Magdalini Paschali

Walter A. Simson, Magdalini Paschali, Vasiliki Sideri-Lampretsa et al. · stanford

Ultrasound is an adjunct tool to mammography that can quickly and safely aid physicians with diagnosing breast abnormalities. Clinical ultrasound often assumes a constant sound speed to form B-mode images for diagnosis. However, the various types of breast tissue, such as glandular, fat, and lesions, differ in sound speed. These differences can degrade the image reconstruction process. Alternatively, sound speed can be a powerful tool for identifying disease. To this end, we propose a deep-learning approach for sound speed estimation from in-phase and quadrature ultrasound signals. First, we develop a large-scale simulated ultrasound dataset that generates quasi-realistic breast tissue by modeling breast gland, skin, and lesions with varying echogenicity and sound speed. We developed a fully convolutional neural network architecture trained on a simulated dataset to produce an estimated sound speed map from inputting three complex-value in-phase and quadrature ultrasound images formed from plane-wave transmissions at separate angles. Furthermore, thermal noise augmentation is used during model optimization to enhance generalizability to real ultrasound data. We evaluate the model on simulated, phantom, and in-vivo breast ultrasound data, demonstrating its ability to accurately estimate sound speeds consistent with previously reported values in the literature. Our simulated dataset and model will be publicly available to provide a step towards accurate and generalizable sound speed estimation for pulse-echo ultrasound imaging.

Tobias Czempiel, Coco Rogers, Matthias Keicher et al. · stanford

Quantifying COVID-19 infection over time is an important task to manage the hospitalization of patients during a global pandemic. Recently, deep learning-based approaches have been proposed to help radiologists automatically quantify COVID-19 pathologies on longitudinal CT scans. However, the learning process of deep learning methods demands extensive training data to learn the complex characteristics of infected regions over longitudinal scans. It is challenging to collect a large-scale dataset, especially for longitudinal training. In this study, we want to address this problem by proposing a new self-supervised learning method to effectively train longitudinal networks for the quantification of COVID-19 infections. For this purpose, longitudinal self-supervision schemes are explored on clinical longitudinal COVID-19 CT scans. Experimental results show that the proposed method is effective, helping the model better exploit the semantics of longitudinal data and improve two COVID-19 quantification tasks.

Magdalini Paschali, Qingyu Zhao, Ehsan Adeli et al. · stanford

A fundamental approach in neuroscience research is to test hypotheses based on neuropsychological and behavioral measures, i.e., whether certain factors (e.g., related to life events) are associated with an outcome (e.g., depression). In recent years, deep learning has become a potential alternative approach for conducting such analyses by predicting an outcome from a collection of factors and identifying the most "informative" ones driving the prediction. However, this approach has had limited impact as its findings are not linked to statistical significance of factors supporting hypotheses. In this article, we proposed a flexible and scalable approach based on the concept of permutation testing that integrates hypothesis testing into the data-driven deep learning analysis. We apply our approach to the yearly self-reported assessments of 621 adolescent participants of the National Consortium of Alcohol and Neurodevelopment in Adolescence (NCANDA) to predict negative valence, a symptom of major depressive disorder according to the NIMH Research Domain Criteria (RDoC). Our method successfully identifies categories of risk factors that further explain the symptom.

Tobias Czempiel, Aidean Sharghi, Magdalini Paschali et al. · stanford

Algorithmic surgical workflow recognition is an ongoing research field and can be divided into laparoscopic (Internal) and operating room (External) analysis. So far many different works for the internal analysis have been proposed with the combination of a frame-level and an additional temporal model to address the temporal ambiguities between different workflow phases. For the External recognition task, Clip-level methods are in the focus of researchers targeting the local ambiguities present in the OR scene. In this work we evaluate combinations of different model architectures for the task of surgical workflow recognition to provide a fair comparison of the methods for both Internal and External analysis. We show that methods designed for the Internal analysis can be transferred to the external task with comparable performance gains for different architectures.

Shizhe He, Magdalini Paschali, Jiahong Ouyang et al. · stanford

Representation learning has become increasingly important, especially as powerful models have shifted towards learning latent representations before fine-tuning for downstream tasks. This approach is particularly valuable in leveraging the structural information within brain anatomy. However, a common limitation of recent models developed for MRIs is their tendency to ignore or remove geometric information, such as translation and rotation, thereby creating invariance with respect to geometric operations. We contend that incorporating knowledge about these geometric transformations into the model can significantly enhance its ability to learn more detailed anatomical information within brain structures. As a result, we propose a novel method for encoding 3D MRIs that enforces equivariance with respect to all rotations in 3D space, in other words, SO(3)-equivariance (SOE). By explicitly modeling this geometric equivariance in the representation space, we ensure that any rotational operation applied to the input image space is also reflected in the embedding representation space. This approach requires moving beyond traditional representation learning methods, as we need a representation vector space that allows for the application of the same SO(3) operation in that space. To facilitate this, we leverage the concept of vector neurons. The representation space formed by our method captures the brain's structural and anatomical information more effectively. We evaluate SOE pretrained on the structural MRIs of two public data sets with respect to the downstream task of predicting age and diagnosing Alzheimer's Disease from T1-weighted brain scans of the ADNI data set. We demonstrate that our approach not only outperforms other methods but is also robust against various degrees of rotation along different axes. The code is available at https://github.com/shizhehe/SOE-representation-learning.

