GEMeX: A Large-Scale, Groundable, and Explainable Medical VQA Benchmark for Chest X-ray Diagnosis

Medical Visual Question Answering (VQA) is an essential technology that integrates computer vision and natural language processing to automatically respond to clinical inquiries about medical images. However, current medical VQA datasets exhibit two significant limitations: (1) they often lack visual and textual explanations for answers, which impedes their ability to satisfy the comprehension needs of patients and junior doctors; (2) they typically offer a narrow range of question formats, inadequately reflecting the diverse requirements encountered in clinical scenarios. These limitations pose significant challenges to the development of a reliable and user-friendly Med-VQA system. To address these challenges, we introduce a large-scale, Groundable, and Explainable Medical VQA benchmark for chest X-ray diagnosis (GEMeX), featuring several innovative components: (1) A multi-modal explainability mechanism that offers detailed visual and textual explanations for each question-answer pair, thereby enhancing answer comprehensibility; (2) Four distinct question types, open-ended, closed-ended, single-choice, and multiple-choice, that better reflect diverse clinical needs. We evaluated 10 representative large vision language models on GEMeX and found that they underperformed, highlighting the dataset's complexity. However, after fine-tuning a baseline model using the training set, we observed a significant performance improvement, demonstrating the dataset's effectiveness. The project is available at www.med-vqa.com/GEMeX.

DB-SAM: Delving into High Quality Universal Medical Image Segmentation

Recently, the Segment Anything Model (SAM) has demonstrated promising segmentation capabilities in a variety of downstream segmentation tasks. However in the context of universal medical image segmentation there exists a notable performance discrepancy when directly applying SAM due to the domain gap between natural and 2D/3D medical data. In this work, we propose a dual-branch adapted SAM framework, named DB-SAM, that strives to effectively bridge this domain gap. Our dual-branch adapted SAM contains two branches in parallel: a ViT branch and a convolution branch. The ViT branch incorporates a learnable channel attention block after each frozen attention block, which captures domain-specific local features. On the other hand, the convolution branch employs a light-weight convolutional block to extract domain-specific shallow features from the input medical image. To perform cross-branch feature fusion, we design a bilateral cross-attention block and a ViT convolution fusion block, which dynamically combine diverse information of two branches for mask decoder. Extensive experiments on large-scale medical image dataset with various 3D and 2D medical segmentation tasks reveal the merits of our proposed contributions. On 21 3D medical image segmentation tasks, our proposed DB-SAM achieves an absolute gain of 8.8%, compared to a recent medical SAM adapter in the literature. The code and model are available at https://github.com/AlfredQin/DB-SAM.

Serp-Mamba: Advancing High-Resolution Retinal Vessel Segmentation with Selective State-Space Model

Ultra-Wide-Field Scanning Laser Ophthalmoscopy (UWF-SLO) images capture high-resolution views of the retina with typically 200 spanning degrees. Accurate segmentation of vessels in UWF-SLO images is essential for detecting and diagnosing fundus disease. Recent studies have revealed that the selective State Space Model (SSM) in Mamba performs well in modeling long-range dependencies, which is crucial for capturing the continuity of elongated vessel structures. Inspired by this, we propose the first Serpentine Mamba (Serp-Mamba) network to address this challenging task. Specifically, we recognize the intricate, varied, and delicate nature of the tubular structure of vessels. Furthermore, the high-resolution of UWF-SLO images exacerbates the imbalance between the vessel and background categories. Based on the above observations, we first devise a Serpentine Interwoven Adaptive (SIA) scan mechanism, which scans UWF-SLO images along curved vessel structures in a snake-like crawling manner. This approach, consistent with vascular texture transformations, ensures the effective and continuous capture of curved vascular structure features. Second, we propose an Ambiguity-Driven Dual Recalibration (ADDR) module to address the category imbalance problem intensified by high-resolution images. Our ADDR module delineates pixels by two learnable thresholds and refines ambiguous pixels through a dual-driven strategy, thereby accurately distinguishing vessels and background regions. Experiment results on three datasets demonstrate the superior performance of our Serp-Mamba on high-resolution vessel segmentation. We also conduct a series of ablation studies to verify the impact of our designs. Our code shall be released upon publication of this work.

