A Survey of Medical Vision-and-Language Applications and Their Techniques

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

AdaCBM: An Adaptive Concept Bottleneck Model for Explainable and Accurate Diagnosis

The integration of vision-language models such as CLIP and Concept Bottleneck Models (CBMs) offers a promising approach to explaining deep neural network (DNN) decisions using concepts understandable by humans, addressing the black-box concern of DNNs. While CLIP provides both explainability and zero-shot classification capability, its pre-training on generic image and text data may limit its classification accuracy and applicability to medical image diagnostic tasks, creating a transfer learning problem. To maintain explainability and address transfer learning needs, CBM methods commonly design post-processing modules after the bottleneck module. However, this way has been ineffective. This paper takes an unconventional approach by re-examining the CBM framework through the lens of its geometrical representation as a simple linear classification system. The analysis uncovers that post-CBM fine-tuning modules merely rescale and shift the classification outcome of the system, failing to fully leverage the system's learning potential. We introduce an adaptive module strategically positioned between CLIP and CBM to bridge the gap between source and downstream domains. This simple yet effective approach enhances classification performance while preserving the explainability afforded by the framework. Our work offers a comprehensive solution that encompasses the entire process, from concept discovery to model training, providing a holistic recipe for leveraging the strengths of GPT, CLIP, and CBM.

Structural Attention: Rethinking Transformer for Unpaired Medical Image Synthesis

Unpaired medical image synthesis aims to provide complementary information for an accurate clinical diagnostics, and address challenges in obtaining aligned multi-modal medical scans. Transformer-based models excel in imaging translation tasks thanks to their ability to capture long-range dependencies. Although effective in supervised training settings, their performance falters in unpaired image synthesis, particularly in synthesizing structural details. This paper empirically demonstrates that, lacking strong inductive biases, Transformer can converge to non-optimal solutions in the absence of paired data. To address this, we introduce UNet Structured Transformer (UNest), a novel architecture incorporating structural inductive biases for unpaired medical image synthesis. We leverage the foundational Segment-Anything Model to precisely extract the foreground structure and perform structural attention within the main anatomy. This guides the model to learn key anatomical regions, thus improving structural synthesis under the lack of supervision in unpaired training. Evaluated on two public datasets, spanning three modalities, i.e., MR, CT, and PET, UNest improves recent methods by up to 19.30% across six medical image synthesis tasks. Our code is released at https://github.com/HieuPhan33/MICCAI2024-UNest.

JointViT: Modeling Oxygen Saturation Levels with Joint Supervision on Long-Tailed OCTA

The oxygen saturation level in the blood (SaO2) is crucial for health, particularly in relation to sleep-related breathing disorders. However, continuous monitoring of SaO2 is time-consuming and highly variable depending on patients' conditions. Recently, optical coherence tomography angiography (OCTA) has shown promising development in rapidly and effectively screening eye-related lesions, offering the potential for diagnosing sleep-related disorders. To bridge this gap, our paper presents three key contributions. Firstly, we propose JointViT, a novel model based on the Vision Transformer architecture, incorporating a joint loss function for supervision. Secondly, we introduce a balancing augmentation technique during data preprocessing to improve the model's performance, particularly on the long-tail distribution within the OCTA dataset. Lastly, through comprehensive experiments on the OCTA dataset, our proposed method significantly outperforms other state-of-the-art methods, achieving improvements of up to 12.28% in overall accuracy. This advancement lays the groundwork for the future utilization of OCTA in diagnosing sleep-related disorders. See project website https://steve-zeyu-zhang.github.io/JointViT

PairAug: What Can Augmented Image-Text Pairs Do for Radiology?

Current vision-language pre-training (VLP) methodologies predominantly depend on paired image-text datasets, a resource that is challenging to acquire in radiology due to privacy considerations and labelling complexities. Data augmentation provides a practical solution to overcome the issue of data scarcity, however, most augmentation methods exhibit a limited focus, prioritising either image or text augmentation exclusively. Acknowledging this limitation, our objective is to devise a framework capable of concurrently augmenting medical image and text data. We design a Pairwise Augmentation (PairAug) approach that contains an Inter-patient Augmentation (InterAug) branch and an Intra-patient Augmentation (IntraAug) branch. Specifically, the InterAug branch of our approach generates radiology images using synthesised yet plausible reports derived from a Large Language Model (LLM). The generated pairs can be considered a collection of new patient cases since they are artificially created and may not exist in the original dataset. In contrast, the IntraAug branch uses newly generated reports to manipulate images. This process allows us to create new paired data for each individual with diverse medical conditions. Our extensive experiments on various downstream tasks covering medical image classification zero-shot and fine-tuning analysis demonstrate that our PairAug, concurrently expanding both image and text data, substantially outperforms image-/text-only expansion baselines and advanced medical VLP baselines. Our code is released at \url{https://github.com/YtongXie/PairAug}.

