Reem Kateb

Ahmad Chaddad, Qizong lu, Jiali Li et al.

Artificial intelligence (AI) continues to transform data analysis in many domains. Progress in each domain is driven by a growing body of annotated data, increased computational resources, and technological innovations. In medicine, the sensitivity of the data, the complexity of the tasks, the potentially high stakes, and a requirement of accountability give rise to a particular set of challenges. In this review, we focus on three key methodological approaches that address some of the particular challenges in AI-driven medical decision making. (1) Explainable AI aims to produce a human-interpretable justification for each output. Such models increase confidence if the results appear plausible and match the clinicians expectations. However, the absence of a plausible explanation does not imply an inaccurate model. Especially in highly non-linear, complex models that are tuned to maximize accuracy, such interpretable representations only reflect a small portion of the justification. (2) Domain adaptation and transfer learning enable AI models to be trained and applied across multiple domains. For example, a classification task based on images acquired on different acquisition hardware. (3) Federated learning enables learning large-scale models without exposing sensitive personal health information. Unlike centralized AI learning, where the centralized learning machine has access to the entire training data, the federated learning process iteratively updates models across multiple sites by exchanging only parameter updates, not personal health data. This narrative review covers the basic concepts, highlights relevant corner-stone and state-of-the-art research in the field, and discusses perspectives.

Xinyuan Zhao, Yihang Wu, Ahmad Chaddad et al.

While deep learning models like Vision Transformer (ViT) have achieved significant advances, they typically require large datasets. With data privacy regulations, access to many original datasets is restricted, especially medical images. Federated learning (FL) addresses this challenge by enabling global model aggregation without data exchange. However, the heterogeneity of the data and the class imbalance that exist in local clients pose challenges for the generalization of the model. This study proposes a FL framework leveraging a dynamic adaptive focal loss (DAFL) and a client-aware aggregation strategy for local training. Specifically, we design a dynamic class imbalance coefficient that adjusts based on each client's sample distribution and class data distribution, ensuring minority classes receive sufficient attention and preventing sparse data from being ignored. To address client heterogeneity, a weighted aggregation strategy is adopted, which adapts to data size and characteristics to better capture inter-client variations. The classification results on three public datasets (ISIC, Ocular Disease and RSNA-ICH) show that the proposed framework outperforms DenseNet121, ResNet50, ViT-S/16, ViT-L/32, FedCLIP, Swin Transformer, CoAtNet, and MixNet in most cases, with accuracy improvements ranging from 0.98\% to 41.69\%. Ablation studies on the imbalanced ISIC dataset validate the effectiveness of the proposed loss function and aggregation strategy compared to traditional loss functions and other FL approaches. The codes can be found at: https://github.com/AIPMLab/ViT-FLDAF.

Yihang Wu, Ahmad Chaddad, Christian Desrosiers et al.

Despite the remarkable performance of vision language models (VLMs) such as Contrastive Language Image Pre-training (CLIP), the large size of these models is a considerable obstacle to their use in federated learning (FL) systems where the parameters of local client models need to be transferred to a global server for aggregation. Another challenge in FL is the heterogeneity of data from different clients, which affects the generalization performance of the solution. In addition, natural pre-trained VLMs exhibit poor generalization ability in the medical datasets, suggests there exists a domain gap. To solve these issues, we introduce a novel method for the Federated Adversarial Adaptation (FAA) of CLIP. Our method, named FAA-CLIP, handles the large communication costs of CLIP using a light-weight feature adaptation module (FAM) for aggregation, effectively adapting this VLM to each client's data while greatly reducing the number of parameters to transfer. By keeping CLIP frozen and only updating the FAM parameters, our method is also computationally efficient. Unlike existing approaches, our FAA-CLIP method directly addresses the problem of domain shifts across clients via a domain adaptation (DA) module. This module employs a domain classifier to predict if a given sample is from the local client or the global server, allowing the model to learn domain-invariant representations. Extensive experiments on six different datasets containing both natural and medical images demonstrate that FAA-CLIP can generalize well on both natural and medical datasets compared to recent FL approaches. Our codes are available at https://github.com/AIPMLab/FAA-CLIP.

