Neural Computing and Applications

Multi-national CT Image-label Pairs Synthesis for COVID-19 Diagnosis via Few-shot

Generative Adversarial Networks Adaptation
--Manuscript Draft--

Manuscript Number: NCAA-D-23-00423

Full Title: Multi-national CT Image-label Pairs Synthesis for COVID-19 Diagnosis via Few-shot
Generative Adversarial Networks Adaptation

Article Type: Original Article

Keywords: COVID-19; Few-shot generative model adaptation; Geographic and class imbalances

Abstract: Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has
threatened global health for years. An accurate and rapid method of diagnosing
COVID-19 infection is essential in light of its high pathogenicity and transmissibility.
Numerous deep learning models have been developed to assist radiologists with chest
computed tomography (CT)-based COVID-19 screening. However, the existing
COVID-19 CT datasets are typically characterized by significant geographic and class
imbalances, making it difficult for models to be generalized to CT datasets from
different patient cohorts. With the advancements in generative adversarial networks
(GANs), a feasible solution to the problem is to generate data for the small target
datasets with only a few available examples by leveraging a large-scale source dataset
as pretraining (i.e., few-shot GANs adaptation). To calibrate the target generative
models during adaptation, we propose to preserve the source images’ diversity
information via combining contrastive learning with LeCam regularization, and reduce
overfitting on the target images by using consistency regularization and differentiable
augmentation. Meanwhile, we integrate the selected off-the-shelf models into the
discriminator ensemble based on the linear separability between real and fake samples
in the feature space for better representation learning. We demonstrate the
effectiveness of our approach by generating realistic and diverse CT image-label pairs
of target datasets and show that it consistently outperforms the state-of-the-art
approaches.

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3 Highlights
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5 Multi-national CT Image-label Pairs Synthesis for COVID-19 Diagnosis via Few-shot Generative
6 Adversarial Networks Adaptation
7 Jing Zhang,Yingpeng Xie,Dandan Sun,Ruidong Huang,Tianfu Wang,Baiying Lei,Kuntao Chen
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 1

Multi-national CT Image-label Pairs Synthesis for COVID-19

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Diagnosis via Few-shot Generative Adversarial Networks Adaptation
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7 Jing Zhanga,1 , Yingpeng Xieb,1 , Dandan Sunb , Ruidong Huanga , Tianfu Wanga , Baiying Leib,∗ and
8 Kuntao Chena
9
10 a Department of Radiology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, 519000, Guangdong, China
11 b National-RegionalKey Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and
12 Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518055, Guangdong, China
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14 ARTICLE INFO ABSTRACT
15
16 Keywords: Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has threatened global
17 COVID-19 health for years. An accurate and rapid method of diagnosing COVID-19 infection is essential in light
18 Few-shot generative model adaptation of its high pathogenicity and transmissibility. Numerous deep learning models have been developed
Geographic and class imbalances to assist radiologists with chest computed tomography (CT)-based COVID-19 screening. However,
19 the existing COVID-19 CT datasets are typically characterized by significant geographic and class
20 imbalances, making it difficult for models to be generalized to CT datasets from different patient
21 cohorts. With the advancements in generative adversarial networks (GANs), a feasible solution to
22 the problem is to generate data for the small target datasets with only a few available examples by
23 leveraging a large-scale source dataset as pretraining (i.e., few-shot GANs adaptation). To calibrate
the target generative models during adaptation, we propose to preserve the source images’ diversity
24 information via combining contrastive learning with LeCam regularization, and reduce overfitting on
25 the target images by using consistency regularization and differentiable augmentation. Meanwhile,
26 we integrate the selected off-the-shelf models into the discriminator ensemble based on the linear
27 separability between real and fake samples in the feature space for better representation learning. We
28 demonstrate the effectiveness of our approach by generating realistic and diverse CT image-label pairs
of target datasets and show that it consistently outperforms the state-of-the-art approaches.
