Multi-scale Attentional Network for Multi-focal Segmentation of Active Bleed After Pelvic Fractures

Trauma is the worldwide leading cause of death and disability in those younger than 45 years, and pelvic fractures are a major source of morbidity and mortality. Automated segmentation of multiple foci of arterial bleeding from abdominopelvic trauma CT could provide rapid objective measurements of the total extent of active bleeding, potentially augmenting outcome prediction at the point of care, while improving patient triage, allocation of appropriate resources, and time to definitive intervention. In spite of the importance of active bleeding in the quick tempo of trauma care, the task is still quite challenging due to the variable contrast, intensity, location, size, shape, and multiplicity of bleeding foci. Existing work presents a heuristic rule-based segmentation technique which requires multiple stages and cannot be efficiently optimized end-to-end. To this end, we present, Multi-Scale Attentional Network (MSAN), the first yet reliable end-to-end network, for automated segmentation of active hemorrhage from contrast-enhanced trauma CT scans. MSAN consists of the following components: (1) an encoder which fully integrates the global contextual information from holistic 2D slices; (2) a multi-scale strategy applied both in the training stage and the inference stage to handle the challenges induced by variation of target sizes; (3) an attentional module to further refine the deep features, leading to better segmentation quality; and (4) a multi-view mechanism to leverage the 3D information. MSAN reports a significant improvement of more than $$7\%$$ compared to prior arts in terms of DSC.