Revisiting CLIP: Efficient Alignment of 3D MRI and Tabular Data using Domain-Specific Foundation Models

Multi-modal models require aligned, shared embedding spaces. However, common CLIP-based approaches need large amounts of samples and do not natively support 3D or tabular data, both of which are crucial in the medical domain. To address these issues, we revisit CLIP-style alignment by training a domain-specific 3D foundation model as an image encoder and demonstrate that modality alignment is feasible with only 62 MRI scans. Our approach is enabled by a simple embedding accumulation strategy required for training in 3D, which scales the amount of negative pairs across batches in order to stabilize training. We perform a thorough evaluation of various design choices, including the choice of backbone and loss functions, and evaluate the proposed methodology on zero-shot classification and image-retrieval tasks. While zero-shot image-retrieval remains challenging, zero-shot classification results demonstrate that the proposed approach can meaningfully align the representations of 3D MRI with tabular data.

KPL: Training-Free Medical Knowledge Mining of Vision-Language Models

Visual Language Models such as CLIP excel in image recognition due to extensive image-text pre-training. However, applying the CLIP inference in zero-shot classification, particularly for medical image diagnosis, faces challenges due to: 1) the inadequacy of representing image classes solely with single category names; 2) the modal gap between the visual and text spaces generated by CLIP encoders. Despite attempts to enrich disease descriptions with large language models, the lack of class-specific knowledge often leads to poor performance. In addition, empirical evidence suggests that existing proxy learning methods for zero-shot image classification on natural image datasets exhibit instability when applied to medical datasets. To tackle these challenges, we introduce the Knowledge Proxy Learning (KPL) to mine knowledge from CLIP. KPL is designed to leverage CLIP's multimodal understandings for medical image classification through Text Proxy Optimization and Multimodal Proxy Learning. Specifically, KPL retrieves image-relevant knowledge descriptions from the constructed knowledge-enhanced base to enrich semantic text proxies. It then harnesses input images and these descriptions, encoded via CLIP, to stably generate multimodal proxies that boost the zero-shot classification performance. Extensive experiments conducted on both medical and natural image datasets demonstrate that KPL enables effective zero-shot image classification, outperforming all baselines. These findings highlight the great potential in this paradigm of mining knowledge from CLIP for medical image classification and broader areas.

CBVLM: Training-free Explainable Concept-based Large Vision Language Models for Medical Image Classification

The main challenges limiting the adoption of deep learning-based solutions in medical workflows are the availability of annotated data and the lack of interpretability of such systems. Concept Bottleneck Models (CBMs) tackle the latter by constraining the final disease prediction on a set of predefined and human-interpretable concepts. However, the increased interpretability achieved through these concept-based explanations implies a higher annotation burden. Moreover, if a new concept needs to be added, the whole system needs to be retrained. Inspired by the remarkable performance shown by Large Vision-Language Models (LVLMs) in few-shot settings, we propose a simple, yet effective, methodology, CBVLM, which tackles both of the aforementioned challenges. First, for each concept, we prompt the LVLM to answer if the concept is present in the input image. Then, we ask the LVLM to classify the image based on the previous concept predictions. Moreover, in both stages, we incorporate a retrieval module responsible for selecting the best examples for in-context learning. By grounding the final diagnosis on the predicted concepts, we ensure explainability, and by leveraging the few-shot capabilities of LVLMs, we drastically lower the annotation cost. We validate our approach with extensive experiments across four medical datasets and twelve LVLMs (both generic and medical) and show that CBVLM consistently outperforms CBMs and task-specific supervised methods without requiring any training and using just a few annotated examples. More information on our project page: https://cristianopatricio.github.io/CBVLM/.

