Enable the Right to be Forgotten with Federated Client Unlearning in Medical Imaging

The right to be forgotten, as stated in most data regulations, poses an underexplored challenge in federated learning (FL), leading to the development of federated unlearning (FU). However, current FU approaches often face trade-offs between efficiency, model performance, forgetting efficacy, and privacy preservation. In this paper, we delve into the paradigm of Federated Client Unlearning (FCU) to guarantee a client the right to erase the contribution or the influence, introducing the first FU framework in medical imaging. In the unlearning process of a client, the proposed model-contrastive unlearning marks a pioneering step towards feature-level unlearning, and frequency-guided memory preservation ensures smooth forgetting of local knowledge while maintaining the generalizability of the trained global model, thus avoiding performance compromises and guaranteeing rapid post-training. We evaluated our FCU framework on two public medical image datasets, including Intracranial hemorrhage diagnosis and skin lesion diagnosis, demonstrating that our framework outperformed other state-of-the-art FU frameworks, with an expected speed-up of 10-15 times compared with retraining from scratch. The code and the organized datasets can be found at: https://github.com/dzp2095/FCU.

Multimodal Data Integration for Precision Oncology: Challenges and Future Directions

The essence of precision oncology lies in its commitment to tailor targeted treatments and care measures to each patient based on the individual characteristics of the tumor. The inherent heterogeneity of tumors necessitates gathering information from diverse data sources to provide valuable insights from various perspectives, fostering a holistic comprehension of the tumor. Over the past decade, multimodal data integration technology for precision oncology has made significant strides, showcasing remarkable progress in understanding the intricate details within heterogeneous data modalities. These strides have exhibited tremendous potential for improving clinical decision-making and model interpretation, contributing to the advancement of cancer care and treatment. Given the rapid progress that has been achieved, we provide a comprehensive overview of about 300 papers detailing cutting-edge multimodal data integration techniques in precision oncology. In addition, we conclude the primary clinical applications that have reaped significant benefits, including early assessment, diagnosis, prognosis, and biomarker discovery. Finally, derived from the findings of this survey, we present an in-depth analysis that explores the pivotal challenges and reveals essential pathways for future research in the field of multimodal data integration for precision oncology.

Dia-LLaMA: Towards Large Language Model-driven CT Report Generation

Medical report generation has achieved remarkable advancements yet has still been faced with several challenges. First, the inherent imbalance in the distribution of normal and abnormal cases may lead models to exhibit a biased focus on normal samples, resulting in unreliable diagnoses. Second, the frequent occurrence of common template sentences in the reports may overwhelm the critical abnormal information. Moreover, existing works focus on 2D chest X-rays, leaving CT report generation underexplored due to the high-dimensional nature of CT images and the limited availability of CT-report pairs. Recently, LLM has shown a great ability to generate reliable answers with appropriate prompts, which shed light on addressing the aforementioned challenges. In this paper, we propose Dia-LLaMA, a framework to adapt the LLaMA2-7B for CT report generation by incorporating diagnostic information as guidance prompts. Considering the high dimension of CT, we leverage a pre-trained ViT3D with perceiver to extract the visual information. To tailor the LLM for report generation and emphasize abnormality, we extract additional diagnostic information by referring to a disease prototype memory bank, which is updated during training to capture common disease representations. Furthermore, we introduce disease-aware attention to enable the model to adjust attention for different diseases. Experiments on the chest CT dataset demonstrated that our proposed method outperformed previous methods and achieved state-of-the-art on both clinical efficacy performance and natural language generation metrics. The code will be made publically available.

XCoOp: Explainable Prompt Learning for Computer-Aided Diagnosis via Concept-guided Context Optimization

Utilizing potent representations of the large vision-language models (VLMs) to accomplish various downstream tasks has attracted increasing attention. Within this research field, soft prompt learning has become a representative approach for efficiently adapting VLMs such as CLIP, to tasks like image classification. However, most existing prompt learning methods learn text tokens that are unexplainable, which cannot satisfy the stringent interpretability requirements of Explainable Artificial Intelligence (XAI) in high-stakes scenarios like healthcare. To address this issue, we propose a novel explainable prompt learning framework that leverages medical knowledge by aligning the semantics of images, learnable prompts, and clinical concept-driven prompts at multiple granularities. Moreover, our framework addresses the lack of valuable concept annotations by eliciting knowledge from large language models and offers both visual and textual explanations for the prompts. Extensive experiments and explainability analyses conducted on various datasets, with and without concept labels, demonstrate that our method simultaneously achieves superior diagnostic performance, flexibility, and interpretability, shedding light on the effectiveness of foundation models in facilitating XAI. The code will be made publically available.