29
30
31
1. Introduction the problem of data heterogeneity caused by variation in
32 scanners or imaging protocols, treating multiple datasets as
33 Coronavirus disease 2019 (COVID-19) is a widespread a whole (Harmon et al., 2020; Tuinstra et al., 2022), which
34 pandemic caused by severe acute respiratory syndrome coro- limits the model performance. Unlike them, He et al. (He
35 navirus 2 (SARS-CoV-2), which has caused considerable et al., 2021a,b) trained the customized deep learning model
36 economic and health damage in recent years. Both real-time
on every COVID-19 dataset, respectively. In spite of this,
37 reverse transcription polymerase chain reaction (rRT-PCR)
a well-generalized DL model demands a large quantity of
38 and computed tomography (CT) imaging play an important annotated data. To our knowledge, even the largest datasets
39 role in COVID-19 diagnosis, wherein CT has a higher sensi-
40 that curate data from a wide variety of CT data sources
tivity to COVID-19 and is less resource-intensive than rRT- still remain significant geographic and class imbalances
41 PCR (Fang et al., 2020; Xie et al., 2020). Some early studies
42 (Tuinstra et al., 2022), which leads to the difficulty of gener-
have shown that certain abnormalities in chest CT images
43 alizing the model across CT datasets from different patient
may be indicative of COVID-19 infections, but may also
44 cohorts. Therefore, increasing the quantity and diversity in
be highly similar in CT appearance with some non-COVID- each patient cohort and balancing the class distribution in
45
46 19 indicators and even cannot be identified by a radiologist constructing the datasets could result in more robust, well-
47 (Bai et al., 2020; Meng et al., 2020). Therefore, it is highly rounded training of DL models (Chen et al., 2022).
48 desirable to automate COVID-19 diagnosis to reduce the To reduce the costs associated with COVID-19 CT data
workload of radiologists and the likelihood of misdiagnosis.
49 collection and annotation, data augmentation targets at aug-
Studies to date have been limited both in terms of the
50 menting existing training data with new samples. Traditional
51 quantity and the diversity of patients, and most have been data augmentation tricks (e.g., crop, flip, color jittering) only
52 confined to cohorts from one country (Zhang et al., 2020; have limited diversity. As an alternative, generative adver-
53 Rahimzadeh et al., 2021; Ning et al., 2020; Revel et al., sarial networks (GANs) (Goodfellow et al., 2020), which
54 2021; Khurana and Soni, 2022). However, the characteristics have shown promising performance on image generation
55 of COVID-19 infection observed in the CT images from a
(Brock et al., 2018; Karras et al., 2021), can generate diverse
56 single country may not generalize to patients worldwide.
samples to augment training data (Acar et al., 2021). For
57 Even though several studies have utilized multiple COVID- example, Jiang et al. (Jiang et al., 2020) proposed a novel
58 19 datasets from different countries, most of them ignore GANs structure for CT image synthesis by designing a
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∗ Corresponding author dual network to reserve global and local image information
61 leiby@szu.edu.cn (B. Lei) individually. Despite that producing overall plausible CT
ORCID (s):
62 1 Indicates
images can be beneficial for training deep learning models,
the two first authors that contributed equally to this work.
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3 they require expensive training data with pixel-wise anno- sensational generation ability of GANs, enormous efforts
4 tations (i.e., lung masks and COVID-19 infection masks). have been made to develop architecture to benefit GANs
5 Moreover, it is unreasonable to expect to fully infer the from deep learning and computing acceleration technologies
6 distribution from just a few observations in a small patient advance (Radford et al., 2015; Brock et al., 2018; Karras
7 cohort. To address this, researchers recently exploit few-shot et al., 2020b), conditioning goal to support the adversarial
8 image generation to generate realistic and diverse images training using category information of the dataset (Zhu et al.,
9 using limited images (Wang et al., 2018; Mo et al., 2020; 2017; Mirza and Osindero, 2014; Miyato and Koyama, 2018;
10 Noguchi and Harada, 2019; Ojha et al., 2021; Zhao et al., Kang et al., 2021; Hou et al., 2022), adversarial loss free
11 2022, 2020; Karras et al., 2020a; Tseng et al., 2021; Kumari from the vanishing gradient problem (Arjovsky et al., 2017),
12 et al., 2022). Most of them followed the route of few-shot regularization for stabilizing adversarial training (Miyato
13 generative model adaptation, which starts with a model pre- et al., 2018). Among them, the GANs with conditioning
14 trained on a large dataset of a source domain and then adapts goal is called conditional Generative Adversarial Networks
15 to the target domain with limited data. Specifically, Wang et (cGANs), and cGANs specialized in conditioning on the
16 al. (Wang et al., 2018) used fine-tuning strategy to model the categorical label has become a representative framework
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distribution of the target domain directly, and subsequently, for high-quality image generation (Brock et al., 2018; Kang
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several works proposed to fine-tune only part of the model et al., 2021; Hou et al., 2022).