MedSAM-U: Uncertainty-Guided Auto Multi-Prompt Adaptation for Reliable MedSAM

The Medical Segment Anything Model (MedSAM) has shown remarkable performance in medical image segmentation, drawing significant attention in the field. However, its sensitivity to varying prompt types and locations poses challenges. This paper addresses these challenges by focusing on the development of reliable prompts that enhance MedSAM's accuracy. We introduce MedSAM-U, an uncertainty-guided framework designed to automatically refine multi-prompt inputs for more reliable and precise medical image segmentation. Specifically, we first train a Multi-Prompt Adapter integrated with MedSAM, creating MPA-MedSAM, to adapt to diverse multi-prompt inputs. We then employ uncertainty-guided multi-prompt to effectively estimate the uncertainties associated with the prompts and their initial segmentation results. In particular, a novel uncertainty-guided prompts adaptation technique is then applied automatically to derive reliable prompts and their corresponding segmentation outcomes. We validate MedSAM-U using datasets from multiple modalities to train a universal image segmentation model. Compared to MedSAM, experimental results on five distinct modal datasets demonstrate that the proposed MedSAM-U achieves an average performance improvement of 1.7\% to 20.5\% across uncertainty-guided prompts.

Say No to Freeloader: Protecting Intellectual Property of Your Deep Model

Model intellectual property (IP) protection has attracted growing attention as science and technology advancements stem from human intellectual labor and computational expenses. Ensuring IP safety for trainers and owners is of utmost importance, particularly in domains where ownership verification and applicability authorization are required. A notable approach to safeguarding model IP involves proactively preventing the use of well-trained models of authorized domains from unauthorized domains. In this paper, we introduce a novel Compact Un-transferable Pyramid Isolation Domain (CUPI-Domain) which serves as a barrier against illegal transfers from authorized to unauthorized domains. Drawing inspiration from human transitive inference and learning abilities, the CUPI-Domain is designed to obstruct cross-domain transfers by emphasizing the distinctive style features of the authorized domain. This emphasis leads to failure in recognizing irrelevant private style features on unauthorized domains. To this end, we propose novel CUPI-Domain generators, which select features from both authorized and CUPI-Domain as anchors. Then, we fuse the style features and semantic features of these anchors to generate labeled and style-rich CUPI-Domain. Additionally, we design external Domain-Information Memory Banks (DIMB) for storing and updating labeled pyramid features to obtain stable domain class features and domain class-wise style features. Based on the proposed whole method, the novel style and discriminative loss functions are designed to effectively enhance the distinction in style and discriminative features between authorized and unauthorized domains, respectively. Moreover, we provide two solutions for utilizing CUPI-Domain based on whether the unauthorized domain is known: target-specified CUPI-Domain and target-free CUPI-Domain.

Beyond the Eye: A Relational Model for Early Dementia Detection Using Retinal OCTA Images

Early detection of dementia, such as Alzheimer's disease (AD) or mild cognitive impairment (MCI), is essential to enable timely intervention and potential treatment. Accurate detection of AD/MCI is challenging due to the high complexity, cost, and often invasive nature of current diagnostic techniques, which limit their suitability for large-scale population screening. Given the shared embryological origins and physiological characteristics of the retina and brain, retinal imaging is emerging as a potentially rapid and cost-effective alternative for the identification of individuals with or at high risk of AD. In this paper, we present a novel PolarNet+ that uses retinal optical coherence tomography angiography (OCTA) to discriminate early-onset AD (EOAD) and MCI subjects from controls. Our method first maps OCTA images from Cartesian coordinates to polar coordinates, allowing approximate sub-region calculation to implement the clinician-friendly early treatment of diabetic retinopathy study (ETDRS) grid analysis. We then introduce a multi-view module to serialize and analyze the images along three dimensions for comprehensive, clinically useful information extraction. Finally, we abstract the sequence embedding into a graph, transforming the detection task into a general graph classification problem. A regional relationship module is applied after the multi-view module to excavate the relationship between the sub-regions. Such regional relationship analyses validate known eye-brain links and reveal new discriminative patterns.

