Breaking the Cycle of Recurring Failures: Applying Generative AI to Root Cause Analysis in Legacy Banking Systems

Traditional banks face significant challenges in digital transformation, primarily due to legacy system constraints and fragmented ownership. Recent incidents show that such fragmentation often results in superficial incident resolutions, leaving root causes unaddressed and causing recurring failures. We introduce a novel approach to post-incident analysis, integrating knowledge-based GenAI agents with the "Five Whys" technique to examine problem descriptions and change request data. This method uncovered that approximately 70% of the incidents previously attributed to management or vendor failures were due to underlying internal code issues. We present a case study to show the impact of our method. By scanning over 5,000 projects, we identified over 400 files with a similar root cause. Overall, we leverage the knowledge-based agents to automate and elevate root cause analysis, transforming it into a more proactive process. These agents can be applied across other phases of the software development lifecycle, further improving development processes.

A Survey of Medical Vision-and-Language Applications and Their Techniques

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

CoSAM: Self-Correcting SAM for Domain Generalization in 2D Medical Image Segmentation

Medical images often exhibit distribution shifts due to variations in imaging protocols and scanners across different medical centers. Domain Generalization (DG) methods aim to train models on source domains that can generalize to unseen target domains. Recently, the segment anything model (SAM) has demonstrated strong generalization capabilities due to its prompt-based design, and has gained significant attention in image segmentation tasks. Existing SAM-based approaches attempt to address the need for manual prompts by introducing prompt generators that automatically generate these prompts. However, we argue that auto-generated prompts may not be sufficiently accurate under distribution shifts, potentially leading to incorrect predictions that still require manual verification and correction by clinicians. To address this challenge, we propose a method for 2D medical image segmentation called Self-Correcting SAM (CoSAM). Our approach begins by generating coarse masks using SAM in a prompt-free manner, providing prior prompts for the subsequent stages, and eliminating the need for prompt generators. To automatically refine these coarse masks, we introduce a generalized error decoder that simulates the correction process typically performed by clinicians. Furthermore, we generate diverse prompts as feedback based on the corrected masks, which are used to iteratively refine the predictions within a self-correcting loop, enhancing the generalization performance of our model. Extensive experiments on two medical image segmentation benchmarks across multiple scenarios demonstrate the superiority of CoSAM over state-of-the-art SAM-based methods.

Touchstone Benchmark: Are We on the Right Way for Evaluating AI Algorithms for Medical Segmentation?

How can we test AI performance? This question seems trivial, but it isn't. Standard benchmarks often have problems such as in-distribution and small-size test sets, oversimplified metrics, unfair comparisons, and short-term outcome pressure. As a consequence, good performance on standard benchmarks does not guarantee success in real-world scenarios. To address these problems, we present Touchstone, a large-scale collaborative segmentation benchmark of 9 types of abdominal organs. This benchmark is based on 5,195 training CT scans from 76 hospitals around the world and 5,903 testing CT scans from 11 additional hospitals. This diverse test set enhances the statistical significance of benchmark results and rigorously evaluates AI algorithms across various out-of-distribution scenarios. We invited 14 inventors of 19 AI algorithms to train their algorithms, while our team, as a third party, independently evaluated these algorithms on three test sets. In addition, we also evaluated pre-existing AI frameworks--which, differing from algorithms, are more flexible and can support different algorithms--including MONAI from NVIDIA, nnU-Net from DKFZ, and numerous other open-source frameworks. We are committed to expanding this benchmark to encourage more innovation of AI algorithms for the medical domain.

