The detection of anatomical landmarks is a vital step for medical image analysis and applications for diagnosis, interpretation and guidance. Manual annotation of landmarks is a tedious process that requires domain-specific expertise and introduces inter-observer variability. This paper proposes a new detection approach for multiple landmarks based on multi-agent reinforcement learning. Our hypothesis is that the position of all anatomical landmarks is interdependent and non-random within the human anatomy, thus finding one landmark can help to deduce the location of others. Using a Deep Q-Network (DQN) architecture we construct an environment and agent with implicit inter-communication such that we can accommodate K agents acting and learning simultaneously, while they attempt to detect K different landmarks. During training the agents collaborate by sharing their accumulated knowledge for a collective gain. We compare our approach with state-of-the-art architectures and achieve significantly better accuracy by reducing the detection error by 50%, while requiring fewer computational resources and time to train compared to the naive approach of training K agents separately.

In interventional radiology, short video sequences of vein structure in motion are captured in order to help medical personnel identify vascular issues or plan intervention. Semantic segmentation can greatly improve the usefulness of these videos by indicating exact position of vessels and instruments, thus reducing the ambiguity. We propose a real-time segmentation method for these tasks, based on U-Net network trained in a Siamese architecture from automatically generated annotations. We make use of noisy low level binary segmentation and optical flow to generate multi class annotations that are successively improved in a multistage segmentation approach. We significantly improve the performance of a state of the art U-Net at the processing speeds of 90fps.