ianpan/ct-head-hemorrhage-detection

CT Head Hemorrhage Detection

Research model for slice- and series-level intracranial hemorrhage detection and slice-level localization on noncontrast head CT. The complete system combines:

1. a 9-channel MaxViT-Tiny slice encoder/classifier;
2. a two-layer bidirectional GRU for contextual slice and series predictions;
3. five DeepLabV3+ decoders sharing that exact encoder state for radiologist-facing localization.

This is research software, not a medical device. It must not be used to diagnose, exclude, triage, or manage intracranial hemorrhage without independent clinical validation and appropriate regulatory review.

Model Details

Component	Specification
Slice encoder	maxvit_tiny_tf_512.in1k, ImageNet initialization
Slice input	Three adjacent axial slices centered on the predicted slice
Channels	Brain, subdural, and bone windows for each slice, flattened to 9 channels
Slice outputs	Epidural, intraparenchymal, intraventricular, subarachnoid, subdural, and any hemorrhage
Sequence head	Two-layer bidirectional GRU, 256 hidden units/direction, class-specific attention
Sequence outputs	Context-refined slice probabilities and attention-pooled series probabilities
Localization	Five-fold DeepLabV3+ decoder ensemble sharing the permanently frozen classification encoder
Inference execution	One encoder pass per slab, followed by the classifier/BiGRU branches and five lightweight decoder passes
Input size	512 x 512 pixels

Class order is always:

epidural, intraparenchymal, intraventricular, subarachnoid, subdural, any

The segmentation output is intended as a localization heatmap after the classifier has flagged a slice. It is not intended for hemorrhage volume measurement.

9-channel slab
      |
      v
shared MaxViT-Tiny encoder (one pass)
      |
      +-- multiscale feature maps --> decoder fold 0 --+
      |                            --> decoder fold 1   |
      |                            --> decoder fold 2   +--> mean heatmap
      |                            --> decoder fold 3   |
      |                            --> decoder fold 4 --+
      |
      +-- deepest map --> classifier head/pool --> 512-D pooled feature
                                                   |               |
                                                   v               v
                                           linear slice head   BiGRU sequence head

Input Processing

The model expects three correctly ordered adjacent slices. At the beginning or end of a series, the missing neighboring slice is replaced by a zero-valued windowed slice.

1. Read each source PNG without reducing its 16-bit depth.

2. Normalize spatial size to 512 x 512. If either source dimension exceeds 640 pixels, resize the complete field of view with area interpolation. Otherwise, center-crop or zero-pad.

3. Convert stored values to Hounsfield units:

   HU = stored_value * rescale_slope + rescale_intercept

4. Apply three linear CT windows independently:

Window	Center	Width	HU interval
Brain	40	80	0 to 80
Subdural	80	200	-20 to 180
Bone	600	2800	-800 to 2000

5. Clip each window and scale it to [0, 1].

6. Flatten in slice-major order:

   [previous brain, previous subdural, previous bone, center brain, ..., next bone]

7. The model linearly normalizes [0, 1] to [-1, 1].

Slices were ordered by the first numeric token in each slice filename within each patient/study/series directory. Physical z-spacing was not available to the sequence model.

Data And Splits

Classification used the RSNA Intracranial Hemorrhage Detection challenge dataset converted to lossless 16-bit PNG. Splits were made at the patient level so no patient appeared in more than one partition. The separate BHSD pixel-annotated subset was excluded from classification training, validation, and test.

Partition	Patients	Studies/series	Slices
Training	16,910	19,102	661,118
Validation	887	1,000	34,865
Heldout test	989	1,450	50,415
Excluded BHSD subset	191	Not reported	6,404

The intended 1,000-study test sample was expanded to all studies belonging to the selected patients, yielding 1,450 heldout studies. This prevents leakage and avoids discarding studies from those patients.

The holdout was first evaluated for the earlier EfficientNetV2-M release. The MaxViT architecture, checkpoint, and blend coefficients were subsequently selected using validation only, then evaluated here to document the replacement release. The test set is therefore consumed and these MaxViT results are a post-selection benchmark, not a pristine one-shot estimate. It must not be used for further tuning.

