Recent Advances, Applications, and Open Challenges in Machine Learning for Health: Reflections from Research Roundtables at ML4H 2023 Symposium

The third ML4H symposium was held in person on December 10, 2023, in New Orleans, Louisiana, USA. The symposium included research roundtable sessions to foster discussions between participants and senior researchers on timely and relevant topics for the \ac{ML4H} community. Encouraged by the successful virtual roundtables in the previous year, we organized eleven in-person roundtables and four virtual roundtables at ML4H 2022. The organization of the research roundtables at the conference involved 17 Senior Chairs and 19 Junior Chairs across 11 tables. Each roundtable session included invited senior chairs (with substantial experience in the field), junior chairs (responsible for facilitating the discussion), and attendees from diverse backgrounds with interest in the session's topic. Herein we detail the organization process and compile takeaways from these roundtable discussions, including recent advances, applications, and open challenges for each topic. We conclude with a summary and lessons learned across all roundtables. This document serves as a comprehensive review paper, summarizing the recent advancements in machine learning for healthcare as contributed by foremost researchers in the field.

Demographic Bias of Expert-Level Vision-Language Foundation Models in Medical Imaging

Advances in artificial intelligence (AI) have achieved expert-level performance in medical imaging applications. Notably, self-supervised vision-language foundation models can detect a broad spectrum of pathologies without relying on explicit training annotations. However, it is crucial to ensure that these AI models do not mirror or amplify human biases, thereby disadvantaging historically marginalized groups such as females or Black patients. The manifestation of such biases could systematically delay essential medical care for certain patient subgroups. In this study, we investigate the algorithmic fairness of state-of-the-art vision-language foundation models in chest X-ray diagnosis across five globally-sourced datasets. Our findings reveal that compared to board-certified radiologists, these foundation models consistently underdiagnose marginalized groups, with even higher rates seen in intersectional subgroups, such as Black female patients. Such demographic biases present over a wide range of pathologies and demographic attributes. Further analysis of the model embedding uncovers its significant encoding of demographic information. Deploying AI systems with these biases in medical imaging can intensify pre-existing care disparities, posing potential challenges to equitable healthcare access and raising ethical questions about their clinical application.

AesBench: An Expert Benchmark for Multimodal Large Language Models on Image Aesthetics Perception

With collective endeavors, multimodal large language models (MLLMs) are undergoing a flourishing development. However, their performances on image aesthetics perception remain indeterminate, which is highly desired in real-world applications. An obvious obstacle lies in the absence of a specific benchmark to evaluate the effectiveness of MLLMs on aesthetic perception. This blind groping may impede the further development of more advanced MLLMs with aesthetic perception capacity. To address this dilemma, we propose AesBench, an expert benchmark aiming to comprehensively evaluate the aesthetic perception capacities of MLLMs through elaborate design across dual facets. (1) We construct an Expert-labeled Aesthetics Perception Database (EAPD), which features diversified image contents and high-quality annotations provided by professional aesthetic experts. (2) We propose a set of integrative criteria to measure the aesthetic perception abilities of MLLMs from four perspectives, including Perception (AesP), Empathy (AesE), Assessment (AesA) and Interpretation (AesI). Extensive experimental results underscore that the current MLLMs only possess rudimentary aesthetic perception ability, and there is still a significant gap between MLLMs and humans. We hope this work can inspire the community to engage in deeper explorations on the aesthetic potentials of MLLMs. Source data will be available at https://github.com/yipoh/AesBench.

The Limits of Fair Medical Imaging AI In The Wild

As artificial intelligence (AI) rapidly approaches human-level performance in medical imaging, it is crucial that it does not exacerbate or propagate healthcare disparities. Prior research has established AI's capacity to infer demographic data from chest X-rays, leading to a key concern: do models using demographic shortcuts have unfair predictions across subpopulations? In this study, we conduct a thorough investigation into the extent to which medical AI utilizes demographic encodings, focusing on potential fairness discrepancies within both in-distribution training sets and external test sets. Our analysis covers three key medical imaging disciplines: radiology, dermatology, and ophthalmology, and incorporates data from six global chest X-ray datasets. We confirm that medical imaging AI leverages demographic shortcuts in disease classification. While correcting shortcuts algorithmically effectively addresses fairness gaps to create "locally optimal" models within the original data distribution, this optimality is not true in new test settings. Surprisingly, we find that models with less encoding of demographic attributes are often most "globally optimal", exhibiting better fairness during model evaluation in new test environments. Our work establishes best practices for medical imaging models which maintain their performance and fairness in deployments beyond their initial training contexts, underscoring critical considerations for AI clinical deployments across populations and sites.

Training Robust Deep Physiological Measurement Models with Synthetic Video-based Data

Recent advances in supervised deep learning techniques have demonstrated the possibility to remotely measure human physiological vital signs (e.g., photoplethysmograph, heart rate) just from facial videos. However, the performance of these methods heavily relies on the availability and diversity of real labeled data. Yet, collecting large-scale real-world data with high-quality labels is typically challenging and resource intensive, which also raises privacy concerns when storing personal bio-metric data. Synthetic video-based datasets (e.g., SCAMPS \cite{mcduff2022scamps}) with photo-realistic synthesized avatars are introduced to alleviate the issues while providing high-quality synthetic data. However, there exists a significant gap between synthetic and real-world data, which hinders the generalization of neural models trained on these synthetic datasets. In this paper, we proposed several measures to add real-world noise to synthetic physiological signals and corresponding facial videos. We experimented with individual and combined augmentation methods and evaluated our framework on three public real-world datasets. Our results show that we were able to reduce the average MAE from 6.9 to 2.0.

