Cross-Fundus Transformer for Multi-modal Diabetic Retinopathy Grading with Cataract

Diabetic retinopathy (DR) is a leading cause of blindness worldwide and a common complication of diabetes. As two different imaging tools for DR grading, color fundus photography (CFP) and infrared fundus photography (IFP) are highly-correlated and complementary in clinical applications. To the best of our knowledge, this is the first study that explores a novel multi-modal deep learning framework to fuse the information from CFP and IFP towards more accurate DR grading. Specifically, we construct a dual-stream architecture Cross-Fundus Transformer (CFT) to fuse the ViT-based features of two fundus image modalities. In particular, a meticulously engineered Cross-Fundus Attention (CFA) module is introduced to capture the correspondence between CFP and IFP images. Moreover, we adopt both the single-modality and multi-modality supervisions to maximize the overall performance for DR grading. Extensive experiments on a clinical dataset consisting of 1,713 pairs of multi-modal fundus images demonstrate the superiority of our proposed method. Our code will be released for public access.

Concept Complement Bottleneck Model for Interpretable Medical Image Diagnosis

Models based on human-understandable concepts have received extensive attention to improve model interpretability for trustworthy artificial intelligence in the field of medical image analysis. These methods can provide convincing explanations for model decisions but heavily rely on the detailed annotation of pre-defined concepts. Consequently, they may not be effective in cases where concepts or annotations are incomplete or low-quality. Although some methods automatically discover effective and new visual concepts rather than using pre-defined concepts or could find some human-understandable concepts via large Language models, they are prone to veering away from medical diagnostic evidence and are challenging to understand. In this paper, we propose a concept complement bottleneck model for interpretable medical image diagnosis with the aim of complementing the existing concept set and finding new concepts bridging the gap between explainable models. Specifically, we propose to use concept adapters for specific concepts to mine the concept differences and score concepts in their own attention channels to support almost fairly concept learning. Then, we devise a concept complement strategy to learn new concepts while jointly using known concepts to improve model performance. Comprehensive experiments on medical datasets demonstrate that our model outperforms the state-of-the-art competitors in concept detection and disease diagnosis tasks while providing diverse explanations to ensure model interpretability effectively.

Self-eXplainable AI for Medical Image Analysis: A Survey and New Outlooks

The increasing demand for transparent and reliable models, particularly in high-stakes decision-making areas such as medical image analysis, has led to the emergence of eXplainable Artificial Intelligence (XAI). Post-hoc XAI techniques, which aim to explain black-box models after training, have been controversial in recent works concerning their fidelity to the models' predictions. In contrast, Self-eXplainable AI (S-XAI) offers a compelling alternative by incorporating explainability directly into the training process of deep learning models. This approach allows models to generate inherent explanations that are closely aligned with their internal decision-making processes. Such enhanced transparency significantly supports the trustworthiness, robustness, and accountability of AI systems in real-world medical applications. To facilitate the development of S-XAI methods for medical image analysis, this survey presents an comprehensive review across various image modalities and clinical applications. It covers more than 200 papers from three key perspectives: 1) input explainability through the integration of explainable feature engineering and knowledge graph, 2) model explainability via attention-based learning, concept-based learning, and prototype-based learning, and 3) output explainability by providing counterfactual explanation and textual explanation. Additionally, this paper outlines the desired characteristics of explainability and existing evaluation methods for assessing explanation quality. Finally, it discusses the major challenges and future research directions in developing S-XAI for medical image analysis.

MOSMOS: Multi-organ segmentation facilitated by medical report supervision

Owing to a large amount of multi-modal data in modern medical systems, such as medical images and reports, Medical Vision-Language Pre-training (Med-VLP) has demonstrated incredible achievements in coarse-grained downstream tasks (i.e., medical classification, retrieval, and visual question answering). However, the problem of transferring knowledge learned from Med-VLP to fine-grained multi-organ segmentation tasks has barely been investigated. Multi-organ segmentation is challenging mainly due to the lack of large-scale fully annotated datasets and the wide variation in the shape and size of the same organ between individuals with different diseases. In this paper, we propose a novel pre-training & fine-tuning framework for Multi-Organ Segmentation by harnessing Medical repOrt Supervision (MOSMOS). Specifically, we first introduce global contrastive learning to maximally align the medical image-report pairs in the pre-training stage. To remedy the granularity discrepancy, we further leverage multi-label recognition to implicitly learn the semantic correspondence between image pixels and organ tags. More importantly, our pre-trained models can be transferred to any segmentation model by introducing the pixel-tag attention maps. Different network settings, i.e., 2D U-Net and 3D UNETR, are utilized to validate the generalization. We have extensively evaluated our approach using different diseases and modalities on BTCV, AMOS, MMWHS, and BRATS datasets. Experimental results in various settings demonstrate the effectiveness of our framework. This framework can serve as the foundation to facilitate future research on automatic annotation tasks under the supervision of medical reports.

Concept-Attention Whitening for Interpretable Skin Lesion Diagnosis

The black-box nature of deep learning models has raised concerns about their interpretability for successful deployment in real-world clinical applications. To address the concerns, eXplainable Artificial Intelligence (XAI) aims to provide clear and understandable explanations of the decision-making process. In the medical domain, concepts such as attributes of lesions or abnormalities serve as key evidence for deriving diagnostic results. However, existing concept-based models mainly depend on concepts that appear independently and require fine-grained concept annotations such as bounding boxes. A medical image usually contains multiple concepts and the fine-grained concept annotations are difficult to acquire. In this paper, we propose a novel Concept-Attention Whitening (CAW) framework for interpretable skin lesion diagnosis. CAW is comprised of a disease diagnosis branch and a concept alignment branch. In the former branch, we train the CNN with a CAW layer inserted to perform skin lesion diagnosis. The CAW layer decorrelates features and aligns image features to conceptual meanings via an orthogonal matrix. In the latter branch, we calculate the orthogonal matrix under the guidance of the concept attention mask. We particularly introduce a weakly-supervised concept mask generator that only leverages coarse concept labels for filtering local regions that are relevant to certain concepts, improving the optimization of the orthogonal matrix. Extensive experiments on two public skin lesion diagnosis datasets demonstrated that CAW not only enhanced interpretability but also maintained a state-of-the-art diagnostic performance.

