MedImageInsight: An Open-Source Embedding Model for General Domain Medical Imaging

In this work, we present MedImageInsight, an open-source medical imaging embedding model. MedImageInsight is trained on medical images with associated text and labels across a diverse collection of domains, including X-Ray, CT, MRI, dermoscopy, OCT, fundus photography, ultrasound, histopathology, and mammography. Rigorous evaluations demonstrate MedImageInsight's ability to achieve state-of-the-art (SOTA) or human expert level performance across classification, image-image search, and fine-tuning tasks. Specifically, on public datasets, MedImageInsight achieves SOTA in CT 3D medical image retrieval, as well as SOTA in disease classification and search for chest X-ray, dermatology, and OCT imaging. Furthermore, MedImageInsight achieves human expert performance in bone age estimation (on both public and partner data), as well as AUC above 0.9 in most other domains. When paired with a text decoder, MedImageInsight achieves near SOTA level single image report findings generation with less than 10\% the parameters of other models. Compared to fine-tuning GPT-4o with only MIMIC-CXR data for the same task, MedImageInsight outperforms in clinical metrics, but underperforms on lexical metrics where GPT-4o sets a new SOTA. Importantly for regulatory purposes, MedImageInsight can generate ROC curves, adjust sensitivity and specificity based on clinical need, and provide evidence-based decision support through image-image search (which can also enable retrieval augmented generation). In an independent clinical evaluation of image-image search in chest X-ray, MedImageInsight outperformed every other publicly available foundation model evaluated by large margins (over 6 points AUC), and significantly outperformed other models in terms of AI fairness (across age and gender). We hope releasing MedImageInsight will help enhance collective progress in medical imaging AI research and development.

ROCOv2: Radiology Objects in COntext Version 2, an Updated Multimodal Image Dataset

Automated medical image analysis systems often require large amounts of training data with high quality labels, which are difficult and time consuming to generate. This paper introduces Radiology Object in COntext version 2 (ROCOv2), a multimodal dataset consisting of radiological images and associated medical concepts and captions extracted from the PMC Open Access subset. It is an updated version of the ROCO dataset published in 2018, and adds 35,705 new images added to PMC since 2018. It further provides manually curated concepts for imaging modalities with additional anatomical and directional concepts for X-rays. The dataset consists of 79,789 images and has been used, with minor modifications, in the concept detection and caption prediction tasks of ImageCLEFmedical Caption 2023. The dataset is suitable for training image annotation models based on image-caption pairs, or for multi-label image classification using Unified Medical Language System (UMLS) concepts provided with each image. In addition, it can serve for pre-training of medical domain models, and evaluation of deep learning models for multi-task learning.

3D-MIR: A Benchmark and Empirical Study on 3D Medical Image Retrieval in Radiology

The increasing use of medical imaging in healthcare settings presents a significant challenge due to the increasing workload for radiologists, yet it also offers opportunity for enhancing healthcare outcomes if effectively leveraged. 3D image retrieval holds potential to reduce radiologist workloads by enabling clinicians to efficiently search through diagnostically similar or otherwise relevant cases, resulting in faster and more precise diagnoses. However, the field of 3D medical image retrieval is still emerging, lacking established evaluation benchmarks, comprehensive datasets, and thorough studies. This paper attempts to bridge this gap by introducing a novel benchmark for 3D Medical Image Retrieval (3D-MIR) that encompasses four different anatomies imaged with computed tomography. Using this benchmark, we explore a diverse set of search strategies that use aggregated 2D slices, 3D volumes, and multi-modal embeddings from popular multi-modal foundation models as queries. Quantitative and qualitative assessments of each approach are provided alongside an in-depth discussion that offers insight for future research. To promote the advancement of this field, our benchmark, dataset, and code are made publicly available.

ACI-BENCH: a Novel Ambient Clinical Intelligence Dataset for Benchmarking Automatic Visit Note Generation

Recent immense breakthroughs in generative models such as in GPT4 have precipitated re-imagined ubiquitous usage of these models in all applications. One area that can benefit by improvements in artificial intelligence (AI) is healthcare. The note generation task from doctor-patient encounters, and its associated electronic medical record documentation, is one of the most arduous time-consuming tasks for physicians. It is also a natural prime potential beneficiary to advances in generative models. However with such advances, benchmarking is more critical than ever. Whether studying model weaknesses or developing new evaluation metrics, shared open datasets are an imperative part of understanding the current state-of-the-art. Unfortunately as clinic encounter conversations are not routinely recorded and are difficult to ethically share due to patient confidentiality, there are no sufficiently large clinic dialogue-note datasets to benchmark this task. Here we present the Ambient Clinical Intelligence Benchmark (ACI-BENCH) corpus, the largest dataset to date tackling the problem of AI-assisted note generation from visit dialogue. We also present the benchmark performances of several common state-of-the-art approaches.

