GMAI-VL-R1: Harnessing Reinforcement Learning for Multimodal Medical Reasoning

Recent advances in general medical AI have made significant strides, but existing models often lack the reasoning capabilities needed for complex medical decision-making. This paper presents GMAI-VL-R1, a multimodal medical reasoning model enhanced by reinforcement learning (RL) to improve its reasoning abilities. Through iterative training, GMAI-VL-R1 optimizes decision-making, significantly boosting diagnostic accuracy and clinical support. We also develop a reasoning data synthesis method, generating step-by-step reasoning data via rejection sampling, which further enhances the model's generalization. Experimental results show that after RL training, GMAI-VL-R1 excels in tasks such as medical image diagnosis and visual question answering. While the model demonstrates basic memorization with supervised fine-tuning, RL is crucial for true generalization. Our work establishes new evaluation benchmarks and paves the way for future advancements in medical reasoning models. Code, data, and model will be released at \href{https://github.com/uni-medical/GMAI-VL-R1}{this link}.

Towards Interpretable Counterfactual Generation via Multimodal Autoregression

Counterfactual medical image generation enables clinicians to explore clinical hypotheses, such as predicting disease progression, facilitating their decision-making. While existing methods can generate visually plausible images from disease progression prompts, they produce silent predictions that lack interpretation to verify how the generation reflects the hypothesized progression -- a critical gap for medical applications that require traceable reasoning. In this paper, we propose Interpretable Counterfactual Generation (ICG), a novel task requiring the joint generation of counterfactual images that reflect the clinical hypothesis and interpretation texts that outline the visual changes induced by the hypothesis. To enable ICG, we present ICG-CXR, the first dataset pairing longitudinal medical images with hypothetical progression prompts and textual interpretations. We further introduce ProgEmu, an autoregressive model that unifies the generation of counterfactual images and textual interpretations. We demonstrate the superiority of ProgEmu in generating progression-aligned counterfactuals and interpretations, showing significant potential in enhancing clinical decision support and medical education. Project page: https://progemu.github.io.

Radiologist-in-the-Loop Self-Training for Generalizable CT Metal Artifact Reduction

Metal artifacts in computed tomography (CT) images can significantly degrade image quality and impede accurate diagnosis. Supervised metal artifact reduction (MAR) methods, trained using simulated datasets, often struggle to perform well on real clinical CT images due to a substantial domain gap. Although state-of-the-art semi-supervised methods use pseudo ground-truths generated by a prior network to mitigate this issue, their reliance on a fixed prior limits both the quality and quantity of these pseudo ground-truths, introducing confirmation bias and reducing clinical applicability. To address these limitations, we propose a novel Radiologist-In-the-loop SElf-training framework for MAR, termed RISE-MAR, which can integrate radiologists' feedback into the semi-supervised learning process, progressively improving the quality and quantity of pseudo ground-truths for enhanced generalization on real clinical CT images. For quality assurance, we introduce a clinical quality assessor model that emulates radiologist evaluations, effectively selecting high-quality pseudo ground-truths for semi-supervised training. For quantity assurance, our self-training framework iteratively generates additional high-quality pseudo ground-truths, expanding the clinical dataset and further improving model generalization. Extensive experimental results on multiple clinical datasets demonstrate the superior generalization performance of our RISE-MAR over state-of-the-art methods, advancing the development of MAR models for practical application. Code is available at https://github.com/Masaaki-75/rise-mar.

GMAI-VL & GMAI-VL-5.5M: A Large Vision-Language Model and A Comprehensive Multimodal Dataset Towards General Medical AI

Despite significant advancements in general artificial intelligence, such as GPT-4, their effectiveness in the medical domain (general medical AI, GMAI) remains constrained due to the absence of specialized medical knowledge. To address this challenge, we present GMAI-VL-5.5M, a comprehensive multimodal medical dataset created by converting hundreds of specialized medical datasets into meticulously constructed image-text pairs. This dataset features comprehensive task coverage, diverse modalities, and high-quality image-text data. Building upon this multimodal dataset, we propose GMAI-VL, a general medical vision-language model with a progressively three-stage training strategy. This approach significantly enhances the model's ability by integrating visual and textual information, thereby improving its ability to process multimodal data and support accurate diagnosis and clinical decision-making. Experimental evaluations demonstrate that GMAI-VL achieves state-of-the-art results across a wide range of multimodal medical tasks, such as visual question answering and medical image diagnosis. Our contributions include the development of the GMAI-VL-5.5M dataset, the introduction of the GMAI-VL model, and the establishment of new benchmarks in multiple medical domains. Code and dataset will be released at https://github.com/uni-medical/GMAI-VL.