Benchmarking Robustness of Contrastive Learning Models for Medical Image-Report Retrieval

Medical images and reports offer invaluable insights into patient health. The heterogeneity and complexity of these data hinder effective analysis. To bridge this gap, we investigate contrastive learning models for cross-domain retrieval, which associates medical images with their corresponding clinical reports. This study benchmarks the robustness of four state-of-the-art contrastive learning models: CLIP, CXR-RePaiR, MedCLIP, and CXR-CLIP. We introduce an occlusion retrieval task to evaluate model performance under varying levels of image corruption. Our findings reveal that all evaluated models are highly sensitive to out-of-distribution data, as evidenced by the proportional decrease in performance with increasing occlusion levels. While MedCLIP exhibits slightly more robustness, its overall performance remains significantly behind CXR-CLIP and CXR-RePaiR. CLIP, trained on a general-purpose dataset, struggles with medical image-report retrieval, highlighting the importance of domain-specific training data. The evaluation of this work suggests that more effort needs to be spent on improving the robustness of these models. By addressing these limitations, we can develop more reliable cross-domain retrieval models for medical applications.

Vision Foundation Models for Computed Tomography

Foundation models (FMs) have shown transformative potential in radiology by performing diverse, complex tasks across imaging modalities. Here, we developed CT-FM, a large-scale 3D image-based pre-trained model designed explicitly for various radiological tasks. CT-FM was pre-trained using 148,000 computed tomography (CT) scans from the Imaging Data Commons through label-agnostic contrastive learning. We evaluated CT-FM across four categories of tasks, namely, whole-body and tumor segmentation, head CT triage, medical image retrieval, and semantic understanding, showing superior performance against state-of-the-art models. Beyond quantitative success, CT-FM demonstrated the ability to cluster regions anatomically and identify similar anatomical and structural concepts across scans. Furthermore, it remained robust across test-retest settings and indicated reasonable salient regions attached to its embeddings. This study demonstrates the value of large-scale medical imaging foundation models and by open-sourcing the model weights, code, and data, aims to support more adaptable, reliable, and interpretable AI solutions in radiology.

Vision-Language Models Do Not Understand Negation

Many practical vision-language applications require models that understand negation, e.g., when using natural language to retrieve images which contain certain objects but not others. Despite advancements in vision-language models (VLMs) through large-scale training, their ability to comprehend negation remains underexplored. This study addresses the question: how well do current VLMs understand negation? We introduce NegBench, a new benchmark designed to evaluate negation understanding across 18 task variations and 79k examples spanning image, video, and medical datasets. The benchmark consists of two core tasks designed to evaluate negation understanding in diverse multimodal settings: Retrieval with Negation and Multiple Choice Questions with Negated Captions. Our evaluation reveals that modern VLMs struggle significantly with negation, often performing at chance level. To address these shortcomings, we explore a data-centric approach wherein we finetune CLIP models on large-scale synthetic datasets containing millions of negated captions. We show that this approach can result in a 10% increase in recall on negated queries and a 40% boost in accuracy on multiple-choice questions with negated captions.

RadAlign: Advancing Radiology Report Generation with Vision-Language Concept Alignment

Automated chest radiographs interpretation requires both accurate disease classification and detailed radiology report generation, presenting a significant challenge in the clinical workflow. Current approaches either focus on classification accuracy at the expense of interpretability or generate detailed but potentially unreliable reports through image captioning techniques. In this study, we present RadAlign, a novel framework that combines the predictive accuracy of vision-language models (VLMs) with the reasoning capabilities of large language models (LLMs). Inspired by the radiologist's workflow, RadAlign first employs a specialized VLM to align visual features with key medical concepts, achieving superior disease classification with an average AUC of 0.885 across multiple diseases. These recognized medical conditions, represented as text-based concepts in the aligned visual-language space, are then used to prompt LLM-based report generation. Enhanced by a retrieval-augmented generation mechanism that grounds outputs in similar historical cases, RadAlign delivers superior report quality with a GREEN score of 0.678, outperforming state-of-the-art methods' 0.634. Our framework maintains strong clinical interpretability while reducing hallucinations, advancing automated medical imaging and report analysis through integrated predictive and generative AI. Code is available at https://github.com/difeigu/RadAlign.

