Improving the Robustness of Surgical Instrument Segmentation Models via GAN-Based Data Augmentation

Machine learning (ML) has been extensively adopted for online sensing-based monitoring in advanced manufacturing systems. However, the sensor data collected under abnormal states are usually insufficient, leading to significant data imbalance issues for supervised ML. A common solution is to incorporate data augmentation techniques; that is, augmenting the available abnormal states data (i.e., minority samples) via synthetic generation. To generate the high-quality minority samples, it is vital to learn the underlying distribution of the abnormal states data. In recent years, generative adversarial network (GAN)–based approaches have become popular to learn data distribution, as well as perform data augmentation. However, in practice, the quality of generated samples from GAN-based data augmentation may vary drastically. In addition, the sensor signals are collected sequentially by time from the manufacturing systems, which means sequential information is also very important in data augmentation. To address these limitations, inspired by the multihead attention mechanism, this article proposed an attention-stacked GAN (AS-GAN) architecture for sensor data augmentation of online monitoring in manufacturing systems. It incorporates a new attention-stacked framework to strengthen the generator in GAN with the capability of capturing sequential information, and thereby the developed attention-stacked framework greatly helps to improve the quality of the generated sensor signals. Afterward, the generated high-quality sensor signals for abnormal states could be applied to train classifiers more accurately, further improving the online monitoring performance of manufacturing systems. The case study conducted in additive manufacturing also successfully validated the effectiveness of the proposed AS-GAN.

Recently, in the building and infrastructure fields, studies on defect detection methods using deep learning have been widely implemented. For robust automatic recognition of defects in buildings, a sufficiently large training dataset is required for the target defects. However, it is challenging to collect sufficient data from degrading building structures. To address the data shortage and imbalance problem, in this study, a data augmentation method was developed using a generative adversarial network (GAN). To confirm the effect of data augmentation in the defect dataset of old structures, two scenarios were compared and experiments were conducted. As a result, in the models that applied the GAN-based data augmentation experimentally, the average performance increased by approximately 0.16 compared to the model trained using a small dataset. Based on the results of the experiments, the GAN-based data augmentation strategy is expected to be a reliable alternative to complement defect datasets with an unbalanced number of objects.

The differential diagnosis of invasive pulmonary aspergillosis (IPA), pulmonary mucormycosis (PM), bacterial pneumonia (BP) and pulmonary tuberculosis (PTB) are challenging due to overlapping clinical and imaging features. Manual CT lesion segmentation is time-consuming, deep-learning (DL)-based segmentation models offer a promising solution, yet disease-specific models for these infections remain underexplored. We aimed to develop and validate dedicated CT segmentation models for IPA, PM, BP and PTB to enhance diagnostic accuracy. Methods：Retrospective multi-centre data (115 IPA, 53 PM, 130 BP, 125 PTB) were used for training/internal validation, with 21 IPA, 8PM, 30 BP and 31 PTB cases for external validation. Expert-annotated lesions served as ground truth. An improved 3D U-Net architecture was employed for segmentation, with preprocessing steps including normalisations, cropping and data augmentation. Performance was evaluated using Dice coefficients. Results：Internal validation achieved Dice scores of 78.83% (IPA), 93.38% (PM), 80.12% (BP) and 90.47% (PTB). External validation showed slightly reduced but robust performance: 75.09% (IPA), 77.53% (PM), 67.40% (BP) and 80.07% (PTB). The PM model demonstrated exceptional generalisability, scoring 83.41% on IPA data. Cross-validation revealed mutual applicability, with IPA/PTB models achieving > 75% Dice for each other's lesions. BP segmentation showed lower but clinically acceptable performance ( ＞72%), likely due to complex radiological patterns. Disease-specific DL segmentation models exhibited high accuracy, particularly for PM and PTB. While IPA and BP models require refinement, all demonstrated cross-disease utility, suggesting immediate clinical value for preliminary lesion annotation. Future efforts should enhance datasets and optimise models for intricate cases.

