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Although explainability is essential in the clinical diagnosis, most deep learning models still function as black boxes without elucidating their decision-making process. In this study, we investigate the explainable model development that can mimic the decision-making process of human experts by fusing the domain knowledge of explicit diagnostic criteria. We introduce a simple yet effective framework, Explicd, towards Explainable language-informed criteria-based diagnosis. Explicd initiates its process by querying domain knowledge from either large language models (LLMs) or human experts to establish diagnostic criteria across various concept axes (e.g., color, shape, texture, or specific patterns of diseases). By leveraging a pretrained vision-language model, Explicd injects these criteria into the embedding space as knowledge anchors, thereby facilitating the learning of corresponding visual concepts within medical images. The final diagnostic outcome is determined based on the similarity scores between the encoded visual concepts and the textual criteria embeddings. Through extensive evaluation of five medical image classification benchmarks, Explicd has demonstrated its inherent explainability and extends to improve classification performance compared to traditional black-box models. Code is available at \url{https://github.com/yhygao/Explicd}., Comment: MICCAI 2024 Early Accept

In-context Learning (ICL) empowers large language models (LLMs) to adapt to unseen tasks during inference by prefixing a few demonstration examples prior to test queries. Despite its versatility, ICL incurs substantial computational and memory overheads compared to zero-shot learning and is susceptible to the selection and order of demonstration examples. In this work, we introduce Implicit In-context Learning (I2CL), an innovative paradigm that addresses the challenges associated with traditional ICL by absorbing demonstration examples within the activation space. I2CL first generates a condensed vector representation, namely a context vector, from the demonstration examples. It then integrates the context vector during inference by injecting a linear combination of the context vector and query activations into the model's residual streams. Empirical evaluation on nine real-world tasks across three model architectures demonstrates that I2CL achieves few-shot performance with zero-shot cost and exhibits robustness against the variation of demonstration examples. Furthermore, I2CL facilitates a novel representation of "task-ids", enhancing task similarity detection and enabling effective transfer learning. We provide a comprehensive analysis of I2CL, offering deeper insights into its mechanisms and broader implications for ICL. The source code is available at: https://github.com/LzVv123456/I2CL.

The task of shape abstraction with semantic part consistency is challenging due to the complex geometries of natural objects. Recent methods learn to represent an object shape using a set of simple primitives to fit the target. \textcolor{black}{However, in these methods, the primitives used do not always correspond to real parts or lack geometric flexibility for semantic interpretation.} In this paper, we investigate salient and efficient primitive descriptors for accurate shape abstractions, and propose \textit{Deep Deformable Models (DDMs)}. DDM employs global deformations and diffeomorphic local deformations. These properties enable DDM to abstract complex object shapes with significantly fewer primitives that offer broader geometry coverage and finer details. DDM is also capable of learning part-level semantic correspondences due to the differentiable and invertible properties of our primitive deformation. Moreover, DDM learning formulation is based on dynamic and kinematic modeling, which enables joint regularization of each sub-transformation during primitive fitting. Extensive experiments on \textit{ShapeNet} demonstrate that DDM outperforms the state-of-the-art in terms of reconstruction and part consistency by a notable margin.

A major focus of clinical imaging workflow is disease diagnosis and management, leading to medical imaging datasets strongly tied to specific clinical objectives. This scenario has led to the prevailing practice of developing task-specific segmentation models, without gaining insights from widespread imaging cohorts. Inspired by the training program of medical radiology residents, we propose a shift towards universal medical image segmentation, a paradigm aiming to build medical image understanding foundation models by leveraging the diversity and commonality across clinical targets, body regions, and imaging modalities. Towards this goal, we develop Hermes, a novel context-prior learning approach to address the challenges of data heterogeneity and annotation differences in medical image segmentation. In a large collection of eleven diverse datasets (2,438 3D images) across five modalities (CT, PET, T1, T2 and cine MRI) and multiple body regions, we demonstrate the merit of the universal paradigm over the traditional paradigm on addressing multiple tasks within a single model. By exploiting the synergy across tasks, Hermes achieves state-of-the-art performance on all testing datasets and shows superior model scalability. Results on two additional datasets reveals Hermes' strong performance for transfer learning, incremental learning, and generalization to downstream tasks. Hermes's learned priors demonstrate an appealing trait to reflect the intricate relations among tasks and modalities, which aligns with the established anatomical and imaging principles in radiology. The code is available: https://github.com/yhygao/universal-medical-image-segmentation., Comment: Accepted by CVPR 2024

