MAP: Evaluation and Multi-Agent Enhancement of Large Language Models for Inpatient Pathways

Inpatient pathways demand complex clinical decision-making based on comprehensive patient information, posing critical challenges for clinicians. Despite advancements in large language models (LLMs) in medical applications, limited research focused on artificial intelligence (AI) inpatient pathways systems, due to the lack of large-scale inpatient datasets. Moreover, existing medical benchmarks typically concentrated on medical question-answering and examinations, ignoring the multifaceted nature of clinical decision-making in inpatient settings. To address these gaps, we first developed the Inpatient Pathway Decision Support (IPDS) benchmark from the MIMIC-IV database, encompassing 51,274 cases across nine triage departments and 17 major disease categories alongside 16 standardized treatment options. Then, we proposed the Multi-Agent Inpatient Pathways (MAP) framework to accomplish inpatient pathways with three clinical agents, including a triage agent managing the patient admission, a diagnosis agent serving as the primary decision maker at the department, and a treatment agent providing treatment plans. Additionally, our MAP framework includes a chief agent overseeing the inpatient pathways to guide and promote these three clinician agents. Extensive experiments showed our MAP improved the diagnosis accuracy by 25.10% compared to the state-of-the-art LLM HuatuoGPT2-13B. It is worth noting that our MAP demonstrated significant clinical compliance, outperforming three board-certified clinicians by 10%-12%, establishing a foundation for inpatient pathways systems.

FedBM: Stealing Knowledge from Pre-trained Language Models for Heterogeneous Federated Learning

Federated learning (FL) has shown great potential in medical image computing since it provides a decentralized learning paradigm that allows multiple clients to train a model collaboratively without privacy leakage. However, current studies have shown that data heterogeneity incurs local learning bias in classifiers and feature extractors of client models during local training, leading to the performance degradation of a federation system. To address these issues, we propose a novel framework called Federated Bias eliMinating (FedBM) to get rid of local learning bias in heterogeneous federated learning (FL), which mainly consists of two modules, i.e., Linguistic Knowledge-based Classifier Construction (LKCC) and Concept-guided Global Distribution Estimation (CGDE). Specifically, LKCC exploits class concepts, prompts and pre-trained language models (PLMs) to obtain concept embeddings. These embeddings are used to estimate the latent concept distribution of each class in the linguistic space. Based on the theoretical derivation, we can rely on these distributions to pre-construct a high-quality classifier for clients to achieve classification optimization, which is frozen to avoid classifier bias during local training. CGDE samples probabilistic concept embeddings from the latent concept distributions to learn a conditional generator to capture the input space of the global model. Three regularization terms are introduced to improve the quality and utility of the generator. The generator is shared by all clients and produces pseudo data to calibrate updates of local feature extractors. Extensive comparison experiments and ablation studies on public datasets demonstrate the superior performance of FedBM over state-of-the-arts and confirm the effectiveness of each module, respectively. The code is available at https://github.com/CUHK-AIM-Group/FedBM.

Polyp-Gen: Realistic and Diverse Polyp Image Generation for Endoscopic Dataset Expansion

Automated diagnostic systems (ADS) have shown significant potential in the early detection of polyps during endoscopic examinations, thereby reducing the incidence of colorectal cancer. However, due to high annotation costs and strict privacy concerns, acquiring high-quality endoscopic images poses a considerable challenge in the development of ADS. Despite recent advancements in generating synthetic images for dataset expansion, existing endoscopic image generation algorithms failed to accurately generate the details of polyp boundary regions and typically required medical priors to specify plausible locations and shapes of polyps, which limited the realism and diversity of the generated images. To address these limitations, we present Polyp-Gen, the first full-automatic diffusion-based endoscopic image generation framework. Specifically, we devise a spatial-aware diffusion training scheme with a lesion-guided loss to enhance the structural context of polyp boundary regions. Moreover, to capture medical priors for the localization of potential polyp areas, we introduce a hierarchical retrieval-based sampling strategy to match similar fine-grained spatial features. In this way, our Polyp-Gen can generate realistic and diverse endoscopic images for building reliable ADS. Extensive experiments demonstrate the state-of-the-art generation quality, and the synthetic images can improve the downstream polyp detection task. Additionally, our Polyp-Gen has shown remarkable zero-shot generalizability on other datasets. The source code is available at https://github.com/CUHK-AIM-Group/Polyp-Gen.

