Retrieve, Reason, and Refine: Generating Accurate and Faithful Patient Instructions

The "Patient Instruction" (PI), which contains critical instructional information provided both to carers and to the patient at the time of discharge, is essential for the patient to manage their condition outside hospital. An accurate and easy-to-follow PI can improve the self-management of patients which can in turn reduce hospital readmission rates. However, writing an appropriate PI can be extremely time-consuming for physicians, and is subject to being incomplete or error-prone for (potentially overworked) physicians. Therefore, we propose a new task that can provide an objective means of avoiding incompleteness, while reducing clinical workload: the automatic generation of the PI, which is imagined as being a document that the clinician can review, modify, and approve as necessary (rather than taking the human "out of the loop"). We build a benchmark clinical dataset and propose the Re3Writer, which imitates the working patterns of physicians to first retrieve related working experience from historical PIs written by physicians, then reason related medical knowledge. Finally, it refines the retrieved working experience and reasoned medical knowledge to extract useful information, which is used to generate the PI for previously-unseen patient according to their health records during hospitalization. Our experiments show that, using our method, the performance of five different models can be substantially boosted across all metrics, with up to 20%, 11%, and 19% relative improvements in BLEU-4, ROUGE-L, and METEOR, respectively. Meanwhile, we show results from human evaluations to measure the effectiveness in terms of its usefulness for clinical practice. The code is available at https://github.com/AI-in-Hospitals/Patient-Instructions

Mine yOur owN Anatomy: Revisiting Medical Image Segmentation with Extremely Limited Labels

Recent studies on contrastive learning have achieved remarkable performance solely by leveraging few labels in the context of medical image segmentation. Existing methods mainly focus on instance discrimination and invariant mapping. However, they face three common pitfalls: (1) tailness: medical image data usually follows an implicit long-tail class distribution. Blindly leveraging all pixels in training hence can lead to the data imbalance issues, and cause deteriorated performance; (2) consistency: it remains unclear whether a segmentation model has learned meaningful and yet consistent anatomical features due to the intra-class variations between different anatomical features; and (3) diversity: the intra-slice correlations within the entire dataset have received significantly less attention. This motivates us to seek a principled approach for strategically making use of the dataset itself to discover similar yet distinct samples from different anatomical views. In this paper, we introduce a novel semi-supervised medical image segmentation framework termed Mine yOur owN Anatomy (MONA), and make three contributions. First, prior work argues that every pixel equally matters to the model training; we observe empirically that this alone is unlikely to define meaningful anatomical features, mainly due to lacking the supervision signal. We show two simple solutions towards learning invariances - through the use of stronger data augmentations and nearest neighbors. Second, we construct a set of objectives that encourage the model to be capable of decomposing medical images into a collection of anatomical features in an unsupervised manner. Lastly, our extensive results on three benchmark datasets with different labeled settings validate the effectiveness of our proposed MONA which achieves new state-of-the-art under different labeled settings.

Learning correspondences of cardiac motion from images using biomechanics-informed modeling

Learning spatial-temporal correspondences in cardiac motion from images is important for understanding the underlying dynamics of cardiac anatomical structures. Many methods explicitly impose smoothness constraints such as the $\mathcal{L}_2$ norm on the displacement vector field (DVF), while usually ignoring biomechanical feasibility in the transformation. Other geometric constraints either regularize specific regions of interest such as imposing incompressibility on the myocardium or introduce additional steps such as training a separate network-based regularizer on physically simulated datasets. In this work, we propose an explicit biomechanics-informed prior as regularization on the predicted DVF in modeling a more generic biomechanically plausible transformation within all cardiac structures without introducing additional training complexity. We validate our methods on two publicly available datasets in the context of 2D MRI data and perform extensive experiments to illustrate the effectiveness and robustness of our proposed methods compared to other competing regularization schemes. Our proposed methods better preserve biomechanical properties by visual assessment and show advantages in segmentation performance using quantitative evaluation metrics. The code is publicly available at \url{https://github.com/Voldemort108X/bioinformed_reg}.