19
20 (Mo et al., 2020; Noguchi and Harada, 2019). Some more
21 recent works proposed to impose different forms of regular- 2.2. Few-shot Image Generation
22 ization during the model adaptation (Ojha et al., 2021; Zhao Few-shot image generation aims at generating realistic
23 et al., 2022). Together with data-efficient training techniques and diverse images using limited images. Due to a wide
24 (Zhao et al., 2020; Karras et al., 2020a; Tseng et al., 2021), range of application scenarios, existing researches roughly
25 they have shown faster convergence speed and better gener- fall into four categories with different experimental settings.
26 ation quality for limited-data settings. Instead of fine-tuning The first category is that the GANs are trained on large,
27 the weights of a source generative model, Kumari et al. related categories and applied to novel categories with a few
28 (Kumari et al., 2022) study the use of a series of pre-trained images (Gu et al., 2021; Hong et al., 2022). These methods
29 large-scale feature extractors to transfer the knowledge of can achieve instant adaptation to multiple unseen categories
30 learned feature representations of computer vision models. without requiring a tedious fine-tuning process, but only
31 In this paper, we seek to generate COVID-19 CT image-label work well on fine-grained datasets with low inter-category
32 pairs of a given dataset with only a few available examples by variance. The second category extends the adaptation from
33 leveraging a large-scale COVID-19 CT dataset as pertaining, the related category to quite a different domain (Wang et al.,
34 thereby improving the generalization of the deep learning 2018; Mo et al., 2020; Li et al., 2020; Ojha et al., 2021;
35 model for COVID-19 diagnosis. The main contributions of Xiao et al., 2022; Kumari et al., 2022), which allows for
36 a broader application. More specifically, a base model is
this paper can be summarized as follows:
37 pre-trained on a large dataset of a source domain and then
38 • We explore few-shot GANs adaptation as a potential adapted to the target domain with limited data by fine-tuning
39
answer to address the problems of geographic and accompanied by regularization or perturbation. Note that
40
class imbalance in multi-national COVID-19 diagno- unlike image-to-image translation (Zhu et al., 2017; Liu
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sis. et al., 2019), which converts an input image from a source
42
43 domain to a target domain with the intrinsic source content
• We propose to calibrate the target generative models
44 preserved and the extrinsic target style transferred, here these
by leveraging both the source generative model and
45 methods are adapting models, not images. The last category,
the source vision models simultaneously, which is
46 instead of following the above adaptation pipeline, directly
motivated to preserve the source images’ diversity
47 trains GANs from scratch on a small dataset with data
in different and complementary feature spaces while
48 augmentation which does not leak to the generator (Zhao
adapting to the target images’ appearance.
49 et al., 2020; Karras et al., 2020a), regularization (Tseng et al.,
50 • We demonstrate that, given a limited number of target 2021), or the knowledge of pre-trained visual representation
51 images, our method not only can synthesize realistic (Kumari et al., 2022).
52
and diverse CT image-label pairs, but also achieve
53
superior classification performance by leveraging the 3. Method
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55 synthetic images.
3.1. Preliminary
56 Vanilla GANs training procedure is to solve a classic
57 2. Related Work mini-max formulation by seeking a Nash Equilibrium in an
58
2.1. Improving GANs Training alternating fashion, in which neither the generator 𝐺 nor
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60 GANs (Goodfellow et al., 2014) is a well-known paradigm the discriminator 𝐷 can improve unilaterally. Specifically,
61 for realistic image synthesis through an adversarial process 𝐷 tries to distinguish whether a certain sample comes from
62 between a generator and a discriminator network. Behind the the probability distribution 𝑝𝑟 (𝑥) of real data 𝑥, while 𝐺
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26 Figure 1: Algorithmic overview. During the GANs adaptation stage, we regularize the generator and discriminator with the
27 objective function described in Eq. 11 to preserve source images’ diversity information while adapting to the target images’
28 appearance using both the source generative models and the source vision models.
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32 takes a latent code 𝑧 as input and strives to generate real- performance of GANs heavily deteriorates since the discrim-
33 istic examples 𝐺(𝑧) to induce 𝐷 to misjudge the generated inator overfits the training set. An overfitted discriminator
34 samples as real. Mathematically, the adversarial processes penalizes any generated samples other than the training data,
35 can be expressed as follows: thereby providing invalid gradients to the generator. In this
36 paper, we follow the route of few-shot generative model
37 adaptation to use diversity knowledge from the source as
min max 𝑎𝑑𝑣 = 𝐸𝑥∼𝑝𝑟 (𝑥) [log 𝐷(𝑥)]
38 𝐺 𝐷 (1) guidance, as detailed below.