Medical Image Debiasing by Learning Adaptive Agreement from a Biased Council

Deep learning could be prone to learning shortcuts raised by dataset bias and result in inaccurate, unreliable, and unfair models, which impedes its adoption in real-world clinical applications. Despite its significance, there is a dearth of research in the medical image classification domain to address dataset bias. Furthermore, the bias labels are often agnostic, as identifying biases can be laborious and depend on post-hoc interpretation. This paper proposes learning Adaptive Agreement from a Biased Council (Ada-ABC), a debiasing framework that does not rely on explicit bias labels to tackle dataset bias in medical images. Ada-ABC develops a biased council consisting of multiple classifiers optimized with generalized cross entropy loss to learn the dataset bias. A debiasing model is then simultaneously trained under the guidance of the biased council. Specifically, the debiasing model is required to learn adaptive agreement with the biased council by agreeing on the correctly predicted samples and disagreeing on the wrongly predicted samples by the biased council. In this way, the debiasing model could learn the target attribute on the samples without spurious correlations while also avoiding ignoring the rich information in samples with spurious correlations. We theoretically demonstrated that the debiasing model could learn the target features when the biased model successfully captures dataset bias. Moreover, to our best knowledge, we constructed the first medical debiasing benchmark from four datasets containing seven different bias scenarios. Our extensive experiments practically showed that our proposed Ada-ABC outperformed competitive approaches, verifying its effectiveness in mitigating dataset bias for medical image classification. The codes and organized benchmark datasets will be made publicly available.

MICA: Towards Explainable Skin Lesion Diagnosis via Multi-Level Image-Concept Alignment

Black-box deep learning approaches have showcased significant potential in the realm of medical image analysis. However, the stringent trustworthiness requirements intrinsic to the medical field have catalyzed research into the utilization of Explainable Artificial Intelligence (XAI), with a particular focus on concept-based methods. Existing concept-based methods predominantly apply concept annotations from a single perspective (e.g., global level), neglecting the nuanced semantic relationships between sub-regions and concepts embedded within medical images. This leads to underutilization of the valuable medical information and may cause models to fall short in harmoniously balancing interpretability and performance when employing inherently interpretable architectures such as Concept Bottlenecks. To mitigate these shortcomings, we propose a multi-modal explainable disease diagnosis framework that meticulously aligns medical images and clinical-related concepts semantically at multiple strata, encompassing the image level, token level, and concept level. Moreover, our method allows for model intervention and offers both textual and visual explanations in terms of human-interpretable concepts. Experimental results on three skin image datasets demonstrate that our method, while preserving model interpretability, attains high performance and label efficiency for concept detection and disease diagnosis.

Rethinking Multiple Instance Learning for Whole Slide Image Classification: A Bag-Level Classifier is a Good Instance-Level Teacher

Multiple Instance Learning (MIL) has demonstrated promise in Whole Slide Image (WSI) classification. However, a major challenge persists due to the high computational cost associated with processing these gigapixel images. Existing methods generally adopt a two-stage approach, comprising a non-learnable feature embedding stage and a classifier training stage. Though it can greatly reduce the memory consumption by using a fixed feature embedder pre-trained on other domains, such scheme also results in a disparity between the two stages, leading to suboptimal classification accuracy. To address this issue, we propose that a bag-level classifier can be a good instance-level teacher. Based on this idea, we design Iteratively Coupled Multiple Instance Learning (ICMIL) to couple the embedder and the bag classifier at a low cost. ICMIL initially fix the patch embedder to train the bag classifier, followed by fixing the bag classifier to fine-tune the patch embedder. The refined embedder can then generate better representations in return, leading to a more accurate classifier for the next iteration. To realize more flexible and more effective embedder fine-tuning, we also introduce a teacher-student framework to efficiently distill the category knowledge in the bag classifier to help the instance-level embedder fine-tuning. Thorough experiments were conducted on four distinct datasets to validate the effectiveness of ICMIL. The experimental results consistently demonstrate that our method significantly improves the performance of existing MIL backbones, achieving state-of-the-art results. The code is available at: https://github.com/Dootmaan/ICMIL/tree/confidence_based

