Multi-Image Visual Question Answering for Unsupervised Anomaly Detection

Unsupervised anomaly detection enables the identification of potential pathological areas by juxtaposing original images with their pseudo-healthy reconstructions generated by models trained exclusively on normal images. However, the clinical interpretation of resultant anomaly maps presents a challenge due to a lack of detailed, understandable explanations. Recent advancements in language models have shown the capability of mimicking human-like understanding and providing detailed descriptions. This raises an interesting question: \textit{How can language models be employed to make the anomaly maps more explainable?} To the best of our knowledge, we are the first to leverage a language model for unsupervised anomaly detection, for which we construct a dataset with different questions and answers. Additionally, we present a novel multi-image visual question answering framework tailored for anomaly detection, incorporating diverse feature fusion strategies to enhance visual knowledge extraction. Our experiments reveal that the framework, augmented by our new Knowledge Q-Former module, adeptly answers questions on the anomaly detection dataset. Besides, integrating anomaly maps as inputs distinctly aids in improving the detection of unseen pathologies.

Weakly Supervised Object Detection in Chest X-Rays with Differentiable ROI Proposal Networks and Soft ROI Pooling

Weakly supervised object detection (WSup-OD) increases the usefulness and interpretability of image classification algorithms without requiring additional supervision. The successes of multiple instance learning in this task for natural images, however, do not translate well to medical images due to the very different characteristics of their objects (i.e. pathologies). In this work, we propose Weakly Supervised ROI Proposal Networks (WSRPN), a new method for generating bounding box proposals on the fly using a specialized region of interest-attention (ROI-attention) module. WSRPN integrates well with classic backbone-head classification algorithms and is end-to-end trainable with only image-label supervision. We experimentally demonstrate that our new method outperforms existing methods in the challenging task of disease localization in chest X-ray images. Code: https://github.com/philip-mueller/wsrpn

Anatomy-Driven Pathology Detection on Chest X-rays

Pathology detection and delineation enables the automatic interpretation of medical scans such as chest X-rays while providing a high level of explainability to support radiologists in making informed decisions. However, annotating pathology bounding boxes is a time-consuming task such that large public datasets for this purpose are scarce. Current approaches thus use weakly supervised object detection to learn the (rough) localization of pathologies from image-level annotations, which is however limited in performance due to the lack of bounding box supervision. We therefore propose anatomy-driven pathology detection (ADPD), which uses easy-to-annotate bounding boxes of anatomical regions as proxies for pathologies. We study two training approaches: supervised training using anatomy-level pathology labels and multiple instance learning (MIL) with image-level pathology labels. Our results show that our anatomy-level training approach outperforms weakly supervised methods and fully supervised detection with limited training samples, and our MIL approach is competitive with both baseline approaches, therefore demonstrating the potential of our approach.

Unlocking the Diagnostic Potential of ECG through Knowledge Transfer from Cardiac MRI

The electrocardiogram (ECG) is a widely available diagnostic tool that allows for a cost-effective and fast assessment of the cardiovascular health. However, more detailed examination with expensive cardiac magnetic resonance (CMR) imaging is often preferred for the diagnosis of cardiovascular diseases. While providing detailed visualization of the cardiac anatomy, CMR imaging is not widely available due to long scan times and high costs. To address this issue, we propose the first self-supervised contrastive approach that transfers domain-specific information from CMR images to ECG embeddings. Our approach combines multimodal contrastive learning with masked data modeling to enable holistic cardiac screening solely from ECG data. In extensive experiments using data from 40,044 UK Biobank subjects, we demonstrate the utility and generalizability of our method. We predict the subject-specific risk of various cardiovascular diseases and determine distinct cardiac phenotypes solely from ECG data. In a qualitative analysis, we demonstrate that our learned ECG embeddings incorporate information from CMR image regions of interest. We make our entire pipeline publicly available, including the source code and pre-trained model weights.

Explainable 2D Vision Models for 3D Medical Data

Training Artificial Intelligence (AI) models on three-dimensional image data presents unique challenges compared to the two-dimensional case: Firstly, the computational resources are significantly higher, and secondly, the availability of large pretraining datasets is often limited, impeding training success. In this study, we propose a simple approach of adapting 2D networks with an intermediate feature representation for processing 3D volumes. Our method involves sequentially applying these networks to slices of a 3D volume from all orientations. Subsequently, a feature reduction module combines the extracted slice features into a single representation, which is then used for classification. We evaluate our approach on medical classification benchmarks and a real-world clinical dataset, demonstrating comparable results to existing methods. Furthermore, by employing attention pooling as a feature reduction module we obtain weighted importance values for each slice during the forward pass. We show that slices deemed important by our approach allow the inspection of the basis of a model's prediction.

