MExD: An Expert-Infused Diffusion Model for Whole-Slide Image Classification

Whole Slide Image (WSI) classification poses unique challenges due to the vast image size and numerous non-informative regions, which introduce noise and cause data imbalance during feature aggregation. To address these issues, we propose MExD, an Expert-Infused Diffusion Model that combines the strengths of a Mixture-of-Experts (MoE) mechanism with a diffusion model for enhanced classification. MExD balances patch feature distribution through a novel MoE-based aggregator that selectively emphasizes relevant information, effectively filtering noise, addressing data imbalance, and extracting essential features. These features are then integrated via a diffusion-based generative process to directly yield the class distribution for the WSI. Moving beyond conventional discriminative approaches, MExD represents the first generative strategy in WSI classification, capturing fine-grained details for robust and precise results. Our MExD is validated on three widely-used benchmarks-Camelyon16, TCGA-NSCLC, and BRACS consistently achieving state-of-the-art performance in both binary and multi-class tasks.

Partially Supervised Unpaired Multi-Modal Learning for Label-Efficient Medical Image Segmentation

Unpaired Multi-Modal Learning (UMML) which leverages unpaired multi-modal data to boost model performance on each individual modality has attracted a lot of research interests in medical image analysis. However, existing UMML methods require multi-modal datasets to be fully labeled, which incurs tremendous annotation cost. In this paper, we investigate the use of partially labeled data for label-efficient unpaired multi-modal learning, which can reduce the annotation cost by up to one half. We term the new learning paradigm as Partially Supervised Unpaired Multi-Modal Learning (PSUMML) and propose a novel Decomposed partial class adaptation with snapshot Ensembled Self-Training (DEST) framework for it. Specifically, our framework consists of a compact segmentation network with modality specific normalization layers for learning with partially labeled unpaired multi-modal data. The key challenge in PSUMML lies in the complex partial class distribution discrepancy due to partial class annotation, which hinders effective knowledge transfer across modalities. We theoretically analyze this phenomenon with a decomposition theorem and propose a decomposed partial class adaptation technique to precisely align the partially labeled classes across modalities to reduce the distribution discrepancy. We further propose a snapshot ensembled self-training technique to leverage the valuable snapshot models during training to assign pseudo-labels to partially labeled pixels for self-training to boost model performance. We perform extensive experiments under different scenarios of PSUMML for two medical image segmentation tasks, namely cardiac substructure segmentation and abdominal multi-organ segmentation. Our framework outperforms existing methods significantly.

Vision-Language Model IP Protection via Prompt-based Learning

Vision-language models (VLMs) like CLIP (Contrastive Language-Image Pre-Training) have seen remarkable success in visual recognition, highlighting the increasing need to safeguard the intellectual property (IP) of well-trained models. Effective IP protection extends beyond ensuring authorized usage; it also necessitates restricting model deployment to authorized data domains, particularly when the model is fine-tuned for specific target domains. However, current IP protection methods often rely solely on the visual backbone, which may lack sufficient semantic richness. To bridge this gap, we introduce IP-CLIP, a lightweight IP protection strategy tailored to CLIP, employing a prompt-based learning approach. By leveraging the frozen visual backbone of CLIP, we extract both image style and content information, incorporating them into the learning of IP prompt. This strategy acts as a robust barrier, effectively preventing the unauthorized transfer of features from authorized domains to unauthorized ones. Additionally, we propose a style-enhancement branch that constructs feature banks for both authorized and unauthorized domains. This branch integrates self-enhanced and cross-domain features, further strengthening IP-CLIP's capability to block features from unauthorized domains. Finally, we present new three metrics designed to better balance the performance degradation of authorized and unauthorized domains. Comprehensive experiments in various scenarios demonstrate its promising potential for application in IP protection tasks for VLMs.

