An Intra- and Cross-frame Topological Consistency Scheme for Semi-supervised Atherosclerotic Coronary Plaque Segmentation

Enhancing the precision of segmenting coronary atherosclerotic plaques from CT Angiography (CTA) images is pivotal for advanced Coronary Atherosclerosis Analysis (CAA), which distinctively relies on the analysis of vessel cross-section images reconstructed via Curved Planar Reformation. This task presents significant challenges due to the indistinct boundaries and structures of plaques and blood vessels, leading to the inadequate performance of current deep learning models, compounded by the inherent difficulty in annotating such complex data. To address these issues, we propose a novel dual-consistency semi-supervised framework that integrates Intra-frame Topological Consistency (ITC) and Cross-frame Topological Consistency (CTC) to leverage labeled and unlabeled data. ITC employs a dual-task network for simultaneous segmentation mask and Skeleton-aware Distance Transform (SDT) prediction, achieving similar prediction of topology structure through consistency constraint without additional annotations. Meanwhile, CTC utilizes an unsupervised estimator for analyzing pixel flow between skeletons and boundaries of adjacent frames, ensuring spatial continuity. Experiments on two CTA datasets show that our method surpasses existing semi-supervised methods and approaches the performance of supervised methods on CAA. In addition, our method also performs better than other methods on the ACDC dataset, demonstrating its generalization.

LLM-RG4: Flexible and Factual Radiology Report Generation across Diverse Input Contexts

Drafting radiology reports is a complex task requiring flexibility, where radiologists tail content to available information and particular clinical demands. However, most current radiology report generation (RRG) models are constrained to a fixed task paradigm, such as predicting the full ``finding'' section from a single image, inherently involving a mismatch between inputs and outputs. The trained models lack the flexibility for diverse inputs and could generate harmful, input-agnostic hallucinations. To bridge the gap between current RRG models and the clinical demands in practice, we first develop a data generation pipeline to create a new MIMIC-RG4 dataset, which considers four common radiology report drafting scenarios and has perfectly corresponded input and output. Secondly, we propose a novel large language model (LLM) based RRG framework, namely LLM-RG4, which utilizes LLM's flexible instruction-following capabilities and extensive general knowledge. We further develop an adaptive token fusion module that offers flexibility to handle diverse scenarios with different input combinations, while minimizing the additional computational burden associated with increased input volumes. Besides, we propose a token-level loss weighting strategy to direct the model's attention towards positive and uncertain descriptions. Experimental results demonstrate that LLM-RG4 achieves state-of-the-art performance in both clinical efficiency and natural language generation on the MIMIC-RG4 and MIMIC-CXR datasets. We quantitatively demonstrate that our model has minimal input-agnostic hallucinations, whereas current open-source models commonly suffer from this problem.

VisionUnite: A Vision-Language Foundation Model for Ophthalmology Enhanced with Clinical Knowledge

The need for improved diagnostic methods in ophthalmology is acute, especially in the less developed regions with limited access to specialists and advanced equipment. Therefore, we introduce VisionUnite, a novel vision-language foundation model for ophthalmology enhanced with clinical knowledge. VisionUnite has been pretrained on an extensive dataset comprising 1.24 million image-text pairs, and further refined using our proposed MMFundus dataset, which includes 296,379 high-quality fundus image-text pairs and 889,137 simulated doctor-patient dialogue instances. Our experiments indicate that VisionUnite outperforms existing generative foundation models such as GPT-4V and Gemini Pro. It also demonstrates diagnostic capabilities comparable to junior ophthalmologists. VisionUnite performs well in various clinical scenarios including open-ended multi-disease diagnosis, clinical explanation, and patient interaction, making it a highly versatile tool for initial ophthalmic disease screening. VisionUnite can also serve as an educational aid for junior ophthalmologists, accelerating their acquisition of knowledge regarding both common and rare ophthalmic conditions. VisionUnite represents a significant advancement in ophthalmology, with broad implications for diagnostics, medical education, and understanding of disease mechanisms.

