Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing \emph{CheXinstruct} - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present \emph{CheXagent} - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce \emph{CheXbench} - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at \url{//stanford-aimi.github.io/chexagent.html}.
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Objectives: Our objective is to create an end-to-end system called AutoRD, which automates extracting information from clinical text about rare diseases. We have conducted various tests to evaluate the performance of AutoRD and highlighted its strengths and limitations in this paper. Materials and Methods: Our system, AutoRD, is a software pipeline involving data preprocessing, entity extraction, relation extraction, entity calibration, and knowledge graph construction. We implement this using large language models and medical knowledge graphs developed from open-source medical ontologies. We quantitatively evaluate our system on entity extraction, relation extraction, and the performance of knowledge graph construction. Results: AutoRD achieves an overall F1 score of 47.3%, a 14.4% improvement compared to the base LLM. In detail, AutoRD achieves an overall entity extraction F1 score of 56.1% (rare_disease: 83.5%, disease: 35.8%, symptom_and_sign: 46.1%, anaphor: 67.5%) and an overall relation extraction F1 score of 38.6% (produces: 34.7%, increases_risk_of: 12.4%, is_a: 37.4%, is_acronym: 44.1%, is_synonym: 16.3%, anaphora: 57.5%). Our qualitative experiment also demonstrates that the performance in constructing the knowledge graph is commendable. Discussion: AutoRD demonstrates the potential of LLM applications in rare disease detection. This improvement is attributed to several design, including the integration of ontologies-enhanced LLMs. Conclusion: AutoRD is an automated end-to-end system for extracting rare disease information from text to build knowledge graphs. It uses ontologies-enhanced LLMs for a robust medical knowledge base. The superior performance of AutoRD is validated by experimental evaluations, demonstrating the potential of LLMs in healthcare.
Phase I clinical trials are essential to bringing novel therapies from chemical development to widespread use. Traditional approaches to dose-finding in Phase I trials, such as the '3+3' method and the Continual Reassessment Method (CRM), provide a principled approach for escalating across dose levels. However, these methods lack the ability to incorporate uncertainty regarding the dose-toxicity ordering as found in combination drug trials. Under this setting, dose-levels vary across multiple drugs simultaneously, leading to multiple possible dose-toxicity orderings. The Partial Ordering CRM (POCRM) extends to these settings by allowing for multiple dose-toxicity orderings. In this work, it is shown that the POCRM is vulnerable to 'estimation incoherency' whereby toxicity estimates shift in an illogical way, threatening patient safety and undermining clinician trust in dose-finding models. To this end, the Bayesian model averaged POCRM (BMA-POCRM) is proposed. BMA-POCRM uses Bayesian model averaging to take into account all possible orderings simultaneously, reducing the frequency of estimation incoherencies. The effectiveness of BMA-POCRM in drug combination settings is demonstrated through a specific instance of estimate incoherency of POCRM and simulation studies. The results highlight the improved safety, accuracy and reduced occurrence of estimate incoherency in trials applying the BMA-POCRM relative to the POCRM model.
Field-Programmable Gate Array (FPGA) accelerators have proven successful in handling latency- and resource-critical deep neural network (DNN) inference tasks. Among the most computationally intensive operations in a neural network (NN) is the dot product between the feature and weight vectors. Thus, some previous FPGA acceleration works have proposed mapping neurons with quantized inputs and outputs directly to lookup tables (LUTs) for hardware implementation. In these works, the boundaries of the neurons coincide with the boundaries of the LUTs. We propose relaxing these boundaries and mapping entire sub-networks to a single LUT. As the sub-networks are absorbed within the LUT, the NN topology and precision within a partition do not affect the size of the lookup tables generated. Therefore, we utilize fully connected layers with floating-point precision inside each partition, which benefit from being universal function approximators, with rigid sparsity and quantization enforced only between partitions, where the NN topology becomes exposed to the circuit topology. Although cheap to implement, this approach can lead to very deep NNs, and so to tackle challenges like vanishing gradients, we also introduce skip connections inside the partitions. The resulting methodology can be seen as training DNNs with a specific sparsity pattern that allows them to be mapped to much shallower circuit-level networks, thereby significantly improving latency. We validate our proposed method on a known latency-critical task, jet substructure tagging, and on the classical computer vision task, the digit classification using MNIST. Our approach allows for greater function expressivity within the LUTs compared to existing work, leading to lower latency NNs for the same accuracy.
Due to the three-dimensional nature of CT- or MR-scans, generative modeling of medical images is a particularly challenging task. Existing approaches mostly apply patch-wise, slice-wise, or cascaded generation techniques to fit the high-dimensional data into the limited GPU memory. However, these approaches may introduce artifacts and potentially restrict the model's applicability for certain downstream tasks. This work presents WDM, a wavelet-based medical image synthesis framework that applies a diffusion model on wavelet decomposed images. The presented approach is a simple yet effective way of scaling diffusion models to high resolutions and can be trained on a single 40 GB GPU. Experimental results on BraTS and LIDC-IDRI unconditional image generation at a resolution of $128 \times 128 \times 128$ show state-of-the-art image fidelity (FID) and sample diversity (MS-SSIM) scores compared to GANs, Diffusion Models, and Latent Diffusion Models. Our proposed method is the only one capable of generating high-quality images at a resolution of $256 \times 256 \times 256$.
