Few-shot Adaptation of Medical Vision-Language Models

Integrating image and text data through multi-modal learning has emerged as a new approach in medical imaging research, following its successful deployment in computer vision. While considerable efforts have been dedicated to establishing medical foundation models and their zero-shot transfer to downstream tasks, the popular few-shot setting remains relatively unexplored. Following on from the currently strong emergence of this setting in computer vision, we introduce the first structured benchmark for adapting medical vision-language models (VLMs) in a strict few-shot regime and investigate various adaptation strategies commonly used in the context of natural images. Furthermore, we evaluate a simple generalization of the linear-probe adaptation baseline, which seeks an optimal blending of the visual prototypes and text embeddings via learnable class-wise multipliers. Surprisingly, such a text-informed linear probe yields competitive performances in comparison to convoluted prompt-learning and adapter-based strategies, while running considerably faster and accommodating the black-box setting. Our extensive experiments span three different medical modalities and specialized foundation models, nine downstream tasks, and several state-of-the-art few-shot adaptation methods. We made our benchmark and code publicly available to trigger further developments in this emergent subject: \url{https://github.com/FereshteShakeri/few-shot-MedVLMs}.

Harmonizing Flows: Leveraging normalizing flows for unsupervised and source-free MRI harmonization

Lack of standardization and various intrinsic parameters for magnetic resonance (MR) image acquisition results in heterogeneous images across different sites and devices, which adversely affects the generalization of deep neural networks. To alleviate this issue, this work proposes a novel unsupervised harmonization framework that leverages normalizing flows to align MR images, thereby emulating the distribution of a source domain. The proposed strategy comprises three key steps. Initially, a normalizing flow network is trained to capture the distribution characteristics of the source domain. Then, we train a shallow harmonizer network to reconstruct images from the source domain via their augmented counterparts. Finally, during inference, the harmonizer network is updated to ensure that the output images conform to the learned source domain distribution, as modeled by the normalizing flow network. Our approach, which is unsupervised, source-free, and task-agnostic is assessed in the context of both adults and neonatal cross-domain brain MRI segmentation, as well as neonatal brain age estimation, demonstrating its generalizability across tasks and population demographics. The results underscore its superior performance compared to existing methodologies. The code is available at https://github.com/farzad-bz/Harmonizing-Flows

Robust Calibration of Large Vision-Language Adapters

This paper addresses the critical issue of miscalibration in CLIP-based model adaptation, particularly in the challenging scenario of out-of-distribution (OOD) samples, which has been overlooked in the existing literature on CLIP adaptation. We empirically demonstrate that popular CLIP adaptation approaches, such as Adapters, Prompt Learning, and Test-Time Adaptation, substantially degrade the calibration capabilities of the zero-shot baseline in the presence of distributional drift. We identify the increase in logit ranges as the underlying cause of miscalibration of CLIP adaptation methods, contrasting with previous work on calibrating fully-supervised models. Motivated by these observations, we present a simple and model-agnostic solution to mitigate miscalibration, by scaling the logit range of each sample to its zero-shot prediction logits. We explore three different alternatives to achieve this, which can be either integrated during adaptation or directly used at inference time. Comprehensive experiments on popular OOD classification benchmarks demonstrate the effectiveness of the proposed approaches in mitigating miscalibration while maintaining discriminative performance, whose improvements are consistent across the three families of these increasingly popular approaches. The code is publicly available at: https://github.com/Bala93/CLIPCalib

Pay Attention to Your Neighbours: Training-Free Open-Vocabulary Semantic Segmentation

