Vision Foundation Models in Medical Image Analysis: Advances and Challenges

The rapid development of Vision Foundation Models (VFMs), particularly Vision Transformers (ViT) and Segment Anything Model (SAM), has sparked significant advances in the field of medical image analysis. These models have demonstrated exceptional capabilities in capturing long-range dependencies and achieving high generalization in segmentation tasks. However, adapting these large models to medical image analysis presents several challenges, including domain differences between medical and natural images, the need for efficient model adaptation strategies, and the limitations of small-scale medical datasets. This paper reviews the state-of-the-art research on the adaptation of VFMs to medical image segmentation, focusing on the challenges of domain adaptation, model compression, and federated learning. We discuss the latest developments in adapter-based improvements, knowledge distillation techniques, and multi-scale contextual feature modeling, and propose future directions to overcome these bottlenecks. Our analysis highlights the potential of VFMs, along with emerging methodologies such as federated learning and model compression, to revolutionize medical image analysis and enhance clinical applications. The goal of this work is to provide a comprehensive overview of current approaches and suggest key areas for future research that can drive the next wave of innovation in medical image segmentation.

Tri-Plane Mamba: Efficiently Adapting Segment Anything Model for 3D Medical Images

General networks for 3D medical image segmentation have recently undergone extensive exploration. Behind the exceptional performance of these networks lies a significant demand for a large volume of pixel-level annotated data, which is time-consuming and labor-intensive. The emergence of the Segment Anything Model (SAM) has enabled this model to achieve superior performance in 2D medical image segmentation tasks via parameter- and data-efficient feature adaptation. However, the introduction of additional depth channels in 3D medical images not only prevents the sharing of 2D pre-trained features but also results in a quadratic increase in the computational cost for adapting SAM. To overcome these challenges, we present the Tri-Plane Mamba (TP-Mamba) adapters tailored for the SAM, featuring two major innovations: 1) multi-scale 3D convolutional adapters, optimized for efficiently processing local depth-level information, 2) a tri-plane mamba module, engineered to capture long-range depth-level representation without significantly increasing computational costs. This approach achieves state-of-the-art performance in 3D CT organ segmentation tasks. Remarkably, this superior performance is maintained even with scarce training data. Specifically using only three CT training samples from the BTCV dataset, it surpasses conventional 3D segmentation networks, attaining a Dice score that is up to 12% higher.

Learning Unlabeled Clients Divergence via Anchor Model Aggregation for Federated Semi-supervised Learning

Federated semi-supervised learning (FedSemi) refers to scenarios where there may be clients with fully labeled data, clients with partially labeled, and even fully unlabeled clients while preserving data privacy. However, challenges arise from client drift due to undefined heterogeneous class distributions and erroneous pseudo-labels. Existing FedSemi methods typically fail to aggregate models from unlabeled clients due to their inherent unreliability, thus overlooking unique information from their heterogeneous data distribution, leading to sub-optimal results. In this paper, we enable unlabeled client aggregation through SemiAnAgg, a novel Semi-supervised Anchor-Based federated Aggregation. SemiAnAgg learns unlabeled client contributions via an anchor model, effectively harnessing their informative value. Our key idea is that by feeding local client data to the same global model and the same consistently initialized anchor model (i.e., random model), we can measure the importance of each unlabeled client accordingly. Extensive experiments demonstrate that SemiAnAgg achieves new state-of-the-art results on four widely used FedSemi benchmarks, leading to substantial performance improvements: a 9% increase in accuracy on CIFAR-100 and a 7.6% improvement in recall on the medical dataset ISIC-18, compared with prior state-of-the-art. Code is available at: https://github.com/xmed-lab/SemiAnAgg.

