv wo sharpen and DMNet wo sharpen, and the results between Supervised DMNet without adv and Supervised DMNet with adv, we can see that adversarial learning strategy can improve the performance whether in supervised setting or semi-supervised setting. From the results of DMNet wo sharpen and DMNet, we can see that the sharpen operation can benefit the learning on unla￾beled data. Comparing the results of DMNet to those of supervised variants

540 K.Fang and W.-J.Li we can conclude that the proposed DMNet can utilize unlabeled data to improve the segmentation performance,especially when the amount of labeled data is lim- ited.When only 10%of labeled data is available,DMNet can improve the mloU from 67.0%to 78.7%.When all labeled data is available,in which case the amount of unlabeled data is almost the same as that of labeled data,DMNet can also improve the mIoU from 84.2%to 87.0%. Table 3.Comparison between DMNet and its variants Method Amount of labeled data 10% 30% 50% 100% Supervised DMNet without adv 59.3% 75.8% 79.4% 84.5% Supervised DMNet with adv 67.0% 76.9% 79.8% 84.2% Separate DMNet 76.1% 84.2% 84.4% 85.0% DMNet_wo_adv_wo_sharpen 75.8% 82.0% 82.5% 86.8% DMNet_wo_sharpen 76.9% 82.3% 83.9% 86.9% DMNet 78.7% 85.0% 85.4% 87.0% 5 Conclusion In this paper,we propose a novel semi-supervised method,called DMNet,for semantic segmentation in medical image analysis.DMNet can be trained with a limited amount of labeled data and a large amount of unlabeled data.Hence, DMNet can be used to solve the problem that it is typically difficult to collect a large amount of labeled data in medical image analysis.Experiments on a kidney tumor dataset and a brain tumor dataset show that DMNet can outperform other baselines,including both supervised ones and semi-supervised ones,to achieve the best performance. References 1.Badrinarayanan,V.,Kendall,A.,Cipolla,R.:SegNet:a deep convolutional encoder-decoder architecture for image segmentation.IEEE Trans.Pattern Anal. Mach.Intell..39(12),2481-2495(2017) 2.Bai,W.,et al.:Semi-supervised learning for network-based cardiac MR image segmentation.In:Descoteaux,M.,Maier-Hein,L.,Franz,A.,Jannin,P.,Collins, D.L.,Duchesne,S.(eds.)MICCAI 2017.LNCS,vol.10434,pp.253-260.Springer, Cham(2017).https:/doi.org/10.1007/978-3-319-66185-829 3.Berthelot,D.,Carlini,N.,Goodfellow,I.J.,Papernot,N.,Oliver,A.,Raffel,C.: MixMatch:a holistic approach to semi-supervised learning.CoRR (2019) 4.Blum,A.,Mitchell,T.M.:Combining labeled and unlabeled data with co-training. In:Proceedings of Annual Conference on Computational Learning Theory (COLT) (1998)

540 K. Fang and W.-J. Li we can conclude that the proposed DMNet can utilize unlabeled data to improve the segmentation performance, especially when the amount of labeled data is lim￾ited. When only 10% of labeled data is available, DMNet can improve the mIoU from 67.0% to 78.7%.When all labeled data is available, in which case the amount of unlabeled data is almost the same as that of labeled data, DMNet can also improve the mIoU from 84.2% to 87.0%. Table 3. Comparison between DMNet and its variants Method Amount of labeled data 10% 30% 50% 100% Supervised DMNet without adv 59.3% 75.8% 79.4% 84.5% Supervised DMNet with adv 67.0% 76.9% 79.8% 84.2% Separate DMNet 76.1% 84.2% 84.4% 85.0% DMNet wo adv wo sharpen 75.8% 82.0% 82.5% 86.8% DMNet wo sharpen 76.9% 82.3% 83.9% 86.9% DMNet 78.7% 85.0% 85.4% 87.0% 5 Conclusion In this paper, we propose a novel semi-supervised method, called DMNet, for semantic segmentation in medical image analysis. DMNet can be trained with a limited amount of labeled data and a large amount of unlabeled data. Hence, DMNet can be used to solve the problem that it is typically difficult to collect a large amount of labeled data in medical image analysis. Experiments on a kidney tumor dataset and a brain tumor dataset show that DMNet can outperform other baselines, including both supervised ones and semi-supervised ones, to achieve the best performance. References 1. Badrinarayanan, V., Kendall, A., Cipolla, R.: SegNet: a deep convolutional encoder-decoder architecture for image segmentation. IEEE Trans. Pattern Anal. Mach. Intell. 39(12), 2481–2495 (2017) 2. Bai, W., et al.: Semi-supervised learning for network-based cardiac MR image segmentation. In: Descoteaux, M., Maier-Hein, L., Franz, A., Jannin, P., Collins, D.L., Duchesne, S. (eds.) MICCAI 2017. LNCS, vol. 10434, pp. 253–260. Springer, Cham (2017). https://doi.org/10.1007/978-3-319-66185-8 29 3. Berthelot, D., Carlini, N., Goodfellow, I.J., Papernot, N., Oliver, A., Raffel, C.: MixMatch: a holistic approach to semi-supervised learning. CoRR (2019) 4. Blum, A., Mitchell, T.M.: Combining labeled and unlabeled data with co-training. In: Proceedings of Annual Conference on Computational Learning Theory (COLT) (1998)