Medical image segmentation is a fundamental and critical step in many image-guided clinical approaches. Recent success of deep learning-based segmentation methods usually relies on a large amount of labeled data, which is particularly difficult and costly to obtain especially in the medical imaging domain where only experts can provide reliable and accurate annotations. Semi-supervised learning has emerged as an appealing strategy and been widely applied to medical image segmentation tasks to train deep models with limited annotations. In this paper, we present a comprehensive review of recently proposed semi-supervised learning methods for medical image segmentation and summarized both the technical novelties and empirical results. Furthermore, we analyze and discuss the limitations and several unsolved problems of existing approaches. We hope this review could inspire the research community to explore solutions for this challenge and further promote the developments in medical image segmentation field.
Image registration is a critical component in the applications of various medical image analyses. In recent years, there has been a tremendous surge in the development of deep learning (DL)-based medical image registration models. This paper provides a comprehensive review of medical image registration. Firstly, a discussion is provided for supervised registration categories, for example, fully supervised, dual supervised, and weakly supervised registration. Next, similarity-based as well as generative adversarial network (GAN)-based registration are presented as part of unsupervised registration. Deep iterative registration is then described with emphasis on deep similarity-based and reinforcement learning-based registration. Moreover, the application areas of medical image registration are reviewed. This review focuses on monomodal and multimodal registration and associated imaging, for instance, X-ray, CT scan, ultrasound, and MRI. The existing challenges are highlighted in this review, where it is shown that a major challenge is the absence of a training dataset with known transformations. Finally, a discussion is provided on the promising future research areas in the field of DL-based medical image registration.
Deep Learning has implemented a wide range of applications and has become increasingly popular in recent years. The goal of multimodal deep learning is to create models that can process and link information using various modalities. Despite the extensive development made for unimodal learning, it still cannot cover all the aspects of human learning. Multimodal learning helps to understand and analyze better when various senses are engaged in the processing of information. This paper focuses on multiple types of modalities, i.e., image, video, text, audio, body gestures, facial expressions, and physiological signals. Detailed analysis of past and current baseline approaches and an in-depth study of recent advancements in multimodal deep learning applications has been provided. A fine-grained taxonomy of various multimodal deep learning applications is proposed, elaborating on different applications in more depth. Architectures and datasets used in these applications are also discussed, along with their evaluation metrics. Last, main issues are highlighted separately for each domain along with their possible future research directions.
Few-shot Knowledge Graph (KG) completion is a focus of current research, where each task aims at querying unseen facts of a relation given its few-shot reference entity pairs. Recent attempts solve this problem by learning static representations of entities and references, ignoring their dynamic properties, i.e., entities may exhibit diverse roles within task relations, and references may make different contributions to queries. This work proposes an adaptive attentional network for few-shot KG completion by learning adaptive entity and reference representations. Specifically, entities are modeled by an adaptive neighbor encoder to discern their task-oriented roles, while references are modeled by an adaptive query-aware aggregator to differentiate their contributions. Through the attention mechanism, both entities and references can capture their fine-grained semantic meanings, and thus render more expressive representations. This will be more predictive for knowledge acquisition in the few-shot scenario. Evaluation in link prediction on two public datasets shows that our approach achieves new state-of-the-art results with different few-shot sizes.
Applying artificial intelligence techniques in medical imaging is one of the most promising areas in medicine. However, most of the recent success in this area highly relies on large amounts of carefully annotated data, whereas annotating medical images is a costly process. In this paper, we propose a novel method, called FocalMix, which, to the best of our knowledge, is the first to leverage recent advances in semi-supervised learning (SSL) for 3D medical image detection. We conducted extensive experiments on two widely used datasets for lung nodule detection, LUNA16 and NLST. Results show that our proposed SSL methods can achieve a substantial improvement of up to 17.3% over state-of-the-art supervised learning approaches with 400 unlabeled CT scans.
We propose a novel attention gate (AG) model for medical imaging that automatically learns to focus on target structures of varying shapes and sizes. Models trained with AGs implicitly learn to suppress irrelevant regions in an input image while highlighting salient features useful for a specific task. This enables us to eliminate the necessity of using explicit external tissue/organ localisation modules of cascaded convolutional neural networks (CNNs). AGs can be easily integrated into standard CNN architectures such as the U-Net model with minimal computational overhead while increasing the model sensitivity and prediction accuracy. The proposed Attention U-Net architecture is evaluated on two large CT abdominal datasets for multi-class image segmentation. Experimental results show that AGs consistently improve the prediction performance of U-Net across different datasets and training sizes while preserving computational efficiency. The code for the proposed architecture is publicly available.
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