Medical vision language pre-training (VLP) has emerged as a frontier of research, enabling zero-shot pathological recognition by comparing the query image with the textual descriptions for each disease. Due to the complex semantics of biomedical texts, current methods struggle to align medical images with key pathological findings in unstructured reports. This leads to the misalignment with the target disease's textual representation. In this paper, we introduce a novel VLP framework designed to dissect disease descriptions into their fundamental aspects, leveraging prior knowledge about the visual manifestations of pathologies. This is achieved by consulting a large language model and medical experts. Integrating a Transformer module, our approach aligns an input image with the diverse elements of a disease, generating aspect-centric image representations. By consolidating the matches from each aspect, we improve the compatibility between an image and its associated disease. Additionally, capitalizing on the aspect-oriented representations, we present a dual-head Transformer tailored to process known and unknown diseases, optimizing the comprehensive detection efficacy. Conducting experiments on seven downstream datasets, ours outperforms recent methods by up to 8.07% and 11.23% in AUC scores for seen and novel categories, respectively. Our code is released at \href{https://github.com/HieuPhan33/MAVL}{https://github.com/HieuPhan33/MAVL}.
Self-supervised learning is an efficient pre-training method for medical image analysis. However, current research is mostly confined to specific-modality data pre-training, consuming considerable time and resources without achieving universality across different modalities. A straightforward solution is combining all modality data for joint self-supervised pre-training, which poses practical challenges. Firstly, our experiments reveal conflicts in representation learning as the number of modalities increases. Secondly, multi-modal data collected in advance cannot cover all real-world scenarios. In this paper, we reconsider versatile self-supervised learning from the perspective of continual learning and propose MedCoSS, a continuous self-supervised learning approach for multi-modal medical data. Unlike joint self-supervised learning, MedCoSS assigns different modality data to different training stages, forming a multi-stage pre-training process. To balance modal conflicts and prevent catastrophic forgetting, we propose a rehearsal-based continual learning method. We introduce the k-means sampling strategy to retain data from previous modalities and rehearse it when learning new modalities. Instead of executing the pretext task on buffer data, a feature distillation strategy and an intra-modal mixup strategy are applied to these data for knowledge retention. We conduct continuous self-supervised pre-training on a large-scale multi-modal unlabeled dataset, including clinical reports, X-rays, CT scans, MRI scans, and pathological images. Experimental results demonstrate MedCoSS's exceptional generalization ability across nine downstream datasets and its significant scalability in integrating new modality data. Code and pre-trained weight are available at https://github.com/yeerwen/MedCoSS.
Annotation scarcity has become a major obstacle for training powerful deep-learning models for medical image segmentation, restricting their deployment in clinical scenarios. To address it, semi-supervised learning by exploiting abundant unlabeled data is highly desirable to boost the model training. However, most existing works still focus on limited medical tasks and underestimate the potential of learning across diverse tasks and multiple datasets. Therefore, in this paper, we introduce a \textbf{Ver}satile \textbf{Semi}-supervised framework (VerSemi) to point out a new perspective that integrates various tasks into a unified model with a broad label space, to exploit more unlabeled data for semi-supervised medical image segmentation. Specifically, we introduce a dynamic task-prompted design to segment various targets from different datasets. Next, this unified model is used to identify the foreground regions from all labeled data, to capture cross-dataset semantics. Particularly, we create a synthetic task with a cutmix strategy to augment foreground targets within the expanded label space. To effectively utilize unlabeled data, we introduce a consistency constraint. This involves aligning aggregated predictions from various tasks with those from the synthetic task, further guiding the model in accurately segmenting foreground regions during training. We evaluated our VerSemi model on four public benchmarking datasets. Extensive experiments demonstrated that VerSemi can consistently outperform the second-best method by a large margin (e.g., an average 2.69\% Dice gain on four datasets), setting new SOTA performance for semi-supervised medical image segmentation. The code will be released.
We administer a Turing Test to AI Chatbots. We examine how Chatbots behave in a suite of classic behavioral games that are designed to elicit characteristics such as trust, fairness, risk-aversion, cooperation, \textit{etc.}; as well as a traditional Big-5 psychological survey that measures personality traits. ChatGPT-4 passes the Turing Test in that it consistently exhibits human-like behavioral and personality traits based on a comparison to the behavior of hundreds of thousands of humans from more than 50 countries. Chatbots also modify their behavior based on previous experience and contexts ``as if'' they were learning from the interactions, and change their behavior in response to different framings of the same strategic situation. Their behaviors are often distinct from average and modal human behaviors, in which case they tend to behave on the more altruistic and cooperative end of the distribution. We estimate that they act as if they are maximizing an average of their own and partner's payoff.
Medical image segmentation plays a crucial role in advancing healthcare systems for disease diagnosis and treatment planning. The u-shaped architecture, popularly known as U-Net, has proven highly successful for various medical image segmentation tasks. However, U-Net's convolution-based operations inherently limit its ability to model long-range dependencies effectively. To address these limitations, researchers have turned to Transformers, renowned for their global self-attention mechanisms, as alternative architectures. One popular network is our previous TransUNet, which leverages Transformers' self-attention to complement U-Net's localized information with the global context. In this paper, we extend the 2D TransUNet architecture to a 3D network by building upon the state-of-the-art nnU-Net architecture, and fully exploring Transformers' potential in both the encoder and decoder design. We introduce two key components: 1) A Transformer encoder that tokenizes image patches from a convolution neural network (CNN) feature map, enabling the extraction of global contexts, and 2) A Transformer decoder that adaptively refines candidate regions by utilizing cross-attention between candidate proposals and U-Net features. Our investigations reveal that different medical tasks benefit from distinct architectural designs. The Transformer encoder excels in multi-organ segmentation, where the relationship among organs is crucial. On the other hand, the Transformer decoder proves more beneficial for dealing with small and challenging segmented targets such as tumor segmentation. Extensive experiments showcase the significant potential of integrating a Transformer-based encoder and decoder into the u-shaped medical image segmentation architecture. TransUNet outperforms competitors in various medical applications.