ConcealGS: Concealing Invisible Copyright Information in 3D Gaussian Splatting

With the rapid development of 3D reconstruction technology, the widespread distribution of 3D data has become a future trend. While traditional visual data (such as images and videos) and NeRF-based formats already have mature techniques for copyright protection, steganographic techniques for the emerging 3D Gaussian Splatting (3D-GS) format have yet to be fully explored. To address this, we propose ConcealGS, an innovative method for embedding implicit information into 3D-GS. By introducing the knowledge distillation and gradient optimization strategy based on 3D-GS, ConcealGS overcomes the limitations of NeRF-based models and enhances the robustness of implicit information and the quality of 3D reconstruction. We evaluate ConcealGS in various potential application scenarios, and experimental results have demonstrated that ConcealGS not only successfully recovers implicit information but also has almost no impact on rendering quality, providing a new approach for embedding invisible and recoverable information into 3D models in the future.

LoCo: Low-Contrast-Enhanced Contrastive Learning for Semi-Supervised Endoscopic Image Segmentation

The segmentation of endoscopic images plays a vital role in computer-aided diagnosis and treatment. The advancements in deep learning have led to the employment of numerous models for endoscopic tumor segmentation, achieving promising segmentation performance. Despite recent advancements, precise segmentation remains challenging due to limited annotations and the issue of low contrast. To address these issues, we propose a novel semi-supervised segmentation framework termed LoCo via low-contrast-enhanced contrastive learning (LCC). This innovative approach effectively harnesses the vast amounts of unlabeled data available for endoscopic image segmentation, improving both accuracy and robustness in the segmentation process. Specifically, LCC incorporates two advanced strategies to enhance the distinctiveness of low-contrast pixels: inter-class contrast enhancement (ICE) and boundary contrast enhancement (BCE), enabling models to segment low-contrast pixels among malignant tumors, benign tumors, and normal tissues. Additionally, a confidence-based dynamic filter (CDF) is designed for pseudo-label selection, enhancing the utilization of generated pseudo-labels for unlabeled data with a specific focus on minority classes. Extensive experiments conducted on two public datasets, as well as a large proprietary dataset collected over three years, demonstrate that LoCo achieves state-of-the-art results, significantly outperforming previous methods. The source code of LoCo is available at the URL of https://github.com/AnoK3111/LoCo.

DEeR: Deviation Eliminating and Noise Regulating for Privacy-preserving Federated Low-rank Adaptation

Integrating low-rank adaptation (LoRA) with federated learning (FL) has received widespread attention recently, aiming to adapt pretrained foundation models (FMs) to downstream medical tasks via privacy-preserving decentralized training. However, owing to the direct combination of LoRA and FL, current methods generally undergo two problems, i.e., aggregation deviation, and differential privacy (DP) noise amplification effect. To address these problems, we propose a novel privacy-preserving federated finetuning framework called \underline{D}eviation \underline{E}liminating and Nois\underline{e} \underline{R}egulating (DEeR). Specifically, we firstly theoretically prove that the necessary condition to eliminate aggregation deviation is guaranteing the equivalence between LoRA parameters of clients. Based on the theoretical insight, a deviation eliminator is designed to utilize alternating minimization algorithm to iteratively optimize the zero-initialized and non-zero-initialized parameter matrices of LoRA, ensuring that aggregation deviation always be zeros during training. Furthermore, we also conduct an in-depth analysis of the noise amplification effect and find that this problem is mainly caused by the ``linear relationship'' between DP noise and LoRA parameters. To suppress the noise amplification effect, we propose a noise regulator that exploits two regulator factors to decouple relationship between DP and LoRA, thereby achieving robust privacy protection and excellent finetuning performance. Additionally, we perform comprehensive ablated experiments to verify the effectiveness of the deviation eliminator and noise regulator. DEeR shows better performance on public medical datasets in comparison with state-of-the-art approaches. The code is available at https://github.com/CUHK-AIM-Group/DEeR.

AutoPET Challenge: Tumour Synthesis for Data Augmentation

Accurate lesion segmentation in whole-body PET/CT scans is crucial for cancer diagnosis and treatment planning, but limited datasets often hinder the performance of automated segmentation models. In this paper, we explore the potential of leveraging the deep prior from a generative model to serve as a data augmenter for automated lesion segmentation in PET/CT scans. We adapt the DiffTumor method, originally designed for CT images, to generate synthetic PET-CT images with lesions. Our approach trains the generative model on the AutoPET dataset and uses it to expand the training data. We then compare the performance of segmentation models trained on the original and augmented datasets. Our findings show that the model trained on the augmented dataset achieves a higher Dice score, demonstrating the potential of our data augmentation approach. In a nutshell, this work presents a promising direction for improving lesion segmentation in whole-body PET/CT scans with limited datasets, potentially enhancing the accuracy and reliability of cancer diagnostics.

