OphCLIP: Hierarchical Retrieval-Augmented Learning for Ophthalmic Surgical Video-Language Pretraining

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

A General-Purpose Multimodal Foundation Model for Dermatology

Diagnosing and treating skin diseases require advanced visual skills across multiple domains and the ability to synthesize information from various imaging modalities. Current deep learning models, while effective at specific tasks such as diagnosing skin cancer from dermoscopic images, fall short in addressing the complex, multimodal demands of clinical practice. Here, we introduce PanDerm, a multimodal dermatology foundation model pretrained through self-supervised learning on a dataset of over 2 million real-world images of skin diseases, sourced from 11 clinical institutions across 4 imaging modalities. We evaluated PanDerm on 28 diverse datasets covering a range of clinical tasks, including skin cancer screening, phenotype assessment and risk stratification, diagnosis of neoplastic and inflammatory skin diseases, skin lesion segmentation, change monitoring, and metastasis prediction and prognosis. PanDerm achieved state-of-the-art performance across all evaluated tasks, often outperforming existing models even when using only 5-10% of labeled data. PanDerm's clinical utility was demonstrated through reader studies in real-world clinical settings across multiple imaging modalities. It outperformed clinicians by 10.2% in early-stage melanoma detection accuracy and enhanced clinicians' multiclass skin cancer diagnostic accuracy by 11% in a collaborative human-AI setting. Additionally, PanDerm demonstrated robust performance across diverse demographic factors, including different body locations, age groups, genders, and skin tones. The strong results in benchmark evaluations and real-world clinical scenarios suggest that PanDerm could enhance the management of skin diseases and serve as a model for developing multimodal foundation models in other medical specialties, potentially accelerating the integration of AI support in healthcare.

MONICA: Benchmarking on Long-tailed Medical Image Classification

Long-tailed learning is considered to be an extremely challenging problem in data imbalance learning. It aims to train well-generalized models from a large number of images that follow a long-tailed class distribution. In the medical field, many diagnostic imaging exams such as dermoscopy and chest radiography yield a long-tailed distribution of complex clinical findings. Recently, long-tailed learning in medical image analysis has garnered significant attention. However, the field currently lacks a unified, strictly formulated, and comprehensive benchmark, which often leads to unfair comparisons and inconclusive results. To help the community improve the evaluation and advance, we build a unified, well-structured codebase called Medical OpeN-source Long-taIled ClassifiCAtion (MONICA), which implements over 30 methods developed in relevant fields and evaluated on 12 long-tailed medical datasets covering 6 medical domains. Our work provides valuable practical guidance and insights for the field, offering detailed analysis and discussion on the effectiveness of individual components within the inbuilt state-of-the-art methodologies. We hope this codebase serves as a comprehensive and reproducible benchmark, encouraging further advancements in long-tailed medical image learning. The codebase is publicly available on https://github.com/PyJulie/MONICA.

OphNet: A Large-Scale Video Benchmark for Ophthalmic Surgical Workflow Understanding

Surgical scene perception via videos are critical for advancing robotic surgery, telesurgery, and AI-assisted surgery, particularly in ophthalmology. However, the scarcity of diverse and richly annotated video datasets has hindered the development of intelligent systems for surgical workflow analysis. Existing datasets for surgical workflow analysis, which typically face challenges such as small scale, a lack of diversity in surgery and phase categories, and the absence of time-localized annotations, limit the requirements for action understanding and model generalization validation in complex and diverse real-world surgical scenarios. To address this gap, we introduce OphNet, a large-scale, expert-annotated video benchmark for ophthalmic surgical workflow understanding. OphNet features: 1) A diverse collection of 2,278 surgical videos spanning 66 types of cataract, glaucoma, and corneal surgeries, with detailed annotations for 102 unique surgical phases and 150 granular operations; 2) It offers sequential and hierarchical annotations for each surgery, phase, and operation, enabling comprehensive understanding and improved interpretability; 3) Moreover, OphNet provides time-localized annotations, facilitating temporal localization and prediction tasks within surgical workflows. With approximately 205 hours of surgical videos, OphNet is about 20 times larger than the largest existing surgical workflow analysis benchmark. Our dataset and code have been made available at: \url{https://github.com/minghu0830/OphNet-benchmark}.