Models should be able to adapt to unseen data during test-time to avoid performance drops caused by inevitable distribution shifts in real-world deployment scenarios. In this work, we tackle the practical yet challenging test-time adaptation (TTA) problem, where a model adapts to the target domain without accessing the source data. We propose a simple recipe called \textit{Data-efficient Prompt Tuning} (DePT) with two key ingredients. First, DePT plugs visual prompts into the vision Transformer and only tunes these source-initialized prompts during adaptation. We find such parameter-efficient finetuning can efficiently adapt the model representation to the target domain without overfitting to the noise in the learning objective. Second, DePT bootstraps the source representation to the target domain by memory bank-based online pseudo-labeling. A hierarchical self-supervised regularization specially designed for prompts is jointly optimized to alleviate error accumulation during self-training. With much fewer tunable parameters, DePT demonstrates not only state-of-the-art performance on major adaptation benchmarks VisDA-C, ImageNet-C, and DomainNet-126, but also superior data efficiency, i.e., adaptation with only 1\% or 10\% data without much performance degradation compared to 100\% data. In addition, DePT is also versatile to be extended to online or multi-source TTA settings.

Combining information from multi-view images is crucial to improve the performance and robustness of automated methods for disease diagnosis. However, due to the non-alignment characteristics of multi-view images, building correlation and data fusion across views largely remain an open problem. In this study, we present TransFusion, a Transformer-based architecture to merge divergent multi-view imaging information using convolutional layers and powerful attention mechanisms. In particular, the Divergent Fusion Attention (DiFA) module is proposed for rich cross-view context modeling and semantic dependency mining, addressing the critical issue of capturing long-range correlations between unaligned data from different image views. We further propose the Multi-Scale Attention (MSA) to collect global correspondence of multi-scale feature representations. We evaluate TransFusion on the Multi-Disease, Multi-View \& Multi-Center Right Ventricular Segmentation in Cardiac MRI (M\&Ms-2) challenge cohort. TransFusion demonstrates leading performance against the state-of-the-art methods and opens up new perspectives for multi-view imaging integration towards robust medical image segmentation.

Top-down instance segmentation framework has shown its superiority in object detection compared to the bottom-up framework. While it is efficient in addressing over-segmentation, top-down instance segmentation suffers from over-crop problem. However, a complete segmentation mask is crucial for biological image analysis as it delivers important morphological properties such as shapes and volumes. In this paper, we propose a region proposal rectification (RPR) module to address this challenging incomplete segmentation problem. In particular, we offer a progressive ROIAlign module to introduce neighbor information into a series of ROIs gradually. The ROI features are fed into an attentive feed-forward network (FFN) for proposal box regression. With additional neighbor information, the proposed RPR module shows significant improvement in correction of region proposal locations and thereby exhibits favorable instance segmentation performances on three biological image datasets compared to state-of-the-art baseline methods. Experimental results demonstrate that the proposed RPR module is effective in both anchor-based and anchor-free top-down instance segmentation approaches, suggesting the proposed method can be applied to general top-down instance segmentation of biological images.