Introduction: Magnetic resonance imaging (MRI) is the most common tool to examine glioblastoma. Preoperative MRI can be used to initial diagnosis, and surgery planning, while follow-up MRIs can be used to evaluate treatment responses, identify recurrency, and detect side effects. The follow-up MRIs are usually taken after the first-line therapy, such as maximal safe resection. In the past, radiologists manually segment the tumor regions from normal brain tissue on follow-up MRIs, which is time-consuming, error-prone, and challenging. Several deep-learning (DL) models have been developed utilizing preoperative images, but their performance has yet to be evaluated on follow-up MRIs. In this research, we built the largest follow-up MRI cohort (311 patients) to assess these DL models and their generalizability and performance on independent preoperative and follow-up images. We also made the first follow-up-based deep learning models for this specific task. Methods: All evaluation deep learning models (10 models) were trained by the Brain Tumor Segmentation challenge 2020 (BraTS’20) and evaluated by fifty pairs of preoperative and follow-up scans from our institution. The segmentation form our institution is evaluated by board certified radiologist. MRIs in the BraTS’20 dataset were all preoperative scans. After the evaluation, we randomly assigned 264 patients’ scans from our institution to the training dataset and 47 patients’ scans to the testing dataset. We compared three types of models in our follow-up deep learning model, including 1) UNet-3D, 2) UNet-3D+transfer-learning, and 3) UNet-3D+transfer-learning+baysian-learning. The benchmark for all models was the Dice similarity coefficient (DSC). DSC can measure the spatial overlap between model prediction and ground truth. The value of DSC is between zero to one. Zero means no overlap and one indicates complete overlap. Results: Our study demonstrates that the BraTS'20 trained models' performance decreased by 13.05% in independent preoperative MRI scans and 19.04% in follow-up MRI scans. The most significant mismatch regions were FLAIR hyperintense regions (3.68% drop in independent preoperative scans and 10.61% drop in independent follow-up scans) and Non-enhancing core (5.20% drop in independent preoperative scans and 11.99% drop in independent follow-up scans). Our best model can achieve the best DSC among three tumor regions compared to all evaluation models (FLAIR hyperintense regions: DSC 0.77 V.S. DSC 0.58; Enhancing tumor region: DSC 0.87 V.S. DSC 0.68; Non-enhancing tumor region: DSC 0.92 V.S. DSC 0.55). Conclusion: Maximal safe resection induced brain structure change, decreasing the performance of the preoperative-based DL model. Implementing a follow-up MRI-based segmentation model is essential to make accurate and generalizable results to address structural changes after maximal safe resection. Our follow-up DL model demonstrates the DSC score can be recovered. We commit to further developing the tool to assist radiologists in handling follow-up MRIs for glioblastoma patients. Citation Format: Kang Lin Hsieh, Tanjida Kabir, Luis Nunez-Rubiano, Yu-Chun Hsu, Yu Cai, Juan Rodriguez Quintero, Octavio Arevalo, Kangyi Zhao, Jackie Zhang, Jiguang Zhu Zhu, Roy Riascos, Xioaqian Jiang, Shayan Shams. A confident and operator-independent deep segmentation model to measure residual tumor volume in the follow-up MRIs for glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB067.

