Large Language Models for Outpatient Referral: Problem Definition, Benchmarking and Challenges

Large language models (LLMs) are increasingly applied to outpatient referral tasks across healthcare systems. However, there is a lack of standardized evaluation criteria to assess their effectiveness, particularly in dynamic, interactive scenarios. In this study, we systematically examine the capabilities and limitations of LLMs in managing tasks within Intelligent Outpatient Referral (IOR) systems and propose a comprehensive evaluation framework specifically designed for such systems. This framework comprises two core tasks: static evaluation, which focuses on evaluating the ability of predefined outpatient referrals, and dynamic evaluation, which evaluates capabilities of refining outpatient referral recommendations through iterative dialogues. Our findings suggest that LLMs offer limited advantages over BERT-like models, but show promise in asking effective questions during interactive dialogues.

Add-One-In: Incremental Sample Selection for Large Language Models via a Choice-Based Greedy Paradigm

Selecting high-quality and diverse training samples from extensive datasets plays a crucial role in reducing training overhead and enhancing the performance of Large Language Models (LLMs). However, existing studies fall short in assessing the overall value of selected data, focusing primarily on individual quality, and struggle to strike an effective balance between ensuring diversity and minimizing data point traversals. Therefore, this paper introduces a novel choice-based sample selection framework that shifts the focus from evaluating individual sample quality to comparing the contribution value of different samples when incorporated into the subset. Thanks to the advanced language understanding capabilities of LLMs, we utilize LLMs to evaluate the value of each option during the selection process. Furthermore, we design a greedy sampling process where samples are incrementally added to the subset, thereby improving efficiency by eliminating the need for exhaustive traversal of the entire dataset with the limited budget. Extensive experiments demonstrate that selected data from our method not only surpass the performance of the full dataset but also achieves competitive results with state-of-the-art (SOTA) studies, while requiring fewer selections. Moreover, we validate our approach on a larger medical dataset, highlighting its practical applicability in real-world applications.

BS-LDM: Effective Bone Suppression in High-Resolution Chest X-Ray Images with Conditional Latent Diffusion Models

The interference of overlapping bones and pulmonary structures can reduce the effectiveness of Chest X-ray (CXR) examinations. Bone suppression techniques have been developed to improve diagnostic accuracy. Dual-energy subtraction (DES) imaging, a common method for bone suppression, is costly and exposes patients to higher radiation levels. Deep learning-based image generation methods have been proposed as alternatives, however, they often fail to produce high-quality and high-resolution images, resulting in the loss of critical lesion information and texture details. To address these issues, in this paper, we introduce an end-to-end framework for bone suppression in high-resolution CXR images, termed BS-LDM. This framework employs a conditional latent diffusion model to generate high-resolution soft tissue images with fine detail and critical lung pathology by performing bone suppression in the latent space. We implement offset noise during the noise addition phase of the training process to better render low-frequency information in soft tissue images. Additionally, we introduce a dynamic clipping strategy during the sampling process to refine pixel intensity in the generated soft tissue images. We compiled a substantial and high-quality bone suppression dataset, SZCH-X-Rays, including high-resolution paired CXR and DES soft tissue images from 818 patients, collected from our partner hospitals. Moreover, we pre-processed 241 pairs of CXR and DES soft tissue images from the JSRT dataset, the largest publicly available dataset. Comprehensive experimental and clinical evaluations demonstrate that BS-LDM exhibits superior bone suppression capabilities, highlighting its significant clinical potential.

Privacy-Preserving Federated Foundation Model for Generalist Ultrasound Artificial Intelligence