Training

Slice classifier

The classifier was trained for three epochs on two GPUs with batch size 32 per GPU, bf16-mixed precision, AdamW (lr=3e-4, weight_decay=1e-2), 5% linear warmup from zero, and cosine decay to 1e-6. The multilabel BCE class weights were [1, 1, 1, 1, 1, 2], giving the any target twice the weight of each subtype.

For the 9-channel stem, timm repeated the three ImageNet input-channel kernels three times and multiplied them by 3/9, preserving the aggregate activation scale at initialization.

Spatial flips were independently applied with probability 0.25 for depth, horizontal, and vertical axes. One transform was then sampled uniformly from: no-op, affine, brightness/contrast, Gaussian or motion blur, Gaussian noise, and coarse dropout.

Sequence model

The frozen classifier produced one 512-dimensional pooled feature per slice. The sequence model used the natural class distribution, a maximum length of 64, normalized slice position, a 512 -> 512 projection, and a two-layer bidirectional GRU with 256 hidden units per direction. Training-time feature augmentation used Gaussian noise SD 0.02, elementwise dropout 0.05, and whole-slice feature dropout 0.02.

The sequence model was trained for 20 epochs on two GPUs with effective batch size 256 series, AdamW (lr=3e-4, weight_decay=1e-2), and the same warmup and cosine schedule. Loss weights were slice BCE 1.00, contextual series BCE 0.25, and auxiliary MIL series BCE 0.10. All objectives used class weights [1, 1, 1, 1, 1, 2]. Seed 88 was selected after a deterministic sweep and the architecture was repeated with seeds 89 and 90.

For sequences longer than 64, inference samples round(linspace(0, length - 1, 64)) and restores predictions to original slice indices with nearest-neighbor assignment. The observed development-data maximum was 60 slices.

Segmentation model

The localization branch was developed on BHSD with five patient-separated folds. It predicts six multilabel maps for the middle slice of the 3-slice input. The final model uses a DeepLabV3+ decoder and per-sample DiceFocalLoss. Training used batch size 32/GPU, AdamW, decoder LR 3e-4, ten epochs, and a threshold sweep from 0.1 through 0.9.

The selected path initialized the decoder from an RSNA pseudomask-training stage and then trained five BHSD folds while freezing the classification encoder. Encoder parameters and buffers were restored from the canonical classifier, kept in evaluation mode throughout training, and verified tensor-for-tensor against the classifier checkpoint after training. The five validation-selected best.ckpt decoder outputs are ensembled by averaging sigmoid probabilities. See Segmentation Evaluation Caveat below.

Inference Blending

Blend logits, not probabilities. For each class:

final_logit = (1 - alpha) * baseline_logit + alpha * contextual_logit

Class	Slice alpha	Series alpha
Epidural	0.75	0.50
Intraparenchymal	0.75	0.25
Intraventricular	0.75	0.50
Subarachnoid	0.75	1.00
Subdural	0.75	0.50
Any	1.00	0.50

For series inference, the baseline is the maximum baseline probability over valid slices, clipped to [1e-6, 1 - 1e-6] and converted back to a logit before blending with the contextual attention logit. Coefficients were independently selected from [0, 0.25, 0.5, 0.75, 1] on validation and frozen before test.

The auxiliary MIL output is retained as a diagnostic but is not part of the selected final blend.

Heldout Test Performance

The test set contains 50,415 slices from 1,450 series belonging to 989 patients. Positive prevalence was 15.65% by slice and 44.97% by series for any hemorrhage. AUROC is threshold-independent and does not imply calibration or a clinically acceptable operating point.

Slice AUROC

Class	Baseline classifier	Contextual BiGRU	Fixed blend
Epidural	0.954060	0.923096	0.947909
Intraparenchymal	0.986440	0.986407	0.987003
Intraventricular	0.994089	0.990694	0.993089
Subarachnoid	0.971642	0.973272	0.974216
Subdural	0.968003	0.971891	0.972305
Any	0.980826	0.982764	0.982764
Macro mean	0.975843	0.971354	0.976214

Series AUROC

Class	Baseline max	Contextual attention	Fixed blend
Epidural	0.926251	0.909021	0.926238
Intraparenchymal	0.968643	0.969831	0.969060
Intraventricular	0.987429	0.984272	0.987287
Subarachnoid	0.950067	0.954478	0.954478
Subdural	0.957891	0.960066	0.960236
Any	0.979037	0.979871	0.980402
Macro mean	0.961553	0.959590	0.962950

Patient-cluster bootstrap comparisons against the baseline gave:

• fixed-blend slice any AUROC delta +0.001952, 95% CI [+0.001283, +0.002693];
• fixed-blend slice macro-AUROC delta +0.000292, 95% CI [-0.001714, +0.001782];
• fixed-blend series any AUROC delta +0.001347, 95% CI [+0.000164, +0.003135];
• fixed-blend series macro-AUROC delta +0.001432, 95% CI [-0.000152, +0.003001].

