Multimodal Causal-Driven Representation Learning for Generalizable Medical Image Segmentation

Vision-Language Models (VLMs), such as CLIP, have demonstrated remarkable zero-shot capabilities in various computer vision tasks. However, their application to medical imaging remains challenging due to the high variability and complexity of medical data. Specifically, medical images often exhibit significant domain shifts caused by various confounders, including equipment differences, procedure artifacts, and imaging modes, which can lead to poor generalization when models are applied to unseen domains. To address this limitation, we propose Multimodal Causal-Driven Representation Learning (MCDRL), a novel framework that integrates causal inference with the VLM to tackle domain generalization in medical image segmentation. MCDRL is implemented in two steps: first, it leverages CLIP's cross-modal capabilities to identify candidate lesion regions and construct a confounder dictionary through text prompts, specifically designed to represent domain-specific variations; second, it trains a causal intervention network that utilizes this dictionary to identify and eliminate the influence of these domain-specific variations while preserving the anatomical structural information critical for segmentation tasks. Extensive experiments demonstrate that MCDRL consistently outperforms competing methods, yielding superior segmentation accuracy and exhibiting robust generalizability.

MAP: Evaluation and Multi-Agent Enhancement of Large Language Models for Inpatient Pathways

Inpatient pathways demand complex clinical decision-making based on comprehensive patient information, posing critical challenges for clinicians. Despite advancements in large language models (LLMs) in medical applications, limited research focused on artificial intelligence (AI) inpatient pathways systems, due to the lack of large-scale inpatient datasets. Moreover, existing medical benchmarks typically concentrated on medical question-answering and examinations, ignoring the multifaceted nature of clinical decision-making in inpatient settings. To address these gaps, we first developed the Inpatient Pathway Decision Support (IPDS) benchmark from the MIMIC-IV database, encompassing 51,274 cases across nine triage departments and 17 major disease categories alongside 16 standardized treatment options. Then, we proposed the Multi-Agent Inpatient Pathways (MAP) framework to accomplish inpatient pathways with three clinical agents, including a triage agent managing the patient admission, a diagnosis agent serving as the primary decision maker at the department, and a treatment agent providing treatment plans. Additionally, our MAP framework includes a chief agent overseeing the inpatient pathways to guide and promote these three clinician agents. Extensive experiments showed our MAP improved the diagnosis accuracy by 25.10% compared to the state-of-the-art LLM HuatuoGPT2-13B. It is worth noting that our MAP demonstrated significant clinical compliance, outperforming three board-certified clinicians by 10%-12%, establishing a foundation for inpatient pathways systems.

SurgBox: Agent-Driven Operating Room Sandbox with Surgery Copilot

Surgical interventions, particularly in neurology, represent complex and high-stakes scenarios that impose substantial cognitive burdens on surgical teams. Although deliberate education and practice can enhance cognitive capabilities, surgical training opportunities remain limited due to patient safety concerns. To address these cognitive challenges in surgical training and operation, we propose SurgBox, an agent-driven sandbox framework to systematically enhance the cognitive capabilities of surgeons in immersive surgical simulations. Specifically, our SurgBox leverages large language models (LLMs) with tailored Retrieval-Augmented Generation (RAG) to authentically replicate various surgical roles, enabling realistic training environments for deliberate practice. In particular, we devise Surgery Copilot, an AI-driven assistant to actively coordinate the surgical information stream and support clinical decision-making, thereby diminishing the cognitive workload of surgical teams during surgery. By incorporating a novel Long-Short Memory mechanism, our Surgery Copilot can effectively balance immediate procedural assistance with comprehensive surgical knowledge. Extensive experiments using real neurosurgical procedure records validate our SurgBox framework in both enhancing surgical cognitive capabilities and supporting clinical decision-making. By providing an integrated solution for training and operational support to address cognitive challenges, our SurgBox framework advances surgical education and practice, potentially transforming surgical outcomes and healthcare quality. The code is available at https://github.com/franciszchen/SurgBox.