Day-Night Adaptation: An Innovative Source-free Adaptation Framework for Medical Image Segmentation

Distribution shifts widely exist in medical images acquired from different medical centers, hindering the deployment of semantic segmentation models trained on data from one center (source domain) to another (target domain). While unsupervised domain adaptation (UDA) has shown significant promise in mitigating these shifts, it poses privacy risks due to sharing data between centers. To facilitate adaptation while preserving data privacy, source-free domain adaptation (SFDA) and test-time adaptation (TTA) have emerged as effective paradigms, relying solely on target domain data. However, the scenarios currently addressed by SFDA and TTA are limited, making them less suitable for clinical applications. In a more realistic clinical scenario, the pre-trained model is deployed in a medical centre to assist with clinical tasks during the day and rest at night. During the daytime process, TTA can be employed to enhance inference performance. During the nighttime process, after collecting the test data from the day, the model can be fine-tuned utilizing SFDA to further adapt to the target domain. With above insights, we propose a novel adaptation framework called Day-Night Adaptation (DyNA). This framework adapts the model to the target domain through day-night loops without requiring access to source data. Specifically, we implement distinct adaptation strategies for daytime and nighttime to better meet the demands of clinical settings. During the daytime, model parameters are frozen, and a specific low-frequency prompt is trained for each test sample. Additionally, we construct a memory bank for prompt initialization and develop a warm-up mechanism to enhance prompt training. During nighttime, we integrate a global student model into the traditional teacher-student self-training paradigm to fine-tune the model while ensuring training stability...

MedUniSeg: 2D and 3D Medical Image Segmentation via a Prompt-driven Universal Model

Universal segmentation models offer significant potential in addressing a wide range of tasks by effectively leveraging discrete annotations. As the scope of tasks and modalities expands, it becomes increasingly important to generate and strategically position task- and modal-specific priors within the universal model. However, existing universal models often overlook the correlations between different priors, and the optimal placement and frequency of these priors remain underexplored. In this paper, we introduce MedUniSeg, a prompt-driven universal segmentation model designed for 2D and 3D multi-task segmentation across diverse modalities and domains. MedUniSeg employs multiple modal-specific prompts alongside a universal task prompt to accurately characterize the modalities and tasks. To generate the related priors, we propose the modal map (MMap) and the fusion and selection (FUSE) modules, which transform modal and task prompts into corresponding priors. These modal and task priors are systematically introduced at the start and end of the encoding process. We evaluate MedUniSeg on a comprehensive multi-modal upstream dataset consisting of 17 sub-datasets. The results demonstrate that MedUniSeg achieves superior multi-task segmentation performance, attaining a 1.2% improvement in the mean Dice score across the 17 upstream tasks compared to nnUNet baselines, while using less than 1/10 of the parameters. For tasks that underperform during the initial multi-task joint training, we freeze MedUniSeg and introduce new modules to re-learn these tasks. This approach yields an enhanced version, MedUniSeg*, which consistently outperforms MedUniSeg across all tasks. Moreover, MedUniSeg surpasses advanced self-supervised and supervised pre-trained models on six downstream tasks, establishing itself as a high-quality, highly generalizable pre-trained segmentation model.

Pre-training Everywhere: Parameter-Efficient Fine-Tuning for Medical Image Analysis via Target Parameter Pre-training

Parameter-efficient fine-tuning (PEFT) techniques have emerged to address issues of overfitting and high computational costs associated with fully fine-tuning in the paradigm of self-supervised learning. Mainstream methods based on PEFT involve adding a few trainable parameters while keeping the pre-trained parameters of the backbone fixed. These methods achieve comparative, and often superior, performance to fully fine-tuning, demonstrating the powerful representation ability of the pre-trained backbone. Despite its success, these methods typically ignore the initialization of the new parameters, often relying solely on random initialization. We argue that if pre-training is significantly beneficial, it should be applied to all parameters requiring representational capacity. Motivated by this insight, we propose a simple yet effective fine-tuning framework based on Target Parameter Pre-training (TPP). The target parameters refer to the new parameters introduced during fine-tuning. TPP includes an additional stage before PEFT to pre-train these target parameters. During this stage, the pre-trained backbone parameters are frozen, and only the target parameters are trainable. A defined pre-text task is used to encourage the target parameters to learn specific representations of downstream data. When PEFT is subsequently employed, the pre-trained target parameters are loaded to enhance fine-tuning efficiency. The proposed TPP framework is versatile, allowing for the integration of various pretext tasks for pre-training and supporting different PEFT methods as backbones. We evaluated the fine-tining performance of our method using five public datasets, including three modalities and two task types. The results demonstrate that the proposed TPP can be easily integrated into existing PEFT methods, significantly improving performance.

