Abstract:Large language models (LLMs) can learn vast amounts of knowledge from diverse domains during pre-training. However, long-tail knowledge from specialized domains is often scarce and underrepresented, rarely appearing in the models' memorization. Prior work has shown that in-context learning (ICL) with retriever augmentation can help LLMs better capture long-tail knowledge, reducing their reliance on pre-trained data. Despite these advances, we observe that LLM predictions for long-tail questions remain uncertain to variations in retrieved samples. To take advantage of the uncertainty in ICL for guiding LLM predictions toward correct answers on long-tail samples, we propose a reinforcement learning-based dynamic uncertainty ranking method for ICL that accounts for the varying impact of each retrieved sample on LLM predictions. Our approach prioritizes more informative and stable samples while demoting misleading ones, updating rankings based on the feedback from the LLM w.r.t. each retrieved sample. To enhance training efficiency and reduce query costs, we introduce a learnable dynamic ranking threshold, adjusted when the model encounters negative prediction shifts. Experimental results on various question-answering datasets from different domains show that our method outperforms the best baseline by $2.76\%$, with a notable $5.96\%$ boost in accuracy on long-tail questions that elude zero-shot inference.
Abstract:Large language models (LLMs) have demonstrated significant potential in clinical decision support. Yet LLMs still suffer from hallucinations and lack fine-grained contextual medical knowledge, limiting their high-stake healthcare applications such as clinical diagnosis. Traditional retrieval-augmented generation (RAG) methods attempt to address these limitations but frequently retrieve sparse or irrelevant information, undermining prediction accuracy. We introduce KARE, a novel framework that integrates knowledge graph (KG) community-level retrieval with LLM reasoning to enhance healthcare predictions. KARE constructs a comprehensive multi-source KG by integrating biomedical databases, clinical literature, and LLM-generated insights, and organizes it using hierarchical graph community detection and summarization for precise and contextually relevant information retrieval. Our key innovations include: (1) a dense medical knowledge structuring approach enabling accurate retrieval of relevant information; (2) a dynamic knowledge retrieval mechanism that enriches patient contexts with focused, multi-faceted medical insights; and (3) a reasoning-enhanced prediction framework that leverages these enriched contexts to produce both accurate and interpretable clinical predictions. Extensive experiments demonstrate that KARE outperforms leading models by up to 10.8-15.0% on MIMIC-III and 12.6-12.7% on MIMIC-IV for mortality and readmission predictions. In addition to its impressive prediction accuracy, our framework leverages the reasoning capabilities of LLMs, enhancing the trustworthiness of clinical predictions.
Abstract:Recent advances in Vision Transformers (ViT) and Stable Diffusion (SD) models with their ability to capture rich semantic features of the image have been used for image correspondence tasks on natural images. In this paper, we examine the ability of a variety of pre-trained ViT (DINO, DINOv2, SAM, CLIP) and SD models, trained exclusively on natural images, for solving the correspondence problems on medical images. While many works have made a case for in-domain training, we show that the models trained on natural images can offer good performance on medical images across different modalities (CT,MR,Ultrasound) sourced from various manufacturers, over multiple anatomical regions (brain, thorax, abdomen, extremities), and on wide variety of tasks. Further, we leverage the correspondence with respect to a template image to prompt a Segment Anything (SAM) model to arrive at single shot segmentation, achieving dice range of 62%-90% across tasks, using just one image as reference. We also show that our single-shot method outperforms the recently proposed few-shot segmentation method - UniverSeg (Dice range 47%-80%) on most of the semantic segmentation tasks(six out of seven) across medical imaging modalities.
Abstract:Sepsis is a life-threatening disease with high morbidity, mortality and healthcare costs. The early prediction and administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis and can save potentially millions of lives and billions in health care costs. Professional clinical care practitioners have proposed clinical criterion which aid in early detection of sepsis; however, performance of these criterion is often limited. Clinical text provides essential information to estimate the severity of the sepsis in addition to structured clinical data. In this study, we explore how clinical text can complement structured data towards early sepsis prediction task. In this paper, we propose multi modal model which incorporates both structured data in the form of patient measurements as well as textual notes on the patient. We employ state-of-the-art NLP models such as BERT and a highly specialized NLP model in Amazon Comprehend Medical to represent the text. On the MIMIC-III dataset containing records of ICU admissions, we show that by using these notes, one achieves an improvement of 6.07 points in a standard utility score for Sepsis prediction and 2.89% in AUROC score. Our methods significantly outperforms a clinical criteria suggested by experts, qSOFA, as well as the winning model of the PhysioNet Computing in Cardiology Challenge for predicting Sepsis.