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With the rapid development of multimodal large language models (MLLMs), especially their capabilities in visual chat through refer and ground functionalities, their significance is increasingly recognized. However, the biomedical field currently exhibits a substantial gap in this area, primarily due to the absence of a dedicated refer and ground dataset for biomedical images. To address this challenge, we devised the Med-GRIT-270k dataset. It comprises 270k question-and-answer pairs and spans eight distinct medical imaging modalities. Most importantly, it is the first dedicated to the biomedical domain and integrating refer and ground conversations. The key idea is to sample large-scale biomedical image-mask pairs from medical segmentation datasets and generate instruction datasets from text using chatGPT. Additionally, we introduce a Refer-and-Ground Multimodal Large Language Model for Biomedicine (BiRD) by using this dataset and multi-task instruction learning. Extensive experiments have corroborated the efficacy of the Med-GRIT-270k dataset and the multi-modal, fine-grained interactive capabilities of the BiRD model. This holds significant reference value for the exploration and development of intelligent biomedical assistants., Comment: Accepted by MICCAI2024

In the field of medical image segmentation, tackling Out-of-Distribution (OOD) segmentation tasks in a cost-effective manner remains a significant challenge. Universal segmentation models is a solution, which aim to generalize across the diverse modality of medical images, yet their effectiveness often diminishes when applied to OOD data modalities and tasks, requiring intricate fine-tuning of model for optimal performance. Few-shot learning segmentation methods are typically designed for specific modalities of data and cannot be directly transferred for use with another modality. Therefore, we introduce SegICL, a novel approach leveraging In-Context Learning (ICL) for image segmentation. Unlike existing methods, SegICL has the capability to employ text-guided segmentation and conduct in-context learning with a small set of image-mask pairs, eliminating the need for training the model from scratch or fine-tuning for OOD tasks (including OOD modality and dataset). Extensive experimental demonstrates a positive correlation between the number of shots and segmentation performance on OOD tasks. The performance of segmentation when provided thre-shots is approximately 1.5 times better than the performance in a zero-shot setting. This indicates that SegICL effectively address new segmentation tasks based on contextual information. Additionally, SegICL also exhibits comparable performance to mainstream models on OOD and in-distribution tasks. Our code will be released after paper review.

Large-scale public datasets with high-quality annotations are rarely available for intelligent medical imaging research, due to data privacy concerns and the cost of annotations. In this paper, we release SynFundus-1M, a high-quality synthetic dataset containing over one million fundus images in terms of \textbf{eleven disease types}. Furthermore, we deliberately assign four readability labels to the key regions of the fundus images. To the best of our knowledge, SynFundus-1M is currently the largest fundus dataset with the most sophisticated annotations. Leveraging over 1.3 million private authentic fundus images from various scenarios, we trained a powerful Denoising Diffusion Probabilistic Model, named SynFundus-Generator. The released SynFundus-1M are generated by SynFundus-Generator under predefined conditions. To demonstrate the value of SynFundus-1M, extensive experiments are designed in terms of the following aspect: 1) Authenticity of the images: we randomly blend the synthetic images with authentic fundus images, and find that experienced annotators can hardly distinguish the synthetic images from authentic ones. Moreover, we show that the disease-related vision features (e.g. lesions) are well simulated in the synthetic images. 2) Effectiveness for down-stream fine-tuning and pretraining: we demonstrate that retinal disease diagnosis models of either convolutional neural networks (CNN) or Vision Transformer (ViT) architectures can benefit from SynFundus-1M, and compared to the datasets commonly used for pretraining, models trained on SynFundus-1M not only achieve superior performance but also demonstrate faster convergence on various downstream tasks. SynFundus-1M is already public available for the open-source community.

Clinically, the accurate annotation of lesions/tissues can significantly facilitate the disease diagnosis. For example, the segmentation of optic disc/cup (OD/OC) on fundus image would facilitate the glaucoma diagnosis, the segmentation of skin lesions on dermoscopic images is helpful to the melanoma diagnosis, etc. With the advancement of deep learning techniques, a wide range of methods proved the lesions/tissues segmentation can also facilitate the automated disease diagnosis models. However, existing methods are limited in the sense that they can only capture static regional correlations in the images. Inspired by the global and dynamic nature of Vision Transformer, in this paper, we propose Segmentation-Assisted diagnosis Transformer (SeATrans) to transfer the segmentation knowledge to the disease diagnosis network. Specifically, we first propose an asymmetric multi-scale interaction strategy to correlate each single low-level diagnosis feature with multi-scale segmentation features. Then, an effective strategy called SeA-block is adopted to vitalize diagnosis feature via correlated segmentation features. To model the segmentation-diagnosis interaction, SeA-block first embeds the diagnosis feature based on the segmentation information via the encoder, and then transfers the embedding back to the diagnosis feature space by a decoder. Experimental results demonstrate that SeATrans surpasses a wide range of state-of-the-art (SOTA) segmentation-assisted diagnosis methods on several disease diagnosis tasks.