39 + 𝐸𝑧∼𝑅𝑑 [log(1 − 𝐷(𝐺(𝑧)))]
40 3.2. Our Method
41 where 𝑅𝑑 is an easily sampled distribution (e.g., uniform or Given a GANs pre-trained on the source domain, we
42 standard normal), and 𝐷(𝑥) supplies the probability that the denote the generator as 𝐺𝑠 and the discriminator as 𝐷𝑠 . The
43 input 𝑥 is real. Such unsupervised dynamics often undergo target generator 𝐺𝑡 and the discriminator 𝐷𝑡 can be obtained
44
instability problem for unknown reasons, resulting in poor- by fine-tuning the pre-trained GANs on the target domain
45
quality and repeating outputs. In addition, practitioners are (note that we omit 𝑝𝑟 (𝑦) in this section for brevity):
46
47 interested in being able to control in advance the content of
48 the generated samples in practical applications. As one of the min max 𝑉 (𝐷𝑡 , 𝐺𝑡 ) = 𝐸𝑥∼𝑝𝑟 (𝑥) [log 𝐷𝑡 (𝑥)]
49 prescriptions for stabilizing and reinforcing GANs, training 𝐺𝑡 𝐷𝑡
(3)
50 GANs with categorical labels (i.e., cGANs) is suggested. A + 𝐸𝑧∼𝑅𝑑 [log(1 − 𝐷𝑡 (𝐺𝑡 (𝑧)))]
51 typical cGANs framework can be formulated by extending
52 the vanilla GANs as: where 𝑅𝑑 is an easily sampled distribution (e.g., Gaussian),
53 𝑝𝑟 (𝑥) is the training (observed) image set. To preserve source
54 images’ diversity information in 𝐺𝑡 while adapting to the
min max 𝑎𝑑𝑣 =𝐸(𝑥,𝑦)∼𝑝𝑟 (𝑥,𝑦) [log 𝑐𝐷(𝑥, 𝑦)] target images’ appearance, we propose a novel method to
55 𝑐𝐺 𝑐𝐷
(2)
56 +𝐸𝑧∼𝑅𝑑 ,𝑦∼𝑝𝑟 (𝑦) [log(1 − 𝑐𝐷(𝑐𝐺(𝑧, 𝑦), 𝑦))] calibrate the target generative model by using both the source
57 generative models and the source vision models simultane-
58 where 𝑐𝐺 and 𝑐𝐷 are variant conditioned on real label ously, as shown in Fig. 1.
59 distribution 𝑝𝑟 (𝑦), and 𝑐𝐷(𝑥, 𝑦) supplies the probability that First, given a set of off-the-shelf feature extractor bank
60 { }𝑁 { }𝑁
the input data-label pair (𝑥, 𝑦) is from the joint distribution 𝐹 = 𝐹𝑛 𝑛=1 , we add small classifier heads 𝐶𝑛 𝑛=1 to
61 of real data and labels 𝑝𝑟 (𝑥, 𝑦). One crucial problem with identify the real and fake source images by fine-tuning the
62 GANs is that given a limited amount of training data, the whole model (𝐷𝑛 = 𝐹𝑛 ◦𝐶𝑛 ), then we use them to measure
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Figure 2: CT image-label pairs synthesis, where each row in a figure contains samples from a fixed class (Upper row: Normal;
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Middle row: CAP; Bottom row: NCP).