Learning 3D Gaussians for Extremely Sparse-View Cone-Beam CT Reconstruction

Cone-Beam Computed Tomography (CBCT) is an indispensable technique in medical imaging, yet the associated radiation exposure raises concerns in clinical practice. To mitigate these risks, sparse-view reconstruction has emerged as an essential research direction, aiming to reduce the radiation dose by utilizing fewer projections for CT reconstruction. Although implicit neural representations have been introduced for sparse-view CBCT reconstruction, existing methods primarily focus on local 2D features queried from sparse projections, which is insufficient to process the more complicated anatomical structures, such as the chest. To this end, we propose a novel reconstruction framework, namely DIF-Gaussian, which leverages 3D Gaussians to represent the feature distribution in the 3D space, offering additional 3D spatial information to facilitate the estimation of attenuation coefficients. Furthermore, we incorporate test-time optimization during inference to further improve the generalization capability of the model. We evaluate DIF-Gaussian on two public datasets, showing significantly superior reconstruction performance than previous state-of-the-art methods.

C^2RV: Cross-Regional and Cross-View Learning for Sparse-View CBCT Reconstruction

Cone beam computed tomography (CBCT) is an important imaging technology widely used in medical scenarios, such as diagnosis and preoperative planning. Using fewer projection views to reconstruct CT, also known as sparse-view reconstruction, can reduce ionizing radiation and further benefit interventional radiology. Compared with sparse-view reconstruction for traditional parallel/fan-beam CT, CBCT reconstruction is more challenging due to the increased dimensionality caused by the measurement process based on cone-shaped X-ray beams. As a 2D-to-3D reconstruction problem, although implicit neural representations have been introduced to enable efficient training, only local features are considered and different views are processed equally in previous works, resulting in spatial inconsistency and poor performance on complicated anatomies. To this end, we propose C^2RV by leveraging explicit multi-scale volumetric representations to enable cross-regional learning in the 3D space. Additionally, the scale-view cross-attention module is introduced to adaptively aggregate multi-scale and multi-view features. Extensive experiments demonstrate that our C^2RV achieves consistent and significant improvement over previous state-of-the-art methods on datasets with diverse anatomy.

Fed-GraB: Federated Long-tailed Learning with Self-Adjusting Gradient Balancer

Data privacy and long-tailed distribution are the norms rather than the exception in many real-world tasks. This paper investigates a federated long-tailed learning (Fed-LT) task in which each client holds a locally heterogeneous dataset; if the datasets can be globally aggregated, they jointly exhibit a long-tailed distribution. Under such a setting, existing federated optimization and/or centralized long-tailed learning methods hardly apply due to challenges in (a) characterizing the global long-tailed distribution under privacy constraints and (b) adjusting the local learning strategy to cope with the head-tail imbalance. In response, we propose a method termed $\texttt{Fed-GraB}$, comprised of a Self-adjusting Gradient Balancer (SGB) module that re-weights clients' gradients in a closed-loop manner, based on the feedback of global long-tailed distribution evaluated by a Direct Prior Analyzer (DPA) module. Using $\texttt{Fed-GraB}$, clients can effectively alleviate the distribution drift caused by data heterogeneity during the model training process and obtain a global model with better performance on the minority classes while maintaining the performance of the majority classes. Extensive experiments demonstrate that $\texttt{Fed-GraB}$ achieves state-of-the-art performance on representative datasets such as CIFAR-10-LT, CIFAR-100-LT, ImageNet-LT, and iNaturalist.

Towards Distribution-Agnostic Generalized Category Discovery

Data imbalance and open-ended distribution are two intrinsic characteristics of the real visual world. Though encouraging progress has been made in tackling each challenge separately, few works dedicated to combining them towards real-world scenarios. While several previous works have focused on classifying close-set samples and detecting open-set samples during testing, it's still essential to be able to classify unknown subjects as human beings. In this paper, we formally define a more realistic task as distribution-agnostic generalized category discovery (DA-GCD): generating fine-grained predictions for both close- and open-set classes in a long-tailed open-world setting. To tackle the challenging problem, we propose a Self-Balanced Co-Advice contrastive framework (BaCon), which consists of a contrastive-learning branch and a pseudo-labeling branch, working collaboratively to provide interactive supervision to resolve the DA-GCD task. In particular, the contrastive-learning branch provides reliable distribution estimation to regularize the predictions of the pseudo-labeling branch, which in turn guides contrastive learning through self-balanced knowledge transfer and a proposed novel contrastive loss. We compare BaCon with state-of-the-art methods from two closely related fields: imbalanced semi-supervised learning and generalized category discovery. The effectiveness of BaCon is demonstrated with superior performance over all baselines and comprehensive analysis across various datasets. Our code is publicly available.

