SemiHVision: Enhancing Medical Multimodal Models with a Semi-Human Annotated Dataset and Fine-Tuned Instruction Generation

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

Auxiliary Input in Training: Incorporating Catheter Features into Deep Learning Models for ECG-Free Dynamic Coronary Roadmapping

Dynamic coronary roadmapping is a technology that overlays the vessel maps (the "roadmap") extracted from an offline image sequence of X-ray angiography onto a live stream of X-ray fluoroscopy in real-time. It aims to offer navigational guidance for interventional surgeries without the need for repeated contrast agent injections, thereby reducing the risks associated with radiation exposure and kidney failure. The precision of the roadmaps is contingent upon the accurate alignment of angiographic and fluoroscopic images based on their cardiac phases, as well as precise catheter tip tracking. The former ensures the selection of a roadmap that closely matches the vessel shape in the current frame, while the latter uses catheter tips as reference points to adjust for translational motion between the roadmap and the present vessel tree. Training deep learning models for both tasks is challenging and underexplored. However, incorporating catheter features into the models could offer substantial benefits, given humans heavily rely on catheters to complete the tasks. To this end, we introduce a simple but effective method, auxiliary input in training (AIT), and demonstrate that it enhances model performance across both tasks, outperforming baseline methods in knowledge incorporation and transfer learning.

Retrieval-augmented Few-shot Medical Image Segmentation with Foundation Models

Medical image segmentation is crucial for clinical decision-making, but the scarcity of annotated data presents significant challenges. Few-shot segmentation (FSS) methods show promise but often require retraining on the target domain and struggle to generalize across different modalities. Similarly, adapting foundation models like the Segment Anything Model (SAM) for medical imaging has limitations, including the need for finetuning and domain-specific adaptation. To address these issues, we propose a novel method that adapts DINOv2 and Segment Anything Model 2 (SAM 2) for retrieval-augmented few-shot medical image segmentation. Our approach uses DINOv2's feature as query to retrieve similar samples from limited annotated data, which are then encoded as memories and stored in memory bank. With the memory attention mechanism of SAM 2, the model leverages these memories as conditions to generate accurate segmentation of the target image. We evaluated our framework on three medical image segmentation tasks, demonstrating superior performance and generalizability across various modalities without the need for any retraining or finetuning. Overall, this method offers a practical and effective solution for few-shot medical image segmentation and holds significant potential as a valuable annotation tool in clinical applications.

Spatiotemporal Diffusion Model with Paired Sampling for Accelerated Cardiac Cine MRI

Current deep learning reconstruction for accelerated cardiac cine MRI suffers from spatial and temporal blurring. We aim to improve image sharpness and motion delineation for cine MRI under high undersampling rates. A spatiotemporal diffusion enhancement model conditional on an existing deep learning reconstruction along with a novel paired sampling strategy was developed. The diffusion model provided sharper tissue boundaries and clearer motion than the original reconstruction in experts evaluation on clinical data. The innovative paired sampling strategy substantially reduced artificial noises in the generative results.

Clinically Feasible Diffusion Reconstruction for Highly-Accelerated Cardiac Cine MRI

The currently limited quality of accelerated cardiac cine reconstruction may potentially be improved by the emerging diffusion models, but the clinically unacceptable long processing time poses a challenge. We aim to develop a clinically feasible diffusion-model-based reconstruction pipeline to improve the image quality of cine MRI. A multi-in multi-out diffusion enhancement model together with fast inference strategies were developed to be used in conjunction with a reconstruction model. The diffusion reconstruction reduced spatial and temporal blurring in prospectively undersampled clinical data, as validated by experts inspection. The 1.5s per video processing time enabled the approach to be applied in clinical scenarios.

Federated Data Model

In artificial intelligence (AI), especially deep learning, data diversity and volume play a pivotal role in model development. However, training a robust deep learning model often faces challenges due to data privacy, regulations, and the difficulty of sharing data between different locations, especially for medical applications. To address this, we developed a method called the Federated Data Model (FDM). This method uses diffusion models to learn the characteristics of data at one site and then creates synthetic data that can be used at another site without sharing the actual data. We tested this approach with a medical image segmentation task, focusing on cardiac magnetic resonance images from different hospitals. Our results show that models trained with this method perform well both on the data they were originally trained on and on data from other sites. This approach offers a promising way to train accurate and privacy-respecting AI models across different locations.