Transformers have demonstrated remarkable performance in natural language processing and computer vision. However, existing vision Transformers struggle to learn from limited medical data and are unable to generalize on diverse medical image tasks. To tackle these challenges, we present MedFormer, a data-scalable Transformer designed for generalizable 3D medical image segmentation. Our approach incorporates three key elements: a desirable inductive bias, hierarchical modeling with linear-complexity attention, and multi-scale feature fusion that integrates spatial and semantic information globally. MedFormer can learn across tiny- to large-scale data without pre-training. Comprehensive experiments demonstrate MedFormer's potential as a versatile segmentation backbone, outperforming CNNs and vision Transformers on seven public datasets covering multiple modalities (e.g., CT and MRI) and various medical targets (e.g., healthy organs, diseased tissues, and tumors). We provide public access to our models and evaluation pipeline, offering solid baselines and unbiased comparisons to advance a wide range of downstream clinical applications.

Multi-modality images have been widely used and provide comprehensive information for medical image analysis. However, acquiring all modalities among all institutes is costly and often impossible in clinical settings. To leverage more comprehensive multi-modality information, we propose a privacy secured decentralized multi-modality adaptive learning architecture named ModalityBank. Our method could learn a set of effective domain-specific modulation parameters plugged into a common domain-agnostic network. We demonstrate by switching different sets of configurations, the generator could output high-quality images for a specific modality. Our method could also complete the missing modalities across all data centers, thus could be used for modality completion purposes. The downstream task trained from the synthesized multi-modality samples could achieve higher performance than learning from one real data center and achieve close-to-real performance compare with all real images., Comment: arXiv admin note: substantial text overlap with arXiv:2012.08604

Transformer architecture has emerged to be successful in a number of natural language processing tasks. However, its applications to medical vision remain largely unexplored. In this study, we present UTNet, a simple yet powerful hybrid Transformer architecture that integrates self-attention into a convolutional neural network for enhancing medical image segmentation. UTNet applies self-attention modules in both encoder and decoder for capturing long-range dependency at different scales with minimal overhead. To this end, we propose an efficient self-attention mechanism along with relative position encoding that reduces the complexity of self-attention operation significantly from $O(n^2)$ to approximate $O(n)$. A new self-attention decoder is also proposed to recover fine-grained details from the skipped connections in the encoder. Our approach addresses the dilemma that Transformer requires huge amounts of data to learn vision inductive bias. Our hybrid layer design allows the initialization of Transformer into convolutional networks without a need of pre-training. We have evaluated UTNet on the multi-label, multi-vendor cardiac magnetic resonance imaging cohort. UTNet demonstrates superior segmentation performance and robustness against the state-of-the-art approaches, holding the promise to generalize well on other medical image segmentations., Comment: Accepted by MICCAI 2021. Code: https://github.com/yhygao/UTNet

Radiotherapy is a treatment where radiation is used to eliminate cancer cells. The delineation of organs-at-risk (OARs) is a vital step in radiotherapy treatment planning to avoid damage to healthy organs. For nasopharyngeal cancer, more than 20 OARs are needed to be precisely segmented in advance. The challenge of this task lies in complex anatomical structure, low-contrast organ contours, and the extremely imbalanced size between large and small organs. Common segmentation methods that treat them equally would generally lead to inaccurate small-organ labeling. We propose a novel two-stage deep neural network, FocusNetv2, to solve this challenging problem by automatically locating, ROI-pooling, and segmenting small organs with specifically designed small-organ localization and segmentation sub-networks while maintaining the accuracy of large organ segmentation. In addition to our original FocusNet, we employ a novel adversarial shape constraint on small organs to ensure the consistency between estimated small-organ shapes and organ shape prior knowledge. Our proposed framework is extensively tested on both self-collected dataset of 1,164 CT scans and the MICCAI Head and Neck Auto Segmentation Challenge 2015 dataset, which shows superior performance compared with state-of-the-art head and neck OAR segmentation methods., Comment: Accepted by Medical Image Analysis