QMix: Quality-aware Learning with Mixed Noise for Robust Retinal Disease Diagnosis

Due to the complexity of medical image acquisition and the difficulty of annotation, medical image datasets inevitably contain noise. Noisy data with wrong labels affects the robustness and generalization ability of deep neural networks. Previous noise learning methods mainly considered noise arising from images being mislabeled, i.e. label noise, assuming that all mislabeled images are of high image quality. However, medical images are prone to suffering extreme quality issues, i.e. data noise, where discriminative visual features are missing for disease diagnosis. In this paper, we propose a noise learning framework, termed as QMix, that learns a robust disease diagnosis model under mixed noise. QMix alternates between sample separation and quality-aware semisupervised training in each training epoch. In the sample separation phase, we design a joint uncertainty-loss criterion to effectively separate (1) correctly labeled images; (2) mislabeled images with high quality and (3) mislabeled images with low quality. In the semi-supervised training phase, we train a disease diagnosis model to learn robust feature representation from the separated samples. Specifically, we devise a sample-reweighing loss to mitigate the effect of mislabeled images with low quality during training. Meanwhile, a contrastive enhancement loss is proposed to further distinguish mislabeled images with low quality from correctly labeled images. QMix achieved state-of-the-art disease diagnosis performance on five public retinal image datasets and exhibited substantial improvement on robustness against mixed noise.

Advancing COVID-19 Detection in 3D CT Scans

To make a more accurate diagnosis of COVID-19, we propose a straightforward yet effective model. Firstly, we analyse the characteristics of 3D CT scans and remove the non-lung parts, facilitating the model to focus on lesion-related areas and reducing computational cost. We use ResNeSt50 as the strong feature extractor, initializing it with pretrained weights which have COVID-19-specific prior knowledge. Our model achieves a Macro F1 Score of 0.94 on the validation set of the 4th COV19D Competition Challenge $\mathrm{I}$, surpassing the baseline by 16%. This indicates its effectiveness in distinguishing between COVID-19 and non-COVID-19 cases, making it a robust method for COVID-19 detection.

Domain Adaptation Using Pseudo Labels for COVID-19 Detection

In response to the need for rapid and accurate COVID-19 diagnosis during the global pandemic, we present a two-stage framework that leverages pseudo labels for domain adaptation to enhance the detection of COVID-19 from CT scans. By utilizing annotated data from one domain and non-annotated data from another, the model overcomes the challenge of data scarcity and variability, common in emergent health crises. The innovative approach of generating pseudo labels enables the model to iteratively refine its learning process, thereby improving its accuracy and adaptability across different hospitals and medical centres. Experimental results on COV19-CT-DB database showcase the model's potential to achieve high diagnostic precision, significantly contributing to efficient patient management and alleviating the strain on healthcare systems. Our method achieves 0.92 Macro F1 Score on the validation set of Covid-19 domain adaptation challenge.

Retrieval-Augmented Egocentric Video Captioning

Understanding human actions from videos of first-person view poses significant challenges. Most prior approaches explore representation learning on egocentric videos only, while overlooking the potential benefit of exploiting existing large-scale third-person videos. In this paper, (1) we develop EgoInstructor, a retrieval-augmented multimodal captioning model that automatically retrieves semantically relevant third-person instructional videos to enhance the video captioning of egocentric videos. (2) For training the cross-view retrieval module, we devise an automatic pipeline to discover ego-exo video pairs from distinct large-scale egocentric and exocentric datasets. (3) We train the cross-view retrieval module with a novel EgoExoNCE loss that pulls egocentric and exocentric video features closer by aligning them to shared text features that describe similar actions. (4) Through extensive experiments, our cross-view retrieval module demonstrates superior performance across seven benchmarks. Regarding egocentric video captioning, EgoInstructor exhibits significant improvements by leveraging third-person videos as references.

DRAC: Diabetic Retinopathy Analysis Challenge with Ultra-Wide Optical Coherence Tomography Angiography Images

Computer-assisted automatic analysis of diabetic retinopathy (DR) is of great importance in reducing the risks of vision loss and even blindness. Ultra-wide optical coherence tomography angiography (UW-OCTA) is a non-invasive and safe imaging modality in DR diagnosis system, but there is a lack of publicly available benchmarks for model development and evaluation. To promote further research and scientific benchmarking for diabetic retinopathy analysis using UW-OCTA images, we organized a challenge named "DRAC - Diabetic Retinopathy Analysis Challenge" in conjunction with the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2022). The challenge consists of three tasks: segmentation of DR lesions, image quality assessment and DR grading. The scientific community responded positively to the challenge, with 11, 12, and 13 teams from geographically diverse institutes submitting different solutions in these three tasks, respectively. This paper presents a summary and analysis of the top-performing solutions and results for each task of the challenge. The obtained results from top algorithms indicate the importance of data augmentation, model architecture and ensemble of networks in improving the performance of deep learning models. These findings have the potential to enable new developments in diabetic retinopathy analysis. The challenge remains open for post-challenge registrations and submissions for benchmarking future methodology developments.