Exploring and Exploiting Multi-Granularity Representations for Machine Reading Comprehension

Recently, the attention-enhanced multi-layer encoder, such as Transformer, has been extensively studied in Machine Reading Comprehension (MRC). To predict the answer, it is common practice to employ a predictor to draw information only from the final encoder layer which generates the coarse-grained representations of the source sequences, i.e., passage and question. The analysis shows that the representation of source sequence becomes more coarse-grained from finegrained as the encoding layer increases. It is generally believed that with the growing number of layers in deep neural networks, the encoding process will gather relevant information for each location increasingly, resulting in more coarse-grained representations, which adds the likelihood of similarity to other locations (referring to homogeneity). Such phenomenon will mislead the model to make wrong judgement and degrade the performance. In this paper, we argue that it would be better if the predictor could exploit representations of different granularity from the encoder, providing different views of the source sequences, such that the expressive power of the model could be fully utilized. To this end, we propose a novel approach called Adaptive Bidirectional Attention-Capsule Network (ABA-Net), which adaptively exploits the source representations of different levels to the predictor. Furthermore, due to the better representations are at the core for boosting MRC performance, the capsule network and self-attention module are carefully designed as the building blocks of our encoders, which provides the capability to explore the local and global representations, respectively. Experimental results on three benchmark datasets, i.e., SQuAD 1.0, SQuAD 2.0 and COQA, demonstrate the effectiveness of our approach. In particular, we set the new state-of-the-art performance on the SQuAD 1.0 dataset

Flow-based Visual Quality Enhancer for Super-resolution Magnetic Resonance Spectroscopic Imaging

Magnetic Resonance Spectroscopic Imaging (MRSI) is an essential tool for quantifying metabolites in the body, but the low spatial resolution limits its clinical applications. Deep learning-based super-resolution methods provided promising results for improving the spatial resolution of MRSI, but the super-resolved images are often blurry compared to the experimentally-acquired high-resolution images. Attempts have been made with the generative adversarial networks to improve the image visual quality. In this work, we consider another type of generative model, the flow-based model, of which the training is more stable and interpretable compared to the adversarial networks. Specifically, we propose a flow-based enhancer network to improve the visual quality of super-resolution MRSI. Different from previous flow-based models, our enhancer network incorporates anatomical information from additional image modalities (MRI) and uses a learnable base distribution. In addition, we impose a guide loss and a data-consistency loss to encourage the network to generate images with high visual quality while maintaining high fidelity. Experiments on a 1H-MRSI dataset acquired from 25 high-grade glioma patients indicate that our enhancer network outperforms the adversarial networks and the baseline flow-based methods. Our method also allows visual quality adjustment and uncertainty estimation.

Multi-scale Super-resolution Magnetic Resonance Spectroscopic Imaging with Adjustable Sharpness

Magnetic Resonance Spectroscopic Imaging (MRSI) is a valuable tool for studying metabolic activities in the human body, but the current applications are limited to low spatial resolutions. The existing deep learning-based MRSI super-resolution methods require training a separate network for each upscaling factor, which is time-consuming and memory inefficient. We tackle this multi-scale super-resolution problem using a Filter Scaling strategy that modulates the convolution filters based on the upscaling factor, such that a single network can be used for various upscaling factors. Observing that each metabolite has distinct spatial characteristics, we also modulate the network based on the specific metabolite. Furthermore, our network is conditioned on the weight of adversarial loss so that the perceptual sharpness of the super-resolved metabolic maps can be adjusted within a single network. We incorporate these network conditionings using a novel Multi-Conditional Module. The experiments were carried out on a 1H-MRSI dataset from 15 high-grade glioma patients. Results indicate that the proposed network achieves the best performance among several multi-scale super-resolution methods and can provide super-resolved metabolic maps with adjustable sharpness.

Graph-in-Graph Network for Automatic Gene Ontology Description Generation

Gene Ontology (GO) is the primary gene function knowledge base that enables computational tasks in biomedicine. The basic element of GO is a term, which includes a set of genes with the same function. Existing research efforts of GO mainly focus on predicting gene term associations. Other tasks, such as generating descriptions of new terms, are rarely pursued. In this paper, we propose a novel task: GO term description generation. This task aims to automatically generate a sentence that describes the function of a GO term belonging to one of the three categories, i.e., molecular function, biological process, and cellular component. To address this task, we propose a Graph-in-Graph network that can efficiently leverage the structural information of GO. The proposed network introduces a two-layer graph: the first layer is a graph of GO terms where each node is also a graph (gene graph). Such a Graph-in-Graph network can derive the biological functions of GO terms and generate proper descriptions. To validate the effectiveness of the proposed network, we build three large-scale benchmark datasets. By incorporating the proposed Graph-in-Graph network, the performances of seven different sequence-to-sequence models can be substantially boosted across all evaluation metrics, with up to 34.7%, 14.5%, and 39.1% relative improvements in BLEU, ROUGE-L, and METEOR, respectively.

