Uncertainty Estimation of Large Language Models in Medical Question Answering

Large Language Models (LLMs) show promise for natural language generation in healthcare, but risk hallucinating factually incorrect information. Deploying LLMs for medical question answering necessitates reliable uncertainty estimation (UE) methods to detect hallucinations. In this work, we benchmark popular UE methods with different model sizes on medical question-answering datasets. Our results show that current approaches generally perform poorly in this domain, highlighting the challenge of UE for medical applications. We also observe that larger models tend to yield better results, suggesting a correlation between model size and the reliability of UE. To address these challenges, we propose Two-phase Verification, a probability-free Uncertainty Estimation approach. First, an LLM generates a step-by-step explanation alongside its initial answer, followed by formulating verification questions to check the factual claims in the explanation. The model then answers these questions twice: first independently, and then referencing the explanation. Inconsistencies between the two sets of answers measure the uncertainty in the original response. We evaluate our approach on three biomedical question-answering datasets using Llama 2 Chat models and compare it against the benchmarked baseline methods. The results show that our Two-phase Verification method achieves the best overall accuracy and stability across various datasets and model sizes, and its performance scales as the model size increases.

Direct Preference Optimization for Suppressing Hallucinated Prior Exams in Radiology Report Generation

Recent advances in generative vision-language models (VLMs) have exciting potential implications for AI in radiology, yet VLMs are also known to produce hallucinations, nonsensical text, and other unwanted behaviors that can waste clinicians' time and cause patient harm. Drawing on recent work on direct preference optimization (DPO), we propose a simple method for modifying the behavior of pretrained VLMs performing radiology report generation by suppressing unwanted types of generations. We apply our method to the prevention of hallucinations of prior exams, addressing a long-established problem behavior in models performing chest X-ray report generation. Across our experiments, we find that DPO fine-tuning achieves a 3.2-4.8x reduction in lines hallucinating prior exams while maintaining model performance on clinical accuracy metrics. Our work is, to the best of our knowledge, the first work to apply DPO to medical VLMs, providing a data- and compute- efficient way to suppress problem behaviors while maintaining overall clinical accuracy.

Cross-Dimensional Medical Self-Supervised Representation Learning Based on a Pseudo-3D Transformation

Medical image analysis suffers from a shortage of data, whether annotated or not. This becomes even more pronounced when it comes to 3D medical images. Self-Supervised Learning (SSL) can partially ease this situation by using unlabeled data. However, most existing SSL methods can only make use of data in a single dimensionality (e.g. 2D or 3D), and are incapable of enlarging the training dataset by using data with differing dimensionalities jointly. In this paper, we propose a new cross-dimensional SSL framework based on a pseudo-3D transformation (CDSSL-P3D), that can leverage both 2D and 3D data for joint pre-training. Specifically, we introduce an image transformation based on the im2col algorithm, which converts 2D images into a format consistent with 3D data. This transformation enables seamless integration of 2D and 3D data, and facilitates cross-dimensional self-supervised learning for 3D medical image analysis. We run extensive experiments on 13 downstream tasks, including 2D and 3D classification and segmentation. The results indicate that our CDSSL-P3D achieves superior performance, outperforming other advanced SSL methods.

A Generalist Learner for Multifaceted Medical Image Interpretation

Current medical artificial intelligence systems are often limited to narrow applications, hindering their widespread adoption in clinical practice. To address this limitation, we propose MedVersa, a generalist learner that enables flexible learning and tasking for medical image interpretation. By leveraging a large language model as a learnable orchestrator, MedVersa can learn from both visual and linguistic supervision, support multimodal inputs, and perform real-time task specification. This versatility allows MedVersa to adapt to various clinical scenarios and perform multifaceted medical image analysis. We introduce MedInterp, the largest multimodal dataset to date for medical image interpretation, consisting of over 13 million annotated instances spanning 11 tasks across 3 modalities, to support the development of MedVersa. Our experiments demonstrate that MedVersa achieves state-of-the-art performance in 9 tasks, sometimes outperforming specialist counterparts by over 10%. MedVersa is the first to showcase the viability of multimodal generative medical AI in implementing multimodal outputs, inputs, and dynamic task specification, highlighting its potential as a multifunctional system for comprehensive medical image analysis. This generalist approach to medical image interpretation paves the way for more adaptable and efficient AI-assisted clinical decision-making.

SDR-Former: A Siamese Dual-Resolution Transformer for Liver Lesion Classification Using 3D Multi-Phase Imaging

Automated classification of liver lesions in multi-phase CT and MR scans is of clinical significance but challenging. This study proposes a novel Siamese Dual-Resolution Transformer (SDR-Former) framework, specifically designed for liver lesion classification in 3D multi-phase CT and MR imaging with varying phase counts. The proposed SDR-Former utilizes a streamlined Siamese Neural Network (SNN) to process multi-phase imaging inputs, possessing robust feature representations while maintaining computational efficiency. The weight-sharing feature of the SNN is further enriched by a hybrid Dual-Resolution Transformer (DR-Former), comprising a 3D Convolutional Neural Network (CNN) and a tailored 3D Transformer for processing high- and low-resolution images, respectively. This hybrid sub-architecture excels in capturing detailed local features and understanding global contextual information, thereby, boosting the SNN's feature extraction capabilities. Additionally, a novel Adaptive Phase Selection Module (APSM) is introduced, promoting phase-specific intercommunication and dynamically adjusting each phase's influence on the diagnostic outcome. The proposed SDR-Former framework has been validated through comprehensive experiments on two clinical datasets: a three-phase CT dataset and an eight-phase MR dataset. The experimental results affirm the efficacy of the proposed framework. To support the scientific community, we are releasing our extensive multi-phase MR dataset for liver lesion analysis to the public. This pioneering dataset, being the first publicly available multi-phase MR dataset in this field, also underpins the MICCAI LLD-MMRI Challenge. The dataset is accessible at:https://bit.ly/3IyYlgN.