DMNet for Semi-supervised Segmentation 541 5.Chartsias,A.,et al.:Factorised spatial representation learning:application in semi- supervised myocardial segmentation.In:Frangi,A.F.,Schnabel,J.A.,Davatzikos, C.,Alberola-Lopez,C.,Fichtinger,G.(eds.)MICCAI 2018.LNCS,vol.11071,pp. 490-498.Springer,.Cham(2018).https://doi.org/10.1007/978-3-030-00934-2.55 6.Chen,L.,Papandreou,G.,Kokkinos,I.,Murphy,K.,Yuille,A.L.:Semantic image segmentation with deep convolutional nets and fully connected CRFs.In:Proceed- ings of International Conference on Learning Representations (ICLR)(2015) 7.Chen,L.,Zhu,Y.,Papandreou,G.,Schroff,F.,Adam,H.:Encoder-decoder with atrous separable convolution for semantic image segmentation.In:Proceedings of European Conference on Computer Vision (ECCV)(2018) 8.Goodfellow,I.J.,et al.:Generative adversarial nets.In:Proceedings of Neural Information Processing Systems (NIPS)(2014) 9.Han,B.,Yao,Q.,Yu,X.,Niu,G.,Xu,M.,Hu,W.,Tsang,I.W.,Sugiyama,M.: Co-teaching:robust training of deep neural networks with extremely noisy labels. In:Proceedings of Neural Information Processing Systems (NIPS)(2018) 10.He,K.,Zhang,X.,Ren,S.,Sun,J.:Deep residual learning for image recognition In:Proceedings of Computer Vision and Pattern Recognition (CVPR)(2016) 11.Jaccard,P.:Etude comparative de la distribution florale dans une portion des alpes et des jura.Bull.Soc.Vaudoise Sci.Nat.37,547-579 (1901) 12.Long,J.,Shelhamer,E.,Darrell,T.:Fully convolutional networks for semantic seg- mentation.In:Proceeding of Computer Vision and Pattern Recognition (CVPR) (2015) 13.Milletari,F.,Navab,N.,Ahmadi,S.:V-net:fully convolutional neural networks for volumetric medical image segmentation.In:Proceeding of 3D Vision (3DV)(2016) 14.Nie,D.,Gao,Y.,Wang,L.,Shen,D.:ASDNet:attention based semi-supervised deep networks for medical image segmentation.In:Frangi,A.F.,Schnabel,J.A., Davatzikos,C.,Alberola-Lopez,C.,Fichtinger,G.(eds.)MICCAI 2018.LNCS, vol.11073,pp.370-378.Springer,Cham (2018).https://doi.org/10.1007/978-3- 030-00937-3.43 15.Qiao,S.,Shen,W.,Zhang,Z.,Wang,B.,Yuille,A.L.:Deep co-training for semi- supervised image recognition.In:Proceedings of European Conference on Com- puter Vision (ECCV)(2018) 16.Ronneberger,O.,Fischer,P.,Brox,T.:U-Net:convolutional networks for biomed- ical image segmentation.In:Navab,N.,Hornegger,J.,Wells,W.M.,Frangi,A.F. (eds.)MICCAI 2015.LNCS,vol.9351,pp.234-241.Springer,Cham (2015). https://doi.org/10.1007/978-3-31924574-428 17.Souly,N.,Spampinato,C.,Shah,M.:Semi and weakly supervised semantic seg- mentation using generative adversarial network.CoRR (2017) 18.Zhou,Y.,et al.:Collaborative learning of semi-supervised segmentation and classi- fication for medical images.In:Proceeding of Computer Vision and Pattern Recog- nition (CVPR)(2019)