The data support improved any discrimination from the fixed contextual blend. Macro-average changes are less certain, and the raw contextual head regresses epidural AUROC substantially. Validation selected a nonzero epidural blend for this MaxViT release, so that regression remains visible rather than being silently replaced with classifier-only output.

Epidural hemorrhage was rare: 264 positive test slices and 27 positive test series. Its per-class estimates and blend coefficient are correspondingly less stable than those of more prevalent labels.

Segmentation Evaluation Caveat

The released corrected frozen-state run produced the following fold-averaged any hemorrhage metrics:

Released best.ckpt ensemble members	Value
Volume Dice, threshold swept per fold	0.6403
Volume Dice at threshold 0.5	0.6362
Slice Dice at threshold 0.5	0.5407
Volume HD95 at threshold 0.5	34.37 mm
Slice HD95 at threshold 0.5	89.02 mm

The checkpoint monitor's fold values were 0.6055, 0.6326, 0.6331, 0.6443, and 0.6858 (mean 0.6403). Empty/empty slice pairs were excluded from slice Dice/HD95. Dice thresholds were swept from 0.1 through 0.9 within each BHSD validation fold, while the fixed-threshold Dice and HD95 values above are fold means at threshold 0.5.

An earlier internal summary reported volume Dice 0.6875 for the frozen-gradient experiment. That value mixed pre-training sanity validation with trained epochs and is not a valid final checkpoint estimate; it is not used for this release.

These are not unbiased generalization estimates. The pseudolabel teacher ensemble was itself derived from BHSD folds, creating an indirect information path back to BHSD validation patients. The results support an optimization and localization prior, not a claim of external segmentation accuracy. No untouched segmentation test set was available.

Artifact Layout

config.json
classifier/model.safetensors
sequence/model.safetensors
segmentation/fold0.safetensors
...
segmentation/fold4.safetensors
inference.py
requirements.txt

The classifier file contains the full slice classifier and the canonical encoder state. Each segmentation fold contains only its DeepLabV3+ decoder and segmentation head; no encoder parameters or BatchNorm buffers are duplicated. For each slab, integrated series inference normalizes once and runs the encoder once. The deepest feature map passes through the classifier convolution, pool, and linear head; the exact same pooled 512-dimensional feature is also passed to the BiGRU. The cached multiscale feature pyramid fans out to all five resident decoders. This is numerically equivalent to the independently executed classifier, sequence head, and corrected frozen-state segmentation checkpoints while avoiding redundant encoder passes.

The implementation, training configurations, frozen-state regression tests, and validation-only sequence architecture comparison are available at source revision 914c57d.

Slice Inference Example

Install requirements.txt, then load three original 16-bit PNG slices. Use None for a missing neighbor at a series boundary.

from inference import HemorrhageSliceModel, preprocess_slab, read_uint16_png

x = preprocess_slab(
    read_uint16_png("previous.png"),
    read_uint16_png("center.png"),
    read_uint16_png("next.png"),
    rescale_slope=1.0,
    rescale_intercept=-1024.0,
)

model = HemorrhageSliceModel()
output = model.predict(x)
class_probabilities = output["classification"]  # shape: (6,)
mask_probabilities = output["segmentation"]      # shape: (6, 512, 512)

This is standalone slice inference. For integrated contextual inference, stack all ordered 9-channel slabs and call predict_series:

series_output = model.predict_series(slabs, batch_size=4)

slice_probabilities = series_output["slice_classification"]
series_probabilities = series_output["series_classification"]
mask_probabilities = series_output["segmentation"]

slabs has shape (number_of_slices, 9, 512, 512). batch_size controls how many slabs are resident on the accelerator at once; each slab is still encoded once regardless of batch size.