Swin-UMamba: Mamba-based UNet with ImageNet-based pretraining

Accurate medical image segmentation demands the integration of multi-scale information, spanning from local features to global dependencies. However, it is challenging for existing methods to model long-range global information, where convolutional neural networks (CNNs) are constrained by their local receptive fields, and vision transformers (ViTs) suffer from high quadratic complexity of their attention mechanism. Recently, Mamba-based models have gained great attention for their impressive ability in long sequence modeling. Several studies have demonstrated that these models can outperform popular vision models in various tasks, offering higher accuracy, lower memory consumption, and less computational burden. However, existing Mamba-based models are mostly trained from scratch and do not explore the power of pretraining, which has been proven to be quite effective for data-efficient medical image analysis. This paper introduces a novel Mamba-based model, Swin-UMamba, designed specifically for medical image segmentation tasks, leveraging the advantages of ImageNet-based pretraining. Our experimental results reveal the vital role of ImageNet-based training in enhancing the performance of Mamba-based models. Swin-UMamba demonstrates superior performance with a large margin compared to CNNs, ViTs, and latest Mamba-based models. Notably, on AbdomenMRI, Encoscopy, and Microscopy datasets, Swin-UMamba outperforms its closest counterpart U-Mamba by an average score of 3.58%. The code and models of Swin-UMamba are publicly available at: https://github.com/JiarunLiu/Swin-UMamba

Less Could Be Better: Parameter-efficient Fine-tuning Advances Medical Vision Foundation Models

Parameter-efficient fine-tuning (PEFT) that was initially developed for exploiting pre-trained large language models has recently emerged as an effective approach to perform transfer learning on computer vision tasks. However, the effectiveness of PEFT on medical vision foundation models is still unclear and remains to be explored. As a proof of concept, we conducted a detailed empirical study on applying PEFT to chest radiography foundation models. Specifically, we delved into LoRA, a representative PEFT method, and compared it against full-parameter fine-tuning (FFT) on two self-supervised radiography foundation models across three well-established chest radiograph datasets. Our results showed that LoRA outperformed FFT in 13 out of 18 transfer learning tasks by at most 2.9% using fewer than 1% tunable parameters. Combining LoRA with foundation models, we set up new state-of-the-art on a range of data-efficient learning tasks, such as an AUROC score of 80.6% using 1% labeled data on NIH ChestX-ray14. We hope this study can evoke more attention from the community in the use of PEFT for transfer learning on medical imaging tasks. Code and models are available at https://github.com/RL4M/MED-PEFT.

Generalizable vision-language pre-training for annotation-free pathology localization

Locating pathologies automatically from medical images aids the understanding of the emergence and progression of diseases, and such an ability can significantly benefit clinical diagnostics. However, existing deep learning models heavily rely on expert annotations and lack generalization capabilities in open clinical environments. In this study, we present a generalizable vision-language pre-training model for Annotation-Free pathology Localization (AFLoc). The core strength of AFLoc lies in its image annotation-free multi-level semantic structure-based contrastive learning, which comprehensively aligns multi-granularity medical concepts from reports with abundant image features, to adapt to the diverse expressions of observed and emerging unseen pathologies. We conducted extensive experimental validation across 4 distinct external datasets, encompassing 11 types of chest pathologies, to verify its generalization ability. The results demonstrate that AFLoc surpasses 6 state-of-the-art methods and even outperforms the human benchmark in locating 5 different pathologies, underscoring its suitability for complex clinical environments.

Enhancing the medical foundation model with multi-scale and cross-modality feature learning

The development of multi-modal medical foundation models has attracted significant attention in the field of medicine and healthcare due to their promising prospects in various clinical applications. One area of focus in this research direction is the extractions of features at different scales. While previous studies have explored feature learning at individual scales, investigation on integrating the diverse scales and modalities of information is lacking, which may hinder the potential for mutual reinforcement among these features. This paper aims to bridge this gap by proposing a method that effectively exploits multi-scale and cross-modality information to enhance the performance of medical foundation models. The proposed method simultaneously exploit features at the local, instance, modality and global aspects, facilitating comprehensive representation learning within the models. We evaluate the effectiveness of the proposed method on six open-source datasets across different clinical tasks, demonstrating its ability to enhance the performance of medical foundation models.

MLIP: Medical Language-Image Pre-training with Masked Local Representation Learning

Existing contrastive language-image pre-training aims to learn a joint representation by matching abundant image-text pairs. However, the number of image-text pairs in medical datasets is usually orders of magnitude smaller than that in natural datasets. Besides, medical image-text pairs often involve numerous complex fine-grained correspondences. This paper aims to enhance the data efficiency by introducing multiple-to-multiple local relationship modeling to capture denser supervisions. More specifically, we propose a Medical Language-Image Pre-training (MLIP) framework, which exploits the limited image-text medical data more efficiently through patch-sentence matching. Furthermore, we introduce a masked contrastive learning strategy with semantic integrity estimation to reduce redundancy in images while preserving the underlying semantics. Our evaluation results show that MLIP outperforms previous work in zero/few-shot classification and few-shot segmentation tasks by a large margin.