FairDomain: Achieving Fairness in Cross-Domain Medical Image Segmentation and Classification

Addressing fairness in artificial intelligence (AI), particularly in medical AI, is crucial for ensuring equitable healthcare outcomes. Recent efforts to enhance fairness have introduced new methodologies and datasets in medical AI. However, the fairness issue under the setting of domain transfer is almost unexplored, while it is common that clinics rely on different imaging technologies (e.g., different retinal imaging modalities) for patient diagnosis. This paper presents FairDomain, a pioneering systemic study into algorithmic fairness under domain shifts, employing state-of-the-art domain adaptation (DA) and generalization (DG) algorithms for both medical segmentation and classification tasks to understand how biases are transferred between different domains. We also introduce a novel plug-and-play fair identity attention (FIA) module that adapts to various DA and DG algorithms to improve fairness by using self-attention to adjust feature importance based on demographic attributes. Additionally, we curate the first fairness-focused dataset with two paired imaging modalities for the same patient cohort on medical segmentation and classification tasks, to rigorously assess fairness in domain-shift scenarios. Excluding the confounding impact of demographic distribution variation between source and target domains will allow clearer quantification of the performance of domain transfer models. Our extensive evaluations reveal that the proposed FIA significantly enhances both model performance accounted for fairness across all domain shift settings (i.e., DA and DG) with respect to different demographics, which outperforms existing methods on both segmentation and classification. The code and data can be accessed at https://ophai.hms.harvard.edu/datasets/harvard-fairdomain20k.

FairCLIP: Harnessing Fairness in Vision-Language Learning

Fairness is a critical concern in deep learning, especially in healthcare, where these models influence diagnoses and treatment decisions. Although fairness has been investigated in the vision-only domain, the fairness of medical vision-language (VL) models remains unexplored due to the scarcity of medical VL datasets for studying fairness. To bridge this research gap, we introduce the first fair vision-language medical dataset Harvard-FairVLMed that provides detailed demographic attributes, ground-truth labels, and clinical notes to facilitate an in-depth examination of fairness within VL foundation models. Using Harvard-FairVLMed, we conduct a comprehensive fairness analysis of two widely-used VL models (CLIP and BLIP2), pre-trained on both natural and medical domains, across four different protected attributes. Our results highlight significant biases in all VL models, with Asian, Male, Non-Hispanic, and Spanish being the preferred subgroups across the protected attributes of race, gender, ethnicity, and language, respectively. In order to alleviate these biases, we propose FairCLIP, an optimal-transport-based approach that achieves a favorable trade-off between performance and fairness by reducing the Sinkhorn distance between the overall sample distribution and the distributions corresponding to each demographic group. As the first VL dataset of its kind, Harvard-FairVLMed holds the potential to catalyze advancements in the development of machine learning models that are both ethically aware and clinically effective. Our dataset and code are available at https://ophai.hms.harvard.edu/datasets/harvard-fairvlmed10k.

MeSa: Masked, Geometric, and Supervised Pre-training for Monocular Depth Estimation

Pre-training has been an important ingredient in developing strong monocular depth estimation models in recent years. For instance, self-supervised learning (SSL) is particularly effective by alleviating the need for large datasets with dense ground-truth depth maps. However, despite these improvements, our study reveals that the later layers of the SOTA SSL method are actually suboptimal. By examining the layer-wise representations, we demonstrate significant changes in these later layers during fine-tuning, indicating the ineffectiveness of their pre-trained features for depth estimation. To address these limitations, we propose MeSa, a comprehensive framework that leverages the complementary strengths of masked, geometric, and supervised pre-training. Hence, MeSa benefits from not only general-purpose representations learnt via masked pre training but also specialized depth-specific features acquired via geometric and supervised pre-training. Our CKA layer-wise analysis confirms that our pre-training strategy indeed produces improved representations for the later layers, overcoming the drawbacks of the SOTA SSL method. Furthermore, via experiments on the NYUv2 and IBims-1 datasets, we demonstrate that these enhanced representations translate to performance improvements in both the in-distribution and out-of-distribution settings. We also investigate the influence of the pre-training dataset and demonstrate the efficacy of pre-training on LSUN, which yields significantly better pre-trained representations. Overall, our approach surpasses the masked pre-training SSL method by a substantial margin of 17.1% on the RMSE. Moreover, even without utilizing any recently proposed techniques, MeSa also outperforms the most recent methods and establishes a new state-of-the-art for monocular depth estimation on the challenging NYUv2 dataset.

Revisiting Fine-Tuning Strategies for Self-supervised Medical Imaging Analysis

Despite the rapid progress in self-supervised learning (SSL), end-to-end fine-tuning still remains the dominant fine-tuning strategy for medical imaging analysis. However, it remains unclear whether this approach is truly optimal for effectively utilizing the pre-trained knowledge, especially considering the diverse categories of SSL that capture different types of features. In this paper, we first establish strong contrastive and restorative SSL baselines that outperform SOTA methods across four diverse downstream tasks. Building upon these strong baselines, we conduct an extensive fine-tuning analysis across multiple pre-training and fine-tuning datasets, as well as various fine-tuning dataset sizes. Contrary to the conventional wisdom of fine-tuning only the last few layers of a pre-trained network, we show that fine-tuning intermediate layers is more effective, with fine-tuning the second quarter (25-50%) of the network being optimal for contrastive SSL whereas fine-tuning the third quarter (50-75%) of the network being optimal for restorative SSL. Compared to the de-facto standard of end-to-end fine-tuning, our best fine-tuning strategy, which fine-tunes a shallower network consisting of the first three quarters (0-75%) of the pre-trained network, yields improvements of as much as 5.48%. Additionally, using these insights, we propose a simple yet effective method to leverage the complementary strengths of multiple SSL models, resulting in enhancements of up to 3.57% compared to using the best model alone. Hence, our fine-tuning strategies not only enhance the performance of individual SSL models, but also enable effective utilization of the complementary strengths offered by multiple SSL models, leading to significant improvements in self-supervised medical imaging analysis.