CAPE: CAM as a Probabilistic Ensemble for Enhanced DNN Interpretation

Deep Neural Networks (DNNs) are widely used for visual classification tasks, but their complex computation process and black-box nature hinder decision transparency and interpretability. Class activation maps (CAMs) and recent variants provide ways to visually explain the DNN decision-making process by displaying 'attention' heatmaps of the DNNs. Nevertheless, the CAM explanation only offers relative attention information, that is, on an attention heatmap, we can interpret which image region is more or less important than the others. However, these regions cannot be meaningfully compared across classes, and the contribution of each region to the model's class prediction is not revealed. To address these challenges that ultimately lead to better DNN Interpretation, in this paper, we propose CAPE, a novel reformulation of CAM that provides a unified and probabilistically meaningful assessment of the contributions of image regions. We quantitatively and qualitatively compare CAPE with state-of-the-art CAM methods on CUB and ImageNet benchmark datasets to demonstrate enhanced interpretability. We also test on a cytology imaging dataset depicting a challenging Chronic Myelomonocytic Leukemia (CMML) diagnosis problem. Code is available at: https://github.com/AIML-MED/CAPE.

Decomposing Disease Descriptions for Enhanced Pathology Detection: A Multi-Aspect Vision-Language Matching Framework

Medical vision language pre-training (VLP) has emerged as a frontier of research, enabling zero-shot pathological recognition by comparing the query image with the textual descriptions for each disease. Due to the complex semantics of biomedical texts, current methods struggle to align medical images with key pathological findings in unstructured reports. This leads to the misalignment with the target disease's textual representation. In this paper, we introduce a novel VLP framework designed to dissect disease descriptions into their fundamental aspects, leveraging prior knowledge about the visual manifestations of pathologies. This is achieved by consulting a large language model and medical experts. Integrating a Transformer module, our approach aligns an input image with the diverse elements of a disease, generating aspect-centric image representations. By consolidating the matches from each aspect, we improve the compatibility between an image and its associated disease. Additionally, capitalizing on the aspect-oriented representations, we present a dual-head Transformer tailored to process known and unknown diseases, optimizing the comprehensive detection efficacy. Conducting experiments on seven downstream datasets, ours outperforms recent methods by up to 8.07% and 11.23% in AUC scores for seen and novel categories, respectively. Our code is released at \href{https://github.com/HieuPhan33/MAVL}{https://github.com/HieuPhan33/MAVL}.

SegReg: Segmenting OARs by Registering MR Images and CT Annotations

Organ at risk (OAR) segmentation is a critical process in radiotherapy treatment planning such as head and neck tumors. Nevertheless, in clinical practice, radiation oncologists predominantly perform OAR segmentations manually on CT scans. This manual process is highly time-consuming and expensive, limiting the number of patients who can receive timely radiotherapy. Additionally, CT scans offer lower soft-tissue contrast compared to MRI. Despite MRI providing superior soft-tissue visualization, its time-consuming nature makes it infeasible for real-time treatment planning. To address these challenges, we propose a method called SegReg, which utilizes Elastic Symmetric Normalization for registering MRI to perform OAR segmentation. SegReg outperforms the CT-only baseline by 16.78% in mDSC and 18.77% in mIoU, showing that it effectively combines the geometric accuracy of CT with the superior soft-tissue contrast of MRI, making accurate automated OAR segmentation for clinical practice become possible.

BHSD: A 3D Multi-Class Brain Hemorrhage Segmentation Dataset

Intracranial hemorrhage (ICH) is a pathological condition characterized by bleeding inside the skull or brain, which can be attributed to various factors. Identifying, localizing and quantifying ICH has important clinical implications, in a bleed-dependent manner. While deep learning techniques are widely used in medical image segmentation and have been applied to the ICH segmentation task, existing public ICH datasets do not support the multi-class segmentation problem. To address this, we develop the Brain Hemorrhage Segmentation Dataset (BHSD), which provides a 3D multi-class ICH dataset containing 192 volumes with pixel-level annotations and 2200 volumes with slice-level annotations across five categories of ICH. To demonstrate the utility of the dataset, we formulate a series of supervised and semi-supervised ICH segmentation tasks. We provide experimental results with state-of-the-art models as reference benchmarks for further model developments and evaluations on this dataset.

Structure-Preserving Synthesis: MaskGAN for Unpaired MR-CT Translation

Medical image synthesis is a challenging task due to the scarcity of paired data. Several methods have applied CycleGAN to leverage unpaired data, but they often generate inaccurate mappings that shift the anatomy. This problem is further exacerbated when the images from the source and target modalities are heavily misaligned. Recently, current methods have aimed to address this issue by incorporating a supplementary segmentation network. Unfortunately, this strategy requires costly and time-consuming pixel-level annotations. To overcome this problem, this paper proposes MaskGAN, a novel and cost-effective framework that enforces structural consistency by utilizing automatically extracted coarse masks. Our approach employs a mask generator to outline anatomical structures and a content generator to synthesize CT contents that align with these structures. Extensive experiments demonstrate that MaskGAN outperforms state-of-the-art synthesis methods on a challenging pediatric dataset, where MR and CT scans are heavily misaligned due to rapid growth in children. Specifically, MaskGAN excels in preserving anatomical structures without the need for expert annotations. The code for this paper can be found at https://github.com/HieuPhan33/MaskGAN.