Continual Segment: Towards a Single, Unified and Non-forgetting Continual Segmentation Model of 143 Whole-body Organs in CT Scans

Deep learning empowers the mainstream medical image segmentation methods. Nevertheless, current deep segmentation approaches are not capable of efficiently and effectively adapting and updating the trained models when new segmentation classes are incrementally added. In the real clinical environment, it can be preferred that segmentation models could be dynamically extended to segment new organs/tumors without the (re-)access to previous training datasets due to obstacles of patient privacy and data storage. This process can be viewed as a continual semantic segmentation (CSS) problem, being understudied for multi-organ segmentation. In this work, we propose a new architectural CSS learning framework to learn a single deep segmentation model for segmenting a total of 143 whole-body organs. Using the encoder/decoder network structure, we demonstrate that a continually trained then frozen encoder coupled with incrementally-added decoders can extract sufficiently representative image features for new classes to be subsequently and validly segmented, while avoiding the catastrophic forgetting in CSS. To maintain a single network model complexity, each decoder is progressively pruned using neural architecture search and teacher-student based knowledge distillation. Finally, we propose a body-part and anomaly-aware output merging module to combine organ predictions originating from different decoders and incorporate both healthy and pathological organs appearing in different datasets. Trained and validated on 3D CT scans of 2500+ patients from four datasets, our single network can segment a total of 143 whole-body organs with very high accuracy, closely reaching the upper bound performance level by training four separate segmentation models (i.e., one model per dataset/task).