Discharge summaries in Electronic Health Records (EHRs) are crucial for clinical decision-making, but their length and complexity make information extraction challenging, especially when dealing with accumulated summaries across multiple patient admissions. Large Language Models (LLMs) show promise in addressing this challenge by efficiently analyzing vast and complex data. Existing benchmarks, however, fall short in properly evaluating LLMs' capabilities in this context, as they typically focus on single-note information or limited topics, failing to reflect the real-world inquiries required by clinicians. To bridge this gap, we introduce EHRNoteQA, a novel benchmark built on the MIMIC-IV EHR, comprising 962 different QA pairs each linked to distinct patients' discharge summaries. Every QA pair is initially generated using GPT-4 and then manually reviewed and refined by three clinicians to ensure clinical relevance. EHRNoteQA includes questions that require information across multiple discharge summaries and covers eight diverse topics, mirroring the complexity and diversity of real clinical inquiries. We offer EHRNoteQA in two formats: open-ended and multi-choice question answering, and propose a reliable evaluation method for each. We evaluate 27 LLMs using EHRNoteQA and examine various factors affecting the model performance (e.g., the length and number of discharge summaries). Furthermore, to validate EHRNoteQA as a reliable proxy for expert evaluations in clinical practice, we measure the correlation between the LLM performance on EHRNoteQA, and the LLM performance manually evaluated by clinicians. Results show that LLM performance on EHRNoteQA have higher correlation with clinician-evaluated performance (Spearman: 0.78, Kendall: 0.62) compared to other benchmarks, demonstrating its practical relevance in evaluating LLMs in clinical settings.
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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.
The recent advancements in artificial intelligence (AI) combined with the extensive amount of data generated by today's clinical systems, has led to the development of imaging AI solutions across the whole value chain of medical imaging, including image reconstruction, medical image segmentation, image-based diagnosis and treatment planning. Notwithstanding the successes and future potential of AI in medical imaging, many stakeholders are concerned of the potential risks and ethical implications of imaging AI solutions, which are perceived as complex, opaque, and difficult to comprehend, utilise, and trust in critical clinical applications. Despite these concerns and risks, there are currently no concrete guidelines and best practices for guiding future AI developments in medical imaging towards increased trust, safety and adoption. To bridge this gap, this paper introduces a careful selection of guiding principles drawn from the accumulated experiences, consensus, and best practices from five large European projects on AI in Health Imaging. These guiding principles are named FUTURE-AI and its building blocks consist of (i) Fairness, (ii) Universality, (iii) Traceability, (iv) Usability, (v) Robustness and (vi) Explainability. In a step-by-step approach, these guidelines are further translated into a framework of concrete recommendations for specifying, developing, evaluating, and deploying technically, clinically and ethically trustworthy AI solutions into clinical practice.
Learning disentanglement aims at finding a low dimensional representation which consists of multiple explanatory and generative factors of the observational data. The framework of variational autoencoder (VAE) is commonly used to disentangle independent factors from observations. However, in real scenarios, factors with semantics are not necessarily independent. Instead, there might be an underlying causal structure which renders these factors dependent. We thus propose a new VAE based framework named CausalVAE, which includes a Causal Layer to transform independent exogenous factors into causal endogenous ones that correspond to causally related concepts in data. We further analyze the model identifiabitily, showing that the proposed model learned from observations recovers the true one up to a certain degree. Experiments are conducted on various datasets, including synthetic and real word benchmark CelebA. Results show that the causal representations learned by CausalVAE are semantically interpretable, and their causal relationship as a Directed Acyclic Graph (DAG) is identified with good accuracy. Furthermore, we demonstrate that the proposed CausalVAE model is able to generate counterfactual data through "do-operation" to the causal factors.
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.
With the capability of modeling bidirectional contexts, denoising autoencoding based pretraining like BERT achieves better performance than pretraining approaches based on autoregressive language modeling. However, relying on corrupting the input with masks, BERT neglects dependency between the masked positions and suffers from a pretrain-finetune discrepancy. In light of these pros and cons, we propose XLNet, a generalized autoregressive pretraining method that (1) enables learning bidirectional contexts by maximizing the expected likelihood over all permutations of the factorization order and (2) overcomes the limitations of BERT thanks to its autoregressive formulation. Furthermore, XLNet integrates ideas from Transformer-XL, the state-of-the-art autoregressive model, into pretraining. Empirically, XLNet outperforms BERT on 20 tasks, often by a large margin, and achieves state-of-the-art results on 18 tasks including question answering, natural language inference, sentiment analysis, and document ranking.
Distant supervision can effectively label data for relation extraction, but suffers from the noise labeling problem. Recent works mainly perform soft bag-level noise reduction strategies to find the relatively better samples in a sentence bag, which is suboptimal compared with making a hard decision of false positive samples in sentence level. In this paper, we introduce an adversarial learning framework, which we named DSGAN, to learn a sentence-level true-positive generator. Inspired by Generative Adversarial Networks, we regard the positive samples generated by the generator as the negative samples to train the discriminator. The optimal generator is obtained until the discrimination ability of the discriminator has the greatest decline. We adopt the generator to filter distant supervision training dataset and redistribute the false positive instances into the negative set, in which way to provide a cleaned dataset for relation classification. The experimental results show that the proposed strategy significantly improves the performance of distant supervision relation extraction comparing to state-of-the-art systems.
ASR (automatic speech recognition) systems like Siri, Alexa, Google Voice or Cortana has become quite popular recently. One of the key techniques enabling the practical use of such systems in people's daily life is deep learning. Though deep learning in computer vision is known to be vulnerable to adversarial perturbations, little is known whether such perturbations are still valid on the practical speech recognition. In this paper, we not only demonstrate such attacks can happen in reality, but also show that the attacks can be systematically conducted. To minimize users' attention, we choose to embed the voice commands into a song, called CommandSong. In this way, the song carrying the command can spread through radio, TV or even any media player installed in the portable devices like smartphones, potentially impacting millions of users in long distance. In particular, we overcome two major challenges: minimizing the revision of a song in the process of embedding commands, and letting the CommandSong spread through the air without losing the voice "command". Our evaluation demonstrates that we can craft random songs to "carry" any commands and the modify is extremely difficult to be noticed. Specially, the physical attack that we play the CommandSongs over the air and record them can success with 94 percentage.
Multi-relation Question Answering is a challenging task, due to the requirement of elaborated analysis on questions and reasoning over multiple fact triples in knowledge base. In this paper, we present a novel model called Interpretable Reasoning Network that employs an interpretable, hop-by-hop reasoning process for question answering. The model dynamically decides which part of an input question should be analyzed at each hop; predicts a relation that corresponds to the current parsed results; utilizes the predicted relation to update the question representation and the state of the reasoning process; and then drives the next-hop reasoning. Experiments show that our model yields state-of-the-art results on two datasets. More interestingly, the model can offer traceable and observable intermediate predictions for reasoning analysis and failure diagnosis.
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