Self-Supervised Attention Mechanism for Pediatric Bone Age Assessment With Efficient Weak Annotation.

Pediatric bone age assessment (BAA) is a common clinical practice to investigate endocrinology, genetic and growth disorders of children. Different specific bone parts are extracted as anatomical Regions of Interest (RoIs) during this task, since their morphological characters have important biological identification in skeletal maturity. Following this clinical prior knowledge, recently developed deep learning methods address BAA with an RoI-based attention mechanism, which segments or detects the discriminative RoIs for meticulous analysis. Great strides have been made, however, these methods strictly require large and precise RoIs annotations, which limits the real-world clinical value. To overcome the severe requirements on RoIs annotations, in this paper, we propose a novel self-supervised learning mechanism to effectively discover the informative RoIs without the need of extra knowledge and precise annotation-only image-level weak annotation is all we take. Our model, termed PEAR-Net for Part Extracting and Age Recognition Network, consists of one Part Extracting (PE) agent for discriminative RoIs discovering and one Age Recognition (AR) agent for age assessment. Without precise supervision, the PE agent is designed to discover and extract RoIs fully automatically. Then the proposed RoIs are fed into AR agent for feature learning and age recognition. Furthermore, we utilize the self-consistency of RoIs to optimize PE agent to understand the part relation and select the most useful RoIs. With this self-supervised design, the PE agent and AR agent can reinforce each other mutually. To the best of our knowledge, this is the first end-to-end bone age assessment method which can discover RoIs automatically with only image-level annotation. We conduct extensive experiments on the public RSNA 2017 dataset and achieve state-of-the-art performance with MAE 3.99 months. Project is available at http://imcc.ustc.edu.cn/project/ssambaa/.