Data augmentation has proved extremely useful by increasing training data variance to alleviate overfitting and improve deep neural networks' generalization performance. In medical image analysis, a well-designed augmentation policy usually requires much expert knowledge and is difficult to generalize to multiple tasks due to the vast discrepancies among pixel intensities, image appearances, and object shapes in different medical tasks. To automate medical data augmentation, we propose a regularized adversarial training framework via two min-max objectives and three differentiable augmentation models covering affine transformation, deformation, and appearance changes. Our method is more automatic and efficient than previous automatic augmentation methods, which still rely on pre-defined operations with human-specified ranges and costly bi-level optimization. Extensive experiments demonstrated that our approach, with less training overhead, achieves superior performance over state-of-the-art auto-augmentation methods on both tasks of 2D skin cancer classification and 3D organs-at-risk segmentation., Comment: Accepted by IPMI 2021

Traditional normalization techniques (e.g., Batch Normalization and Instance Normalization) generally and simplistically assume that training and test data follow the same distribution. As distribution shifts are inevitable in real-world applications, well-trained models with previous normalization methods can perform badly in new environments. Can we develop new normalization methods to improve generalization robustness under distribution shifts? In this paper, we answer the question by proposing CrossNorm and SelfNorm. CrossNorm exchanges channel-wise mean and variance between feature maps to enlarge training distribution, while SelfNorm uses attention to recalibrate the statistics to bridge gaps between training and test distributions. CrossNorm and SelfNorm can complement each other, though exploring different directions in statistics usage. Extensive experiments on different fields (vision and language), tasks (classification and segmentation), settings (supervised and semi-supervised), and distribution shift types (synthetic and natural) show the effectiveness. Code is available at https://github.com/amazon-research/crossnorm-selfnorm, Comment: ICCV 2021

Data augmentation is one of the most important tools in training modern deep neural networks. Recently, great advances have been made in searching for optimal augmentation policies in the image classification domain. However, two key points related to data augmentation remain uncovered by the current methods. First is that most if not all modern augmentation search methods are offline and learning policies are isolated from their usage. The learned policies are mostly constant throughout the training process and are not adapted to the current training model state. Second, the policies rely on class-preserving image processing functions. Hence applying current offline methods to new tasks may require domain knowledge to specify such kind of operations. In this work, we offer an orthogonal online data augmentation scheme together with three new augmentation networks, co-trained with the target learning task. It is both more efficient, in the sense that it does not require expensive offline training when entering a new domain, and more adaptive as it adapts to the learner state. Our augmentation networks require less domain knowledge and are easily applicable to new tasks. Extensive experiments demonstrate that the proposed scheme alone performs on par with the state-of-the-art offline data augmentation methods, as well as improving upon the state-of-the-art in combination with those methods. Code is available at https://github.com/zhiqiangdon/online-augment ., Comment: ECCV2020

In this paper, we propose an end-to-end deep neural network for solving the problem of imbalanced large and small organ segmentation in head and neck (HaN) CT images. To conduct radiotherapy planning for nasopharyngeal cancer, more than 10 organs-at-risk (normal organs) need to be precisely segmented in advance. However, the size ratio between large and small organs in the head could reach hundreds. Directly using such imbalanced organ annotations to train deep neural networks generally leads to inaccurate small-organ label maps. We propose a novel end-to-end deep neural network to solve this challenging problem by automatically locating, ROI-pooling, and segmenting small organs with specifically designed small-organ sub-networks while maintaining the accuracy of large organ segmentation. A strong main network with densely connected atrous spatial pyramid pooling and squeeze-and-excitation modules is used for segmenting large organs, where large organs' label maps are directly output. For small organs, their probabilistic locations instead of label maps are estimated by the main network. High-resolution and multi-scale feature volumes for each small organ are ROI-pooled according to their locations and are fed into small-organ networks for accurate segmenting small organs. Our proposed network is extensively tested on both collected real data and the \emph{MICCAI Head and Neck Auto Segmentation Challenge 2015} dataset, and shows superior performance compared with state-of-the-art segmentation methods., Comment: MICCAI 2019