Interactive and Explainable Region-guided Radiology Report Generation

The automatic generation of radiology reports has the potential to assist radiologists in the time-consuming task of report writing. Existing methods generate the full report from image-level features, failing to explicitly focus on anatomical regions in the image. We propose a simple yet effective region-guided report generation model that detects anatomical regions and then describes individual, salient regions to form the final report. While previous methods generate reports without the possibility of human intervention and with limited explainability, our method opens up novel clinical use cases through additional interactive capabilities and introduces a high degree of transparency and explainability. Comprehensive experiments demonstrate our method's effectiveness in report generation, outperforming previous state-of-the-art models, and highlight its interactive capabilities. The code and checkpoints are available at https://github.com/ttanida/rgrg .

Robust Detection Outcome: A Metric for Pathology Detection in Medical Images

Detection of pathologies is a fundamental task in medical imaging and the evaluation of algorithms that can perform this task automatically is crucial. However, current object detection metrics for natural images do not reflect the specific clinical requirements in pathology detection sufficiently. To tackle this problem, we propose Robust Detection Outcome (RoDeO); a novel metric for evaluating algorithms for pathology detection in medical images, especially in chest X-rays. RoDeO evaluates different errors directly and individually, and reflects clinical needs better than current metrics. Extensive evaluation on the ChestX-ray8 dataset shows the superiority of our metrics compared to existing ones. We released the code at https://github.com/FeliMe/RoDeO and published RoDeO as pip package (rodeometric).

The Role of Local Alignment and Uniformity in Image-Text Contrastive Learning on Medical Images

Image-text contrastive learning has proven effective for pretraining medical image models. When targeting localized downstream tasks like semantic segmentation or object detection, additional local contrastive losses that align image regions with sentences have shown promising results. We study how local contrastive losses are related to global (per-sample) contrastive losses and which effects they have on localized medical downstream tasks. Based on a theoretical comparison, we propose to remove some components of local losses and replace others by a novel distribution prior which enforces uniformity of representations within each sample. We empirically study this approach on chest X-ray tasks and find it to be very effective, outperforming methods without local losses on 12 of 18 tasks.

Joint Learning of Localized Representations from Medical Images and Reports

Contrastive learning has proven effective for pre-training image models on unlabeled data with promising results for tasks such as medical image classification. Using paired text and images (such as radiological reports and images) during pre-training improved the results even further. Still, most existing methods target image classification as downstream tasks and may not be optimal for localized tasks like semantic segmentation or object detection. We therefore propose Localized representation learning from Vision and Text (LoVT), to our best knowledge, the first text-supervised pre-training method that targets localized medical imaging tasks. Our method combines instance-level image-report contrastive learning with local contrastive learning on image region and report sentence representations. We evaluate LoVT and commonly used pre-training methods on a novel evaluation framework consisting of 18 localized tasks on chest X-rays from five public datasets. While there is no single best method, LoVT performs best on 11 out of the 18 studied tasks making it the preferred method of choice for localized tasks.

Rotation-Equivariant Deep Learning for Diffusion MRI

Convolutional networks are successful, but they have recently been outperformed by new neural networks that are equivariant under rotations and translations. These new networks work better because they do not struggle with learning each possible orientation of each image feature separately. So far, they have been proposed for 2D and 3D data. Here we generalize them to 6D diffusion MRI data, ensuring joint equivariance under 3D roto-translations in image space and the matching 3D rotations in $q$-space, as dictated by the image formation. Such equivariant deep learning is appropriate for diffusion MRI, because microstructural and macrostructural features such as neural fibers can appear at many different orientations, and because even non-rotation-equivariant deep learning has so far been the best method for many diffusion MRI tasks. We validate our equivariant method on multiple-sclerosis lesion segmentation. Our proposed neural networks yield better results and require fewer scans for training compared to non-rotation-equivariant deep learning. They also inherit all the advantages of deep learning over classical diffusion MRI methods. Our implementation is available at https://github.com/philip-mueller/equivariant-deep-dmri and can be used off the shelf without understanding the mathematical background.