BenchX: A Unified Benchmark Framework for Medical Vision-Language Pretraining on Chest X-Rays

Medical Vision-Language Pretraining (MedVLP) shows promise in learning generalizable and transferable visual representations from paired and unpaired medical images and reports. MedVLP can provide useful features to downstream tasks and facilitate adapting task-specific models to new setups using fewer examples. However, existing MedVLP methods often differ in terms of datasets, preprocessing, and finetuning implementations. This pose great challenges in evaluating how well a MedVLP method generalizes to various clinically-relevant tasks due to the lack of unified, standardized, and comprehensive benchmark. To fill this gap, we propose BenchX, a unified benchmark framework that enables head-to-head comparison and systematical analysis between MedVLP methods using public chest X-ray datasets. Specifically, BenchX is composed of three components: 1) Comprehensive datasets covering nine datasets and four medical tasks; 2) Benchmark suites to standardize data preprocessing, train-test splits, and parameter selection; 3) Unified finetuning protocols that accommodate heterogeneous MedVLP methods for consistent task adaptation in classification, segmentation, and report generation, respectively. Utilizing BenchX, we establish baselines for nine state-of-the-art MedVLP methods and found that the performance of some early MedVLP methods can be enhanced to surpass more recent ones, prompting a revisiting of the developments and conclusions from prior works in MedVLP. Our code are available at https://github.com/yangzhou12/BenchX.

Enhancing Community Vision Screening -- AI Driven Retinal Photography for Early Disease Detection and Patient Trust

Community vision screening plays a crucial role in identifying individuals with vision loss and preventing avoidable blindness, particularly in rural communities where access to eye care services is limited. Currently, there is a pressing need for a simple and efficient process to screen and refer individuals with significant eye disease-related vision loss to tertiary eye care centers for further care. An ideal solution should seamlessly and readily integrate with existing workflows, providing comprehensive initial screening results to service providers, thereby enabling precise patient referrals for timely treatment. This paper introduces the Enhancing Community Vision Screening (ECVS) solution, which addresses the aforementioned concerns with a novel and feasible solution based on simple, non-invasive retinal photography for the detection of pathology-based visual impairment. Our study employs four distinct deep learning models: RETinal photo Quality Assessment (RETQA), Pathology Visual Impairment detection (PVI), Eye Disease Diagnosis (EDD) and Visualization of Lesion Regions of the eye (VLR). We conducted experiments on over 10 datasets, totaling more than 80,000 fundus photos collected from various sources. The models integrated into ECVS achieved impressive AUC scores of 0.98 for RETQA, 0.95 for PVI, and 0.90 for EDD, along with a DICE coefficient of 0.48 for VLR. These results underscore the promising capabilities of ECVS as a straightforward and scalable method for community-based vision screening.

UrFound: Towards Universal Retinal Foundation Models via Knowledge-Guided Masked Modeling

Retinal foundation models aim to learn generalizable representations from diverse retinal images, facilitating label-efficient model adaptation across various ophthalmic tasks. Despite their success, current retinal foundation models are generally restricted to a single imaging modality, such as Color Fundus Photography (CFP) or Optical Coherence Tomography (OCT), limiting their versatility. Moreover, these models may struggle to fully leverage expert annotations and overlook the valuable domain knowledge essential for domain-specific representation learning. To overcome these limitations, we introduce UrFound, a retinal foundation model designed to learn universal representations from both multimodal retinal images and domain knowledge. UrFound is equipped with a modality-agnostic image encoder and accepts either CFP or OCT images as inputs. To integrate domain knowledge into representation learning, we encode expert annotation in text supervision and propose a knowledge-guided masked modeling strategy for model pre-training. It involves reconstructing randomly masked patches of retinal images while predicting masked text tokens conditioned on the corresponding retinal image. This approach aligns multimodal images and textual expert annotations within a unified latent space, facilitating generalizable and domain-specific representation learning. Experimental results demonstrate that UrFound exhibits strong generalization ability and data efficiency when adapting to various tasks in retinal image analysis. By training on ~180k retinal images, UrFound significantly outperforms the state-of-the-art retinal foundation model trained on up to 1.6 million unlabelled images across 8 public retinal datasets. Our code and data are available at https://github.com/yukkai/UrFound.