Ultrasound imaging is widely used in clinical diagnosis due to its non-invasive nature and real-time capabilities. However, conventional ultrasound diagnostics face several limitations, including high dependence on physician expertise and suboptimal image quality, which complicates interpretation and increases the likelihood of diagnostic errors. Artificial intelligence (AI) has emerged as a promising solution to enhance clinical diagnosis, particularly in detecting abnormalities across various biomedical imaging modalities. Nonetheless, current AI models for ultrasound imaging face critical challenges. First, these models often require large volumes of labeled medical data, raising concerns over patient privacy breaches. Second, most existing models are task-specific, which restricts their broader clinical utility. To overcome these challenges, we present UltraFedFM, an innovative privacy-preserving ultrasound foundation model. UltraFedFM is collaboratively pre-trained using federated learning across 16 distributed medical institutions in 9 countries, leveraging a dataset of over 1 million ultrasound images covering 19 organs and 10 ultrasound modalities. This extensive and diverse data, combined with a secure training framework, enables UltraFedFM to exhibit strong generalization and diagnostic capabilities. It achieves an average area under the receiver operating characteristic curve of 0.927 for disease diagnosis and a dice similarity coefficient of 0.878 for lesion segmentation. Notably, UltraFedFM surpasses the diagnostic accuracy of mid-level ultrasonographers and matches the performance of expert-level sonographers in the joint diagnosis of 8 common systemic diseases. These findings indicate that UltraFedFM can significantly enhance clinical diagnostics while safeguarding patient privacy, marking an advancement in AI-driven ultrasound imaging for future clinical applications.

An Empirical Study on Information Extraction using Large Language Models

Human-like large language models (LLMs), especially the most powerful and popular ones in OpenAI's GPT family, have proven to be very helpful for many natural language processing (NLP) related tasks. Therefore, various attempts have been made to apply LLMs to information extraction (IE), which is a fundamental NLP task that involves extracting information from unstructured plain text. To demonstrate the latest representative progress in LLMs' information extraction ability, we assess the information extraction ability of GPT-4 (the latest version of GPT at the time of writing this paper) from four perspectives: Performance, Evaluation Criteria, Robustness, and Error Types. Our results suggest a visible performance gap between GPT-4 and state-of-the-art (SOTA) IE methods. To alleviate this problem, considering the LLMs' human-like characteristics, we propose and analyze the effects of a series of simple prompt-based methods, which can be generalized to other LLMs and NLP tasks. Rich experiments show our methods' effectiveness and some of their remaining issues in improving GPT-4's information extraction ability.

Self-Instructed Derived Prompt Generation Meets In-Context Learning: Unlocking New Potential of Black-Box LLMs

Large language models (LLMs) have shown success in generating high-quality responses. In order to achieve better alignment with LLMs with human preference, various works are proposed based on specific optimization process, which, however, is not suitable to Black-Box LLMs like GPT-4, due to inaccessible parameters. In Black-Box LLMs case, their performance is highly dependent on the quality of the provided prompts. Existing methods to enhance response quality often involve a prompt refinement model, yet these approaches potentially suffer from semantic inconsistencies between the refined and original prompts, and typically overlook the relationship between them. To address these challenges, we introduce a self-instructed in-context learning framework that empowers LLMs to deliver more effective responses by generating reliable derived prompts to construct informative contextual environments. Our approach incorporates a self-instructed reinforcement learning mechanism, enabling direct interaction with the response model during derived prompt generation for better alignment. We then formulate querying as an in-context learning task, using responses from LLMs combined with the derived prompts to establish a contextual demonstration for the original prompt. This strategy ensures alignment with the original query, reduces discrepancies from refined prompts, and maximizes the LLMs' in-context learning capability. Extensive experiments demonstrate that the proposed method not only generates more reliable derived prompts but also significantly enhances LLMs' ability to deliver more effective responses, including Black-Box models such as GPT-4.

Detecting AI Flaws: Target-Driven Attacks on Internal Faults in Language Models

Large Language Models (LLMs) have become a focal point in the rapidly evolving field of artificial intelligence. However, a critical concern is the presence of toxic content within the pre-training corpus of these models, which can lead to the generation of inappropriate outputs. Investigating methods for detecting internal faults in LLMs can help us understand their limitations and improve their security. Existing methods primarily focus on jailbreaking attacks, which involve manually or automatically constructing adversarial content to prompt the target LLM to generate unexpected responses. These methods rely heavily on prompt engineering, which is time-consuming and usually requires specially designed questions. To address these challenges, this paper proposes a target-driven attack paradigm that focuses on directly eliciting the target response instead of optimizing the prompts. We introduce the use of another LLM as the detector for toxic content, referred to as ToxDet. Given a target toxic response, ToxDet can generate a possible question and a preliminary answer to provoke the target model into producing desired toxic responses with meanings equivalent to the provided one. ToxDet is trained by interacting with the target LLM and receiving reward signals from it, utilizing reinforcement learning for the optimization process. While the primary focus of the target models is on open-source LLMs, the fine-tuned ToxDet can also be transferred to attack black-box models such as GPT-4o, achieving notable results. Experimental results on AdvBench and HH-Harmless datasets demonstrate the effectiveness of our methods in detecting the tendencies of target LLMs to generate harmful responses. This algorithm not only exposes vulnerabilities but also provides a valuable resource for researchers to strengthen their models against such attacks.