Diffusion Model Driven Test-Time Image Adaptation for Robust Skin Lesion Classification

Deep learning-based diagnostic systems have demonstrated potential in skin disease diagnosis. However, their performance can easily degrade on test domains due to distribution shifts caused by input-level corruptions, such as imaging equipment variability, brightness changes, and image blur. This will reduce the reliability of model deployment in real-world scenarios. Most existing solutions focus on adapting the source model through retraining on different target domains. Although effective, this retraining process is sensitive to the amount of data and the hyperparameter configuration for optimization. In this paper, we propose a test-time image adaptation method to enhance the accuracy of the model on test data by simultaneously updating and predicting test images. We modify the target test images by projecting them back to the source domain using a diffusion model. Specifically, we design a structure guidance module that adds refinement operations through low-pass filtering during reverse sampling, regularizing the diffusion to preserve structural information. Additionally, we introduce a self-ensembling scheme automatically adjusts the reliance on adapted and unadapted inputs, enhancing adaptation robustness by rejecting inappropriate generative modeling results. To facilitate this study, we constructed the ISIC2019-C and Dermnet-C corruption robustness evaluation benchmarks. Extensive experiments on the proposed benchmarks demonstrate that our method makes the classifier more robust across various corruptions, architectures, and data regimes. Our datasets and code will be available at \url{https://github.com/minghu0830/Skin-TTA_Diffusion}.

Generalizing CLIP to Unseen Domain via Text-Guided Diverse Novel Feature Synthesis

Vision-language foundation models like CLIP have shown impressive zero-shot generalization, but finetuning on downstream datasets can cause overfitting and loss of its generalization ability on unseen domains. Although collecting additional data from new domains of interest is possible, this method is often impractical due to the challenges in obtaining annotated data. To address this, we propose a plug-and-play feature augmentation method called LDFS (Language-Guided Diverse Feature Synthesis) to synthesize new domain features and improve existing CLIP fine-tuning strategies. LDFS has three main contributions: 1) To synthesize novel domain features and promote diversity, we propose an instance-conditional feature augmentation strategy based on a textguided feature augmentation loss. 2) To maintain feature quality after augmenting, we introduce a pairwise regularizer to preserve augmented feature coherence within the CLIP feature space. 3) We propose to use stochastic text feature augmentation to reduce the modality gap and further facilitate the process of text-guided feature synthesis. Extensive experiments show LDFS superiority in improving CLIP generalization ability on unseen domains without collecting data from those domains. The code will be made publicly available.

Prompt-driven Latent Domain Generalization for Medical Image Classification

Deep learning models for medical image analysis easily suffer from distribution shifts caused by dataset artifacts bias, camera variations, differences in the imaging station, etc., leading to unreliable diagnoses in real-world clinical settings. Domain generalization (DG) methods, which aim to train models on multiple domains to perform well on unseen domains, offer a promising direction to solve the problem. However, existing DG methods assume domain labels of each image are available and accurate, which is typically feasible for only a limited number of medical datasets. To address these challenges, we propose a novel DG framework for medical image classification without relying on domain labels, called Prompt-driven Latent Domain Generalization (PLDG). PLDG consists of unsupervised domain discovery and prompt learning. This framework first discovers pseudo domain labels by clustering the bias-associated style features, then leverages collaborative domain prompts to guide a Vision Transformer to learn knowledge from discovered diverse domains. To facilitate cross-domain knowledge learning between different prompts, we introduce a domain prompt generator that enables knowledge sharing between domain prompts and a shared prompt. A domain mixup strategy is additionally employed for more flexible decision margins and mitigates the risk of incorrect domain assignments. Extensive experiments on three medical image classification tasks and one debiasing task demonstrate that our method can achieve comparable or even superior performance than conventional DG algorithms without relying on domain labels. Our code will be publicly available upon the paper is accepted.

