Preference Fine-Tuning for Factuality in Chest X-Ray Interpretation Models Without Human Feedback

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Overview of the First Shared Task on Clinical Text Generation: RRG24 and "Discharge Me!"

Recent developments in natural language generation have tremendous implications for healthcare. For instance, state-of-the-art systems could automate the generation of sections in clinical reports to alleviate physician workload and streamline hospital documentation. To explore these applications, we present a shared task consisting of two subtasks: (1) Radiology Report Generation (RRG24) and (2) Discharge Summary Generation ("Discharge Me!"). RRG24 involves generating the 'Findings' and 'Impression' sections of radiology reports given chest X-rays. "Discharge Me!" involves generating the 'Brief Hospital Course' and 'Discharge Instructions' sections of discharge summaries for patients admitted through the emergency department. "Discharge Me!" submissions were subsequently reviewed by a team of clinicians. Both tasks emphasize the goal of reducing clinician burnout and repetitive workloads by generating documentation. We received 201 submissions from across 8 teams for RRG24, and 211 submissions from across 16 teams for "Discharge Me!".

Merlin: A Vision Language Foundation Model for 3D Computed Tomography

Over 85 million computed tomography (CT) scans are performed annually in the US, of which approximately one quarter focus on the abdomen. Given the current radiologist shortage, there is a large impetus to use artificial intelligence to alleviate the burden of interpreting these complex imaging studies. Prior state-of-the-art approaches for automated medical image interpretation leverage vision language models (VLMs). However, current medical VLMs are generally limited to 2D images and short reports, and do not leverage electronic health record (EHR) data for supervision. We introduce Merlin - a 3D VLM that we train using paired CT scans (6+ million images from 15,331 CTs), EHR diagnosis codes (1.8+ million codes), and radiology reports (6+ million tokens). We evaluate Merlin on 6 task types and 752 individual tasks. The non-adapted (off-the-shelf) tasks include zero-shot findings classification (31 findings), phenotype classification (692 phenotypes), and zero-shot cross-modal retrieval (image to findings and image to impressions), while model adapted tasks include 5-year disease prediction (6 diseases), radiology report generation, and 3D semantic segmentation (20 organs). We perform internal validation on a test set of 5,137 CTs, and external validation on 7,000 clinical CTs and on two public CT datasets (VerSe, TotalSegmentator). Beyond these clinically-relevant evaluations, we assess the efficacy of various network architectures and training strategies to depict that Merlin has favorable performance to existing task-specific baselines. We derive data scaling laws to empirically assess training data needs for requisite downstream task performance. Furthermore, unlike conventional VLMs that require hundreds of GPUs for training, we perform all training on a single GPU.

CheXpert Plus: Augmenting a Large Chest X-ray Dataset with Text Radiology Reports, Patient Demographics and Additional Image Formats

Since the release of the original CheXpert paper five years ago, CheXpert has become one of the most widely used and cited clinical AI datasets. The emergence of vision language models has sparked an increase in demands for sharing reports linked to CheXpert images, along with a growing interest among AI fairness researchers in obtaining demographic data. To address this, CheXpert Plus serves as a new collection of radiology data sources, made publicly available to enhance the scaling, performance, robustness, and fairness of models for all subsequent machine learning tasks in the field of radiology. CheXpert Plus is the largest text dataset publicly released in radiology, with a total of 36 million text tokens, including 13 million impression tokens. To the best of our knowledge, it represents the largest text de-identification effort in radiology, with almost 1 million PHI spans anonymized. It is only the second time that a large-scale English paired dataset has been released in radiology, thereby enabling, for the first time, cross-institution training at scale. All reports are paired with high-quality images in DICOM format, along with numerous image and patient metadata covering various clinical and socio-economic groups, as well as many pathology labels and RadGraph annotations. We hope this dataset will boost research for AI models that can further assist radiologists and help improve medical care. Data is available at the following URL: https://stanfordaimi.azurewebsites.net/datasets/5158c524-d3ab-4e02-96e9-6ee9efc110a1 Models are available at the following URL: https://github.com/Stanford-AIMI/chexpert-plus

GREEN: Generative Radiology Report Evaluation and Error Notation

Evaluating radiology reports is a challenging problem as factual correctness is extremely important due to the need for accurate medical communication about medical images. Existing automatic evaluation metrics either suffer from failing to consider factual correctness (e.g., BLEU and ROUGE) or are limited in their interpretability (e.g., F1CheXpert and F1RadGraph). In this paper, we introduce GREEN (Generative Radiology Report Evaluation and Error Notation), a radiology report generation metric that leverages the natural language understanding of language models to identify and explain clinically significant errors in candidate reports, both quantitatively and qualitatively. Compared to current metrics, GREEN offers: 1) a score aligned with expert preferences, 2) human interpretable explanations of clinically significant errors, enabling feedback loops with end-users, and 3) a lightweight open-source method that reaches the performance of commercial counterparts. We validate our GREEN metric by comparing it to GPT-4, as well as to error counts of 6 experts and preferences of 2 experts. Our method demonstrates not only higher correlation with expert error counts, but simultaneously higher alignment with expert preferences when compared to previous approaches."

