OphCLIP: Hierarchical Retrieval-Augmented Learning for Ophthalmic Surgical Video-Language Pretraining

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

VisionUnite: A Vision-Language Foundation Model for Ophthalmology Enhanced with Clinical Knowledge

The need for improved diagnostic methods in ophthalmology is acute, especially in the less developed regions with limited access to specialists and advanced equipment. Therefore, we introduce VisionUnite, a novel vision-language foundation model for ophthalmology enhanced with clinical knowledge. VisionUnite has been pretrained on an extensive dataset comprising 1.24 million image-text pairs, and further refined using our proposed MMFundus dataset, which includes 296,379 high-quality fundus image-text pairs and 889,137 simulated doctor-patient dialogue instances. Our experiments indicate that VisionUnite outperforms existing generative foundation models such as GPT-4V and Gemini Pro. It also demonstrates diagnostic capabilities comparable to junior ophthalmologists. VisionUnite performs well in various clinical scenarios including open-ended multi-disease diagnosis, clinical explanation, and patient interaction, making it a highly versatile tool for initial ophthalmic disease screening. VisionUnite can also serve as an educational aid for junior ophthalmologists, accelerating their acquisition of knowledge regarding both common and rare ophthalmic conditions. VisionUnite represents a significant advancement in ophthalmology, with broad implications for diagnostics, medical education, and understanding of disease mechanisms.

A Novel Hybrid Convolutional Neural Network for Accurate Organ Segmentation in 3D Head and Neck CT Images

Radiation therapy (RT) is widely employed in the clinic for the treatment of head and neck (HaN) cancers. An essential step of RT planning is the accurate segmentation of various organs-at-risks (OARs) in HaN CT images. Nevertheless, segmenting OARs manually is time-consuming, tedious, and error-prone considering that typical HaN CT images contain tens to hundreds of slices. Automated segmentation algorithms are urgently required. Recently, convolutional neural networks (CNNs) have been extensively investigated on this task. Particularly, 3D CNNs are frequently adopted to process 3D HaN CT images. There are two issues with na\"ive 3D CNNs. First, the depth resolution of 3D CT images is usually several times lower than the in-plane resolution. Direct employment of 3D CNNs without distinguishing this difference can lead to the extraction of distorted image features and influence the final segmentation performance. Second, a severe class imbalance problem exists, and large organs can be orders of times larger than small organs. It is difficult to simultaneously achieve accurate segmentation for all the organs. To address these issues, we propose a novel hybrid CNN that fuses 2D and 3D convolutions to combat the different spatial resolutions and extract effective edge and semantic features from 3D HaN CT images. To accommodate large and small organs, our final model, named OrganNet2.5D, consists of only two instead of the classic four downsampling operations, and hybrid dilated convolutions are introduced to maintain the respective field. Experiments on the MICCAI 2015 challenge dataset demonstrate that OrganNet2.5D achieves promising performance compared to state-of-the-art methods.

Group Shift Pointwise Convolution for Volumetric Medical Image Segmentation

Recent studies have witnessed the effectiveness of 3D convolutions on segmenting volumetric medical images. Compared with the 2D counterparts, 3D convolutions can capture the spatial context in three dimensions. Nevertheless, models employing 3D convolutions introduce more trainable parameters and are more computationally complex, which may lead easily to model overfitting especially for medical applications with limited available training data. This paper aims to improve the effectiveness and efficiency of 3D convolutions by introducing a novel Group Shift Pointwise Convolution (GSP-Conv). GSP-Conv simplifies 3D convolutions into pointwise ones with 1x1x1 kernels, which dramatically reduces the number of model parameters and FLOPs (e.g. 27x fewer than 3D convolutions with 3x3x3 kernels). Na\"ive pointwise convolutions with limited receptive fields cannot make full use of the spatial image context. To address this problem, we propose a parameter-free operation, Group Shift (GS), which shifts the feature maps along with different spatial directions in an elegant way. With GS, pointwise convolutions can access features from different spatial locations, and the limited receptive fields of pointwise convolutions can be compensated. We evaluate the proposed methods on two datasets, PROMISE12 and BraTS18. Results show that our method, with substantially decreased model complexity, achieves comparable or even better performance than models employing 3D convolutions.