DAMPER: A Dual-Stage Medical Report Generation Framework with Coarse-Grained MeSH Alignment and Fine-Grained Hypergraph Matching

Medical report generation is crucial for clinical diagnosis and patient management, summarizing diagnoses and recommendations based on medical imaging. However, existing work often overlook the clinical pipeline involved in report writing, where physicians typically conduct an initial quick review followed by a detailed examination. Moreover, current alignment methods may lead to misaligned relationships. To address these issues, we propose DAMPER, a dual-stage framework for medical report generation that mimics the clinical pipeline of report writing in two stages. In the first stage, a MeSH-Guided Coarse-Grained Alignment (MCG) stage that aligns chest X-ray (CXR) image features with medical subject headings (MeSH) features to generate a rough keyphrase representation of the overall impression. In the second stage, a Hypergraph-Enhanced Fine-Grained Alignment (HFG) stage that constructs hypergraphs for image patches and report annotations, modeling high-order relationships within each modality and performing hypergraph matching to capture semantic correlations between image regions and textual phrases. Finally,the coarse-grained visual features, generated MeSH representations, and visual hypergraph features are fed into a report decoder to produce the final medical report. Extensive experiments on public datasets demonstrate the effectiveness of DAMPER in generating comprehensive and accurate medical reports, outperforming state-of-the-art methods across various evaluation metrics.

{S$^3$-Mamba}: Small-Size-Sensitive Mamba for Lesion Segmentation

Small lesions play a critical role in early disease diagnosis and intervention of severe infections. Popular models often face challenges in segmenting small lesions, as it occupies only a minor portion of an image, while down\_sampling operations may inevitably lose focus on local features of small lesions. To tackle the challenges, we propose a {\bf S}mall-{\bf S}ize-{\bf S}ensitive {\bf Mamba} ({\bf S$^3$-Mamba}), which promotes the sensitivity to small lesions across three dimensions: channel, spatial, and training strategy. Specifically, an Enhanced Visual State Space block is designed to focus on small lesions through multiple residual connections to preserve local features, and selectively amplify important details while suppressing irrelevant ones through channel-wise attention. A Tensor-based Cross-feature Multi-scale Attention is designed to integrate input image features and intermediate-layer features with edge features and exploit the attentive support of features across multiple scales, thereby retaining spatial details of small lesions at various granularities. Finally, we introduce a novel regularized curriculum learning to automatically assess lesion size and sample difficulty, and gradually focus from easy samples to hard ones like small lesions. Extensive experiments on three medical image segmentation datasets show the superiority of our S$^3$-Mamba, especially in segmenting small lesions. Our code is available at https://github.com/ErinWang2023/S3-Mamba.

WSI-LLaVA: A Multimodal Large Language Model for Whole Slide Image

Recent advancements in computational pathology have produced patch-level Multi-modal Large Language Models (MLLMs), but these models are limited by their inability to analyze whole slide images (WSIs) comprehensively and their tendency to bypass crucial morphological features that pathologists rely on for diagnosis. To address these challenges, we first introduce WSI-Bench, a large-scale morphology-aware benchmark containing 180k VQA pairs from 9,850 WSIs across 30 cancer types, designed to evaluate MLLMs' understanding of morphological characteristics crucial for accurate diagnosis. Building upon this benchmark, we present WSI-LLaVA, a novel framework for gigapixel WSI understanding that employs a three-stage training approach: WSI-text alignment, feature space alignment, and task-specific instruction tuning. To better assess model performance in pathological contexts, we develop two specialized WSI metrics: WSI-Precision and WSI-Relevance. Experimental results demonstrate that WSI-LLaVA outperforms existing models across all capability dimensions, with a significant improvement in morphological analysis, establishing a clear correlation between morphological understanding and diagnostic accuracy.

Medchain: Bridging the Gap Between LLM Agents and Clinical Practice through Interactive Sequential Benchmarking

Clinical decision making (CDM) is a complex, dynamic process crucial to healthcare delivery, yet it remains a significant challenge for artificial intelligence systems. While Large Language Model (LLM)-based agents have been tested on general medical knowledge using licensing exams and knowledge question-answering tasks, their performance in the CDM in real-world scenarios is limited due to the lack of comprehensive testing datasets that mirror actual medical practice. To address this gap, we present MedChain, a dataset of 12,163 clinical cases that covers five key stages of clinical workflow. MedChain distinguishes itself from existing benchmarks with three key features of real-world clinical practice: personalization, interactivity, and sequentiality. Further, to tackle real-world CDM challenges, we also propose MedChain-Agent, an AI system that integrates a feedback mechanism and a MCase-RAG module to learn from previous cases and adapt its responses. MedChain-Agent demonstrates remarkable adaptability in gathering information dynamically and handling sequential clinical tasks, significantly outperforming existing approaches. The relevant dataset and code will be released upon acceptance of this paper.