Yunyao Lu, Yihang Wu, Reem Kateb et al.

Traditional supervised medical image segmentation models require large amounts of labeled data for training; however, obtaining such large-scale labeled datasets in the real world is extremely challenging. Recent semi-supervised segmentation models also suffer from noisy pseudo-label issue and limited supervision in feature space. To solve these challenges, we propose an innovative semi-supervised 3D medical image segmentation method to reduce the dependency on large, expert-labeled datasets. Furthermore, we introduce a dual-network architecture to address the limitations of existing methods in using contextual information and generating reliable pseudo-labels. In addition, a self-supervised contrastive learning strategy is used to enhance the representation of the network and reduce prediction uncertainty by distinguishing between reliable and unreliable predictions. Experiments on clinical magnetic resonance imaging demonstrate that our approach outperforms state-of-the-art techniques. Our code is available at https://github.com/AIPMLab/Semi-supervised-Segmentation.

Yihang Wu, Muhammad Owais, Reem Kateb et al.

Deep models, such as convolutional neural networks (CNNs) and vision transformer (ViT), demonstrate remarkable performance in image classification. However, those deep models require large data to fine-tune, which is impractical in the medical domain due to the data privacy issue. Furthermore, despite the feasible performance of contrastive language image pre-training (CLIP) in the natural domain, the potential of CLIP has not been fully investigated in the medical field. To face these challenges, we considered three scenarios: 1) we introduce a novel CLIP variant using four CNNs and eight ViTs as image encoders for the classification of brain cancer and skin cancer, 2) we combine 12 deep models with two federated learning techniques to protect data privacy, and 3) we involve traditional machine learning (ML) methods to improve the generalization ability of those deep models in unseen domain data. The experimental results indicate that maxvit shows the highest averaged (AVG) test metrics (AVG = 87.03\%) in HAM10000 dataset with multimodal learning, while convnext\_l demonstrates remarkable test with an F1-score of 83.98\% compared to swin\_b with 81.33\% in FL model. Furthermore, the use of support vector machine (SVM) can improve the overall test metrics with AVG of $\sim 2\%$ for swin transformer series in ISIC2018. Our codes are available at https://github.com/AIPMLab/SkinCancerSimulation.

Ahmad Chaddad, Yan Hu, Yihang Wu et al.

Objective. This paper presents an overview of generalizable and explainable artificial intelligence (XAI) in deep learning (DL) for medical imaging, aimed at addressing the urgent need for transparency and explainability in clinical applications. Methodology. We propose to use four CNNs in three medical datasets (brain tumor, skin cancer, and chest x-ray) for medical image classification tasks. In addition, we perform paired t-tests to show the significance of the differences observed between different methods. Furthermore, we propose to combine ResNet50 with five common XAI techniques to obtain explainable results for model prediction, aiming at improving model transparency. We also involve a quantitative metric (confidence increase) to evaluate the usefulness of XAI techniques. Key findings. The experimental results indicate that ResNet50 can achieve feasible accuracy and F1 score in all datasets (e.g., 86.31\% accuracy in skin cancer). Furthermore, the findings show that while certain XAI methods, such as XgradCAM, effectively highlight relevant abnormal regions in medical images, others, like EigenGradCAM, may perform less effectively in specific scenarios. In addition, XgradCAM indicates higher confidence increase (e.g., 0.12 in glioma tumor) compared to GradCAM++ (0.09) and LayerCAM (0.08). Implications. Based on the experimental results and recent advancements, we outline future research directions to enhance the robustness and generalizability of DL models in the field of biomedical imaging.

Xinyuan Zhao, Yihang Wu, Ahmad Chaddad et al.