For a DICOM- or NIfTI-derived HU volume, avoid materializing the complete 9-channel slab array in host memory:

series_output = model.predict_hu_volume(
    volume,                 # shape: (D, H, W), physically ordered, in HU
    batch_size=2,           # lower this if accelerator memory is limited
    return_segmentation=True,
)

This windows and transfers only one batch at a time. Returning all six full-resolution segmentation maps still requires approximately 6 MiB of host memory per source slice; set return_segmentation=False when only classification is needed.

The same pooled features drive the standalone classifier and BiGRU, and the same feature maps drive all five decoder folds. Series longer than 64 slices use the training dataset's deterministic fallback by default: uniformly sample 64 positions, run the BiGRU, and restore contextual slice predictions by nearest-neighbor assignment. The standalone classifier and all five decoders still run on every source slice. long_series_mode="full" is available because the BiGRU has no architectural length limit, but lengths above 64 were not represented during development and full-length behavior has not been validated. The standalone and contextual logits are combined using the fixed class-specific blends documented above.

DICOM series

The loader filters scouts and mixed-series files, sorts slices by projected ImagePositionPatient, applies each slice's RescaleSlope and RescaleIntercept, and returns a physically ordered HU volume. Missing rescale metadata is treated as an error rather than silently interpreting stored pixels as HU.

from inference import preprocess_hu_volume_slab, read_dicom_series

series = read_dicom_series("dicom_series/")
center_index = len(series["image"]) // 2
x = preprocess_hu_volume_slab(series["image"], center_index)
output = model.predict(x)

Only single-frame CT series are supported. Multiframe DICOM, localizers, mixed series, and duplicate slice positions are rejected or filtered. The returned metadata includes physical spacing, orientation code, sorted source files, excluded files, and per-slice rescale values.

NIfTI volume

NIfTI voxel values must represent HU after header scaling. The loader applies the NIfTI scale proxy, permutes/flips voxel axes to LPS, then returns a DICOM-like (inferior-to-superior, anterior-to-posterior, right-to-left) volume in (D, H, W) order.

from inference import preprocess_hu_volume_slab, read_nifti_volume

volume = read_nifti_volume("head_ct.nii.gz")
center_index = len(volume) // 2
x = preprocess_hu_volume_slab(volume, center_index)
output = model.predict(x)

This is nearest-axis permutation/flip reorientation. It does not resample an arbitrarily oblique acquisition into a true axial series. Review orientation and HU values before inference when converting data from another system.

Demo Scope

The linked static Space shows standalone slice-classifier probabilities and segmentation heatmaps precomputed from heldout 3-slice slabs. It does not run the BiGRU because a single 3-slice slab does not provide a complete CT series. Therefore, Space classification corresponds to the baseline column, not the contextual or fixed-blend column.

The included heldout examples are deidentified, subtype-isolated slices selected for clear qualitative demonstration. They are not a random sample and must not be interpreted as another performance evaluation.

Limitations

• Retrospective development and testing used one public challenge dataset.
• No external, prospective, site-stratified, scanner-stratified, demographic, or clinical workflow validation was performed.
• Probabilities were not temperature-scaled and should not be interpreted as calibrated risks.
• No clinical sensitivity/specificity threshold has been selected.
• Series ordering uses filenames rather than physical z-coordinate or spacing.
• The model expects noncontrast axial head CT with the specified preprocessing; behavior on reformats, contrast CT, postoperative anatomy, severe artifact, pediatric patients, or other domains is unknown.
• The segmentation branch is affected by indirect BHSD leakage described above and should be interpreted only as a qualitative localization aid.
• Subtype labels can overlap, and epidural performance is especially uncertain because of low prevalence.
• The model may produce confident false negatives or false positives. A heatmap is not evidence that a prediction is correct.

Ethical And Clinical Considerations

Outputs must be reviewed by qualified clinicians in the context of the complete exam and clinical history. Do not use this model to delay image interpretation, replace a radiologist, or exclude hemorrhage. Any deployment requires local data governance, privacy review, cybersecurity controls, monitoring for domain drift, failure analysis, calibration, threshold selection, and prospective validation.

Citation

If this artifact is useful, cite the model repository and the original RSNA Intracranial Hemorrhage Detection challenge. The software is released under the MIT License; underlying datasets retain their own terms of use.