GEM: Context-Aware Gaze EstiMation with Visual Search Behavior Matching for Chest Radiograph

Gaze estimation is pivotal in human scene comprehension tasks, particularly in medical diagnostic analysis. Eye-tracking technology facilitates the recording of physicians' ocular movements during image interpretation, thereby elucidating their visual attention patterns and information-processing strategies. In this paper, we initially define the context-aware gaze estimation problem in medical radiology report settings. To understand the attention allocation and cognitive behavior of radiologists during the medical image interpretation process, we propose a context-aware Gaze EstiMation (GEM) network that utilizes eye gaze data collected from radiologists to simulate their visual search behavior patterns throughout the image interpretation process. It consists of a context-awareness module, visual behavior graph construction, and visual behavior matching. Within the context-awareness module, we achieve intricate multimodal registration by establishing connections between medical reports and images. Subsequently, for a more accurate simulation of genuine visual search behavior patterns, we introduce a visual behavior graph structure, capturing such behavior through high-order relationships (edges) between gaze points (nodes). To maintain the authenticity of visual behavior, we devise a visual behavior-matching approach, adjusting the high-order relationships between them by matching the graph constructed from real and estimated gaze points. Extensive experiments on four publicly available datasets demonstrate the superiority of GEM over existing methods and its strong generalizability, which also provides a new direction for the effective utilization of diverse modalities in medical image interpretation and enhances the interpretability of models in the field of medical imaging. https://github.com/Tiger-SN/GEM

Towards a Holistic Framework for Multimodal Large Language Models in Three-dimensional Brain CT Report Generation

Multi-modal large language models (MLLMs) have been given free rein to explore exciting medical applications with a primary focus on radiology report generation. Nevertheless, the preliminary success in 2D radiology captioning is incompetent to reflect the real-world diagnostic challenge in the volumetric 3D anatomy. To mitigate three crucial limitation aspects in the existing literature, including (1) data complexity, (2) model capacity, and (3) evaluation metric fidelity, we collected an 18,885 text-scan pairs 3D-BrainCT dataset and applied clinical visual instruction tuning (CVIT) to train BrainGPT models to generate radiology-adherent 3D brain CT reports. Statistically, our BrainGPT scored BLEU-1 = 44.35, BLEU-4 = 20.38, METEOR = 30.13, ROUGE-L = 47.6, and CIDEr-R = 211.77 during internal testing and demonstrated an accuracy of 0.91 in captioning midline shifts on the external validation CQ500 dataset. By further inspecting the captioned report, we reported that the traditional metrics appeared to measure only the surface text similarity and failed to gauge the information density of the diagnostic purpose. To close this gap, we proposed a novel Feature-Oriented Radiology Task Evaluation (FORTE) to estimate the report's clinical relevance (lesion feature and landmarks). Notably, the BrainGPT model scored an average FORTE F1-score of 0.71 (degree=0.661; landmark=0.706; feature=0.693; impression=0.779). To demonstrate that BrainGPT models possess objective readiness to generate human-like radiology reports, we conducted a Turing test that enrolled 11 physician evaluators, and around 74% of the BrainGPT-generated captions were indistinguishable from those written by humans. Our work embodies a holistic framework that showcased the first-hand experience of curating a 3D brain CT dataset, fine-tuning anatomy-sensible language models, and proposing robust radiology evaluation metrics.

Spatial-temporal Hierarchical Reinforcement Learning for Interpretable Pathology Image Super-Resolution

Pathology image are essential for accurately interpreting lesion cells in cytopathology screening, but acquiring high-resolution digital slides requires specialized equipment and long scanning times. Though super-resolution (SR) techniques can alleviate this problem, existing deep learning models recover pathology image in a black-box manner, which can lead to untruthful biological details and misdiagnosis. Additionally, current methods allocate the same computational resources to recover each pixel of pathology image, leading to the sub-optimal recovery issue due to the large variation of pathology image. In this paper, we propose the first hierarchical reinforcement learning framework named Spatial-Temporal hierARchical Reinforcement Learning (STAR-RL), mainly for addressing the aforementioned issues in pathology image super-resolution problem. We reformulate the SR problem as a Markov decision process of interpretable operations and adopt the hierarchical recovery mechanism in patch level, to avoid sub-optimal recovery. Specifically, the higher-level spatial manager is proposed to pick out the most corrupted patch for the lower-level patch worker. Moreover, the higher-level temporal manager is advanced to evaluate the selected patch and determine whether the optimization should be stopped earlier, thereby avoiding the over-processed problem. Under the guidance of spatial-temporal managers, the lower-level patch worker processes the selected patch with pixel-wise interpretable actions at each time step. Experimental results on medical images degraded by different kernels show the effectiveness of STAR-RL. Furthermore, STAR-RL validates the promotion in tumor diagnosis with a large margin and shows generalizability under various degradations. The source code is available at https://github.com/CUHK-AIM-Group/STAR-RL.

