ELIXR: Towards a general purpose X-ray artificial intelligence system through alignment of large language models and radiology vision encoders

Our approach, which we call Embeddings for Language/Image-aligned X-Rays, or ELIXR, leverages a language-aligned image encoder combined or grafted onto a fixed LLM, PaLM 2, to perform a broad range of tasks. We train this lightweight adapter architecture using images paired with corresponding free-text radiology reports from the MIMIC-CXR dataset. ELIXR achieved state-of-the-art performance on zero-shot chest X-ray (CXR) classification (mean AUC of 0.850 across 13 findings), data-efficient CXR classification (mean AUCs of 0.893 and 0.898 across five findings (atelectasis, cardiomegaly, consolidation, pleural effusion, and pulmonary edema) for 1% (~2,200 images) and 10% (~22,000 images) training data), and semantic search (0.76 normalized discounted cumulative gain (NDCG) across nineteen queries, including perfect retrieval on twelve of them). Compared to existing data-efficient methods including supervised contrastive learning (SupCon), ELIXR required two orders of magnitude less data to reach similar performance. ELIXR also showed promise on CXR vision-language tasks, demonstrating overall accuracies of 58.7% and 62.5% on visual question answering and report quality assurance tasks, respectively. These results suggest that ELIXR is a robust and versatile approach to CXR AI.

Factorized Contrastive Learning: Going Beyond Multi-view Redundancy

In a wide range of multimodal tasks, contrastive learning has become a particularly appealing approach since it can successfully learn representations from abundant unlabeled data with only pairing information (e.g., image-caption or video-audio pairs). Underpinning these approaches is the assumption of multi-view redundancy - that shared information between modalities is necessary and sufficient for downstream tasks. However, in many real-world settings, task-relevant information is also contained in modality-unique regions: information that is only present in one modality but still relevant to the task. How can we learn self-supervised multimodal representations to capture both shared and unique information relevant to downstream tasks? This paper proposes FactorCL, a new multimodal representation learning method to go beyond multi-view redundancy. FactorCL is built from three new contributions: (1) factorizing task-relevant information into shared and unique representations, (2) capturing task-relevant information via maximizing MI lower bounds and removing task-irrelevant information via minimizing MI upper bounds, and (3) multimodal data augmentations to approximate task relevance without labels. On large-scale real-world datasets, FactorCL captures both shared and unique information and achieves state-of-the-art results on six benchmarks.