Are Large Language Models Possible to Conduct Cognitive Behavioral Therapy?

In contemporary society, the issue of psychological health has become increasingly prominent, characterized by the diversification, complexity, and universality of mental disorders. Cognitive Behavioral Therapy (CBT), currently the most influential and clinically effective psychological treatment method with no side effects, has limited coverage and poor quality in most countries. In recent years, researches on the recognition and intervention of emotional disorders using large language models (LLMs) have been validated, providing new possibilities for psychological assistance therapy. However, are LLMs truly possible to conduct cognitive behavioral therapy? Many concerns have been raised by mental health experts regarding the use of LLMs for therapy. Seeking to answer this question, we collected real CBT corpus from online video websites, designed and conducted a targeted automatic evaluation framework involving the evaluation of emotion tendency of generated text, structured dialogue pattern and proactive inquiry ability. For emotion tendency, we calculate the emotion tendency score of the CBT dialogue text generated by each model. For structured dialogue pattern, we use a diverse range of automatic evaluation metrics to compare speaking style, the ability to maintain consistency of topic and the use of technology in CBT between different models . As for inquiring to guide the patient, we utilize PQA (Proactive Questioning Ability) metric. We also evaluated the CBT ability of the LLM after integrating a CBT knowledge base to explore the help of introducing additional knowledge to enhance the model's CBT counseling ability. Four LLM variants with excellent performance on natural language processing are evaluated, and the experimental result shows the great potential of LLMs in psychological counseling realm, especially after combining with other technological means.

Rethinking Abdominal Organ Segmentation (RAOS) in the clinical scenario: A robustness evaluation benchmark with challenging cases

Deep learning has enabled great strides in abdominal multi-organ segmentation, even surpassing junior oncologists on common cases or organs. However, robustness on corner cases and complex organs remains a challenging open problem for clinical adoption. To investigate model robustness, we collected and annotated the RAOS dataset comprising 413 CT scans ($\sim$80k 2D images, $\sim$8k 3D organ annotations) from 413 patients each with 17 (female) or 19 (male) labelled organs, manually delineated by oncologists. We grouped scans based on clinical information into 1) diagnosis/radiotherapy (317 volumes), 2) partial excision without the whole organ missing (22 volumes), and 3) excision with the whole organ missing (74 volumes). RAOS provides a potential benchmark for evaluating model robustness including organ hallucination. It also includes some organs that can be very hard to access on public datasets like the rectum, colon, intestine, prostate and seminal vesicles. We benchmarked several state-of-the-art methods in these three clinical groups to evaluate performance and robustness. We also assessed cross-generalization between RAOS and three public datasets. This dataset and comprehensive analysis establish a potential baseline for future robustness research: \url{https://github.com/Luoxd1996/RAOS}.

Enhance the Image: Super Resolution using Artificial Intelligence in MRI

This chapter provides an overview of deep learning techniques for improving the spatial resolution of MRI, ranging from convolutional neural networks, generative adversarial networks, to more advanced models including transformers, diffusion models, and implicit neural representations. Our exploration extends beyond the methodologies to scrutinize the impact of super-resolved images on clinical and neuroscientific assessments. We also cover various practical topics such as network architectures, image evaluation metrics, network loss functions, and training data specifics, including downsampling methods for simulating low-resolution images and dataset selection. Finally, we discuss existing challenges and potential future directions regarding the feasibility and reliability of deep learning-based MRI super-resolution, with the aim to facilitate its wider adoption to benefit various clinical and neuroscientific applications.