Robustness-Guided Image Synthesis for Data-Free Quantization

Quantization has emerged as a promising direction for model compression. Recently, data-free quantization has been widely studied as a promising method to avoid privacy concerns, which synthesizes images as an alternative to real training data. Existing methods use classification loss to ensure the reliability of the synthesized images. Unfortunately, even if these images are well-classified by the pre-trained model, they still suffer from low semantics and homogenization issues. Intuitively, these low-semantic images are sensitive to perturbations, and the pre-trained model tends to have inconsistent output when the generator synthesizes an image with poor semantics. To this end, we propose Robustness-Guided Image Synthesis (RIS), a simple but effective method to enrich the semantics of synthetic images and improve image diversity, further boosting the performance of downstream data-free compression tasks. Concretely, we first introduce perturbations on input and model weight, then define the inconsistency metrics at feature and prediction levels before and after perturbations. On the basis of inconsistency on two levels, we design a robustness optimization objective to enhance the semantics of synthetic images. Moreover, we also make our approach diversity-aware by forcing the generator to synthesize images with small correlations in the label space. With RIS, we achieve state-of-the-art performance for various settings on data-free quantization and can be extended to other data-free compression tasks.

CLIPN for Zero-Shot OOD Detection: Teaching CLIP to Say No

Out-of-distribution (OOD) detection refers to training the model on an in-distribution (ID) dataset to classify whether the input images come from unknown classes. Considerable effort has been invested in designing various OOD detection methods based on either convolutional neural networks or transformers. However, zero-shot OOD detection methods driven by CLIP, which only require class names for ID, have received less attention. This paper presents a novel method, namely CLIP saying no (CLIPN), which empowers the logic of saying no within CLIP. Our key motivation is to equip CLIP with the capability of distinguishing OOD and ID samples using positive-semantic prompts and negation-semantic prompts. Specifically, we design a novel learnable no prompt and a no text encoder to capture negation semantics within images. Subsequently, we introduce two loss functions: the image-text binary-opposite loss and the text semantic-opposite loss, which we use to teach CLIPN to associate images with no prompts, thereby enabling it to identify unknown samples. Furthermore, we propose two threshold-free inference algorithms to perform OOD detection by utilizing negation semantics from no prompts and the text encoder. Experimental results on 9 benchmark datasets (3 ID datasets and 6 OOD datasets) for the OOD detection task demonstrate that CLIPN, based on ViT-B-16, outperforms 7 well-used algorithms by at least 2.34% and 11.64% in terms of AUROC and FPR95 for zero-shot OOD detection on ImageNet-1K. Our CLIPN can serve as a solid foundation for effectively leveraging CLIP in downstream OOD tasks. The code is available on https://github.com/xmed-lab/CLIPN.

Uniformly Distributed Category Prototype-Guided Vision-Language Framework for Long-Tail Recognition

Recently, large-scale pre-trained vision-language models have presented benefits for alleviating class imbalance in long-tailed recognition. However, the long-tailed data distribution can corrupt the representation space, where the distance between head and tail categories is much larger than the distance between two tail categories. This uneven feature space distribution causes the model to exhibit unclear and inseparable decision boundaries on the uniformly distributed test set, which lowers its performance. To address these challenges, we propose the uniformly category prototype-guided vision-language framework to effectively mitigate feature space bias caused by data imbalance. Especially, we generate a set of category prototypes uniformly distributed on a hypersphere. Category prototype-guided mechanism for image-text matching makes the features of different classes converge to these distinct and uniformly distributed category prototypes, which maintain a uniform distribution in the feature space, and improve class boundaries. Additionally, our proposed irrelevant text filtering and attribute enhancement module allows the model to ignore irrelevant noisy text and focus more on key attribute information, thereby enhancing the robustness of our framework. In the image recognition fine-tuning stage, to address the positive bias problem of the learnable classifier, we design the class feature prototype-guided classifier, which compensates for the performance of tail classes while maintaining the performance of head classes. Our method outperforms previous vision-language methods for long-tailed learning work by a large margin and achieves state-of-the-art performance.