The segmentation of optic disc(OD) and optic cup(OC) from fundus images is an important fundamental task for glaucoma diagnosis. In the clinical practice, it is often necessary to collect opinions from multiple experts to obtain the final OD/OC annotation. This clinical routine helps to mitigate the individual bias. But when data is multiply annotated, standard deep learning models will be inapplicable. In this paper, we propose a novel neural network framework to learn OD/OC segmentation from multi-rater annotations. The segmentation results are self-calibrated through the iterative optimization of multi-rater expertness estimation and calibrated OD/OC segmentation. In this way, the proposed method can realize a mutual improvement of both tasks and finally obtain a refined segmentation result. Specifically, we propose Diverging Model(DivM) and Converging Model(ConM) to process the two tasks respectively. ConM segments the raw image based on the multi-rater expertness map provided by DivM. DivM generates multi-rater expertness map from the segmentation mask provided by ConM. The experiment results show that by recurrently running ConM and DivM, the results can be self-calibrated so as to outperform a range of state-of-the-art(SOTA) multi-rater segmentation methods.

Pre-training is essential to deep learning model performance, especially in medical image analysis tasks where limited training data are available. However, existing pre-training methods are inflexible as the pre-trained weights of one model cannot be reused by other network architectures. In this paper, we propose an architecture-irrelevant hyper-initializer, which can initialize any given network architecture well after being pre-trained for only once. The proposed initializer is a hypernetwork which takes a downstream architecture as input graphs and outputs the initialization parameters of the respective architecture. We show the effectiveness and efficiency of the hyper-initializer through extensive experimental results on multiple medical imaging modalities, especially in data-limited fields. Moreover, we prove that the proposed algorithm can be reused as a favorable plug-and-play initializer for any downstream architecture and task (both classification and segmentation) of the same modality.

We present an effective method for Intracranial Hemorrhage Detection (IHD) which exceeds the performance of the winner solution in RSNA-IHD competition (2019). Meanwhile, our model only takes quarter parameters and ten percent FLOPs compared to the winner's solution. The IHD task needs to predict the hemorrhage category of each slice for the input brain CT. We review the top-5 solutions for the IHD competition held by the Radiological Society of North America(RSNA) in 2019. Nearly all the top solutions rely on 2D convolutional networks and sequential models (Bidirectional GRU or LSTM) to extract intra-slice and inter-slice features, respectively. All the top solutions enhance the performance by leveraging the model ensemble, and the model number varies from 7 to 31. In the past years, since much progress has been made in the computer vision regime especially Transformer-based models, we introduce the Transformer-based techniques to extract the features in both intra-slice and inter-slice views for IHD tasks. Additionally, a semi-supervised method is embedded into our workflow to further improve the performance. The code is available in the manuscript.

With the advancement of deep learning techniques, an increasing number of methods have been proposed for optic disc and cup (OD/OC) segmentation from the fundus images. Clinically, OD/OC segmentation is often annotated by multiple clinical experts to mitigate the personal bias. However, it is hard to train the automated deep learning models on multiple labels. A common practice to tackle the issue is majority vote, e.g., taking the average of multiple labels. However such a strategy ignores the different expertness of medical experts. Motivated by the observation that OD/OC segmentation is often used for the glaucoma diagnosis clinically, in this paper, we propose a novel strategy to fuse the multi-rater OD/OC segmentation labels via the glaucoma diagnosis performance. Specifically, we assess the expertness of each rater through an attentive glaucoma diagnosis network. For each rater, its contribution for the diagnosis will be reflected as an expertness map. To ensure the expertness maps are general for different glaucoma diagnosis models, we further propose an Expertness Generator (ExpG) to eliminate the high-frequency components in the optimization process. Based on the obtained expertness maps, the multi-rater labels can be fused as a single ground-truth which we dubbed as Diagnosis First Ground-truth (DiagFirstGT). Experimental results show that by using DiagFirstGT as ground-truth, OD/OC segmentation networks will predict the masks with superior glaucoma diagnosis performance., Comment: MICCAI 2022

Diabetic retinopathy (DR) grading from fundus images has attracted increasing interest in both academic and industrial communities. Most convolutional neural network (CNN) based algorithms treat DR grading as a classification task via image-level annotations. However, these algorithms have not fully explored the valuable information in the DR-related lesions. In this paper, we present a robust framework, which collaboratively utilizes patch-level and image-level annotations, for DR severity grading. By an end-to-end optimization, this framework can bi-directionally exchange the fine-grained lesion and image-level grade information. As a result, it exploits more discriminative features for DR grading. The proposed framework shows better performance than the recent state-of-the-art algorithms and three clinical ophthalmologists with over nine years of experience. By testing on datasets of different distributions (such as label and camera), we prove that our algorithm is robust when facing image quality and distribution variations that commonly exist in real-world practice. We inspect the proposed framework through extensive ablation studies to indicate the effectiveness and necessity of each motivation. The code and some valuable annotations are now publicly available.

Training recurrent neural networks (RNNs) with backpropagation through time (BPTT) has known drawbacks such as being difficult to capture longterm dependencies in sequences. Successful alternatives to BPTT have not yet been discovered. Recently, BP with synthetic gradients by a decoupled neural interface module has been proposed to replace BPTT for training RNNs. On the other hand, it has been shown that the representations learned with synthetic and real gradients are different though they are functionally identical. In this project, we explore ways of combining synthetic and real gradients with application to neural language modeling tasks. Empirically, we demonstrate the effectiveness of alternating training with synthetic and real gradients after periodic warm restarts on language modeling tasks., Comment: renew the ideas