From Few to More: Scribble-based Medical Image Segmentation via Masked Context Modeling and Continuous Pseudo Labels

Scribble-based weakly supervised segmentation techniques offer comparable performance to fully supervised methods while significantly reducing annotation costs, making them an appealing alternative. Existing methods often rely on auxiliary tasks to enforce semantic consistency and use hard pseudo labels for supervision. However, these methods often overlook the unique requirements of models trained with sparse annotations. Since the model must predict pixel-wise segmentation maps with limited annotations, the ability to handle varying levels of annotation richness is critical. In this paper, we adopt the principle of `from few to more' and propose MaCo, a weakly supervised framework designed for medical image segmentation. MaCo employs masked context modeling (MCM) and continuous pseudo labels (CPL). MCM uses an attention-based masking strategy to disrupt the input image, compelling the model's predictions to remain consistent with those of the original image. CPL converts scribble annotations into continuous pixel-wise labels by applying an exponential decay function to distance maps, resulting in continuous maps that represent the confidence of each pixel belonging to a specific category, rather than using hard pseudo labels. We evaluate MaCo against other weakly supervised methods using three public datasets. The results indicate that MaCo outperforms competing methods across all datasets, setting a new record in weakly supervised medical image segmentation.

Gradient Alignment Improves Test-Time Adaptation for Medical Image Segmentation

Although recent years have witnessed significant advancements in medical image segmentation, the pervasive issue of domain shift among medical images from diverse centres hinders the effective deployment of pre-trained models. Many Test-time Adaptation (TTA) methods have been proposed to address this issue by fine-tuning pre-trained models with test data during inference. These methods, however, often suffer from less-satisfactory optimization due to suboptimal optimization direction (dictated by the gradient) and fixed step-size (predicated on the learning rate). In this paper, we propose the Gradient alignment-based Test-time adaptation (GraTa) method to improve both the gradient direction and learning rate in the optimization procedure. Unlike conventional TTA methods, which primarily optimize the pseudo gradient derived from a self-supervised objective, our method incorporates an auxiliary gradient with the pseudo one to facilitate gradient alignment. Such gradient alignment enables the model to excavate the similarities between different gradients and correct the gradient direction to approximate the empirical gradient related to the current segmentation task. Additionally, we design a dynamic learning rate based on the cosine similarity between the pseudo and auxiliary gradients, thereby empowering the adaptive fine-tuning of pre-trained models on diverse test data. Extensive experiments establish the effectiveness of the proposed gradient alignment and dynamic learning rate and substantiate the superiority of our GraTa method over other state-of-the-art TTA methods on a benchmark medical image segmentation task. The code and weights of pre-trained source models will be available.

Unleashing the Potential of Open-set Noisy Samples Against Label Noise for Medical Image Classification

The challenge of addressing mixed closed-set and open-set label noise in medical image classification remains largely unexplored. Unlike natural image classification where there is a common practice of segregation and separate processing of closed-set and open-set noisy samples from clean ones, medical image classification faces difficulties due to high inter-class similarity which complicates the identification of open-set noisy samples. Moreover, prevailing methods do not leverage the full potential of open-set noisy samples for label noise mitigation, often leading to their exclusion or application of uniform soft labels. To address these issues, we propose an Extended Noise-robust Contrastive and Open-set Feature Augmentation (ENCOFA) framework. ENCOFA includes the Extended Noise-robust Supervised Contrastive (ENSC) Loss, which aids in distinguishing features across classes. The ENSC loss regards open-set noisy samples as an extended class and mitigates label noise by weighting contrastive pairs with label reliability. Furthermore, we develop an Open-set Feature Augmentation (OSFeatAug) module that enriches the features of open-set samples, utilizing the model's extra capacity to prevent overfitting to noisy data. We conducted experiments on a synthetic noisy dataset and a real-world noisy dataset. Our results indicate the superiority of ENCOFA and the effectiveness of leveraging the open-set noisy samples to combat label noise.