CLIP-DR: Textual Knowledge-Guided Diabetic Retinopathy Grading with Ranking-aware Prompting

Diabetic retinopathy (DR) is a complication of diabetes and usually takes decades to reach sight-threatening levels. Accurate and robust detection of DR severity is critical for the timely management and treatment of diabetes. However, most current DR grading methods suffer from insufficient robustness to data variability (\textit{e.g.} colour fundus images), posing a significant difficulty for accurate and robust grading. In this work, we propose a novel DR grading framework CLIP-DR based on three observations: 1) Recent pre-trained visual language models, such as CLIP, showcase a notable capacity for generalisation across various downstream tasks, serving as effective baseline models. 2) The grading of image-text pairs for DR often adheres to a discernible natural sequence, yet most existing DR grading methods have primarily overlooked this aspect. 3) A long-tailed distribution among DR severity levels complicates the grading process. This work proposes a novel ranking-aware prompting strategy to help the CLIP model exploit the ordinal information. Specifically, we sequentially design learnable prompts between neighbouring text-image pairs in two different ranking directions. Additionally, we introduce a Similarity Matrix Smooth module into the structure of CLIP to balance the class distribution. Finally, we perform extensive comparisons with several state-of-the-art methods on the GDRBench benchmark, demonstrating our CLIP-DR's robustness and superior performance. The implementation code is available \footnote{\url{https://github.com/Qinkaiyu/CLIP-DR}

STLLaVA-Med: Self-Training Large Language and Vision Assistant for Medical

Large Vision-Language Models (LVLMs) have shown significant potential in assisting medical diagnosis by leveraging extensive biomedical datasets. However, the advancement of medical image understanding and reasoning critically depends on building high-quality visual instruction data, which is costly and labor-intensive to obtain, particularly in the medical domain. To mitigate this data-starving issue, we introduce Self-Training Large Language and Vision Assistant for Medical (STLLaVA-Med). The proposed method is designed to train a policy model (an LVLM) capable of auto-generating medical visual instruction data to improve data efficiency, guided through Direct Preference Optimization (DPO). Specifically, a more powerful and larger LVLM (e.g., GPT-4o) is involved as a biomedical expert to oversee the DPO fine-tuning process on the auto-generated data, encouraging the policy model to align efficiently with human preferences. We validate the efficacy and data efficiency of STLLaVA-Med across three major medical Visual Question Answering (VQA) benchmarks, demonstrating competitive zero-shot performance with the utilization of only 9% of the medical data.

ViDSOD-100: A New Dataset and a Baseline Model for RGB-D Video Salient Object Detection

With the rapid development of depth sensor, more and more RGB-D videos could be obtained. Identifying the foreground in RGB-D videos is a fundamental and important task. However, the existing salient object detection (SOD) works only focus on either static RGB-D images or RGB videos, ignoring the collaborating of RGB-D and video information. In this paper, we first collect a new annotated RGB-D video SOD (ViDSOD-100) dataset, which contains 100 videos within a total of 9,362 frames, acquired from diverse natural scenes. All the frames in each video are manually annotated to a high-quality saliency annotation. Moreover, we propose a new baseline model, named attentive triple-fusion network (ATF-Net), for RGB-D video salient object detection. Our method aggregates the appearance information from an input RGB image, spatio-temporal information from an estimated motion map, and the geometry information from the depth map by devising three modality-specific branches and a multi-modality integration branch. The modality-specific branches extract the representation of different inputs, while the multi-modality integration branch combines the multi-level modality-specific features by introducing the encoder feature aggregation (MEA) modules and decoder feature aggregation (MDA) modules. The experimental findings conducted on both our newly introduced ViDSOD-100 dataset and the well-established DAVSOD dataset highlight the superior performance of the proposed ATF-Net. This performance enhancement is demonstrated both quantitatively and qualitatively, surpassing the capabilities of current state-of-the-art techniques across various domains, including RGB-D saliency detection, video saliency detection, and video object segmentation. Our data and our code are available at github.com/jhl-Det/RGBD_Video_SOD.

Enhancing Diagnostic Reliability of Foundation Model with Uncertainty Estimation in OCT Images

Inability to express the confidence level and detect unseen classes has limited the clinical implementation of artificial intelligence in the real-world. We developed a foundation model with uncertainty estimation (FMUE) to detect 11 retinal conditions on optical coherence tomography (OCT). In the internal test set, FMUE achieved a higher F1 score of 96.76% than two state-of-the-art algorithms, RETFound and UIOS, and got further improvement with thresholding strategy to 98.44%. In the external test sets obtained from other OCT devices, FMUE achieved an accuracy of 88.75% and 92.73% before and after thresholding. Our model is superior to two ophthalmologists with a higher F1 score (95.17% vs. 61.93% &71.72%). Besides, our model correctly predicts high uncertainty scores for samples with ambiguous features, of non-target-category diseases, or with low-quality to prompt manual checks and prevent misdiagnosis. FMUE provides a trustworthy method for automatic retinal anomalies detection in the real-world clinical open set environment.