SegBook: A Simple Baseline and Cookbook for Volumetric Medical Image Segmentation

Computed Tomography (CT) is one of the most popular modalities for medical imaging. By far, CT images have contributed to the largest publicly available datasets for volumetric medical segmentation tasks, covering full-body anatomical structures. Large amounts of full-body CT images provide the opportunity to pre-train powerful models, e.g., STU-Net pre-trained in a supervised fashion, to segment numerous anatomical structures. However, it remains unclear in which conditions these pre-trained models can be transferred to various downstream medical segmentation tasks, particularly segmenting the other modalities and diverse targets. To address this problem, a large-scale benchmark for comprehensive evaluation is crucial for finding these conditions. Thus, we collected 87 public datasets varying in modality, target, and sample size to evaluate the transfer ability of full-body CT pre-trained models. We then employed a representative model, STU-Net with multiple model scales, to conduct transfer learning across modalities and targets. Our experimental results show that (1) there may be a bottleneck effect concerning the dataset size in fine-tuning, with more improvement on both small- and large-scale datasets than medium-size ones. (2) Models pre-trained on full-body CT demonstrate effective modality transfer, adapting well to other modalities such as MRI. (3) Pre-training on the full-body CT not only supports strong performance in structure detection but also shows efficacy in lesion detection, showcasing adaptability across target tasks. We hope that this large-scale open evaluation of transfer learning can direct future research in volumetric medical image segmentation.

Deep Learning Techniques for Automatic Lateral X-ray Cephalometric Landmark Detection: Is the Problem Solved?

Localization of the craniofacial landmarks from lateral cephalograms is a fundamental task in cephalometric analysis. The automation of the corresponding tasks has thus been the subject of intense research over the past decades. In this paper, we introduce the "Cephalometric Landmark Detection (CL-Detection)" dataset, which is the largest publicly available and comprehensive dataset for cephalometric landmark detection. This multi-center and multi-vendor dataset includes 600 lateral X-ray images with 38 landmarks acquired with different equipment from three medical centers. The overarching objective of this paper is to measure how far state-of-the-art deep learning methods can go for cephalometric landmark detection. Following the 2023 MICCAI CL-Detection Challenge, we report the results of the top ten research groups using deep learning methods. Results show that the best methods closely approximate the expert analysis, achieving a mean detection rate of 75.719% and a mean radial error of 1.518 mm. While there is room for improvement, these findings undeniably open the door to highly accurate and fully automatic location of craniofacial landmarks. We also identify scenarios for which deep learning methods are still failing. Both the dataset and detailed results are publicly available online, while the platform will remain open for the community to benchmark future algorithm developments at https://cl-detection2023.grand-challenge.org/.

Universal Incomplete-View CT Reconstruction with Prompted Contextual Transformer

Despite the reduced radiation dose, suitability for objects with physical constraints, and accelerated scanning procedure, incomplete-view computed tomography (CT) images suffer from severe artifacts, hampering their value for clinical diagnosis. The incomplete-view CT can be divided into two scenarios depending on the sampling of projection, sparse-view CT and limited-angle CT, each encompassing various settings for different clinical requirements. Existing methods tackle with these settings separately and individually due to their significantly different artifact patterns; this, however, gives rise to high computational and storage costs, hindering its flexible adaptation to new settings. To address this challenge, we present the first-of-its-kind all-in-one incomplete-view CT reconstruction model with PROmpted Contextual Transformer, termed ProCT. More specifically, we first devise the projection view-aware prompting to provide setting-discriminative information, enabling a single model to handle diverse incomplete-view CT settings. Then, we propose artifact-aware contextual learning to provide the contextual guidance of image pairs from either CT phantom or publicly available datasets, making ProCT capable of accurately removing the complex artifacts from the incomplete-view CT images. Extensive experiments demonstrate that ProCT can achieve superior performance on a wide range of incomplete-view CT settings using a single model. Remarkably, our model with only image-domain information surpasses the state-of-the-art dual-domain methods that require the access to raw data. The code is available at: https://github.com/Masaaki-75/proct