Iterative Semi-Supervised Learning for Abdominal Organs and Tumor Segmentation

Deep-learning (DL) based methods are playing an important role in the task of abdominal organs and tumors segmentation in CT scans. However, the large requirements of annotated datasets heavily limit its development. The FLARE23 challenge provides a large-scale dataset with both partially and fully annotated data, which also focuses on both segmentation accuracy and computational efficiency. In this study, we propose to use the strategy of Semi-Supervised Learning (SSL) and iterative pseudo labeling to address FLARE23. Initially, a deep model (nn-UNet) trained on datasets with complete organ annotations (about 220 scans) generates pseudo labels for the whole dataset. These pseudo labels are then employed to train a more powerful segmentation model. Employing the FLARE23 dataset, our approach achieves an average DSC score of 89.63% for organs and 46.07% for tumors on online validation leaderboard. For organ segmentation, We obtain 0.9007\% DSC and 0.9493\% NSD. For tumor segmentation, we obtain 0.3785% DSC and 0.2842% NSD. Our code is available at https://github.com/USTguy/Flare23.

Deep Omni-supervised Learning for Rib Fracture Detection from Chest Radiology Images

Deep learning (DL)-based rib fracture detection has shown promise of playing an important role in preventing mortality and improving patient outcome. Normally, developing DL-based object detection models requires huge amount of bounding box annotation. However, annotating medical data is time-consuming and expertise-demanding, making obtaining a large amount of fine-grained annotations extremely infeasible. This poses pressing need of developing label-efficient detection models to alleviate radiologists' labeling burden. To tackle this challenge, the literature of object detection has witnessed an increase of weakly-supervised and semi-supervised approaches, yet still lacks a unified framework that leverages various forms of fully-labeled, weakly-labeled, and unlabeled data. In this paper, we present a novel omni-supervised object detection network, ORF-Netv2, to leverage as much available supervision as possible. Specifically, a multi-branch omni-supervised detection head is introduced with each branch trained with a specific type of supervision. A co-training-based dynamic label assignment strategy is then proposed to enable flexibly and robustly learning from the weakly-labeled and unlabeled data. Extensively evaluation was conducted for the proposed framework with three rib fracture datasets on both chest CT and X-ray. By leveraging all forms of supervision, ORF-Netv2 achieves mAPs of 34.7, 44.7, and 19.4 on the three datasets, respectively, surpassing the baseline detector which uses only box annotations by mAP gains of 3.8, 4.8, and 5.0, respectively. Furthermore, ORF-Netv2 consistently outperforms other competitive label-efficient methods over various scenarios, showing a promising framework for label-efficient fracture detection.

Advancing Volumetric Medical Image Segmentation via Global-Local Masked Autoencoder

Masked autoencoder (MAE) has emerged as a promising self-supervised pretraining technique to enhance the representation learning of a neural network without human intervention. To adapt MAE onto volumetric medical images, existing methods exhibit two challenges: first, the global information crucial for understanding the clinical context of the holistic data is lacked; second, there was no guarantee of stabilizing the representations learned from the randomly masked inputs. To tackle these limitations, we proposed Global-Local Masked AutoEncoder (GL-MAE), a simple yet effective self-supervised pre-training strategy. GL-MAE reconstructs both the masked global and masked local volumes, which enables learning the essential local details as well as the global context. We further introduced global-to-global consistency and local-to-global correspondence via global-guided consistency learning to enhance and stabilize the representation learning of the masked volumes. Finetuning results on multiple datasets illustrate the superiority of our method over other state-of-the-art self-supervised algorithms, demonstrating its effectiveness on versatile volumetric medical image segmentation tasks, even when annotations are scarce. Codes and models will be released upon acceptance.