Large Multimodal Agents: A Survey

Large language models (LLMs) have achieved superior performance in powering text-based AI agents, endowing them with decision-making and reasoning abilities akin to humans. Concurrently, there is an emerging research trend focused on extending these LLM-powered AI agents into the multimodal domain. This extension enables AI agents to interpret and respond to diverse multimodal user queries, thereby handling more intricate and nuanced tasks. In this paper, we conduct a systematic review of LLM-driven multimodal agents, which we refer to as large multimodal agents ( LMAs for short). First, we introduce the essential components involved in developing LMAs and categorize the current body of research into four distinct types. Subsequently, we review the collaborative frameworks integrating multiple LMAs , enhancing collective efficacy. One of the critical challenges in this field is the diverse evaluation methods used across existing studies, hindering effective comparison among different LMAs . Therefore, we compile these evaluation methodologies and establish a comprehensive framework to bridge the gaps. This framework aims to standardize evaluations, facilitating more meaningful comparisons. Concluding our review, we highlight the extensive applications of LMAs and propose possible future research directions. Our discussion aims to provide valuable insights and guidelines for future research in this rapidly evolving field. An up-to-date resource list is available at https://github.com/jun0wanan/awesome-large-multimodal-agents.

ALLaVA: Harnessing GPT4V-synthesized Data for A Lite Vision-Language Model

Recent advancements in Large Vision-Language Models (LVLMs) have enabled processing of multimodal inputs in language models but require significant computational resources for deployment, especially in edge devices. This study aims to bridge the performance gap between traditional-scale LVLMs and resource-friendly lite versions by adopting high-quality training data. To do this, a synthetic dataset is created by leveraging GPT-4V's ability to generate detailed captions, complex reasoning instructions and detailed answers from images. The resulted model trained with our data, ALLaVA, achieves competitive performance on 12 benchmarks up to 3B LVLMs. This work highlights the feasibility of adopting high-quality data in crafting more efficient LVLMs. Our online demo is available at \url{https://allava.freedomai.cn}.

CheXagent: Towards a Foundation Model for Chest X-Ray Interpretation

Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing \emph{CheXinstruct} - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present \emph{CheXagent} - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce \emph{CheXbench} - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at \url{https://stanford-aimi.github.io/chexagent.html}.

MLLM-Bench, Evaluating Multi-modal LLMs using GPT-4V

In the pursuit of Artificial General Intelligence (AGI), the integration of vision in language models has marked a significant milestone. The advent of vision-language models (MLLMs) like GPT-4V have expanded AI applications, aligning with the multi-modal capabilities of the human brain. However, evaluating the efficacy of MLLMs poses a substantial challenge due to the subjective nature of tasks that lack definitive answers. Existing automatic evaluation methodologies on multi-modal large language models rely on objective queries that have standard answers, inadequately addressing the nuances of creative and associative multi-modal tasks. To address this, we introduce MLLM-Bench, an innovative benchmark inspired by Vicuna, spanning a diverse array of scenarios, including Perception, Understanding, Applying, Analyzing, Evaluating, and Creation along with the ethical consideration. MLLM-Bench is designed to reflect user experience more accurately and provide a more holistic assessment of model performance. Comparative evaluations indicate a significant performance gap between existing open-source models and GPT-4V. We posit that MLLM-Bench will catalyze progress in the open-source community towards developing user-centric vision-language models that meet a broad spectrum of real-world applications. See online leaderboard in \url{https://mllm-bench.llmzoo.com}.

Exploiting Low-confidence Pseudo-labels for Source-free Object Detection

Source-free object detection (SFOD) aims to adapt a source-trained detector to an unlabeled target domain without access to the labeled source data. Current SFOD methods utilize a threshold-based pseudo-label approach in the adaptation phase, which is typically limited to high-confidence pseudo-labels and results in a loss of information. To address this issue, we propose a new approach to take full advantage of pseudo-labels by introducing high and low confidence thresholds. Specifically, the pseudo-labels with confidence scores above the high threshold are used conventionally, while those between the low and high thresholds are exploited using the Low-confidence Pseudo-labels Utilization (LPU) module. The LPU module consists of Proposal Soft Training (PST) and Local Spatial Contrastive Learning (LSCL). PST generates soft labels of proposals for soft training, which can mitigate the label mismatch problem. LSCL exploits the local spatial relationship of proposals to improve the model's ability to differentiate between spatially adjacent proposals, thereby optimizing representational features further. Combining the two components overcomes the challenges faced by traditional methods in utilizing low-confidence pseudo-labels. Extensive experiments on five cross-domain object detection benchmarks demonstrate that our proposed method outperforms the previous SFOD methods, achieving state-of-the-art performance.