NurViD: A Large Expert-Level Video Database for Nursing Procedure Activity Understanding

The application of deep learning to nursing procedure activity understanding has the potential to greatly enhance the quality and safety of nurse-patient interactions. By utilizing the technique, we can facilitate training and education, improve quality control, and enable operational compliance monitoring. However, the development of automatic recognition systems in this field is currently hindered by the scarcity of appropriately labeled datasets. The existing video datasets pose several limitations: 1) these datasets are small-scale in size to support comprehensive investigations of nursing activity; 2) they primarily focus on single procedures, lacking expert-level annotations for various nursing procedures and action steps; and 3) they lack temporally localized annotations, which prevents the effective localization of targeted actions within longer video sequences. To mitigate these limitations, we propose NurViD, a large video dataset with expert-level annotation for nursing procedure activity understanding. NurViD consists of over 1.5k videos totaling 144 hours, making it approximately four times longer than the existing largest nursing activity datasets. Notably, it encompasses 51 distinct nursing procedures and 177 action steps, providing a much more comprehensive coverage compared to existing datasets that primarily focus on limited procedures. To evaluate the efficacy of current deep learning methods on nursing activity understanding, we establish three benchmarks on NurViD: procedure recognition on untrimmed videos, procedure and action recognition on trimmed videos, and action detection. Our benchmark and code will be available at \url{https://github.com/minghu0830/NurViD-benchmark}.

EPVT: Environment-aware Prompt Vision Transformer for Domain Generalization in Skin Lesion Recognition

Skin lesion recognition using deep learning has made remarkable progress, and there is an increasing need for deploying these systems in real-world scenarios. However, recent research has revealed that deep neural networks for skin lesion recognition may overly depend on disease-irrelevant image artifacts (i.e. dark corners, dense hairs), leading to poor generalization in unseen environments. To address this issue, we propose a novel domain generalization method called EPVT, which involves embedding prompts into the vision transformer to collaboratively learn knowledge from diverse domains. Concretely, EPVT leverages a set of domain prompts, each of which plays as a domain expert, to capture domain-specific knowledge; and a shared prompt for general knowledge over the entire dataset. To facilitate knowledge sharing and the interaction of different prompts, we introduce a domain prompt generator that enables low-rank multiplicative updates between domain prompts and the shared prompt. A domain mixup strategy is additionally devised to reduce the co-occurring artifacts in each domain, which allows for more flexible decision margins and mitigates the issue of incorrectly assigned domain labels. Experiments on four out-of-distribution datasets and six different biased ISIC datasets demonstrate the superior generalization ability of EPVT in skin lesion recognition across various environments. Our code and dataset will be released at https://github.com/SiyuanYan1/EPVT.

Towards Trustable Skin Cancer Diagnosis via Rewriting Model's Decision

Deep neural networks have demonstrated promising performance on image recognition tasks. However, they may heavily rely on confounding factors, using irrelevant artifacts or bias within the dataset as the cue to improve performance. When a model performs decision-making based on these spurious correlations, it can become untrustable and lead to catastrophic outcomes when deployed in the real-world scene. In this paper, we explore and try to solve this problem in the context of skin cancer diagnosis. We introduce a human-in-the-loop framework in the model training process such that users can observe and correct the model's decision logic when confounding behaviors happen. Specifically, our method can automatically discover confounding factors by analyzing the co-occurrence behavior of the samples. It is capable of learning confounding concepts using easily obtained concept exemplars. By mapping the black-box model's feature representation onto an explainable concept space, human users can interpret the concept and intervene via first order-logic instruction. We systematically evaluate our method on our newly crafted, well-controlled skin lesion dataset and several public skin lesion datasets. Experiments show that our method can effectively detect and remove confounding factors from datasets without any prior knowledge about the category distribution and does not require fully annotated concept labels. We also show that our method enables the model to focus on clinical-related concepts, improving the model's performance and trustworthiness during model inference.