Let Video Teaches You More: Video-to-Image Knowledge Distillation using DEtection TRansformer for Medical Video Lesion Detection

AI-assisted lesion detection models play a crucial role in the early screening of cancer. However, previous image-based models ignore the inter-frame contextual information present in videos. On the other hand, video-based models capture the inter-frame context but are computationally expensive. To mitigate this contradiction, we delve into Video-to-Image knowledge distillation leveraging DEtection TRansformer (V2I-DETR) for the task of medical video lesion detection. V2I-DETR adopts a teacher-student network paradigm. The teacher network aims at extracting temporal contexts from multiple frames and transferring them to the student network, and the student network is an image-based model dedicated to fast prediction in inference. By distilling multi-frame contexts into a single frame, the proposed V2I-DETR combines the advantages of utilizing temporal contexts from video-based models and the inference speed of image-based models. Through extensive experiments, V2I-DETR outperforms previous state-of-the-art methods by a large margin while achieving the real-time inference speed (30 FPS) as the image-based model.

Towards a Benchmark for Colorectal Cancer Segmentation in Endorectal Ultrasound Videos: Dataset and Model Development

Endorectal ultrasound (ERUS) is an important imaging modality that provides high reliability for diagnosing the depth and boundary of invasion in colorectal cancer. However, the lack of a large-scale ERUS dataset with high-quality annotations hinders the development of automatic ultrasound diagnostics. In this paper, we collected and annotated the first benchmark dataset that covers diverse ERUS scenarios, i.e. colorectal cancer segmentation, detection, and infiltration depth staging. Our ERUS-10K dataset comprises 77 videos and 10,000 high-resolution annotated frames. Based on this dataset, we further introduce a benchmark model for colorectal cancer segmentation, named the Adaptive Sparse-context TRansformer (ASTR). ASTR is designed based on three considerations: scanning mode discrepancy, temporal information, and low computational complexity. For generalizing to different scanning modes, the adaptive scanning-mode augmentation is proposed to convert between raw sector images and linear scan ones. For mining temporal information, the sparse-context transformer is incorporated to integrate inter-frame local and global features. For reducing computational complexity, the sparse-context block is introduced to extract contextual features from auxiliary frames. Finally, on the benchmark dataset, the proposed ASTR model achieves a 77.6% Dice score in rectal cancer segmentation, largely outperforming previous state-of-the-art methods.

Diffuse-UDA: Addressing Unsupervised Domain Adaptation in Medical Image Segmentation with Appearance and Structure Aligned Diffusion Models

The scarcity and complexity of voxel-level annotations in 3D medical imaging present significant challenges, particularly due to the domain gap between labeled datasets from well-resourced centers and unlabeled datasets from less-resourced centers. This disparity affects the fairness of artificial intelligence algorithms in healthcare. We introduce Diffuse-UDA, a novel method leveraging diffusion models to tackle Unsupervised Domain Adaptation (UDA) in medical image segmentation. Diffuse-UDA generates high-quality image-mask pairs with target domain characteristics and various structures, thereby enhancing UDA tasks. Initially, pseudo labels for target domain samples are generated. Subsequently, a specially tailored diffusion model, incorporating deformable augmentations, is trained on image-label or image-pseudo-label pairs from both domains. Finally, source domain labels guide the diffusion model to generate image-label pairs for the target domain. Comprehensive evaluations on several benchmarks demonstrate that Diffuse-UDA outperforms leading UDA and semi-supervised strategies, achieving performance close to or even surpassing the theoretical upper bound of models trained directly on target domain data. Diffuse-UDA offers a pathway to advance the development and deployment of AI systems in medical imaging, addressing disparities between healthcare environments. This approach enables the exploration of innovative AI-driven diagnostic tools, improves outcomes, saves time, and reduces human error.