When 3D Partial Points Meets SAM: Tooth Point Cloud Segmentation with Sparse Labels

Tooth point cloud segmentation is a fundamental task in many orthodontic applications. Current research mainly focuses on fully supervised learning which demands expensive and tedious manual point-wise annotation. Although recent weakly-supervised alternatives are proposed to use weak labels for 3D segmentation and achieve promising results, they tend to fail when the labels are extremely sparse. Inspired by the powerful promptable segmentation capability of the Segment Anything Model (SAM), we propose a framework named SAMTooth that leverages such capacity to complement the extremely sparse supervision. To automatically generate appropriate point prompts for SAM, we propose a novel Confidence-aware Prompt Generation strategy, where coarse category predictions are aggregated with confidence-aware filtering. Furthermore, to fully exploit the structural and shape clues in SAM's outputs for assisting the 3D feature learning, we advance a Mask-guided Representation Learning that re-projects the generated tooth masks of SAM into 3D space and constrains these points of different teeth to possess distinguished representations. To demonstrate the effectiveness of the framework, we conduct experiments on the public dataset and surprisingly find with only 0.1\% annotations (one point per tooth), our method can surpass recent weakly supervised methods by a large margin, and the performance is even comparable to the recent fully-supervised methods, showcasing the significant potential of applying SAM to 3D perception tasks with sparse labels. Code is available at https://github.com/CUHK-AIM-Group/SAMTooth.

DiffRect: Latent Diffusion Label Rectification for Semi-supervised Medical Image Segmentation

Semi-supervised medical image segmentation aims to leverage limited annotated data and rich unlabeled data to perform accurate segmentation. However, existing semi-supervised methods are highly dependent on the quality of self-generated pseudo labels, which are prone to incorrect supervision and confirmation bias. Meanwhile, they are insufficient in capturing the label distributions in latent space and suffer from limited generalization to unlabeled data. To address these issues, we propose a Latent Diffusion Label Rectification Model (DiffRect) for semi-supervised medical image segmentation. DiffRect first utilizes a Label Context Calibration Module (LCC) to calibrate the biased relationship between classes by learning the category-wise correlation in pseudo labels, then apply Latent Feature Rectification Module (LFR) on the latent space to formulate and align the pseudo label distributions of different levels via latent diffusion. It utilizes a denoising network to learn the coarse to fine and fine to precise consecutive distribution transportations. We evaluate DiffRect on three public datasets: ACDC, MS-CMRSEG 2019, and Decathlon Prostate. Experimental results demonstrate the effectiveness of DiffRect, e.g. it achieves 82.40\% Dice score on ACDC with only 1\% labeled scan available, outperforms the previous state-of-the-art by 4.60\% in Dice, and even rivals fully supervised performance. Code is released at \url{https://github.com/CUHK-AIM-Group/DiffRect}.

GTP-4o: Modality-prompted Heterogeneous Graph Learning for Omni-modal Biomedical Representation

Recent advances in learning multi-modal representation have witnessed the success in biomedical domains. While established techniques enable handling multi-modal information, the challenges are posed when extended to various clinical modalities and practical modalitymissing setting due to the inherent modality gaps. To tackle these, we propose an innovative Modality-prompted Heterogeneous Graph for Omnimodal Learning (GTP-4o), which embeds the numerous disparate clinical modalities into a unified representation, completes the deficient embedding of missing modality and reformulates the cross-modal learning with a graph-based aggregation. Specially, we establish a heterogeneous graph embedding to explicitly capture the diverse semantic properties on both the modality-specific features (nodes) and the cross-modal relations (edges). Then, we design a modality-prompted completion that enables completing the inadequate graph representation of missing modality through a graph prompting mechanism, which generates hallucination graphic topologies to steer the missing embedding towards the intact representation. Through the completed graph, we meticulously develop a knowledge-guided hierarchical cross-modal aggregation consisting of a global meta-path neighbouring to uncover the potential heterogeneous neighbors along the pathways driven by domain knowledge, and a local multi-relation aggregation module for the comprehensive cross-modal interaction across various heterogeneous relations. We assess the efficacy of our methodology on rigorous benchmarking experiments against prior state-of-the-arts. In a nutshell, GTP-4o presents an initial foray into the intriguing realm of embedding, relating and perceiving the heterogeneous patterns from various clinical modalities holistically via a graph theory. Project page: https://gtp-4-o.github.io/.