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43 the gap between the real and fake target images during the first two parts are derived from the Dual Contrastive
{ }𝑁
44 adaptation by fine-tuning only 𝐶𝑛 𝑛=1 for providing the Learning (DCL) (Zhao et al., 2022) to maximize the mutual
45 gradients to the target generator: information between the source and target image features
46 originated from the same input noise:
47 ∑
𝑁
( ) ( ( ) ( ))
48 min max 𝑉 (𝐷𝑡 , 𝐺𝑡 ) + 𝑉 𝐷𝑛 , 𝐺𝑡 (4) 𝑓 𝐺𝑡𝑙 𝑧𝑖 , 𝐺𝑠𝑙 𝑧𝑖
𝐺𝑡 𝐷 , 𝐶 𝑁
𝑡 { 𝑛 }𝑛=1 𝐶𝐿1 = − log ∑ (6)
𝑁−1 ( 𝑙 ( ) ( ))
49 𝑛=1
𝑓 𝐺 𝑧 , 𝐺 𝑙 𝑧
50 𝑗=0 𝑡 𝑖 𝑠 𝑗
where 𝐷𝑛 = 𝐶𝑛 ◦𝐹𝑛 . In practice, we select a small subset of
51 𝐾 (where 𝐾 < 𝑁) models based on the linear separability
52
of real and fake images in the feature space as in (Kumari ( ( ( )) ( ( )))
53 𝐶𝐿2 = − log 𝑓 𝐷𝑡𝑙 𝐺𝑡 𝑧𝑖 , 𝐷𝑡𝑙 𝐺𝑠 𝑧𝑖 (7)
et al., 2022):
54
{ }
55 ( ′ )
56 𝑘 = arg max max 𝑉 𝐷 , 𝐺 (5)
𝑛 ′ 𝐶𝑛 𝑛 ( ( ) ( )) ( ( ( ) ( )) )
57 𝑓 𝐺𝑡𝑙 𝑧𝑖 , 𝐺𝑠𝑙 𝑧𝑖 = exp Cos Sim 𝐺𝑡𝑙 𝑧𝑖 , 𝐺𝑠𝑙 𝑧𝑖 ∕𝜏
58 where 𝐷𝑛′ = 𝐶𝑛′ ◦𝐹𝑛 denotes the model corresponding to 𝑘𝑡ℎ (8)
59 selected model and 𝑘 ∈ {1, … , 𝐾}.
60 Then, the objective functions of our method also include where 𝑙 represents the loss computed at the 𝑙-th layer’s
61 four parts. Given the anchor images 𝐺𝑡 (𝑧𝑖 ) and 𝐺𝑠 (𝑧𝑖 ) gen- features in network, 𝜏 is a hyperparameter temperature (𝜏 =
62 erated on the source and the target domain, respectively, 0.07). The point different from DCL is that we do not
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Figure 3: Class-conditional latent space interpolation. We first sample two random vectors in the latent space and interpolate
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linearly from one to another, and then we map these vectors to the image space conditioned on a fixed label for each class (Upper
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row: Normal; Middle row: CAP; Bottom row: NCP).
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44 regularize the discriminator predictions to push away the
45 discriminating features of 𝐺𝑡 (𝑧) and 𝑥 since several recent
‖ ‖2
46 studies have shown that the distributions of its outputs for 𝐵𝐶𝑅 = ‖𝐷𝑡𝑙 (𝑥) − 𝐷𝑡𝑙 (𝑇 (𝑥))‖
‖ ‖ (10)
47 𝐺𝑡 (𝑧) and 𝑥 gradually diverge from each other when the
‖ 𝑙 𝑙 ‖2
48 discriminator starts to overfit. Hence, as opposed to differ- + ‖𝐷𝑡 (𝐺𝑡 (𝑧𝑖 )) − 𝐷𝑡 (𝑇 (𝐺𝑡 (𝑧𝑖 )))‖
‖ ‖
49 entiating them, we introduce LeCam regularization (Tseng
50 et al., 2021) to regulate the discriminator predictions to mix where 𝑇 is the differentiable augmentation used in the orig-
51 the outputs of 𝐺𝑡 (𝑧) and 𝑥 using two exponential moving inal paper (Zhao et al., 2021). The final objective of our
52 average variables that track the discriminator predictions method is:
53 throughout training:
54
55 ∑
𝐾
( )
56 ‖ ‖2 min max
{ }
𝑉 (𝐷𝑡 , 𝐺𝑡 ) + 𝑉 𝐷𝑘′ , 𝐺𝑡
𝐿𝐶 = ‖𝐷𝑡 (𝒙) − 𝐷𝑡𝐸𝑀𝐴 (𝐺𝑡 (𝒛𝒊 ))‖ 𝐺𝑡 𝐾
(11)
57 ‖ ‖ (9)
𝐷𝑡 , 𝐶𝑘′
𝑘=1
𝑘=1
58 ‖ ‖2
+ ‖𝐷𝑡 (𝐺𝑡 (𝒛𝒊 )) − 𝐷𝑡𝐸𝑀𝐴 (𝒙)‖ +𝜆1 𝐶𝐿1 + 𝜆2 𝐶𝐿2 + 𝜆3 𝐿𝐶 + 𝜆4 𝐵𝐶𝑅
59 ‖ ‖
60 Furthermore, to explicitly prevent over-fitting to the tar- In each iteration, we randomly select different layers (i.e.,
61 get data, we regularize the discriminator with Balanced 𝑙 is random) of 𝐺𝑡 and 𝐷𝑡 to perform our method with multi-
62 Consistency Regularization (BCR) (Zhao et al., 2021): level features. In practice, we follow the original setting in
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21 Figure 4: K-Nearest Neighbor Analysis, the images in the first column are generated images (Upper row: Normal; Middle row:
22 CAP; Bottom row: NCP).
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37 Figure 5: Class-conditional latent space interpolation. We first sample two random vectors in the latent space and interpolate
38 linearly from one to another, and then we map these vectors to the image space conditioned on a fixed label for each class (Upper
39 row: Normal; Middle row: CAP; Bottom row: NCP).