Hierarchical Context Transformer for Multi-level Semantic Scene Understanding

A comprehensive and explicit understanding of surgical scenes plays a vital role in developing context-aware computer-assisted systems in the operating theatre. However, few works provide systematical analysis to enable hierarchical surgical scene understanding. In this work, we propose to represent the tasks set [phase recognition --> step recognition --> action and instrument detection] as multi-level semantic scene understanding (MSSU). For this target, we propose a novel hierarchical context transformer (HCT) network and thoroughly explore the relations across the different level tasks. Specifically, a hierarchical relation aggregation module (HRAM) is designed to concurrently relate entries inside multi-level interaction information and then augment task-specific features. To further boost the representation learning of the different tasks, inter-task contrastive learning (ICL) is presented to guide the model to learn task-wise features via absorbing complementary information from other tasks. Furthermore, considering the computational costs of the transformer, we propose HCT+ to integrate the spatial and temporal adapter to access competitive performance on substantially fewer tunable parameters. Extensive experiments on our cataract dataset and a publicly available endoscopic PSI-AVA dataset demonstrate the outstanding performance of our method, consistently exceeding the state-of-the-art methods by a large margin. The code is available at https://github.com/Aurora-hao/HCT.

ViLa-MIL: Dual-scale Vision-Language Multiple Instance Learning for Whole Slide Image Classification

Multiple instance learning (MIL)-based framework has become the mainstream for processing the whole slide image (WSI) with giga-pixel size and hierarchical image context in digital pathology. However, these methods heavily depend on a substantial number of bag-level labels and solely learn from the original slides, which are easily affected by variations in data distribution. Recently, vision language model (VLM)-based methods introduced the language prior by pre-training on large-scale pathological image-text pairs. However, the previous text prompt lacks the consideration of pathological prior knowledge, therefore does not substantially boost the model's performance. Moreover, the collection of such pairs and the pre-training process are very time-consuming and source-intensive.To solve the above problems, we propose a dual-scale vision-language multiple instance learning (ViLa-MIL) framework for whole slide image classification. Specifically, we propose a dual-scale visual descriptive text prompt based on the frozen large language model (LLM) to boost the performance of VLM effectively. To transfer the VLM to process WSI efficiently, for the image branch, we propose a prototype-guided patch decoder to aggregate the patch features progressively by grouping similar patches into the same prototype; for the text branch, we introduce a context-guided text decoder to enhance the text features by incorporating the multi-granular image contexts. Extensive studies on three multi-cancer and multi-center subtyping datasets demonstrate the superiority of ViLa-MIL.

MM-Retinal V2: Transfer an Elite Knowledge Spark into Fundus Vision-Language Pretraining

Vision-language pretraining (VLP) has been investigated to generalize across diverse downstream tasks for fundus image analysis. Although recent methods showcase promising achievements, they significantly rely on large-scale private image-text data but pay less attention to the pretraining manner, which limits their further advancements. In this work, we introduce MM-Retinal V2, a high-quality image-text paired dataset comprising CFP, FFA, and OCT image modalities. Then, we propose a novel fundus vision-language pretraining model, namely KeepFIT V2, which is pretrained by integrating knowledge from the elite data spark into categorical public datasets. Specifically, a preliminary textual pretraining is adopted to equip the text encoder with primarily ophthalmic textual knowledge. Moreover, a hybrid image-text knowledge injection module is designed for knowledge transfer, which is essentially based on a combination of global semantic concepts from contrastive learning and local appearance details from generative learning. Extensive experiments across zero-shot, few-shot, and linear probing settings highlight the generalization and transferability of KeepFIT V2, delivering performance competitive to state-of-the-art fundus VLP models trained on large-scale private image-text datasets. Our dataset and model are publicly available via https://github.com/lxirich/MM-Retinal.

