Training Small Multimodal Models to Bridge Biomedical Competency Gap: A Case Study in Radiology Imaging

The scaling laws and extraordinary performance of large foundation models motivate the development and utilization of such large models in biomedicine. However, despite early promising results on some biomedical benchmarks, there are still major challenges that need to be addressed before these models can be used in real-world applications. Frontier models such as GPT-4V still have major competency gaps in multimodal capabilities for biomedical applications. Moreover, pragmatic issues such as access, cost, latency, and compliance make it hard for clinicians to use privately-hosted state-of-the-art large models directly on private patient data. In this paper, we explore training open-source small multimodal models (SMMs) to bridge biomedical competency gaps for unmet clinical needs. To maximize data efficiency, we adopt a modular approach by incorporating state-of-the-art pre-trained models for image and text modalities, and focusing on training a lightweight adapter to ground each modality to the text embedding space. We conduct a comprehensive study of this approach on radiology imaging. For training, we assemble a large dataset with over 1 million image-text pairs. For evaluation, we propose a clinically driven novel approach using GPT-4 and demonstrate its parity with expert evaluation. We also study grounding qualitatively using attention. For best practice, we conduct a systematic ablation study on various choices in data engineering and multimodal training. The resulting LLaVA-Rad (7B) model attains state-of-the-art results on radiology tasks such as report generation and cross-modal retrieval, even outperforming much larger models such as GPT-4V and Med-PaLM M (84B). LLaVA-Rad is fast and can be run on a single V100 GPU in private settings, offering a promising state-of-the-art tool for real-world clinical applications.

Foundation Models for Biomedical Image Segmentation: A Survey

Recent advancements in biomedical image analysis have been significantly driven by the Segment Anything Model (SAM). This transformative technology, originally developed for general-purpose computer vision, has found rapid application in medical image processing. Within the last year, marked by over 100 publications, SAM has demonstrated its prowess in zero-shot learning adaptations for medical imaging. The fundamental premise of SAM lies in its capability to segment or identify objects in images without prior knowledge of the object type or imaging modality. This approach aligns well with tasks achievable by the human visual system, though its application in non-biological vision contexts remains more theoretically challenging. A notable feature of SAM is its ability to adjust segmentation according to a specified resolution scale or area of interest, akin to semantic priming. This adaptability has spurred a wave of creativity and innovation in applying SAM to medical imaging. Our review focuses on the period from April 1, 2023, to September 30, 2023, a critical first six months post-initial publication. We examine the adaptations and integrations of SAM necessary to address longstanding clinical challenges, particularly in the context of 33 open datasets covered in our analysis. While SAM approaches or achieves state-of-the-art performance in numerous applications, it falls short in certain areas, such as segmentation of the carotid artery, adrenal glands, optic nerve, and mandible bone. Our survey delves into the innovative techniques where SAM's foundational approach excels and explores the core concepts in translating and applying these models effectively in diverse medical imaging scenarios.

SMURF-THP: Score Matching-based UnceRtainty quantiFication for Transformer Hawkes Process

Transformer Hawkes process models have shown to be successful in modeling event sequence data. However, most of the existing training methods rely on maximizing the likelihood of event sequences, which involves calculating some intractable integral. Moreover, the existing methods fail to provide uncertainty quantification for model predictions, e.g., confidence intervals for the predicted event's arrival time. To address these issues, we propose SMURF-THP, a score-based method for learning Transformer Hawkes process and quantifying prediction uncertainty. Specifically, SMURF-THP learns the score function of events' arrival time based on a score-matching objective that avoids the intractable computation. With such a learned score function, we can sample arrival time of events from the predictive distribution. This naturally allows for the quantification of uncertainty by computing confidence intervals over the generated samples. We conduct extensive experiments in both event type prediction and uncertainty quantification of arrival time. In all the experiments, SMURF-THP outperforms existing likelihood-based methods in confidence calibration while exhibiting comparable prediction accuracy.

