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.

MSDet: Receptive Field Enhanced Multiscale Detection for Tiny Pulmonary Nodule

Pulmonary nodules are critical indicators for the early diagnosis of lung cancer, making their detection essential for timely treatment. However, traditional CT imaging methods suffered from cumbersome procedures, low detection rates, and poor localization accuracy. The subtle differences between pulmonary nodules and surrounding tissues in complex lung CT images, combined with repeated downsampling in feature extraction networks, often lead to missed or false detections of small nodules. Existing methods such as FPN, with its fixed feature fusion and limited receptive field, struggle to effectively overcome these issues. To address these challenges, our paper proposed three key contributions: Firstly, we proposed MSDet, a multiscale attention and receptive field network for detecting tiny pulmonary nodules. Secondly, we proposed the extended receptive domain (ERD) strategy to capture richer contextual information and reduce false positives caused by nodule occlusion. We also proposed the position channel attention mechanism (PCAM) to optimize feature learning and reduce multiscale detection errors, and designed the tiny object detection block (TODB) to enhance the detection of tiny nodules. Lastly, we conducted thorough experiments on the public LUNA16 dataset, achieving state-of-the-art performance, with an mAP improvement of 8.8% over the previous state-of-the-art method YOLOv8. These advancements significantly boosted detection accuracy and reliability, providing a more effective solution for early lung cancer diagnosis. The code will be available at https://github.com/CaiGuoHui123/MSDet

AdaCBM: An Adaptive Concept Bottleneck Model for Explainable and Accurate Diagnosis

The integration of vision-language models such as CLIP and Concept Bottleneck Models (CBMs) offers a promising approach to explaining deep neural network (DNN) decisions using concepts understandable by humans, addressing the black-box concern of DNNs. While CLIP provides both explainability and zero-shot classification capability, its pre-training on generic image and text data may limit its classification accuracy and applicability to medical image diagnostic tasks, creating a transfer learning problem. To maintain explainability and address transfer learning needs, CBM methods commonly design post-processing modules after the bottleneck module. However, this way has been ineffective. This paper takes an unconventional approach by re-examining the CBM framework through the lens of its geometrical representation as a simple linear classification system. The analysis uncovers that post-CBM fine-tuning modules merely rescale and shift the classification outcome of the system, failing to fully leverage the system's learning potential. We introduce an adaptive module strategically positioned between CLIP and CBM to bridge the gap between source and downstream domains. This simple yet effective approach enhances classification performance while preserving the explainability afforded by the framework. Our work offers a comprehensive solution that encompasses the entire process, from concept discovery to model training, providing a holistic recipe for leveraging the strengths of GPT, CLIP, and CBM.

Structural Attention: Rethinking Transformer for Unpaired Medical Image Synthesis

Unpaired medical image synthesis aims to provide complementary information for an accurate clinical diagnostics, and address challenges in obtaining aligned multi-modal medical scans. Transformer-based models excel in imaging translation tasks thanks to their ability to capture long-range dependencies. Although effective in supervised training settings, their performance falters in unpaired image synthesis, particularly in synthesizing structural details. This paper empirically demonstrates that, lacking strong inductive biases, Transformer can converge to non-optimal solutions in the absence of paired data. To address this, we introduce UNet Structured Transformer (UNest), a novel architecture incorporating structural inductive biases for unpaired medical image synthesis. We leverage the foundational Segment-Anything Model to precisely extract the foreground structure and perform structural attention within the main anatomy. This guides the model to learn key anatomical regions, thus improving structural synthesis under the lack of supervision in unpaired training. Evaluated on two public datasets, spanning three modalities, i.e., MR, CT, and PET, UNest improves recent methods by up to 19.30% across six medical image synthesis tasks. Our code is released at https://github.com/HieuPhan33/MICCAI2024-UNest.

JointViT: Modeling Oxygen Saturation Levels with Joint Supervision on Long-Tailed OCTA

The oxygen saturation level in the blood (SaO2) is crucial for health, particularly in relation to sleep-related breathing disorders. However, continuous monitoring of SaO2 is time-consuming and highly variable depending on patients' conditions. Recently, optical coherence tomography angiography (OCTA) has shown promising development in rapidly and effectively screening eye-related lesions, offering the potential for diagnosing sleep-related disorders. To bridge this gap, our paper presents three key contributions. Firstly, we propose JointViT, a novel model based on the Vision Transformer architecture, incorporating a joint loss function for supervision. Secondly, we introduce a balancing augmentation technique during data preprocessing to improve the model's performance, particularly on the long-tail distribution within the OCTA dataset. Lastly, through comprehensive experiments on the OCTA dataset, our proposed method significantly outperforms other state-of-the-art methods, achieving improvements of up to 12.28% in overall accuracy. This advancement lays the groundwork for the future utilization of OCTA in diagnosing sleep-related disorders. See project website https://steve-zeyu-zhang.github.io/JointViT

CAPE: CAM as a Probabilistic Ensemble for Enhanced DNN Interpretation

Deep Neural Networks (DNNs) are widely used for visual classification tasks, but their complex computation process and black-box nature hinder decision transparency and interpretability. Class activation maps (CAMs) and recent variants provide ways to visually explain the DNN decision-making process by displaying 'attention' heatmaps of the DNNs. Nevertheless, the CAM explanation only offers relative attention information, that is, on an attention heatmap, we can interpret which image region is more or less important than the others. However, these regions cannot be meaningfully compared across classes, and the contribution of each region to the model's class prediction is not revealed. To address these challenges that ultimately lead to better DNN Interpretation, in this paper, we propose CAPE, a novel reformulation of CAM that provides a unified and probabilistically meaningful assessment of the contributions of image regions. We quantitatively and qualitatively compare CAPE with state-of-the-art CAM methods on CUB and ImageNet benchmark datasets to demonstrate enhanced interpretability. We also test on a cytology imaging dataset depicting a challenging Chronic Myelomonocytic Leukemia (CMML) diagnosis problem. Code is available at: https://github.com/AIML-MED/CAPE.

