Glaucoma is one of the leading causes of irreversible but preventable blindness in working age populations.Color fundus photography (CFP) is the most cost-effective imaging modality to screen for retinal disorders.However, its application to glaucoma has been limited to the computation of a few related biomarkers such as the vertical cup-to-disc ratio. Deep learning approaches, although widely applied for medical image analysis, have not been extensively used for glaucoma assessment due to the limited size of the available data sets. Furthermore, the lack of a standardize benchmark strategy makes difficult to compare existing methods in a uniform way. In order to overcome these issues we set up the Retinal Fundus Glaucoma Challenge, REFUGE (https://refuge.grand-challenge.org), held in conjunction with MICCAI 2018. The challenge consisted * Corresponding authors: Yanwu Xu (ywxu@ieee.org) and Xiulan Zhang (

BackgroundMost current algorithms for automatic glaucoma assessment using fundus images rely on handcrafted features based on segmentation, which are affected by the performance of the chosen segmentation method and the extracted features. Among other characteristics, convolutional neural networks (CNNs) are known because of their ability to learn highly discriminative features from raw pixel intensities.MethodsIn this paper, we employed five different ImageNet-trained models (VGG16, VGG19, InceptionV3, ResNet50 and Xception) for automatic glaucoma assessment using fundus images. Results from an extensive validation using cross-validation and cross-testing strategies were compared with previous works in the literature.ResultsUsing five public databases (1707 images), an average AUC of 0.9605 with a 95% confidence interval of 95.92–97.07%, an average specificity of 0.8580 and an average sensitivity of 0.9346 were obtained after using the Xception architecture, significantly improving the performance of other state-of-the-art works. Moreover, a new clinical database, ACRIMA, has been made publicly available, containing 705 labelled images. It is composed of 396 glaucomatous images and 309 normal images, which means, the largest public database for glaucoma diagnosis. The high specificity and sensitivity obtained from the proposed approach are supported by an extensive validation using not only the cross-validation strategy but also the cross-testing validation on, to the best of the authors’ knowledge, all publicly available glaucoma-labelled databases.ConclusionsThese results suggest that using ImageNet-trained models is a robust alternative for automatic glaucoma screening system. All images, CNN weights and software used to fine-tune and test the five CNNs are publicly available, which could be used as a testbed for further comparisons.

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Artificial Intelligence (AI) is having a tremendous impact across most areas of science. Applications of AI in healthcare have the potential to improve our ability to detect, diagnose, prognose, and intervene on human disease. For AI models to be used clinically, they need to be made safe, reproducible and robust, and the underlying software framework must be aware of the particularities (e.g. geometry, physiology, physics) of medical data being processed. This work introduces MONAI, a freely available, community-supported, and consortium-led PyTorch-based framework for deep learning in healthcare. MONAI extends PyTorch to support medical data, with a particular focus on imaging, and provide purpose-specific AI model architectures, transformations and utilities that streamline the development and deployment of medical AI models. MONAI follows best practices for software-development, providing an easy-to-use, robust, welldocumented, and well-tested software framework. MONAI preserves the simple, additive, and compositional approach of its underlying PyTorch libraries. MONAI is being used by and receiving contributions from research, clinical and industrial teams from around the world, who are pursuing applications spanning nearly every aspect of healthcare.

Image registration is a fundamental task in multiple medical image analysis applications. With the advent of deep learning, there have been significant advances in algorithmic performance for various computer vision tasks in recent years, including medical image registration. The last couple of years have seen a dramatic increase in the development of deep learning-based medical image registration algorithms. Consequently, a comprehensive review of the current state-of-the-art algorithms in the field is timely, and necessary. This review is aimed at understanding the clinical applications and challenges that drove this innovation, analysing the functionality and limitations of existing approaches, and at providing insights to open challenges and as yet unmet clinical needs that could shape future research directions. To this end, the main contributions of this paper are: (a) discussion of all deep learning-based medical image registration papers published since 2013 with significant methodological and/or functional contributions to the field; (b) analysis of the development and evolution of deep learning-based image registration methods, summarising the current trends and challenges in the domain; and (c) overview of unmet clinical needs and potential directions for future research in deep learning-based medical image registration.