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.
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.
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.
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
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 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.
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.
Convolutional Neural Networks (CNNs) have shown remarkable progress in medical image segmentation. However, lesion segmentation remains a challenge to state-of-the-art CNN-based algorithms due to the variance in scales and shapes. On the one hand, tiny lesions are hard to be delineated precisely from the medical images which are often of low resolutions. On the other hand, segmenting large-size lesions requires large receptive fields, which exacerbates the first challenge. In this paper, we present a scale-aware super-resolution network to adaptively segment lesions of various sizes from the low-resolution medical images. Our proposed network contains dual branches to simultaneously conduct lesion mask super-resolution and lesion image super-resolution. The image super-resolution branch will provide more detailed features for the segmentation branch, i.e., the mask super-resolution branch, for fine-grained segmentation. Meanwhile, we introduce scale-aware dilated convolution blocks into the multi-task decoders to adaptively adjust the receptive fields of the convolutional kernels according to the lesion sizes. To guide the segmentation branch to learn from richer high-resolution features, we propose a feature affinity module and a scale affinity module to enhance the multi-task learning of the dual branches. On multiple challenging lesion segmentation datasets, our proposed network achieved consistent improvements compared to other state-of-the-art methods.
Breast cancer has reached the highest incidence rate worldwide among all malignancies since 2020. Breast imaging plays a significant role in early diagnosis and intervention to improve the outcome of breast cancer patients. In the past decade, deep learning has shown remarkable progress in breast cancer imaging analysis, holding great promise in interpreting the rich information and complex context of breast imaging modalities. Considering the rapid improvement in the deep learning technology and the increasing severity of breast cancer, it is critical to summarize past progress and identify future challenges to be addressed. In this paper, we provide an extensive survey of deep learning-based breast cancer imaging research, covering studies on mammogram, ultrasound, magnetic resonance imaging, and digital pathology images over the past decade. The major deep learning methods, publicly available datasets, and applications on imaging-based screening, diagnosis, treatment response prediction, and prognosis are described in detail. Drawn from the findings of this survey, we present a comprehensive discussion of the challenges and potential avenues for future research in deep learning-based breast cancer imaging.
Federated learning (FL) has been introduced to the healthcare domain as a decentralized learning paradigm that allows multiple parties to train a model collaboratively without privacy leakage. However, most previous studies have assumed that every client holds an identical label set. In reality, medical specialists tend to annotate only diseases within their knowledge domain or interest. This implies that label sets in each client can be different and even disjoint. In this paper, we propose the framework FedLSM to solve the problem Label Set Mismatch. FedLSM adopts different training strategies on data with different uncertainty levels to efficiently utilize unlabeled or partially labeled data as well as class-wise adaptive aggregation in the classification layer to avoid inaccurate aggregation when clients have missing labels. We evaluate FedLSM on two public real-world medical image datasets, including chest x-ray (CXR) diagnosis with 112,120 CXR images and skin lesion diagnosis with 10,015 dermoscopy images, and show that it significantly outperforms other state-of-the-art FL algorithms. Code will be made available upon acceptance.