HomeRadiology: Imaging CancerVol. 2, No. 2 Previous Research HighlightsFree AccessA New Approach for Automated Image Segmentation of Organs at Risk in Cervical CancerMeredith Jones, Lacey R. McNallyMeredith Jones, Lacey R. McNallyMeredith JonesLacey R. McNallyPublished Online:Mar 27 2020https://doi.org/10.1148/rycan.2020204010MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Take-Away Points■ Major Focus: Development of an automated multiclass image segmentation model to identify organs at risk (OARs) on CT scans in patients with locally advanced cervical cancer, prior to radiation therapy.■ Key Results: The convolutional neural network model outperformed model-based, intensity-based, and atlas-based segmentation algorithms, with comparable results to other deep learning segmentation models while also decreasing the time needed for image segmentation by several thousand-fold.■ Impact: Reduction of intra- and interuser variability imposed by manual OAR delineation can lead to more accurate and efficient radiation therapy planning.The recent article by Liu et al developed an automated multiclass image segmentation model to identify organs at risk (OARs) on CT scans. To plan effective and safe radiation therapy in the context of cervical cancer, a CT scan is often acquired prior to the first treatment. Currently, a radiation oncologist will segment the CT images by hand, which is a time-consuming process, subject to intra- and interobserver variability, to identify OARs. To overcome these potential limitations and biases, automated image segmentation techniques can be utilized to improve accuracy and speed of annotating each image. A major problem in creation of deep learning image segmentation models for medical images is the lack of available datasets for model training and validation. Liu et al developed a two-dimensional image segmentation model based off the established convolutional neural network architecture, U-Net. U-Net was utilized because it is feasible to train from scratch with a small training set.This study looked at the CT scans of 105 patients with locally advanced cervical cancer. OAR segmentation for cervical cancer is a particularly challenging problem due to variability in organ size and frequent unclear boundaries. Even an experienced radiologist will have trouble. Seven organs were identified as OARs for cervical cancer radiation therapy: bladder, bone marrow, femoral head left, femoral head right, rectum, small intestine, and spinal cord.The model uses context aggregation blocks where U-Net has convolution layers. These context aggregation blocks use dilation convolution layers with different dilated rates and normal convolution layers with different kernel sizes to yield a low false-positive rate and accurate feature extraction in a large receptive field. A squeeze-extract block was used to ensure proper consideration of organs that are small. A class-weighted cross-entropy loss function was also used to overcome the imbalance in the datasets created by the differences in size and shape of each OAR.A ground truth was available based on the radiation oncologist’s annotations, allowing a Dice similarity coefficient (DSC) and 95th Hausdorff distance (HD) to be calculated and used as an evaluation metric. The DSC and the HD metrics indicated a comparable performance to other deep learning image segmentation models in most of the organs analyzed; inferior results were seen in the rectum and superior results in the intestines. All results were analyzed by an oncologist who determined that greater than 90% of results produced by this model were highly acceptable to be used during radiation therapy planning. To make the model more robust and generalizable, it is necessary to acquire a larger dataset with scans from different sources. Translation of this model to three dimensional may ultimately improve clinical translation.Highlighted ArticleLiu Z, Liu X, Xiao B, et al. Segmentation of organs-at-risk in cervical cancer CT images with a convolutional neural network. Physica Medica 2020;69:184-191. doi: https://doi.org/10.1016/j.ejmp.2019.12.008Highlighted ArticleLiu Z, Liu X, Xiao B, et al. Segmentation of organs-at-risk in cervical cancer CT images with a convolutional neural network. Physica Medica 2020;69:184-191. doi: https://doi.org/10.1016/j.ejmp.2019.12.008 Crossref, Medline, Google ScholarArticle HistoryPublished online: Mar 27 2020 FiguresReferencesRelatedDetailsCited ByJournal of Biomimetics, Biomaterials and Biomedical Engineering, Vol. 49Mathematical Problems in Engineering, Vol. 2020Recommended Articles nnU-Net: Further Automating Biomedical Image AutosegmentationRadiology: Imaging Cancer2021Volume: 3Issue: 1Deep Learning: A Primer for RadiologistsRadioGraphics2017Volume: 37Issue: 7pp. 2113-2131Generative Adversarial Networks: A Primer for RadiologistsRadioGraphics2021Volume: 41Issue: 3pp. 840-857Current Applications and Future Impact of Machine Learning in RadiologyRadiology2018Volume: 288Issue: 2pp. 318-328Deep Generative Adversarial Networks: Applications in Musculoskeletal ImagingRadiology: Artificial Intelligence2021Volume: 3Issue: 3See More RSNA Education Exhibits A Multidisciplinary Approach for Program Development with Artificial Intelligence in Pancreatic Cancer: How We Fit InDigital Posters2019Abnormal Changes After Radiation Therapy: What Radiologists Should KnowDigital Posters2018Artificial Intelligence in Diagnostic Imaging: Current Applications and Future PerspectiveDigital Posters2019 RSNA Case Collection Acute Radiation EnteropathyRSNA Case Collection2021Small Bowel LymphomaRSNA Case Collection2021Hirschsprung DiseaseRSNA Case Collection2021 Vol. 2, No. 2 Metrics Downloaded 310 times Altmetric Score

Two deep learning networks, patch-based and fully convolutional networks, are employed for automated detection and segmentation of shoulder joint structure on MRI. First, four segmentation models are build including three U-Net based models (glenoid segmentation model, humeral head segmentation model, glenoid and humeral head as a whole segmentation model) and one patch-based adjusted AlexNet (AANet) segmentation model. Then the four segmentation models are used to get the candidate bone regions from which the correct locations and regions of glenoid and humeral head are obtained by voting. Last, AANet model is further used to segment the edge of the bone with accuracy at the pixel level. From the experimental results, Dice Coefficient, Positive Predicted Value (PPV) and Sensitivity average accuracy are $0.92\pm 0.02,0.96\pm 0.03$ and $0.94\pm 0.02$ respectively. Note that our framework is also generic enough to be applied to the precise segmentation of specific organs and tissues in CT and MRI under small sample data.