Fundus Image Quality Assessment and Enhancement: a Systematic Review

As an affordable and convenient eye scan, fundus photography holds the potential for preventing vision impairment, especially in resource-limited regions. However, fundus image degradation is common under intricate imaging environments, impacting following diagnosis and treatment. Consequently, image quality assessment (IQA) and enhancement (IQE) are essential for ensuring the clinical value and reliability of fundus images. While existing reviews offer some overview of this field, a comprehensive analysis of the interplay between IQA and IQE, along with their clinical deployment challenges, is lacking. This paper addresses this gap by providing a thorough review of fundus IQA and IQE algorithms, research advancements, and practical applications. We outline the fundamentals of the fundus photography imaging system and the associated interferences, and then systematically summarize the paradigms in fundus IQA and IQE. Furthermore, we discuss the practical challenges and solutions in deploying IQA and IQE, as well as offer insights into potential future research directions.

No More Sliding Window: Efficient 3D Medical Image Segmentation with Differentiable Top-k Patch Sampling

3D models are favored over 2D for 3D medical image segmentation tasks due to their ability to leverage inter-slice relationship, yielding higher segmentation accuracy. However, 3D models demand significantly more GPU memory with increased model size and intermediate tensors. A common solution is to use patch-based training and make whole-volume predictions with sliding window (SW) inference. SW inference reduces memory usage but is slower due to equal resource allocation across patches and less accurate as it overlooks global features beyond patches. We propose NMSW-Net (No-More-Sliding-Window-Net), a novel framework that enhances efficiency and accuracy of any given 3D segmentation model by eliminating SW inference and incorporating global predictions when necessary. NMSW-Net incorporates a differentiable Top-k module to sample only the relevant patches that enhance segmentation accuracy, thereby minimizing redundant computations. Additionally, it learns to leverage coarse global predictions when patch prediction alone is insufficient. NMSW-Net is model-agnostic, making it compatible with any 3D segmentation model that previously relied on SW inference. Evaluated across 3 tasks with 3 segmentation backbones, NMSW-Net achieves competitive or sometimes superior accuracy compared to SW, while reducing computational complexity by 90% (87.5 to 7.95 TFLOPS), delivering 4x faster inference on the H100 GPU (19.0 to 4.3 sec), and 7x faster inference on the Intel Xeon Gold CPU (1710 to 230 seconds).

AIF-SFDA: Autonomous Information Filter-driven Source-Free Domain Adaptation for Medical Image Segmentation

Decoupling domain-variant information (DVI) from domain-invariant information (DII) serves as a prominent strategy for mitigating domain shifts in the practical implementation of deep learning algorithms. However, in medical settings, concerns surrounding data collection and privacy often restrict access to both training and test data, hindering the empirical decoupling of information by existing methods. To tackle this issue, we propose an Autonomous Information Filter-driven Source-free Domain Adaptation (AIF-SFDA) algorithm, which leverages a frequency-based learnable information filter to autonomously decouple DVI and DII. Information Bottleneck (IB) and Self-supervision (SS) are incorporated to optimize the learnable frequency filter. The IB governs the information flow within the filter to diminish redundant DVI, while SS preserves DII in alignment with the specific task and image modality. Thus, the autonomous information filter can overcome domain shifts relying solely on target data. A series of experiments covering various medical image modalities and segmentation tasks were conducted to demonstrate the benefits of AIF-SFDA through comparisons with leading algorithms and ablation studies. The code is available at https://github.com/JingHuaMan/AIF-SFDA.

Look Back for More: Harnessing Historical Sequential Updates for Personalized Federated Adapter Tuning

Personalized federated learning (PFL) studies effective model personalization to address the data heterogeneity issue among clients in traditional federated learning (FL). Existing PFL approaches mainly generate personalized models by relying solely on the clients' latest updated models while ignoring their previous updates, which may result in suboptimal personalized model learning. To bridge this gap, we propose a novel framework termed pFedSeq, designed for personalizing adapters to fine-tune a foundation model in FL. In pFedSeq, the server maintains and trains a sequential learner, which processes a sequence of past adapter updates from clients and generates calibrations for personalized adapters. To effectively capture the cross-client and cross-step relations hidden in previous updates and generate high-performing personalized adapters, pFedSeq adopts the powerful selective state space model (SSM) as the architecture of sequential learner. Through extensive experiments on four public benchmark datasets, we demonstrate the superiority of pFedSeq over state-of-the-art PFL methods.