Multi-Dataset Multi-Task Learning for COVID-19 Prognosis

In the fight against the COVID-19 pandemic, leveraging artificial intelligence to predict disease outcomes from chest radiographic images represents a significant scientific aim. The challenge, however, lies in the scarcity of large, labeled datasets with compatible tasks for training deep learning models without leading to overfitting. Addressing this issue, we introduce a novel multi-dataset multi-task training framework that predicts COVID-19 prognostic outcomes from chest X-rays (CXR) by integrating correlated datasets from disparate sources, distant from conventional multi-task learning approaches, which rely on datasets with multiple and correlated labeling schemes. Our framework hypothesizes that assessing severity scores enhances the model's ability to classify prognostic severity groups, thereby improving its robustness and predictive power. The proposed architecture comprises a deep convolutional network that receives inputs from two publicly available CXR datasets, AIforCOVID for severity prognostic prediction and BRIXIA for severity score assessment, and branches into task-specific fully connected output networks. Moreover, we propose a multi-task loss function, incorporating an indicator function, to exploit multi-dataset integration. The effectiveness and robustness of the proposed approach are demonstrated through significant performance improvements in prognosis classification tasks across 18 different convolutional neural network backbones in different evaluation strategies. This improvement is evident over single-task baselines and standard transfer learning strategies, supported by extensive statistical analysis, showing great application potential.

Eye-gaze Guided Multi-modal Alignment Framework for Radiology

In multi-modal frameworks, the alignment of cross-modal features presents a significant challenge. The predominant approach in multi-modal pre-training emphasizes either global or local alignment between modalities, utilizing extensive datasets. This bottom-up driven method often suffers from a lack of interpretability, a critical concern in radiology. Previous studies have integrated high-level labels in medical images or text, but these still rely on manual annotation, a costly and labor-intensive process. Our work introduces a novel approach by using eye-gaze data, collected synchronously by radiologists during diagnostic evaluations. This data, indicating radiologists' focus areas, naturally links chest X-rays to diagnostic texts. We propose the Eye-gaze Guided Multi-modal Alignment (EGMA) framework to harness eye-gaze data for better alignment of image and text features, aiming to reduce reliance on manual annotations and thus cut training costs. Our model demonstrates robust performance, outperforming other state-of-the-art methods in zero-shot classification and retrieval tasks. The incorporation of easily-obtained eye-gaze data during routine radiological diagnoses signifies a step towards minimizing manual annotation dependency. Additionally, we explore the impact of varying amounts of eye-gaze data on model performance, highlighting the feasibility and utility of integrating this auxiliary data into multi-modal pre-training.

Medical Image Synthesis via Fine-Grained Image-Text Alignment and Anatomy-Pathology Prompting

Data scarcity and privacy concerns limit the availability of high-quality medical images for public use, which can be mitigated through medical image synthesis. However, current medical image synthesis methods often struggle to accurately capture the complexity of detailed anatomical structures and pathological conditions. To address these challenges, we propose a novel medical image synthesis model that leverages fine-grained image-text alignment and anatomy-pathology prompts to generate highly detailed and accurate synthetic medical images. Our method integrates advanced natural language processing techniques with image generative modeling, enabling precise alignment between descriptive text prompts and the synthesized images' anatomical and pathological details. The proposed approach consists of two key components: an anatomy-pathology prompting module and a fine-grained alignment-based synthesis module. The anatomy-pathology prompting module automatically generates descriptive prompts for high-quality medical images. To further synthesize high-quality medical images from the generated prompts, the fine-grained alignment-based synthesis module pre-defines a visual codebook for the radiology dataset and performs fine-grained alignment between the codebook and generated prompts to obtain key patches as visual clues, facilitating accurate image synthesis. We validate the superiority of our method through experiments on public chest X-ray datasets and demonstrate that our synthetic images preserve accurate semantic information, making them valuable for various medical applications.