MIRNF: Medical Image Registration via Neural Fields

Image registration is widely used in medical image analysis to provide spatial correspondences between two images. Recently learning-based methods utilizing convolutional neural networks (CNNs) have been proposed for solving image registration problems. The learning-based methods tend to be much faster than traditional optimization-based methods, but the accuracy improvements gained from the complex CNN-based methods are modest. Here we introduce a new deep-neural net-based image registration framework, named \textbf{MIRNF}, which represents the correspondence mapping with a continuous function implemented via Neural Fields. MIRNF outputs either a deformation vector or velocity vector given a 3D coordinate as input. To ensure the mapping is diffeomorphic, the velocity vector output from MIRNF is integrated using the Neural ODE solver to derive the correspondences between two images. Furthermore, we propose a hybrid coordinate sampler along with a cascaded architecture to achieve the high-similarity mapping performance and low-distortion deformation fields. We conduct experiments on two 3D MR brain scan datasets, showing that our proposed framework provides state-of-art registration performance while maintaining comparable optimization time.

Bootstrapping Semi-supervised Medical Image Segmentation with Anatomical-aware Contrastive Distillation

Contrastive learning has shown great promise over annotation scarcity problems in the context of medical image segmentation. Existing approaches typically assume a balanced class distribution for both labeled and unlabeled medical images. However, medical image data in reality is commonly imbalanced (i.e., multi-class label imbalance), which naturally yields blurry contours and usually incorrectly labels rare objects. Moreover, it remains unclear whether all negative samples are equally negative. In this work, we present ACTION, an Anatomical-aware ConTrastive dIstillatiON framework, for semi-supervised medical image segmentation. Specifically, we first develop an iterative contrastive distillation algorithm by softly labeling the negatives rather than binary supervision between positive and negative pairs. We also capture more semantically similar features from the randomly chosen negative set compared to the positives to enforce the diversity of the sampled data. Second, we raise a more important question: Can we really handle imbalanced samples to yield better performance? Hence, the key innovation in ACTION is to learn global semantic relationship across the entire dataset and local anatomical features among the neighbouring pixels with minimal additional memory footprint. During the training, we introduce anatomical contrast by actively sampling a sparse set of hard negative pixels, which can generate smoother segmentation boundaries and more accurate predictions. Extensive experiments across two benchmark datasets and different unlabeled settings show that ACTION performs comparable or better than the current state-of-the-art supervised and semi-supervised methods. Our code and models will be publicly available.

Incremental Learning Meets Transfer Learning: Application to Multi-site Prostate MRI Segmentation

Many medical datasets have recently been created for medical image segmentation tasks, and it is natural to question whether we can use them to sequentially train a single model that (1) performs better on all these datasets, and (2) generalizes well and transfers better to the unknown target site domain. Prior works have achieved this goal by jointly training one model on multi-site datasets, which achieve competitive performance on average but such methods rely on the assumption about the availability of all training data, thus limiting its effectiveness in practical deployment. In this paper, we propose a novel multi-site segmentation framework called incremental-transfer learning (ITL), which learns a model from multi-site datasets in an end-to-end sequential fashion. Specifically, "incremental" refers to training sequentially constructed datasets, and "transfer" is achieved by leveraging useful information from the linear combination of embedding features on each dataset. In addition, we introduce our ITL framework, where we train the network including a site-agnostic encoder with pre-trained weights and at most two segmentation decoder heads. We also design a novel site-level incremental loss in order to generalize well on the target domain. Second, we show for the first time that leveraging our ITL training scheme is able to alleviate challenging catastrophic forgetting problems in incremental learning. We conduct experiments using five challenging benchmark datasets to validate the effectiveness of our incremental-transfer learning approach. Our approach makes minimal assumptions on computation resources and domain-specific expertise, and hence constitutes a strong starting point in multi-site medical image segmentation.