This study evaluated the performance of a multi-stage Segmentation Residual Network (SegResNet)-based deep learning (DL) model for the automatic segmentation of cone-beam computed tomography (CBCT) images of patients with stage III and IV periodontitis. Seventy pre-processed CBCT scans from patients undergoing periodontal rehabilitation were used for training and validation. The model was tested on 10 CBCT scans independent from the training dataset by comparing results with semi-automatic (SA) segmentations. Segmentation accuracy was assessed using the Dice similarity coefficient (DSC), Intersection over Union (IoU), and Hausdorff distance 95th percentile (HD95). Linear periodontal measurements were performed on four tooth surfaces to assess the validity of the DL segmentation in the periodontal region. The DL model achieved a mean DSC of 0.9650 ± 0.0097, with an IoU of 0.9340 ± 0.0180 and HD95 of 0.4820 mm ± 0.1269 mm, showing strong agreement with SA segmentation. Linear measurements revealed high statistical correlations between the mesial, distal, and lingual surfaces, with intraclass correlation coefficients (ICC) of 0.9442 (p < 0.0001), 0.9232 (p < 0.0001), and 0.9598(p < 0.0001), respectively, while buccal measurements revealed lower consistency, with an ICC of 0.7481 (p < 0.0001). The DL method reduced the segmentation time by 47 times compared to the SA method. Acquired 3D models may enable precise treatment planning in cases where conventional diagnostic modalities are insufficient. However, the robustness of the model must be increased to improve its general reliability and consistency at the buccal aspect of the periodontal region. This study presents a DL model for the CBCT-based segmentation of periodontal defects, demonstrating high accuracy and a 47-fold time reduction compared to SA methods, thus improving the feasibility of 3D diagnostics for advanced periodontitis.

Fat-fraction has been established as a relevant marker for the assessment and diagnosis of neuromuscular diseases. For computing this metric, segmentation of muscle tissue in MR images is a first crucial step. To tackle the high degree of variability in combination with the high annotation effort for training supervised segmentation models (such as fully convolutional neural networks). Prospective. In all, 41 patients consisting of 20 patients showing fatty infiltration and 21 healthy subjects. Field Strength/Sequence: The T1 -weighted MR-pulse sequences were acquired on a 1.5T scanner. To increase performance with limited training data, we propose a domain-specific technique for simulating fatty infiltrations (i.e., texture augmentation) in nonaffected subjects' MR images in combination with shape augmentation. For simulating the fatty infiltrations, we make use of an architecture comprising several competing networks (generative adversarial networks) that facilitate a realistic artificial conversion between healthy and infiltrated MR images. Finally, we assess the segmentation accuracy (Dice similarity coefficient). A Wilcoxon signed rank test was performed to assess whether differences in segmentation accuracy are significant. The mean Dice similarity coefficients significantly increase from 0.84-0.88 (P < 0.01) using data augmentation if training is performed with mixed data and from 0.59-0.87 (P < 0.001) if training is conducted with healthy subjects only. Domain-specific data adaptation is highly suitable for facilitating neural network-based segmentation of thighs with feasible manual effort for creating training data. The results even suggest an approach completely bypassing manual annotations. 4 Technical Efficacy: Stage 3.

This paper presents a novel approach for synthesizing facial affect; either in terms of the six basic expressions (i.e., anger, disgust, fear, joy, sadness and surprise), or in terms of valence (i.e., how positive or negative is an emotion) and arousal (i.e., power of the emotion activation). The proposed approach accepts the following inputs:(i) a neutral 2D image of a person; (ii) a basic facial expression or a pair of valence-arousal (VA) emotional state descriptors to be generated, or a path of affect in the 2D VA space to be generated as an image sequence. In order to synthesize affect in terms of VA, for this person, 600,000 frames from the 4DFAB database were annotated. The affect synthesis is implemented by fitting a 3D Morphable Model on the neutral image, then deforming the reconstructed face and adding the inputted affect, and blending the new face with the given affect into the original image. Qualitative experiments illustrate the generation of realistic images, when the neutral image is sampled from fifteen well known lab-controlled or in-the-wild databases, including Aff-Wild, AffectNet, RAF-DB; comparisons with generative adversarial networks (GANs) show the higher quality achieved by the proposed approach. Then, quantitative experiments are conducted, in which the synthesized images are used for data augmentation in training deep neural networks to perform affect recognition over all databases; greatly improved performances are achieved when compared with state-of-the-art methods, as well as with GAN-based data augmentation, in all cases.