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43 (Zhao et al., 2022; Tseng et al., 2021; Zhao et al., 2021) to Table 1
44 set 𝜆1 = 2, 𝜆2 = 0.5, 𝜆3 = 0.01, and 𝜆4 = 10. Distribution of chest CT slices by data source and infection
45 type.
46 4. Experiments Infection Type
47 Data Source Total
48 4.1. Data Source Normal CAP NCP
49 COVIDx dataset (Tuinstra et al., 2022) is a carefully CNCB 45758 39009 31070 115837
50 processed and curated CT dataset from several data sources COVID-CT-MD 11405 2652 9223 23280
51 around the world which were collected using a variety of Radiopaedia 550 1282 1742 3574
52 CT scanners and protocols. To our knowledge, COVIDx
53 dataset is the largest COVID-19 CT dataset that is publicly
54 available currently. Each image is associated with one of since they contain all three possible infection types and
55 three possible types: normal control, community-acquired cover different countries. The detailed description of the
56 pneumonia (CAP), or novel coronavirus pneumonia (NCP). used datasets is shown in Table 1.
57 Despite efforts to curate data from a wide variety of CT data
58 sources, COVIDx dataset remains significant geographic 4.2. Implementation Details
59 and class imbalances. In this work, we adopt three subdataset We train the generative model on the large-scale CNCB
60 from the COVIDx dataset, including China National Center dataset from scratch and then adopt this pre-trained model
61 for Bioinformation (CNCB) (Zhang et al., 2020), COVID- to the relatively small COVID-CT-MD and Radiopaedia
62 CT-MD (Afshar et al., 2021), and Radiopaedia collection datasets. We compute Fréchet Inception Distance (FID)
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24 Figure 6: t-SNE plots of features associated with the real images and generated images (Upper row: CNCB; Middle row: COVID-
25 CT-MD; Bottom row: Radiopaedia), where each color represents different classes (Red: Normal; Green: CAP; Blue: NCP). Note:
the label distribution of generated images is set to be uniform (i.e., class-balanced distribution).
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29 (Heusel et al., 2017) using the clean-fid library (Parmar et al., Table 2
30 2022) to evaluate the generation performance since it has FID values (mean(±std)) of applying state-of-the-art class-
31 been shown to correlate well with human judgment and has conditional GANs on the CNCB dataset with two kinds of
32 become the most often used metric in GANs evaluation. resolution (128 × 128 or 256 × 256).
33 As well, we evaluate on PRDC (Precision, Recall, Density,
Model FID ↓
34 Coverage) (Parmar et al., 2022) metric on the target datasets
35 to quantify the trade-off between fidelity and diversity. The SNGAN (Miyato et al., 2018) 15.340 (± 0.152)
36 mean results and standard derivations are computed by 5 dif- BigGAN (Brock et al., 2018) 12.456 (± 0.413)
37 ferent runs, a lower FID score indicates better performance. StyleGAN2 (Karras et al., 2020b) 16.571 (± 0.658)
38 StyleGAN2 + ADA (Karras et al., 2020a) 20.385 (± 0.132)
We first conduct experiments on how the existing class-
39
conditional generative models perform on the large-scale SNGAN (256Res) (Miyato et al., 2018) 15.483 (± 0.381)
40
CNCB dataset and present the results in Table. 2. Ac- BigGAN (256Res) (Brock et al., 2018) 15.083 (± 0.513)
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42 cordingly, we adopt the leading class-conditional generative StyleGAN2 (256Res) (Karras et al., 2020b) 21.613 (± 0.797)

43 model BigGAN (Brock et al., 2018) as the GANs architec-

44 ture for pretraining and few-shot adaptation. Considering the
image resolution requirement in the clinic and our accessible in the certain Field of View. Also, the refined details are
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computing resource, all images for training and evaluation well generated while the style and texture features are fit-
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47 are interpolated to a moderate resolution of 256 × 256 with ted to the target dataset. Visual evaluation, however, may