An Investigation of Evaluation Metrics for Automated Medical Note Generation

Recent studies on automatic note generation have shown that doctors can save significant amounts of time when using automatic clinical note generation (Knoll et al., 2022). Summarization models have been used for this task to generate clinical notes as summaries of doctor-patient conversations (Krishna et al., 2021; Cai et al., 2022). However, assessing which model would best serve clinicians in their daily practice is still a challenging task due to the large set of possible correct summaries, and the potential limitations of automatic evaluation metrics. In this paper, we study evaluation methods and metrics for the automatic generation of clinical notes from medical conversations. In particular, we propose new task-specific metrics and we compare them to SOTA evaluation metrics in text summarization and generation, including: (i) knowledge-graph embedding-based metrics, (ii) customized model-based metrics, (iii) domain-adapted/fine-tuned metrics, and (iv) ensemble metrics. To study the correlation between the automatic metrics and manual judgments, we evaluate automatic notes/summaries by comparing the system and reference facts and computing the factual correctness, and the hallucination and omission rates for critical medical facts. This study relied on seven datasets manually annotated by domain experts. Our experiments show that automatic evaluation metrics can have substantially different behaviors on different types of clinical notes datasets. However, the results highlight one stable subset of metrics as the most correlated with human judgments with a relevant aggregation of different evaluation criteria.

Reinforcement Learning for Abstractive Question Summarization with Question-aware Semantic Rewards

The growth of online consumer health questions has led to the necessity for reliable and accurate question answering systems. A recent study showed that manual summarization of consumer health questions brings significant improvement in retrieving relevant answers. However, the automatic summarization of long questions is a challenging task due to the lack of training data and the complexity of the related subtasks, such as the question focus and type recognition. In this paper, we introduce a reinforcement learning-based framework for abstractive question summarization. We propose two novel rewards obtained from the downstream tasks of (i) question-type identification and (ii) question-focus recognition to regularize the question generation model. These rewards ensure the generation of semantically valid questions and encourage the inclusion of key medical entities/foci in the question summary. We evaluated our proposed method on two benchmark datasets and achieved higher performance over state-of-the-art models. The manual evaluation of the summaries reveals that the generated questions are more diverse and have fewer factual inconsistencies than the baseline summaries

Question-aware Transformer Models for Consumer Health Question Summarization

Searching for health information online is becoming customary for more and more consumers every day, which makes the need for efficient and reliable question answering systems more pressing. An important contributor to the success rates of these systems is their ability to fully understand the consumers' questions. However, these questions are frequently longer than needed and mention peripheral information that is not useful in finding relevant answers. Question summarization is one of the potential solutions to simplifying long and complex consumer questions before attempting to find an answer. In this paper, we study the task of abstractive summarization for real-world consumer health questions. We develop an abstractive question summarization model that leverages the semantic interpretation of a question via recognition of medical entities, which enables the generation of informative summaries. Towards this, we propose multiple Cloze tasks (i.e. the task of filing missing words in a given context) to identify the key medical entities that enforce the model to have better coverage in question-focus recognition. Additionally, we infuse the decoder inputs with question-type information to generate question-type driven summaries. When evaluated on the MeQSum benchmark corpus, our framework outperformed the state-of-the-art method by 10.2 ROUGE-L points. We also conducted a manual evaluation to assess the correctness of the generated summaries.

Question-Driven Summarization of Answers to Consumer Health Questions

Automatic summarization of natural language is a widely studied area in computer science, one that is broadly applicable to anyone who routinely needs to understand large quantities of information. For example, in the medical domain, recent developments in deep learning approaches to automatic summarization have the potential to make health information more easily accessible to patients and consumers. However, to evaluate the quality of automatically generated summaries of health information, gold-standard, human generated summaries are required. Using answers provided by the National Library of Medicine's consumer health question answering system, we present the MEDIQA Answer Summarization dataset, the first summarization collection containing question-driven summaries of answers to consumer health questions. This dataset can be used to evaluate single or multi-document summaries generated by algorithms using extractive or abstractive approaches. In order to benchmark the dataset, we include results of baseline and state-of-the-art deep learning summarization models, demonstrating that this dataset can be used to effectively evaluate question-driven machine-generated summaries and promote further machine learning research in medical question answering.

A Question-Entailment Approach to Question Answering

One of the challenges in large-scale information retrieval (IR) is to develop fine-grained and domain-specific methods to answer natural language questions. Despite the availability of numerous sources and datasets for answer retrieval, Question Answering (QA) remains a challenging problem due to the difficulty of the question understanding and answer extraction tasks. One of the promising tracks investigated in QA is to map new questions to formerly answered questions that are `similar'. In this paper, we propose a novel QA approach based on Recognizing Question Entailment (RQE) and we describe the QA system and resources that we built and evaluated on real medical questions. First, we compare machine learning and deep learning methods for RQE using different kinds of datasets, including textual inference, question similarity and entailment in both the open and clinical domains. Second, we combine IR models with the best RQE method to select entailed questions and rank the retrieved answers. To study the end-to-end QA approach, we built the MedQuAD collection of 47,457 question-answer pairs from trusted medical sources, that we introduce and share in the scope of this paper. Following the evaluation process used in TREC 2017 LiveQA, we find that our approach exceeds the best results of the medical task with a 29.8% increase over the best official score. The evaluation results also support the relevance of question entailment for QA and highlight the effectiveness of combining IR and RQE for future QA efforts. Our findings also show that relying on a restricted set of reliable answer sources can bring a substantial improvement in medical QA.