u-LLaVA: Unifying Multi-Modal Tasks via Large Language Model

Recent advances such as LLaVA and Mini-GPT4 have successfully integrated visual information into LLMs, yielding inspiring outcomes and giving rise to a new generation of multi-modal LLMs, or MLLMs. Nevertheless, these methods struggle with hallucinations and the mutual interference between tasks. To tackle these problems, we propose an efficient and accurate approach to adapt to downstream tasks by utilizing LLM as a bridge to connect multiple expert models, namely u-LLaVA. Firstly, we incorporate the modality alignment module and multi-task modules into LLM. Then, we reorganize or rebuild multi-type public datasets to enable efficient modality alignment and instruction following. Finally, task-specific information is extracted from the trained LLM and provided to different modules for solving downstream tasks. The overall framework is simple, effective, and achieves state-of-the-art performance across multiple benchmarks. We also release our model, the generated data, and the code base publicly available.

Towards long-tailed, multi-label disease classification from chest X-ray: Overview of the CXR-LT challenge

Many real-world image recognition problems, such as diagnostic medical imaging exams, are "long-tailed" $\unicode{x2013}$ there are a few common findings followed by many more relatively rare conditions. In chest radiography, diagnosis is both a long-tailed and multi-label problem, as patients often present with multiple findings simultaneously. While researchers have begun to study the problem of long-tailed learning in medical image recognition, few have studied the interaction of label imbalance and label co-occurrence posed by long-tailed, multi-label disease classification. To engage with the research community on this emerging topic, we conducted an open challenge, CXR-LT, on long-tailed, multi-label thorax disease classification from chest X-rays (CXRs). We publicly release a large-scale benchmark dataset of over 350,000 CXRs, each labeled with at least one of 26 clinical findings following a long-tailed distribution. We synthesize common themes of top-performing solutions, providing practical recommendations for long-tailed, multi-label medical image classification. Finally, we use these insights to propose a path forward involving vision-language foundation models for few- and zero-shot disease classification.

CLIP Brings Better Features to Visual Aesthetics Learners

The success of pre-training approaches on a variety of downstream tasks has revitalized the field of computer vision. Image aesthetics assessment (IAA) is one of the ideal application scenarios for such methods due to subjective and expensive labeling procedure. In this work, an unified and flexible two-phase \textbf{C}LIP-based \textbf{S}emi-supervised \textbf{K}nowledge \textbf{D}istillation paradigm is proposed, namely \textbf{\textit{CSKD}}. Specifically, we first integrate and leverage a multi-source unlabeled dataset to align rich features between a given visual encoder and an off-the-shelf CLIP image encoder via feature alignment loss. Notably, the given visual encoder is not limited by size or structure and, once well-trained, it can seamlessly serve as a better visual aesthetic learner for both student and teacher. In the second phase, the unlabeled data is also utilized in semi-supervised IAA learning to further boost student model performance when applied in latency-sensitive production scenarios. By analyzing the attention distance and entropy before and after feature alignment, we notice an alleviation of feature collapse issue, which in turn showcase the necessity of feature alignment instead of training directly based on CLIP image encoder. Extensive experiments indicate the superiority of CSKD, which achieves state-of-the-art performance on multiple widely used IAA benchmarks.

BigSmall: Efficient Multi-Task Learning for Disparate Spatial and Temporal Physiological Measurements

Understanding of human visual perception has historically inspired the design of computer vision architectures. As an example, perception occurs at different scales both spatially and temporally, suggesting that the extraction of salient visual information may be made more effective by paying attention to specific features at varying scales. Visual changes in the body due to physiological processes also occur at different scales and with modality-specific characteristic properties. Inspired by this, we present BigSmall, an efficient architecture for physiological and behavioral measurement. We present the first joint camera-based facial action, cardiac, and pulmonary measurement model. We propose a multi-branch network with wrapping temporal shift modules that yields both accuracy and efficiency gains. We observe that fusing low-level features leads to suboptimal performance, but that fusing high level features enables efficiency gains with negligible loss in accuracy. Experimental results demonstrate that BigSmall significantly reduces the computational costs. Furthermore, compared to existing task-specific models, BigSmall achieves comparable or better results on multiple physiological measurement tasks simultaneously with a unified model.

Change is Hard: A Closer Look at Subpopulation Shift

Machine learning models often perform poorly on subgroups that are underrepresented in the training data. Yet, little is understood on the variation in mechanisms that cause subpopulation shifts, and how algorithms generalize across such diverse shifts at scale. In this work, we provide a fine-grained analysis of subpopulation shift. We first propose a unified framework that dissects and explains common shifts in subgroups. We then establish a comprehensive benchmark of 20 state-of-the-art algorithms evaluated on 12 real-world datasets in vision, language, and healthcare domains. With results obtained from training over 10,000 models, we reveal intriguing observations for future progress in this space. First, existing algorithms only improve subgroup robustness over certain types of shifts but not others. Moreover, while current algorithms rely on group-annotated validation data for model selection, we find that a simple selection criterion based on worst-class accuracy is surprisingly effective even without any group information. Finally, unlike existing works that solely aim to improve worst-group accuracy (WGA), we demonstrate the fundamental tradeoff between WGA and other important metrics, highlighting the need to carefully choose testing metrics. Code and data are available at: https://github.com/YyzHarry/SubpopBench.