48 PIL.BICUBIC interpolation. In our experiments, differen- favor models that concentrate on limited sections of the
49 tiable augmentation (Zhao et al., 2020) is adopted by default training data. Therefore, we demonstrate the generalization
50 to augment the training data without manipulating the target capability of the generator via class-conditional latent space
51 distribution. As for the off-shelf model, we consider seven interpolation in Fig. 3, which also allows us to appreciate
52 common classification models pre-trained on ImageNet, in- how the generator generalizes to different outputs. Specif-
53 cluding ResNet-50, EfficientNet-b0, Swin-T, ConvNeXt-T, ically, given a set of interpolating latent variables between
54 HorNet-T, MViTv2-T, Swinv2-T. arbitrary two points within a predefined prior distribution,
55 we can appreciate how the generator transit seamlessly from
56 4.3. CT Image-label Pairs Synthesis one image to another with a different visual appearance
57 An intuitive method of evaluating GANs is through without losing label semantics. Meanwhile, we conduct the
58 the visual evaluation of synthetic samples. In Fig. 2, we K-Nearest Neighbor Analysis in Fig. 4 to find the most
59
present some synthetic CT image-label pairs of the two target similar real images given a generated image. In addition,
60 we conduct the Frequency Analysis in Fig. 5 to display the
datasets. The global consistency of the image is correct
61 spectrum of real images and fake images. Furthermore, we
62 since the model learned to introduce visual content only
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23 Figure 7: The effect of synthetic image for COVID-19 diagnosis. We train image classifiers from scratch and employ them to
24 predict the labels of real images in the validation set.
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27 Table 3
28 Quantitative evaluation of the generator with different few-shot GANs adaptation methods.
29 COVID-CT-MD Radiopaedia
30 Method
FID Precision Recall Density Coverage FID Precision Recall Density Coverage
31
32 TGAN 43.21 0.49 0.43 0.38 0.40 66.16 0.44 0.29 0.28 0.38
33 (Wang et al., 2018) (±0.54) (±0.01) (±0.02) (±0.02) (±0.03) (±0.45) (±0.01) (±0.02) (±0.02) (±0.01)
FreezeD 33.21 0.58 0.47 0.51 0.42 48.37 0.49 0.37 0.32 0.42
34 (Mo et al., 2020) (±0.35) (±0.01) (±0.02) (±0.02) (±0.01) (±0.37) (±0.02) (±0.02) (±0.01) (±0.03)
35 EWC 38.25 0.55 0.43 0.44 0.43 46.92 0.55 0.35 0.28 0.40
36 (Li et al., 2020) (±0.68) (±0.01) (±0.02) (±0.02) (±0.01) (±0.59) (±0.03) (±0.01) (±0.02) (±0.02)
37 CDC 28.14 0.59 0.48 0.47 0.51 38.98 0.54 0.39 0.27 0.44
38 (Ojha et al., 2021) (±0.25) (±0.03) (±0.02) (±0.02) (±0.03) (±0.33) (±0.02) (±0.02) (±0.03) (±0.02)
Vision-aided 34.75 0.57 0.45 0.46 0.49 39.82 0.54 0.40 0.29 0.45
39 (Kumari et al., 2022) (±0.78) (±0.02) (±0.01) (±0.02) (±0.03) (±0.26) (±0.02) (±0.03) (±0.01) (±0.02)
40 DCL 25.32 0.62 0.55 0.52 0.45 32.28 0.55 0.40 0.36 0.41
41 (Zhao et al., 2022) (±0.78) (±0.03) (±0.02) (±0.02) (±0.02) (±0.26) (±0.02) (±0.04) (±0.01) (±0.01)
42 16.79 0.64 0.53 0.55 0.52 25.96 0.60 0.43 0.36 0.45
Ours
43 (±0.62) (±0.02) (±0.01) (±0.03) (±0.01) (±0.41) (±0.01) (±0.02) (±0.02) (±0.01)
44
45
46 Table 4 remarkable capability of generating realistic CT image-label
47 Ablation studies evaluated on FID metric (mean(±std)). pairs on such two relatively small target datasets.
48 Besides, we conduct experiments on how existing state-
49 Method COVID-CT-MD Radiopaedia of-the-art few-shot GANs adaptation methods perform on
50 Ours 16.793 (±0.625) 25.960 (±0.412) the two target datasets, Table. 3 shows the quantitative
51 w/o CL 28.551 (±0.656) 35.361 (±0.432) results. The results show that our method consistently sur-
52 w/o LeCam 17.534 (±0.360) 26.787 (±0.651) passes all the comparison methods on the two target datasets,
53 w/o BCR 16.989 (±0.551) 26.252 (±0.124) showing the lowest FID and highest PRDC in most cases.