Enhancing Cardiac MRI Segmentation via Classifier-Guided Two-Stage Network and All-Slice Information Fusion Transformer

Cardiac Magnetic Resonance imaging (CMR) is the gold standard for assessing cardiac function. Segmenting the left ventricle (LV), right ventricle (RV), and LV myocardium (MYO) in CMR images is crucial but time-consuming. Deep learning-based segmentation methods have emerged as effective tools for automating this process. However, CMR images present additional challenges due to irregular and varying heart shapes, particularly in basal and apical slices. In this study, we propose a classifier-guided two-stage network with an all-slice fusion transformer to enhance CMR segmentation accuracy, particularly in basal and apical slices. Our method was evaluated on extensive clinical datasets and demonstrated better performance in terms of Dice score compared to previous CNN-based and transformer-based models. Moreover, our method produces visually appealing segmentation shapes resembling human annotations and avoids common issues like holes or fragments in other models' segmentations.

An Unsupervised Framework for Joint MRI Super Resolution and Gibbs Artifact Removal

The k-space data generated from magnetic resonance imaging (MRI) is only a finite sampling of underlying signals. Therefore, MRI images often suffer from low spatial resolution and Gibbs ringing artifacts. Previous studies tackled these two problems separately, where super resolution methods tend to enhance Gibbs artifacts, whereas Gibbs ringing removal methods tend to blur the images. It is also a challenge that high resolution ground truth is hard to obtain in clinical MRI. In this paper, we propose an unsupervised learning framework for both MRI super resolution and Gibbs artifacts removal without using high resolution ground truth. Furthermore, we propose regularization methods to improve the model's generalizability across out-of-distribution MRI images. We evaluated our proposed methods with other state-of-the-art methods on eight MRI datasets with various contrasts and anatomical structures. Our method not only achieves the best SR performance but also significantly reduces the Gibbs artifacts. Our method also demonstrates good generalizability across different datasets, which is beneficial to clinical applications where training data are usually scarce and biased.

Dynamic MLP for MRI Reconstruction

As convolutional neural networks (CNN) become the most successful reconstruction technique for accelerated Magnetic Resonance Imaging (MRI), CNN reaches its limit on image quality especially in sharpness. Further improvement on image quality often comes at massive computational costs, hindering their practicability in the clinic setting. MRI reconstruction is essentially a deconvolution problem, which demands long-distance information that is difficult to be captured by CNNs with small convolution kernels. The multi-layer perceptron (MLP) is able to model such long-distance information, but it restricts a fixed input size while the reconstruction of images in flexible resolutions is required in the clinic setting. In this paper, we proposed a hybrid CNN and MLP reconstruction strategy, featured by dynamic MLP (dMLP) that accepts arbitrary image sizes. Experiments were conducted using 3D multi-coil MRI. Our results suggested the proposed dMLP can improve image sharpness compared to its pure CNN counterpart, while costing minor additional GPU memory and computation time. We further compared the proposed dMLP with CNNs using large kernels and studied pure MLP-based reconstruction using a stack of 1D dMLPs, as well as its CNN counterpart using only 1D convolutions. We observed the enlarged receptive field has noticeably improved image quality, while simply using CNN with a large kernel leads to difficulties in training. Noticeably, the pure MLP-based method has been outperformed by CNN-involved methods, which matches the observations in other computer vision tasks for natural images.

Holistic Multi-Slice Framework for Dynamic Simultaneous Multi-Slice MRI Reconstruction

Dynamic Magnetic Resonance Imaging (dMRI) is widely used to assess various cardiac conditions such as cardiac motion and blood flow. To accelerate MR acquisition, techniques such as undersampling and Simultaneous Multi-Slice (SMS) are often used. Special reconstruction algorithms are needed to reconstruct multiple SMS image slices from the entangled information. Deep learning (DL)-based methods have shown promising results for single-slice MR reconstruction, but the addition of SMS acceleration raises unique challenges due to the composite k-space signals and the resulting images with strong inter-slice artifacts. Furthermore, many dMRI applications lack sufficient data for training reconstruction neural networks. In this study, we propose a novel DL-based framework for dynamic SMS reconstruction. Our main contributions are 1) a combination of data transformation steps and network design that effectively leverages the unique characteristics of undersampled dynamic SMS data, and 2) an MR physics-guided transfer learning strategy that addresses the data scarcity issue. Thorough comparisons with multiple baseline methods illustrate the strengths of our proposed methods.