MP43-02 LESSONS LEARNED IN APPLYING DEEP LEARNING TO FACILITATE PROSTATE MR-US FUSION BIOPSY WORKFLOW

ABSTRACTTumor detection and segmentation are essential for cervical cancer (CC) treatment and diagnosis. This study presents a model that segmented the tumor, uterus, and vagina based on deep learning automatically on magnetic resonance imaging (MRI) images of patients with CC. The tumor detection dataset consists of 68 CC patients' diffusion‐weighted magnetic resonance imaging (DWI) images. The segmented dataset consists of 73 CC patients' T2‐weighted imaging (T2WI) images. First, the three clear images of the patient's DWI images are detected using a single‐shot multibox detector (SSD). Second, the serial number of the clearest image is obtained by scores, while the corresponding T2WI image with the same serial number is selected. Third, the selected images are segmented by employing the semantic segmentation (U‐Net) model with the squeeze‐and‐excitation (SE) block and attention gate (SE‐ATT‐Unet). Three segmentation models are implemented to automatically segment the tumor, uterus, and vagina separately by adding different attention mechanisms at different locations. The target detection accuracy of the model is 92.32%, and the selection accuracy is 90.9%. The dice similarity coefficient (DSC) on the tumor is 92.20%, pixel accuracy (PA) is 93.08%, and the mean Hausdorff distance (HD) is 3.41 mm. The DSC on the uterus is 93.63%, PA is 91.75%, and the mean HD is 9.79 mm. The DSC on the vagina is 75.70%, PA is 85.46%, and the mean HD is 10.52 mm. The results show that the proposed method accurately selects images for segmentation, and the SE‐ATT‐Unet is effective in segmenting different regions on MRI images.

In recent years, generative adversarial networks (GANs) have gained tremendous popularity for various imaging related tasks such as artificial image generation to support AI training. GANs are especially useful for medical imaging-related tasks where training datasets are usually limited in size and heavily imbalanced against the diseased class. We present a systematic review, following the PRISMA guidelines, of recent GAN architectures used for medical image analysis to help the readers in making an informed decision before employing GANs in developing medical image classification and segmentation models. We have extracted 54 papers that highlight the capabilities and application of GANs in medical imaging from January 2015 to August 2020 and inclusion criteria for meta-analysis. Our results show four main architectures of GAN that are used for segmentation or classification in medical imaging. We provide a comprehensive overview of recent trends in the application of GANs in clinical diagnosis through medical image segmentation and classification and ultimately share experiences for task-based GAN implementations.

OBJECTIVE. Deep learning applications in radiology often suffer from overfitting, limiting generalization to external centers. The objective of this study was to develop a high-quality prostate segmentation model capable of maintaining a high degree of performance across multiple independent datasets using transfer learning and data augmentation. MATERIALS AND METHODS. A retrospective cohort of 648 patients who underwent prostate MRI between February 2015 and November 2018 at a single center was used for training and validation. A deep learning approach combining 2D and 3D architecture was used for training, which incorporated transfer learning. A data augmentation strategy was used that was specific to the deformations, intensity, and alterations in image quality seen on radiology images. Five independent datasets, four of which were from outside centers, were used for testing, which was conducted with and without fine-tuning of the original model. The Dice similarity coefficient was used to evaluate model performance. RESULTS. When prostate segmentation models utilizing transfer learning were applied to the internal validation cohort, the mean Dice similarity coefficient was 93.1 for whole prostate and 89.0 for transition zone segmentations. When the models were applied to multiple test set cohorts, the improvement in performance achieved using data augmentation alone was 2.2% for the whole prostate models and 3.0% for the transition zone segmentation models. However, the best test-set results were obtained with models fine-tuned on test center data with mean Dice similarity coefficients of 91.5 for whole prostate segmentation and 89.7 for transition zone segmentation. CONCLUSION. Transfer learning allowed for the development of a high-performing prostate segmentation model, and data augmentation and fine-tuning approaches improved performance of a prostate segmentation model when applied to datasets from external centers.