FDNeRF: Semantics-Driven Face Reconstruction, Prompt Editing and Relighting with Diffusion Models

The ability to create high-quality 3D faces from a single image has become increasingly important with wide applications in video conferencing, AR/VR, and advanced video editing in movie industries. In this paper, we propose Face Diffusion NeRF (FDNeRF), a new generative method to reconstruct high-quality Face NeRFs from single images, complete with semantic editing and relighting capabilities. FDNeRF utilizes high-resolution 3D GAN inversion and expertly trained 2D latent-diffusion model, allowing users to manipulate and construct Face NeRFs in zero-shot learning without the need for explicit 3D data. With carefully designed illumination and identity preserving loss, as well as multi-modal pre-training, FD-NeRF offers users unparalleled control over the editing process enabling them to create and edit face NeRFs using just single-view images, text prompts, and explicit target lighting. The advanced features of FDNeRF have been designed to produce more impressive results than existing 2D editing approaches that rely on 2D segmentation maps for editable attributes. Experiments show that our FDNeRF achieves exceptionally realistic results and unprecedented flexibility in editing compared with state-of-the-art 3D face reconstruction and editing methods. Our code will be available at https://github.com/BillyXYB/FDNeRF.

Large-Scale Domain-Specific Pretraining for Biomedical Vision-Language Processing

Contrastive pretraining on parallel image-text data has attained great success in vision-language processing (VLP), as exemplified by CLIP and related methods. However, prior explorations tend to focus on general domains in the web. Biomedical images and text are rather different, but publicly available datasets are small and skew toward chest X-ray, thus severely limiting progress. In this paper, we conducted by far the largest study on biomedical VLP, using 15 million figure-caption pairs extracted from biomedical research articles in PubMed Central. Our dataset (PMC-15M) is two orders of magnitude larger than existing biomedical image-text datasets such as MIMIC-CXR, and spans a diverse range of biomedical images. The standard CLIP method is suboptimal for the biomedical domain. We propose BiomedCLIP with domain-specific adaptations tailored to biomedical VLP. We conducted extensive experiments and ablation studies on standard biomedical imaging tasks from retrieval to classification to visual question-answering (VQA). BiomedCLIP established new state of the art in a wide range of standard datasets, substantially outperformed prior VLP approaches. Surprisingly, BiomedCLIP even outperformed radiology-specific state-of-the-art models such as BioViL on radiology-specific tasks such as RSNA pneumonia detection, thus highlighting the utility in large-scale pretraining across all biomedical image types. We will release our models at https://aka.ms/biomedclip to facilitate future research in biomedical VLP.

UnfoldML: Cost-Aware and Uncertainty-Based Dynamic 2D Prediction for Multi-Stage Classification

Machine Learning (ML) research has focused on maximizing the accuracy of predictive tasks. ML models, however, are increasingly more complex, resource intensive, and costlier to deploy in resource-constrained environments. These issues are exacerbated for prediction tasks with sequential classification on progressively transitioned stages with ''happens-before'' relation between them.We argue that it is possible to ''unfold'' a monolithic single multi-class classifier, typically trained for all stages using all data, into a series of single-stage classifiers. Each single-stage classifier can be cascaded gradually from cheaper to more expensive binary classifiers that are trained using only the necessary data modalities or features required for that stage. UnfoldML is a cost-aware and uncertainty-based dynamic 2D prediction pipeline for multi-stage classification that enables (1) navigation of the accuracy/cost tradeoff space, (2) reducing the spatio-temporal cost of inference by orders of magnitude, and (3) early prediction on proceeding stages. UnfoldML achieves orders of magnitude better cost in clinical settings, while detecting multi-stage disease development in real time. It achieves within 0.1% accuracy from the highest-performing multi-class baseline, while saving close to 20X on spatio-temporal cost of inference and earlier (3.5hrs) disease onset prediction. We also show that UnfoldML generalizes to image classification, where it can predict different level of labels (from coarse to fine) given different level of abstractions of a image, saving close to 5X cost with as little as 0.4% accuracy reduction.