Gaze estimation methods commonly use facial appearances to predict the direction of a person gaze. However, previous studies show three major challenges with convolutional neural network (CNN)-based, transformer-based, and contrastive language-image pre-training (CLIP)-based methods, including late fusion of image features, lack of factor-aware conditioning, and impractical capacity scaling. To address these challenges, we propose Globally-conditioned Multi-scale Gaze estimation (GMGaze), which leverages a multi-scale transformer architecture. Specifically, the model first introduces semantic prototype conditioning, which modulates the CLIP global image embedding using four learned prototype banks (i.e., illumination, background, head pose and appearance) to generate two complementary context-biased global tokens. These tokens, along with the CLIP patch and CNN tokens, are fused at the first layer. This early unified fusion prevents information loss common in late-stage merging. Finally, each token passes through sparse Mixture-of-Experts modules, providing conditional computational capacity without uniformly increasing dense parameters. For cross-domain adaptation, we incorporate an adversarial domain adaptation technique with a feature separation loss that encourages the two global tokens to remain de-correlated. Experiments using four public benchmarks (MPIIFaceGaze, EYEDIAP, Gaze360, and ETH-XGaze) show that GMGaze achieves mean angular errors of 2.49$^\circ$, 3.22$^\circ$, 10.16$^\circ$, and 1.44$^\circ$, respectively, outperforming previous baselines in all within-domain settings. In cross-domain evaluations, it provides state-of-the-art (SOTA) results on two standard transfer routes.

Yunyao Lu, Yihang Wu, Ahmad Chaddad et al.

Despite the remarkable performance of supervised medical image segmentation models, relying on a large amount of labeled data is impractical in real-world situations. Semi-supervised learning approaches aim to alleviate this challenge using unlabeled data through pseudo-label generation. Yet, existing semi-supervised segmentation methods still suffer from noisy pseudo-labels and insufficient supervision within the feature space. To solve these challenges, this paper proposes a novel semi-supervised 3D medical image segmentation framework based on a dual-network architecture. Specifically, we investigate a Cross Consistency Enhancement module using both cross pseudo and entropy-filtered supervision to reduce the noisy pseudo-labels, while we design a dynamic weighting strategy to adjust the contributions of pseudo-labels using an uncertainty-aware mechanism (i.e., Kullback-Leibler divergence). In addition, we use a self-supervised contrastive learning mechanism to align uncertain voxel features with reliable class prototypes by effectively differentiating between trustworthy and uncertain predictions, thus reducing prediction uncertainty. Extensive experiments are conducted on three 3D segmentation datasets, Left Atrial, NIH Pancreas and BraTS-2019. The proposed approach consistently exhibits superior performance across various settings (e.g., 89.95\% Dice score on left Atrial with 10\% labeled data) compared to the state-of-the-art methods. Furthermore, the usefulness of the proposed modules is further validated via ablation experiments.

Ahmad Chaddad, Yihang Wu, Reem Kateb et al.

Domain adaptation (DA) techniques have the potential in machine learning to alleviate distribution differences between training and test sets by leveraging information from source domains. In image classification, most advances in DA have been made using natural images rather than medical data, which are harder to work with. Moreover, even for natural images, the use of mainstream datasets can lead to performance bias. {With the aim of better understanding the benefits of DA for both natural and medical images, this study performs 557 simulation studies using seven widely-used DA techniques for image classification in five natural and eight medical datasets that cover various scenarios, such as out-of-distribution, dynamic data streams, and limited training samples.} Our experiments yield detailed results and insightful observations highlighting the performance and medical applicability of these techniques. Notably, our results have shown the outstanding performance of the Deep Subdomain Adaptation Network (DSAN) algorithm. This algorithm achieved feasible classification accuracy (91.2\%) in the COVID-19 dataset using Resnet50 and showed an important accuracy improvement in the dynamic data stream DA scenario (+6.7\%) compared to the baseline. Our results also demonstrate that DSAN exhibits remarkable level of explainability when evaluated on COVID-19 and skin cancer datasets. These results contribute to the understanding of DA techniques and offer valuable insight into the effective adaptation of models to medical data.