CPT: Consistent Proxy Tuning for Black-box Optimization

Black-box tuning has attracted recent attention due to that the structure or inner parameters of advanced proprietary models are not accessible. Proxy-tuning provides a test-time output adjustment for tuning black-box language models. It applies the difference of the output logits before and after tuning a smaller white-box "proxy" model to improve the black-box model. However, this technique serves only as a decoding-time algorithm, leading to an inconsistency between training and testing which potentially limits overall performance. To address this problem, we introduce Consistent Proxy Tuning (CPT), a simple yet effective black-box tuning method. Different from Proxy-tuning, CPT additionally exploits the frozen large black-box model and another frozen small white-box model, ensuring consistency between training-stage optimization objective and test-time proxies. This consistency benefits Proxy-tuning and enhances model performance. Note that our method focuses solely on logit-level computation, which makes it model-agnostic and applicable to any task involving logit classification. Extensive experimental results demonstrate the superiority of our CPT in both black-box tuning of Large Language Models (LLMs) and Vision-Language Models (VLMs) across various datasets. The code is available at https://github.com/chunmeifeng/CPT.

Clinical Domain Knowledge-Derived Template Improves Post Hoc AI Explanations in Pneumothorax Classification

Background: Pneumothorax is an acute thoracic disease caused by abnormal air collection between the lungs and chest wall. To address the opaqueness often associated with deep learning (DL) models, explainable artificial intelligence (XAI) methods have been introduced to outline regions related to pneumothorax diagnoses made by DL models. However, these explanations sometimes diverge from actual lesion areas, highlighting the need for further improvement. Method: We propose a template-guided approach to incorporate the clinical knowledge of pneumothorax into model explanations generated by XAI methods, thereby enhancing the quality of these explanations. Utilizing one lesion delineation created by radiologists, our approach first generates a template that represents potential areas of pneumothorax occurrence. This template is then superimposed on model explanations to filter out extraneous explanations that fall outside the template's boundaries. To validate its efficacy, we carried out a comparative analysis of three XAI methods with and without our template guidance when explaining two DL models in two real-world datasets. Results: The proposed approach consistently improved baseline XAI methods across twelve benchmark scenarios built on three XAI methods, two DL models, and two datasets. The average incremental percentages, calculated by the performance improvements over the baseline performance, were 97.8% in Intersection over Union (IoU) and 94.1% in Dice Similarity Coefficient (DSC) when comparing model explanations and ground-truth lesion areas. Conclusions: In the context of pneumothorax diagnoses, we proposed a template-guided approach for improving AI explanations. We anticipate that our template guidance will forge a fresh approach to elucidating AI models by integrating clinical domain expertise.

RLPeri: Accelerating Visual Perimetry Test with Reinforcement Learning and Convolutional Feature Extraction

Visual perimetry is an important eye examination that helps detect vision problems caused by ocular or neurological conditions. During the test, a patient's gaze is fixed at a specific location while light stimuli of varying intensities are presented in central and peripheral vision. Based on the patient's responses to the stimuli, the visual field mapping and sensitivity are determined. However, maintaining high levels of concentration throughout the test can be challenging for patients, leading to increased examination times and decreased accuracy. In this work, we present RLPeri, a reinforcement learning-based approach to optimize visual perimetry testing. By determining the optimal sequence of locations and initial stimulus values, we aim to reduce the examination time without compromising accuracy. Additionally, we incorporate reward shaping techniques to further improve the testing performance. To monitor the patient's responses over time during testing, we represent the test's state as a pair of 3D matrices. We apply two different convolutional kernels to extract spatial features across locations as well as features across different stimulus values for each location. Through experiments, we demonstrate that our approach results in a 10-20% reduction in examination time while maintaining the accuracy as compared to state-of-the-art methods. With the presented approach, we aim to make visual perimetry testing more efficient and patient-friendly, while still providing accurate results.

Learning Prompt with Distribution-Based Feature Replay for Few-Shot Class-Incremental Learning

Few-shot Class-Incremental Learning (FSCIL) aims to continuously learn new classes based on very limited training data without forgetting the old ones encountered. Existing studies solely relied on pure visual networks, while in this paper we solved FSCIL by leveraging the Vision-Language model (e.g., CLIP) and propose a simple yet effective framework, named Learning Prompt with Distribution-based Feature Replay (LP-DiF). We observe that simply using CLIP for zero-shot evaluation can substantially outperform the most influential methods. Then, prompt tuning technique is involved to further improve its adaptation ability, allowing the model to continually capture specific knowledge from each session. To prevent the learnable prompt from forgetting old knowledge in the new session, we propose a pseudo-feature replay approach. Specifically, we preserve the old knowledge of each class by maintaining a feature-level Gaussian distribution with a diagonal covariance matrix, which is estimated by the image features of training images and synthesized features generated from a VAE. When progressing to a new session, pseudo-features are sampled from old-class distributions combined with training images of the current session to optimize the prompt, thus enabling the model to learn new knowledge while retaining old knowledge. Experiments on three prevalent benchmarks, i.e., CIFAR100, mini-ImageNet, CUB-200, and two more challenging benchmarks, i.e., SUN-397 and CUB-200$^*$ proposed in this paper showcase the superiority of LP-DiF, achieving new state-of-the-art (SOTA) in FSCIL. Code is publicly available at https://github.com/1170300714/LP-DiF.