Despite the significant progress in deep learning for dense visual recognition problems, such as semantic segmentation, traditional methods are constrained by fixed class sets. Meanwhile, vision-language foundation models, such as CLIP, have showcased remarkable effectiveness in numerous zero-shot image-level tasks, owing to their robust generalizability. Recently, a body of work has investigated utilizing these models in open-vocabulary semantic segmentation (OVSS). However, existing approaches often rely on impractical supervised pre-training or access to additional pre-trained networks. In this work, we propose a strong baseline for training-free OVSS, termed Neighbour-Aware CLIP (NACLIP), representing a straightforward adaptation of CLIP tailored for this scenario. Our method enforces localization of patches in the self-attention of CLIP's vision transformer which, despite being crucial for dense prediction tasks, has been overlooked in the OVSS literature. By incorporating design choices favouring segmentation, our approach significantly improves performance without requiring additional data, auxiliary pre-trained networks, or extensive hyperparameter tuning, making it highly practical for real-world applications. Experiments are performed on 8 popular semantic segmentation benchmarks, yielding state-of-the-art performance on most scenarios. Our code is publicly available at https://github.com/sinahmr/NACLIP .

LP++: A Surprisingly Strong Linear Probe for Few-Shot CLIP

In a recent, strongly emergent literature on few-shot CLIP adaptation, Linear Probe (LP) has been often reported as a weak baseline. This has motivated intensive research building convoluted prompt learning or feature adaptation strategies. In this work, we propose and examine from convex-optimization perspectives a generalization of the standard LP baseline, in which the linear classifier weights are learnable functions of the text embedding, with class-wise multipliers blending image and text knowledge. As our objective function depends on two types of variables, i.e., the class visual prototypes and the learnable blending parameters, we propose a computationally efficient block coordinate Majorize-Minimize (MM) descent algorithm. In our full-batch MM optimizer, which we coin LP++, step sizes are implicit, unlike standard gradient descent practices where learning rates are intensively searched over validation sets. By examining the mathematical properties of our loss (e.g., Lipschitz gradient continuity), we build majorizing functions yielding data-driven learning rates and derive approximations of the loss's minima, which provide data-informed initialization of the variables. Our image-language objective function, along with these non-trivial optimization insights and ingredients, yields, surprisingly, highly competitive few-shot CLIP performances. Furthermore, LP++ operates in black-box, relaxes intensive validation searches for the optimization hyper-parameters, and runs orders-of-magnitudes faster than state-of-the-art few-shot CLIP adaptation methods. Our code is available at: \url{https://github.com/FereshteShakeri/FewShot-CLIP-Strong-Baseline.git}.

Do not trust what you trust: Miscalibration in Semi-supervised Learning

State-of-the-art semi-supervised learning (SSL) approaches rely on highly confident predictions to serve as pseudo-labels that guide the training on unlabeled samples. An inherent drawback of this strategy stems from the quality of the uncertainty estimates, as pseudo-labels are filtered only based on their degree of uncertainty, regardless of the correctness of their predictions. Thus, assessing and enhancing the uncertainty of network predictions is of paramount importance in the pseudo-labeling process. In this work, we empirically demonstrate that SSL methods based on pseudo-labels are significantly miscalibrated, and formally demonstrate the minimization of the min-entropy, a lower bound of the Shannon entropy, as a potential cause for miscalibration. To alleviate this issue, we integrate a simple penalty term, which enforces the logit distances of the predictions on unlabeled samples to remain low, preventing the network predictions to become overconfident. Comprehensive experiments on a variety of SSL image classification benchmarks demonstrate that the proposed solution systematically improves the calibration performance of relevant SSL models, while also enhancing their discriminative power, being an appealing addition to tackle SSL tasks.

Class and Region-Adaptive Constraints for Network Calibration

In this work, we present a novel approach to calibrate segmentation networks that considers the inherent challenges posed by different categories and object regions. In particular, we present a formulation that integrates class and region-wise constraints into the learning objective, with multiple penalty weights to account for class and region differences. Finding the optimal penalty weights manually, however, might be unfeasible, and potentially hinder the optimization process. To overcome this limitation, we propose an approach based on Class and Region-Adaptive constraints (CRaC), which allows to learn the class and region-wise penalty weights during training. CRaC is based on a general Augmented Lagrangian method, a well-established technique in constrained optimization. Experimental results on two popular segmentation benchmarks, and two well-known segmentation networks, demonstrate the superiority of CRaC compared to existing approaches. The code is available at: https://github.com/Bala93/CRac/