Activating Associative Disease-Aware Vision Token Memory for LLM-Based X-ray Report Generation

X-ray image based medical report generation achieves significant progress in recent years with the help of the large language model, however, these models have not fully exploited the effective information in visual image regions, resulting in reports that are linguistically sound but insufficient in describing key diseases. In this paper, we propose a novel associative memory-enhanced X-ray report generation model that effectively mimics the process of professional doctors writing medical reports. It considers both the mining of global and local visual information and associates historical report information to better complete the writing of the current report. Specifically, given an X-ray image, we first utilize a classification model along with its activation maps to accomplish the mining of visual regions highly associated with diseases and the learning of disease query tokens. Then, we employ a visual Hopfield network to establish memory associations for disease-related tokens, and a report Hopfield network to retrieve report memory information. This process facilitates the generation of high-quality reports based on a large language model and achieves state-of-the-art performance on multiple benchmark datasets, including the IU X-ray, MIMIC-CXR, and Chexpert Plus. The source code of this work is released on \url{https://github.com/Event-AHU/Medical_Image_Analysis}.

A Review on the Integration of Artificial Intelligence and Medical Imaging in IVF Ovarian Stimulation

Artificial intelligence (AI) has emerged as a powerful tool to enhance decision-making and optimize treatment protocols in in vitro fertilization (IVF). In particular, AI shows significant promise in supporting decision-making during the ovarian stimulation phase of the IVF process. This review evaluates studies focused on the applications of AI combined with medical imaging in ovarian stimulation, examining methodologies, outcomes, and current limitations. Our analysis of 13 studies on this topic reveals that, reveal that while AI algorithms demonstrated notable potential in predicting optimal hormonal dosages, trigger timing, and oocyte retrieval outcomes, the medical imaging data utilized predominantly came from two-dimensional (2D) ultrasound which mainly involved basic quantifications, such as follicle size and number, with limited use of direct feature extraction or advanced image analysis techniques. This points to an underexplored opportunity where advanced image analysis approaches, such as deep learning, and more diverse imaging modalities, like three-dimensional (3D) ultrasound, could unlock deeper insights. Additionally, the lack of explainable AI (XAI) in most studies raises concerns about the transparency and traceability of AI-driven decisions - key factors for clinical adoption and trust. Furthermore, many studies relied on single-center designs and small datasets, which limit the generalizability of their findings. This review highlights the need for integrating advanced imaging analysis techniques with explainable AI methodologies, as well as the importance of leveraging multicenter collaborations and larger datasets. Addressing these gaps has the potential to enhance ovarian stimulation management, paving the way for efficient, personalized, and data-driven treatment pathways that improve IVF outcomes.

Transversal PACS Browser API: Addressing Interoperability Challenges in Medical Imaging Systems

Advances in imaging technologies have revolutionised the medical imaging and healthcare sectors, leading to the widespread adoption of PACS for the storage, retrieval, and communication of medical images. Although these systems have improved operational efficiency, significant challenges remain in effectively retrieving DICOM images, which are essential for diagnosis and overall patient care. Moreover, issues such as fragmented systems, interoperability barriers, and complex user interfaces can often prevent healthcare professionals from efficiently accessing medical images. Addressing these challenges, the Transversal PACS Browser API is a robust and user-friendly solution designed to enhance the process of querying and retrieving DICOM images. It offers advanced filtering capabilities through a variety of filter options as well as a custom field search, that allows users to easily navigate through large medical image collections with ease. Additionally, the application provides a unified interface for querying and retrieving from multiple PACS stations, addressing the challenges of fragmentation and complexity associated with accessing medical images. Other key features include the ability to pre-view images directly within the application. All of this contributes to the transversal nature of the API, serving not only healthcare providers, but anyone who relies on efficient access to these resources. To validate the performance and usability of the application, comprehensive testing was carried out with stakeholders of the field, the results of which showed general satisfaction, highlighting the API's clean design, ease of use, and effective search capabilities of the API, as well as the usefulness of previewing images within the application.