TransEditor: Transformer-Based Dual-Space GAN for Highly Controllable Facial Editing

Recent advances like StyleGAN have promoted the growth of controllable facial editing. To address its core challenge of attribute decoupling in a single latent space, attempts have been made to adopt dual-space GAN for better disentanglement of style and content representations. Nonetheless, these methods are still incompetent to obtain plausible editing results with high controllability, especially for complicated attributes. In this study, we highlight the importance of interaction in a dual-space GAN for more controllable editing. We propose TransEditor, a novel Transformer-based framework to enhance such interaction. Besides, we develop a new dual-space editing and inversion strategy to provide additional editing flexibility. Extensive experiments demonstrate the superiority of the proposed framework in image quality and editing capability, suggesting the effectiveness of TransEditor for highly controllable facial editing.

Split-Treatment Analysis to Rank Heterogeneous Causal Effects for Prospective Interventions

For many kinds of interventions, such as a new advertisement, marketing intervention, or feature recommendation, it is important to target a specific subset of people for maximizing its benefits at minimum cost or potential harm. However, a key challenge is that no data is available about the effect of such a prospective intervention since it has not been deployed yet. In this work, we propose a split-treatment analysis that ranks the individuals most likely to be positively affected by a prospective intervention using past observational data. Unlike standard causal inference methods, the split-treatment method does not need any observations of the target treatments themselves. Instead it relies on observations of a proxy treatment that is caused by the target treatment. Under reasonable assumptions, we show that the ranking of heterogeneous causal effect based on the proxy treatment is the same as the ranking based on the target treatment's effect. In the absence of any interventional data for cross-validation, Split-Treatment uses sensitivity analyses for unobserved confounding to select model parameters. We apply Split-Treatment to both a simulated data and a large-scale, real-world targeting task and validate our discovered rankings via a randomized experiment for the latter.

DeepRite: Deep Recurrent Inverse TreatmEnt Weighting for Adjusting Time-varying Confounding in Modern Longitudinal Observational Data

Counterfactual prediction is about predicting outcome of the unobserved situation from the data. For example, given patient is on drug A, what would be the outcome if she switch to drug B. Most of existing works focus on modeling counterfactual outcome based on static data. However, many applications have time-varying confounding effects such as multiple treatments over time. How to model such time-varying effects from longitudinal observational data? How to model complex high-dimensional dependency in the data? To address these challenges, we propose Deep Recurrent Inverse TreatmEnt weighting (DeepRite) by incorporating recurrent neural networks into two-phase adjustments for the existence of time-varying confounding in modern longitudinal data. In phase I cohort reweighting we fit one network for emitting time dependent inverse probabilities of treatment, use them to generate a pseudo balanced cohort. In phase II outcome progression, we input the adjusted data to the subsequent predictive network for making counterfactual predictions. We evaluate DeepRite on both synthetic data and a real data collected from sepsis patients in the intensive care units. DeepRite is shown to recover the ground truth from synthetic data, and estimate unbiased treatment effects from real data that can be better aligned with the standard guidelines for management of sepsis thanks to its applicability to create balanced cohorts.

HOLMES: Health OnLine Model Ensemble Serving for Deep Learning Models in Intensive Care Units

Deep learning models have achieved expert-level performance in healthcare with an exclusive focus on training accurate models. However, in many clinical environments such as intensive care unit (ICU), real-time model serving is equally if not more important than accuracy, because in ICU patient care is simultaneously more urgent and more expensive. Clinical decisions and their timeliness, therefore, directly affect both the patient outcome and the cost of care. To make timely decisions, we argue the underlying serving system must be latency-aware. To compound the challenge, health analytic applications often require a combination of models instead of a single model, to better specialize individual models for different targets, multi-modal data, different prediction windows, and potentially personalized predictions. To address these challenges, we propose HOLMES-an online model ensemble serving framework for healthcare applications. HOLMES dynamically identifies the best performing set of models to ensemble for highest accuracy, while also satisfying sub-second latency constraints on end-to-end prediction. We demonstrate that HOLMES is able to navigate the accuracy/latency tradeoff efficiently, compose the ensemble, and serve the model ensemble pipeline, scaling to simultaneously streaming data from 100 patients, each producing waveform data at 250~Hz. HOLMES outperforms the conventional offline batch-processed inference for the same clinical task in terms of accuracy and latency (by order of magnitude). HOLMES is tested on risk prediction task on pediatric cardio ICU data with above 95% prediction accuracy and sub-second latency on 64-bed simulation.