Exploring the Transferability of a Foundation Model for Fundus Images: Application to Hypertensive Retinopathy

Using deep learning models pre-trained on Imagenet is the traditional solution for medical image classification to deal with data scarcity. Nevertheless, relevant literature supports that this strategy may offer limited gains due to the high dissimilarity between domains. Currently, the paradigm of adapting domain-specialized foundation models is proving to be a promising alternative. However, how to perform such knowledge transfer, and the benefits and limitations it presents, are under study. The CGI-HRDC challenge for Hypertensive Retinopathy diagnosis on fundus images introduces an appealing opportunity to evaluate the transferability of a recently released vision-language foundation model of the retina, FLAIR. In this work, we explore the potential of using FLAIR features as starting point for fundus image classification, and we compare its performance with regard to Imagenet initialization on two popular transfer learning methods: Linear Probing (LP) and Fine-Tuning (FP). Our empirical observations suggest that, in any case, the use of the traditional strategy provides performance gains. In contrast, direct transferability from FLAIR model allows gains of 2.5%. When fine-tuning the whole network, the performance gap increases up to 4%. In this case, we show that avoiding feature deterioration via LP initialization of the classifier allows the best re-use of the rich pre-trained features. Although direct transferability using LP still offers limited performance, we believe that foundation models such as FLAIR will drive the evolution of deep-learning-based fundus image analysis.

Neighbor-Aware Calibration of Segmentation Networks with Penalty-Based Constraints

Ensuring reliable confidence scores from deep neural networks is of paramount significance in critical decision-making systems, particularly in real-world domains such as healthcare. Recent literature on calibrating deep segmentation networks has resulted in substantial progress. Nevertheless, these approaches are strongly inspired by the advancements in classification tasks, and thus their uncertainty is usually modeled by leveraging the information of individual pixels, disregarding the local structure of the object of interest. Indeed, only the recent Spatially Varying Label Smoothing (SVLS) approach considers pixel spatial relationships across classes, by softening the pixel label assignments with a discrete spatial Gaussian kernel. In this work, we first present a constrained optimization perspective of SVLS and demonstrate that it enforces an implicit constraint on soft class proportions of surrounding pixels. Furthermore, our analysis shows that SVLS lacks a mechanism to balance the contribution of the constraint with the primary objective, potentially hindering the optimization process. Based on these observations, we propose NACL (Neighbor Aware CaLibration), a principled and simple solution based on equality constraints on the logit values, which enables to control explicitly both the enforced constraint and the weight of the penalty, offering more flexibility. Comprehensive experiments on a wide variety of well-known segmentation benchmarks demonstrate the superior calibration performance of the proposed approach, without affecting its discriminative power. Furthermore, ablation studies empirically show the model agnostic nature of our approach, which can be used to train a wide span of deep segmentation networks.

A Closer Look at the Few-Shot Adaptation of Large Vision-Language Models

Efficient transfer learning (ETL) is receiving increasing attention to adapt large pre-trained language-vision models on downstream tasks with a few labeled samples. While significant progress has been made, we reveal that state-of-the-art ETL approaches exhibit strong performance only in narrowly-defined experimental setups, and with a careful adjustment of hyperparameters based on a large corpus of labeled samples. In particular, we make two interesting, and surprising empirical observations. First, to outperform a simple Linear Probing baseline, these methods require to optimize their hyper-parameters on each target task. And second, they typically underperform -- sometimes dramatically -- standard zero-shot predictions in the presence of distributional drifts. Motivated by the unrealistic assumptions made in the existing literature, i.e., access to a large validation set and case-specific grid-search for optimal hyperparameters, we propose a novel approach that meets the requirements of real-world scenarios. More concretely, we introduce a CLass-Adaptive linear Probe (CLAP) objective, whose balancing term is optimized via an adaptation of the general Augmented Lagrangian method tailored to this context. We comprehensively evaluate CLAP on a broad span of datasets and scenarios, demonstrating that it consistently outperforms SoTA approaches, while yet being a much more efficient alternative.