DMNet for Semi-supervised Segmentation 541 5. Chartsias, A., et al.: Factorised spatial representation learning: application in semi￾supervised myocardial segmentation. In: Frangi, A.F., Schnabel, J.A., Davatzikos, C., Alberola-L´opez, C., Fichtinger, G. (eds.) MICCAI 2018. LNCS, vol. 11071, pp. 490–498. Springer, Cham (2018). https://doi.org/10.1007/978-3-030-00934-2 55 6. Chen, L., Papandreou, G., Kokkinos, I., Murphy, K., Yuille, A.L.: Semantic image segmentation with deep convolutional nets and fully connected CRFs. In: Proceed￾ings of International Conference on Learning Representations (ICLR) (2015) 7. Chen, L., Zhu, Y., Papandreou, G., Schroff, F., Adam, H.: Encoder-decoder with atrous separable convolution for semantic image segmentation. In: Proceedings of European Conference on Computer Vision (ECCV) (2018) 8. Goodfellow, I.J., et al.: Generative adversarial nets. In: Proceedings of Neural Information Processing Systems (NIPS) (2014) 9. Han, B., Yao, Q., Yu, X., Niu, G., Xu, M., Hu, W., Tsang, I.W., Sugiyama, M.: Co-teaching: robust training of deep neural networks with extremely noisy labels. In: Proceedings of Neural Information Processing Systems (NIPS) (2018) 10. He, K., Zhang, X., Ren, S., Sun, J.: Deep residual learning for image recognition. In: Proceedings of Computer Vision and Pattern Recognition (CVPR) (2016) 11. Jaccard, P.: Etude comparative de la distribution florale dans une portion des alpes ´ et des jura. Bull. Soc. Vaudoise Sci. Nat. 37, 547–579 (1901) 12. Long, J., Shelhamer, E., Darrell, T.: Fully convolutional networks for semantic seg￾mentation. In: Proceeding of Computer Vision and Pattern Recognition (CVPR) (2015) 13. Milletari, F., Navab, N., Ahmadi, S.: V-net: fully convolutional neural networks for volumetric medical image segmentation. In: Proceeding of 3D Vision (3DV) (2016) 14. Nie, D., Gao, Y., Wang, L., Shen, D.: ASDNet: attention based semi-supervised deep networks for medical image segmentation. In: Frangi, A.F., Schnabel, J.A., Davatzikos, C., Alberola-L´opez, C., Fichtinger, G. (eds.) MICCAI 2018. LNCS, vol. 11073, pp. 370–378. Springer, Cham (2018). https://doi.org/10.1007/978-3- 030-00937-3 43 15. Qiao, S., Shen, W., Zhang, Z., Wang, B., Yuille, A.L.: Deep co-training for semi￾supervised image recognition. In: Proceedings of European Conference on Com￾puter Vision (ECCV) (2018) 16. Ronneberger, O., Fischer, P., Brox, T.: U-Net: convolutional networks for biomed￾ical image segmentation. In: Navab, N., Hornegger, J., Wells, W.M., Frangi, A.F. (eds.) MICCAI 2015. LNCS, vol. 9351, pp. 234–241. Springer, Cham (2015). https://doi.org/10.1007/978-3-319-24574-4 28 17. Souly, N., Spampinato, C., Shah, M.: Semi and weakly supervised semantic seg￾mentation using generative adversarial network. CoRR (2017) 18. Zhou, Y., et al.: Collaborative learning of semi-supervised segmentation and classi- fication for medical images. In: Proceeding of Computer Vision and Pattern Recog￾nition (CVPR) (2019)

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