Prompt-In-Prompt Learning for Universal Image Restoration

Image restoration, which aims to retrieve and enhance degraded images, is fundamental across a wide range of applications. While conventional deep learning approaches have notably improved the image quality across various tasks, they still suffer from (i) the high storage cost needed for various task-specific models and (ii) the lack of interactivity and flexibility, hindering their wider application. Drawing inspiration from the pronounced success of prompts in both linguistic and visual domains, we propose novel Prompt-In-Prompt learning for universal image restoration, named PIP. First, we present two novel prompts, a degradation-aware prompt to encode high-level degradation knowledge and a basic restoration prompt to provide essential low-level information. Second, we devise a novel prompt-to-prompt interaction module to fuse these two prompts into a universal restoration prompt. Third, we introduce a selective prompt-to-feature interaction module to modulate the degradation-related feature. By doing so, the resultant PIP works as a plug-and-play module to enhance existing restoration models for universal image restoration. Extensive experimental results demonstrate the superior performance of PIP on multiple restoration tasks, including image denoising, deraining, dehazing, deblurring, and low-light enhancement. Remarkably, PIP is interpretable, flexible, efficient, and easy-to-use, showing promising potential for real-world applications. The code is available at https://github.com/longzilicart/pip_universal.

Learning to Distill Global Representation for Sparse-View CT

Sparse-view computed tomography (CT) -- using a small number of projections for tomographic reconstruction -- enables much lower radiation dose to patients and accelerated data acquisition. The reconstructed images, however, suffer from strong artifacts, greatly limiting their diagnostic value. Current trends for sparse-view CT turn to the raw data for better information recovery. The resultant dual-domain methods, nonetheless, suffer from secondary artifacts, especially in ultra-sparse view scenarios, and their generalization to other scanners/protocols is greatly limited. A crucial question arises: have the image post-processing methods reached the limit? Our answer is not yet. In this paper, we stick to image post-processing methods due to great flexibility and propose global representation (GloRe) distillation framework for sparse-view CT, termed GloReDi. First, we propose to learn GloRe with Fourier convolution, so each element in GloRe has an image-wide receptive field. Second, unlike methods that only use the full-view images for supervision, we propose to distill GloRe from intermediate-view reconstructed images that are readily available but not explored in previous literature. The success of GloRe distillation is attributed to two key components: representation directional distillation to align the GloRe directions, and band-pass-specific contrastive distillation to gain clinically important details. Extensive experiments demonstrate the superiority of the proposed GloReDi over the state-of-the-art methods, including dual-domain ones. The source code is available at https://github.com/longzilicart/GloReDi.

YOLOrtho -- A Unified Framework for Teeth Enumeration and Dental Disease Detection

Detecting dental diseases through panoramic X-rays images is a standard procedure for dentists. Normally, a dentist need to identify diseases and find the infected teeth. While numerous machine learning models adopting this two-step procedure have been developed, there has not been an end-to-end model that can identify teeth and their associated diseases at the same time. To fill the gap, we develop YOLOrtho, a unified framework for teeth enumeration and dental disease detection. We develop our model on Dentex Challenge 2023 data, which consists of three distinct types of annotated data. The first part is labeled with quadrant, and the second part is labeled with quadrant and enumeration and the third part is labeled with quadrant, enumeration and disease. To further improve detection, we make use of Tufts Dental public dataset. To fully utilize the data and learn both teeth detection and disease identification simultaneously, we formulate diseases as attributes attached to their corresponding teeth. Due to the nature of position relation in teeth enumeration, We replace convolution layer with CoordConv in our model to provide more position information for the model. We also adjust the model architecture and insert one more upsampling layer in FPN in favor of large object detection. Finally, we propose a post-process strategy for teeth layout that corrects teeth enumeration based on linear sum assignment. Results from experiments show that our model exceeds large Diffusion-based model.