54 w/o Vision models 18.815 (±0.273) 28.187 (±0.552) Furthermore, we conduct ablation experiments in Table. 4 to
55 verify the effectiveness of each component in our proposed
56 method by ablating each part. First, it can be observed that
57 also show the t-SNE plots of features associated with the the source generator plays the most important role during
58 real images and synthetic images in Fig. 6. It can be seen the GANs adaptation stage since it explicitly calibrates the
59 that the real images are characterized by a class-imbalanced target generator via contrast learning. Second, the introduced
60 distribution, while the label distribution of fake images can two regularization terms (LeCam and BCR) improve the
61 be manually set to be uniform. Overall, rather than trivially performance by regularizing the discriminator under limited
62 memorizing the limited training set, our method shows a
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3 Table 5
4 The effect of synthetic samples for classification.
5
Data COVID-CT-MD COVID-CT-MD
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7 Accuracy Precision Recall F1_score Accuracy Precision Recall F1_score
8 91.71 90.01 84.04 86.27 64.27 59.63 61.91 60.51
9 Real samples
(±0.53) (±1.51) (±1.53) (±1.12) (±1.47) (±2.51) (±3.12) (±2.52)
10 86.47 79.20 83.65 80.47 61.40 62.04 60.52 61.20
11 Synthetic samples
(±1.31) (±2.41) (±1.12) (±1.53) (±2.54) (±1.32) (±2.12) (±1.71)
12 93.33 93.58 87.71 90.04 69.63 67.71 67.13 67.33
13 Real+Synthetic samples
(±0.51) (±1.01) (±1.48) (±1.91) (±2.21) (±1.51) (±1.13) (±1.61)
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35 Figure 8: Confusion matrix of the ResNet-50 model trained with both real and synthetic samples on the two target datasets.
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39 data. Finally, vision models also help the performance since samples are accurate enough to be informative about object
40 it enables the generator to match the real distribution in class in the target datasets. Also, we present the confusion
41 different, complementary feature spaces. matrix in Fig.8 to intuitively show the source of model
42 performance. In addition, to show how the top-3 models
43 4.4. COVID-19 diagnosis Using Synthetic Data reach their decision, we present the attention map in Fig. 9.
44 One major motivation for this research is the increasing It is intuitive to observe the difference between each model
45 need for annotated medical image data in the automated in identifying the lesion regions.
46 image analysis field. It is thereby meaningful to evaluate
47 if the generated images could be used to train DL models. 4.5. Limitations and Future work
48 As shown in Fig.7, we first train the seven DL models In this work, we propose to use both the source genera-
49 for COVID-19 diagnosis using only the real images and tive model and source vision models to help in the GANs
50 illustrate their performance and loss on the validation set adaptation. Despite significantly improving the quality of
51 during the training phase. Then, we conduct experiments generated images, this increases the memory requirement
52 on how synthetic CT image-label pairs help in this task for training. In this regard, exploring the use of efficient
53 by training the ResNet-50 model using both real and fake computer vision models (Sandler et al., 2018) may make our
54 images, the performance is also shown in Fig.7. It can be method more accessible.
55
seen that, even though the best model on different datasets In general, an additional pool of training examples that
56
are usually different, the ResNet-50 model trained with both can be readily generated on demand could have a significant
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58 real and fake images (Ours) usually achieve the best perfor- impact on the size and capacity of the models being devel-
59 mance, especially in the Radiopaedia dataset with extremely oped within the medical image analysis community. Also,
60 limited data. Moreover, as shown in Table. 5, even with legal concerns regarding patient privacy and anonymized
61 only synthetic samples, we can still obtain a classifier with medical records may also be addressed via image synthesis.
62 comparable performance, which indicates that the synthetic Moreover, a compelling problem to investigate would be to
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Figure 9: Attention of learned models visualized by Grad-CAM for identifying discriminative regions of COVID-19 Diagnosis in
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29 generate a series of 2D CT slice images to replace missing 7.2. Data availability statements
30 or corrupted images within 3D CT scans. All data generated or analyzed during this study are
31 included in this published article (Tuinstra et al., 2022).
32
33 5. Conclusion
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