VQA4CIR: Boosting Composed Image Retrieval with Visual Question Answering

Albeit progress has been made in Composed Image Retrieval (CIR), we empirically find that a certain percentage of failure retrieval results are not consistent with their relative captions. To address this issue, this work provides a Visual Question Answering (VQA) perspective to boost the performance of CIR. The resulting VQA4CIR is a post-processing approach and can be directly plugged into existing CIR methods. Given the top-C retrieved images by a CIR method, VQA4CIR aims to decrease the adverse effect of the failure retrieval results being inconsistent with the relative caption. To find the retrieved images inconsistent with the relative caption, we resort to the "QA generation to VQA" self-verification pipeline. For QA generation, we suggest fine-tuning LLM (e.g., LLaMA) to generate several pairs of questions and answers from each relative caption. We then fine-tune LVLM (e.g., LLaVA) to obtain the VQA model. By feeding the retrieved image and question to the VQA model, one can find the images inconsistent with relative caption when the answer by VQA is inconsistent with the answer in the QA pair. Consequently, the CIR performance can be boosted by modifying the ranks of inconsistently retrieved images. Experimental results show that our proposed method outperforms state-of-the-art CIR methods on the CIRR and Fashion-IQ datasets.

Leveraging Anatomical Constraints with Uncertainty for Pneumothorax Segmentation

Pneumothorax is a medical emergency caused by abnormal accumulation of air in the pleural space - the potential space between the lungs and chest wall. On 2D chest radiographs, pneumothorax occurs within the thoracic cavity and outside of the mediastinum and we refer to this area as "lung+ space". While deep learning (DL) has increasingly been utilized to segment pneumothorax lesions in chest radiographs, many existing DL models employ an end-to-end approach. These models directly map chest radiographs to clinician-annotated lesion areas, often neglecting the vital domain knowledge that pneumothorax is inherently location-sensitive. We propose a novel approach that incorporates the lung+ space as a constraint during DL model training for pneumothorax segmentation on 2D chest radiographs. To circumvent the need for additional annotations and to prevent potential label leakage on the target task, our method utilizes external datasets and an auxiliary task of lung segmentation. This approach generates a specific constraint of lung+ space for each chest radiograph. Furthermore, we have incorporated a discriminator to eliminate unreliable constraints caused by the domain shift between the auxiliary and target datasets. Our results demonstrated significant improvements, with average performance gains of 4.6%, 3.6%, and 3.3% regarding Intersection over Union (IoU), Dice Similarity Coefficient (DSC), and Hausdorff Distance (HD). Our research underscores the significance of incorporating medical domain knowledge about the location-specific nature of pneumothorax to enhance DL-based lesion segmentation.

Sentence-level Prompts Benefit Composed Image Retrieval

Composed image retrieval (CIR) is the task of retrieving specific images by using a query that involves both a reference image and a relative caption. Most existing CIR models adopt the late-fusion strategy to combine visual and language features. Besides, several approaches have also been suggested to generate a pseudo-word token from the reference image, which is further integrated into the relative caption for CIR. However, these pseudo-word-based prompting methods have limitations when target image encompasses complex changes on reference image, e.g., object removal and attribute modification. In this work, we demonstrate that learning an appropriate sentence-level prompt for the relative caption (SPRC) is sufficient for achieving effective composed image retrieval. Instead of relying on pseudo-word-based prompts, we propose to leverage pretrained V-L models, e.g., BLIP-2, to generate sentence-level prompts. By concatenating the learned sentence-level prompt with the relative caption, one can readily use existing text-based image retrieval models to enhance CIR performance. Furthermore, we introduce both image-text contrastive loss and text prompt alignment loss to enforce the learning of suitable sentence-level prompts. Experiments show that our proposed method performs favorably against the state-of-the-art CIR methods on the Fashion-IQ and CIRR datasets. The source code and pretrained model are publicly available at https://github.com/chunmeifeng/SPRC