Decomposing Disease Descriptions for Enhanced Pathology Detection: A Multi-Aspect Vision-Language Matching Framework

Medical vision language pre-training (VLP) has emerged as a frontier of research, enabling zero-shot pathological recognition by comparing the query image with the textual descriptions for each disease. Due to the complex semantics of biomedical texts, current methods struggle to align medical images with key pathological findings in unstructured reports. This leads to the misalignment with the target disease's textual representation. In this paper, we introduce a novel VLP framework designed to dissect disease descriptions into their fundamental aspects, leveraging prior knowledge about the visual manifestations of pathologies. This is achieved by consulting a large language model and medical experts. Integrating a Transformer module, our approach aligns an input image with the diverse elements of a disease, generating aspect-centric image representations. By consolidating the matches from each aspect, we improve the compatibility between an image and its associated disease. Additionally, capitalizing on the aspect-oriented representations, we present a dual-head Transformer tailored to process known and unknown diseases, optimizing the comprehensive detection efficacy. Conducting experiments on seven downstream datasets, ours outperforms recent methods by up to 8.07% and 11.23% in AUC scores for seen and novel categories, respectively. Our code is released at \href{https://github.com/HieuPhan33/MAVL}{https://github.com/HieuPhan33/MAVL}.

Structure-Preserving Synthesis: MaskGAN for Unpaired MR-CT Translation

Medical image synthesis is a challenging task due to the scarcity of paired data. Several methods have applied CycleGAN to leverage unpaired data, but they often generate inaccurate mappings that shift the anatomy. This problem is further exacerbated when the images from the source and target modalities are heavily misaligned. Recently, current methods have aimed to address this issue by incorporating a supplementary segmentation network. Unfortunately, this strategy requires costly and time-consuming pixel-level annotations. To overcome this problem, this paper proposes MaskGAN, a novel and cost-effective framework that enforces structural consistency by utilizing automatically extracted coarse masks. Our approach employs a mask generator to outline anatomical structures and a content generator to synthesize CT contents that align with these structures. Extensive experiments demonstrate that MaskGAN outperforms state-of-the-art synthesis methods on a challenging pediatric dataset, where MR and CT scans are heavily misaligned due to rapid growth in children. Specifically, MaskGAN excels in preserving anatomical structures without the need for expert annotations. The code for this paper can be found at https://github.com/HieuPhan33/MaskGAN.

CNN Attention Guidance for Improved Orthopedics Radiographic Fracture Classification

Convolutional neural networks (CNNs) have gained significant popularity in orthopedic imaging in recent years due to their ability to solve fracture classification problems. A common criticism of CNNs is their opaque learning and reasoning process, making it difficult to trust machine diagnosis and the subsequent adoption of such algorithms in clinical setting. This is especially true when the CNN is trained with limited amount of medical data, which is a common issue as curating sufficiently large amount of annotated medical imaging data is a long and costly process. While interest has been devoted to explaining CNN learnt knowledge by visualizing network attention, the utilization of the visualized attention to improve network learning has been rarely investigated. This paper explores the effectiveness of regularizing CNN network with human-provided attention guidance on where in the image the network should look for answering clues. On two orthopedics radiographic fracture classification datasets, through extensive experiments we demonstrate that explicit human-guided attention indeed can direct correct network attention and consequently significantly improve classification performance. The development code for the proposed attention guidance is publicly available on GitHub.

Pairwise Relation Learning for Semi-supervised Gland Segmentation

Accurate and automated gland segmentation on histology tissue images is an essential but challenging task in the computer-aided diagnosis of adenocarcinoma. Despite their prevalence, deep learning models always require a myriad number of densely annotated training images, which are difficult to obtain due to extensive labor and associated expert costs related to histology image annotations. In this paper, we propose the pairwise relation-based semi-supervised (PRS^2) model for gland segmentation on histology images. This model consists of a segmentation network (S-Net) and a pairwise relation network (PR-Net). The S-Net is trained on labeled data for segmentation, and PR-Net is trained on both labeled and unlabeled data in an unsupervised way to enhance its image representation ability via exploiting the semantic consistency between each pair of images in the feature space. Since both networks share their encoders, the image representation ability learned by PR-Net can be transferred to S-Net to improve its segmentation performance. We also design the object-level Dice loss to address the issues caused by touching glands and combine it with other two loss functions for S-Net. We evaluated our model against five recent methods on the GlaS dataset and three recent methods on the CRAG dataset. Our results not only demonstrate the effectiveness of the proposed PR-Net and object-level Dice loss, but also indicate that our PRS^2 model achieves the state-of-the-art gland segmentation performance on both benchmarks.