ScribFormer: Transformer Makes CNN Work Better for Scribble-based Medical Image Segmentation

Most recent scribble-supervised segmentation methods commonly adopt a CNN framework with an encoder-decoder architecture. Despite its multiple benefits, this framework generally can only capture small-range feature dependency for the convolutional layer with the local receptive field, which makes it difficult to learn global shape information from the limited information provided by scribble annotations. To address this issue, this paper proposes a new CNN-Transformer hybrid solution for scribble-supervised medical image segmentation called ScribFormer. The proposed ScribFormer model has a triple-branch structure, i.e., the hybrid of a CNN branch, a Transformer branch, and an attention-guided class activation map (ACAM) branch. Specifically, the CNN branch collaborates with the Transformer branch to fuse the local features learned from CNN with the global representations obtained from Transformer, which can effectively overcome limitations of existing scribble-supervised segmentation methods. Furthermore, the ACAM branch assists in unifying the shallow convolution features and the deep convolution features to improve model's performance further. Extensive experiments on two public datasets and one private dataset show that our ScribFormer has superior performance over the state-of-the-art scribble-supervised segmentation methods, and achieves even better results than the fully-supervised segmentation methods. The code is released at https://github.com/HUANGLIZI/ScribFormer.

nnSAM: Plug-and-play Segment Anything Model Improves nnUNet Performance

The recent developments of foundation models in computer vision, especially the Segment Anything Model (SAM), allow scalable and domain-agnostic image segmentation to serve as a general-purpose segmentation tool. In parallel, the field of medical image segmentation has benefited significantly from specialized neural networks like the nnUNet, which is trained on domain-specific datasets and can automatically configure the network to tailor to specific segmentation challenges. To combine the advantages of foundation models and domain-specific models, we present nnSAM, which synergistically integrates the SAM model with the nnUNet model to achieve more accurate and robust medical image segmentation. The nnSAM model leverages the powerful and robust feature extraction capabilities of SAM, while harnessing the automatic configuration capabilities of nnUNet to promote dataset-tailored learning. Our comprehensive evaluation of nnSAM model on different sizes of training samples shows that it allows few-shot learning, which is highly relevant for medical image segmentation where high-quality, annotated data can be scarce and costly to obtain. By melding the strengths of both its predecessors, nnSAM positions itself as a potential new benchmark in medical image segmentation, offering a tool that combines broad applicability with specialized efficiency. The code is available at https://github.com/Kent0n-Li/Medical-Image-Segmentation.

Can Large Language Models Understand Real-World Complex Instructions?

Large language models (LLMs) can understand human instructions, showing their potential for pragmatic applications beyond traditional NLP tasks. However, they still struggle with complex instructions, which can be either complex task descriptions that require multiple tasks and constraints, or complex input that contains long context, noise, heterogeneous information and multi-turn format. Due to these features, LLMs often ignore semantic constraints from task descriptions, generate incorrect formats, violate length or sample count constraints, and be unfaithful to the input text. Existing benchmarks are insufficient to assess LLMs' ability to understand complex instructions, as they are close-ended and simple. To bridge this gap, we propose CELLO, a benchmark for evaluating LLMs' ability to follow complex instructions systematically. We design eight features for complex instructions and construct a comprehensive evaluation dataset from real-world scenarios. We also establish four criteria and develop corresponding metrics, as current ones are inadequate, biased or too strict and coarse-grained. We compare the performance of representative Chinese-oriented and English-oriented models in following complex instructions through extensive experiments. Resources of CELLO are publicly available at https://github.com/Abbey4799/CELLO.

ScribbleVC: Scribble-supervised Medical Image Segmentation with Vision-Class Embedding

Medical image segmentation plays a critical role in clinical decision-making, treatment planning, and disease monitoring. However, accurate segmentation of medical images is challenging due to several factors, such as the lack of high-quality annotation, imaging noise, and anatomical differences across patients. In addition, there is still a considerable gap in performance between the existing label-efficient methods and fully-supervised methods. To address the above challenges, we propose ScribbleVC, a novel framework for scribble-supervised medical image segmentation that leverages vision and class embeddings via the multimodal information enhancement mechanism. In addition, ScribbleVC uniformly utilizes the CNN features and Transformer features to achieve better visual feature extraction. The proposed method combines a scribble-based approach with a segmentation network and a class-embedding module to produce accurate segmentation masks. We evaluate ScribbleVC on three benchmark datasets and compare it with state-of-the-art methods. The experimental results demonstrate that our method outperforms existing approaches in terms of accuracy, robustness, and efficiency. The datasets and code are released on GitHub.