Semi-supervised learning (SSL) has been proven beneficial for mitigating the issue of limited labeled data especially on the task of volumetric medical image segmentation. Unlike previous SSL methods which focus on exploring highly confident pseudo-labels or developing consistency regularization schemes, our empirical findings suggest that inconsistent decoder features emerge naturally when two decoders strive to generate consistent predictions. Based on the observation, we first analyze the treasure of discrepancy in learning towards consistency, under both pseudo-labeling and consistency regularization settings, and subsequently propose a novel SSL method called LeFeD, which learns the feature-level discrepancy obtained from two decoders, by feeding the discrepancy as a feedback signal to the encoder. The core design of LeFeD is to enlarge the difference by training differentiated decoders, and then learn from the inconsistent information iteratively. We evaluate LeFeD against eight state-of-the-art (SOTA) methods on three public datasets. Experiments show LeFeD surpasses competitors without any bells and whistles such as uncertainty estimation and strong constraints, as well as setting a new state-of-the-art for semi-supervised medical image segmentation. Code is available at \textcolor{cyan}{https://github.com/maxwell0027/LeFeD}
Intracranial hemorrhage (ICH) is a pathological condition characterized by bleeding inside the skull or brain, which can be attributed to various factors. Identifying, localizing and quantifying ICH has important clinical implications, in a bleed-dependent manner. While deep learning techniques are widely used in medical image segmentation and have been applied to the ICH segmentation task, existing public ICH datasets do not support the multi-class segmentation problem. To address this, we develop the Brain Hemorrhage Segmentation Dataset (BHSD), which provides a 3D multi-class ICH dataset containing 192 volumes with pixel-level annotations and 2200 volumes with slice-level annotations across five categories of ICH. To demonstrate the utility of the dataset, we formulate a series of supervised and semi-supervised ICH segmentation tasks. We provide experimental results with state-of-the-art models as reference benchmarks for further model developments and evaluations on this dataset.
Manual medical image segmentation is subjective and suffers from annotator-related bias, which can be mimicked or amplified by deep learning methods. Recently, researchers have suggested that such bias is the combination of the annotator preference and stochastic error, which are modeled by convolution blocks located after decoder and pixel-wise independent Gaussian distribution, respectively. It is unlikely that convolution blocks can effectively model the varying degrees of preference at the full resolution level. Additionally, the independent pixel-wise Gaussian distribution disregards pixel correlations, leading to a discontinuous boundary. This paper proposes a Transformer-based Annotation Bias-aware (TAB) medical image segmentation model, which tackles the annotator-related bias via modeling annotator preference and stochastic errors. TAB employs the Transformer with learnable queries to extract the different preference-focused features. This enables TAB to produce segmentation with various preferences simultaneously using a single segmentation head. Moreover, TAB takes the multivariant normal distribution assumption that models pixel correlations, and learns the annotation distribution to disentangle the stochastic error. We evaluated our TAB on an OD/OC segmentation benchmark annotated by six annotators. Our results suggest that TAB outperforms existing medical image segmentation models which take into account the annotator-related bias.
Medical image segmentation plays an important role in computer-aided diagnosis. Attention mechanisms that distinguish important parts from irrelevant parts have been widely used in medical image segmentation tasks. This paper systematically reviews the basic principles of attention mechanisms and their applications in medical image segmentation. First, we review the basic concepts of attention mechanism and formulation. Second, we surveyed over 300 articles related to medical image segmentation, and divided them into two groups based on their attention mechanisms, non-Transformer attention and Transformer attention. In each group, we deeply analyze the attention mechanisms from three aspects based on the current literature work, i.e., the principle of the mechanism (what to use), implementation methods (how to use), and application tasks (where to use). We also thoroughly analyzed the advantages and limitations of their applications to different tasks. Finally, we summarize the current state of research and shortcomings in the field, and discuss the potential challenges in the future, including task specificity, robustness, standard evaluation, etc. We hope that this review can showcase the overall research context of traditional and Transformer attention methods, provide a clear reference for subsequent research, and inspire more advanced attention research, not only in medical image segmentation, but also in other image analysis scenarios.
In this paper, we seek to design a report generation model that is able to generate reasonable reports even given different images of various body parts. We start by directly merging multiple datasets and training a single report generation model on this one. We, however, observe that the reports generated in such a simple way only obtain comparable performance compared with that trained separately on each specific dataset. We suspect that this is caused by the dilemma between the diversity of body parts and the limited availability of medical data. To develop robust and generalizable models, it is important to consider a diverse range of body parts and medical conditions. However, collecting a sufficiently large dataset for each specific body part can be difficult due to various factors, such as data availability and privacy concerns. Thus, rather than striving for more data, we propose a single-for-multiple (S4M) framework, which seeks to facilitate the learning of the report generation model with two auxiliary priors: an explicit prior (\ie, feeding radiology-informed knowledge) and an implicit prior (\ie, guided by cross-modal features). Specifically, based on the conventional encoder-decoder report generation framework, we incorporate two extra branches: a Radiology-informed Knowledge Aggregation (RadKA) branch and an Implicit Prior Guidance (IPG) branch. We conduct the experiments on our merged dataset which consists of a public dataset (\ie, IU-Xray) and five private datasets, covering six body parts: chest, abdomen, knee, hip, wrist and shoulder. Our S4M model outperforms all the baselines, regardless of whether they are trained on separate or merged datasets. Code is available at: \url{https://github.com/YtongXie/S4M}.