Background Missing MRI sequences represent an obstacle in the development and use of deep learning (DL) models that require multiple inputs. Purpose To determine if synthesizing brain MRI scans using generative adversarial networks (GANs) allows for the use of a DL model for brain lesion segmentation that requires T1-weighted images, postcontrast T1-weighted images, fluid-attenuated inversion recovery (FLAIR) images, and T2-weighted images. Materials and Methods In this retrospective study, brain MRI scans obtained between 2011 and 2019 were collected, and scenarios were simulated in which the T1-weighted images and FLAIR images were missing. Two GANs were trained, validated, and tested using 210 glioblastomas (GBMs) (Multimodal Brain Tumor Image Segmentation Benchmark [BRATS] 2017) to generate T1-weighted images from postcontrast T1-weighted images and FLAIR images from T2-weighted images. The quality of the generated images was evaluated with mean squared error (MSE) and the structural similarity index (SSI). The segmentations obtained with the generated scans were compared with those obtained with the original MRI scans using the dice similarity coefficient (DSC). The GANs were validated on sets of GBMs and central nervous system lymphomas from the authors' institution to assess their generalizability. Statistical analysis was performed using the Mann-Whitney, Friedman, and Dunn tests. Results Two hundred ten GBMs from the BRATS data set and 46 GBMs (mean patient age, 58 years ± 11 [standard deviation]; 27 men [59%] and 19 women [41%]) and 21 central nervous system lymphomas (mean patient age, 67 years ± 13; 12 men [57%] and nine women [43%]) from the authors' institution were evaluated. The median MSE for the generated T1-weighted images ranged from 0.005 to 0.013, and the median MSE for the generated FLAIR images ranged from 0.004 to 0.103. The median SSI ranged from 0.82 to 0.92 for the generated T1-weighted images and from 0.76 to 0.92 for the generated FLAIR images. The median DSCs for the segmentation of the whole lesion, the FLAIR hyperintensities, and the contrast-enhanced areas using the generated scans were 0.82, 0.71, and 0.92, respectively, when replacing both T1-weighted and FLAIR images; 0.84, 0.74, and 0.97 when replacing only the FLAIR images; and 0.97, 0.95, and 0.92 when replacing only the T1-weighted images. Conclusion Brain MRI scans generated using generative adversarial networks can be used as deep learning model inputs in case MRI sequences are missing. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Zhong in this issue. An earlier incorrect version of this article appeared online. This article was corrected on April 12, 2021.

Accurate segmentation and delineation of the sub-tumor regions are very challenging tasks due to the nature of the tumor. Traditionally, convolutional neural networks (CNNs) have succeeded in achieving most promising performance for the segmentation of brain tumor; however, handcrafted features remain very important in identification of tumor's boundary regions accurately. The present work proposes a robust deep learning-based model with three different CNN architectures along with pre-defined handcrafted features for brain tumor segmentation, mainly to find out more prominent boundaries of the core and enhanced tumor regions. Generally, automatic CNN architecture does not use the pre-defined handcrafted features because it extracts the features automatically. In this present work, several pre-defined handcrafted features are computed from four MRI modalities (T2, FLAIR, T1c, and T1) with the help of additional handcrafted masks according to user interest and fed to the convolutional features (automatic features) to improve the overall performance of the proposed CNN model for tumor segmentation. Multi-pathway CNN is explored in this present work along with single-pathway CNN, which extracts simultaneously both local and global features to identify the accurate sub-regions of the tumor with the help of handcrafted features. The present work uses a cascaded CNN architecture, where the outcome of a CNN is considered as an additional input information to next subsequent CNNs. To extract the handcrafted features, convolutional operation was applied on the four MRI modalities with the help of several pre-defined masks to produce a predefined set of handcrafted features. The present work also investigates the usefulness of intensity normalization and data augmentation in pre-processing stage in order to handle the difficulties related to the imbalance of tumor labels. The proposed method is experimented on the BraST 2018 datasets and achieved promising results than the existing (currently published) methods with respect to different metrics such as specificity, sensitivity, and dice similarity coefficient (DSC) for complete, core, and enhanced tumor regions. Quantitatively, a notable gain is achieved around the boundaries of the sub-tumor regions using the proposed two-pathway CNN along with the handcrafted features. Graphical Abstract This data is mandatory. Please provide.