Stefania L. Moroianu, Christian Bluethgen, Pierre Chambon et al. · stanford

Achieving robust performance and fairness across diverse patient populations remains a challenge in developing clinically deployable deep learning models for diagnostic imaging. Synthetic data generation has emerged as a promising strategy to address limitations in dataset scale and diversity. We introduce RoentGen-v2, a text-to-image diffusion model for chest radiographs that enables fine-grained control over both radiographic findings and patient demographic attributes, including sex, age, and race/ethnicity. RoentGen-v2 is the first model to generate clinically plausible images with demographic conditioning, facilitating the creation of a large, demographically balanced synthetic dataset comprising over 565,000 images. We use this large synthetic dataset to evaluate optimal training pipelines for downstream disease classification models. In contrast to prior work that combines real and synthetic data naively, we propose an improved training strategy that leverages synthetic data for supervised pretraining, followed by fine-tuning on real data. Through extensive evaluation on over 137,000 chest radiographs from five institutions, we demonstrate that synthetic pretraining consistently improves model performance, generalization to out-of-distribution settings, and fairness across demographic subgroups. Across datasets, synthetic pretraining led to a 6.5% accuracy increase in the performance of downstream classification models, compared to a modest 2.7% increase when naively combining real and synthetic data. We observe this performance improvement simultaneously with the reduction of the underdiagnosis fairness gap by 19.3%. These results highlight the potential of synthetic imaging to advance equitable and generalizable medical deep learning under real-world data constraints. We open source our code, trained models, and synthetic dataset at https://github.com/StanfordMIMI/RoentGen-v2 .

Asad Aali, Vasiliki Bikia, Maya Varma et al. · stanford

With the growing use of language models (LMs) in clinical environments, there is an immediate need to evaluate the accuracy and safety of LM-generated medical text. Currently, such evaluation relies solely on manual physician review. However, detecting errors in LM-generated text is challenging because 1) manual review is costly and 2) expert-composed reference outputs are often unavailable in real-world settings. While the "LM-as-judge" paradigm (a LM evaluating another LM) offers scalable evaluation, even frontier LMs can miss subtle but clinically significant errors. To address these challenges, we propose MedVAL, a novel, self-supervised, data-efficient distillation method that leverages synthetic data to train evaluator LMs to assess whether LM-generated medical outputs are factually consistent with inputs, without requiring physician labels or reference outputs. To evaluate LM performance, we introduce MedVAL-Bench, a dataset of 840 physician-annotated outputs across 6 diverse medical tasks capturing real-world challenges. Across 10 state-of-the-art LMs spanning open-source and proprietary models, MedVAL distillation significantly improves (p < 0.001) alignment with physicians across seen and unseen tasks, increasing average F1 scores from 66% to 83%. Despite strong baseline performance, MedVAL improves the best-performing proprietary LM (GPT-4o) by 8% without training on physician-labeled data, demonstrating a performance statistically non-inferior to a single human expert (p < 0.001). To support a scalable, risk-aware pathway towards clinical integration, we open-source: 1) Codebase (https://github.com/StanfordMIMI/MedVAL), 2) MedVAL-Bench (https://huggingface.co/datasets/stanfordmimi/MedVAL-Bench), 3) MedVAL-4B (https://huggingface.co/stanfordmimi/MedVAL-4B). Our benchmark provides evidence of LMs approaching expert-level ability in validating AI-generated medical text.

Louis Blankemeier, Ashwin Kumar, Joseph Paul Cohen et al.

The large volume of abdominal computed tomography (CT) scans coupled with the shortage of radiologists have intensified the need for automated medical image analysis tools. Previous state-of-the-art approaches for automated analysis leverage vision-language models (VLMs) that jointly model images and radiology reports. However, current medical VLMs are generally limited to 2D images and short reports. Here to overcome these shortcomings for abdominal CT interpretation, we introduce Merlin, a 3D VLM that learns from volumetric CT scans, electronic health record data and radiology reports. This approach is enabled by a multistage pretraining framework that does not require additional manual annotations. We trained Merlin using a high-quality clinical dataset of paired CT scans (>6 million images from 15,331 CT scans), diagnosis codes (>1.8 million codes) and radiology reports (>6 million tokens). We comprehensively evaluated Merlin on 6 task types and 752 individual tasks that covered diagnostic, prognostic and quality-related tasks. The non-adapted (off-the-shelf) tasks included zero-shot classification of findings (30 findings), phenotype classification (692 phenotypes) and zero-shot cross-modal retrieval (image-to-findings and image-to-impression). The model-adapted tasks included 5-year chronic disease prediction (6 diseases), radiology report generation and 3D semantic segmentation (20 organs). We validated Merlin at scale, with internal testing on 5,137 CT scans and external testing on 44,098 CT scans from 3 independent sites and 2 public datasets. The results demonstrated high generalization across institutions and anatomies. Merlin outperformed 2D VLMs, CT foundation models and off-the-shelf radiology models. We also release our trained models, code, and dataset, available at: https://github.com/StanfordMIMI/Merlin.

Zhihong Chen, Maya Varma, Justin Xu et al. · mila, oxford

Over 1.4 billion chest X-rays (CXRs) are performed annually due to their cost-effectiveness as an initial diagnostic test. This scale of radiological studies provides a significant opportunity to streamline CXR interpretation and documentation. While foundation models are a promising solution, the lack of publicly available large-scale datasets and benchmarks inhibits their iterative development and real-world evaluation. To overcome these challenges, we constructed a large-scale dataset (CheXinstruct), which we utilized to train a vision-language foundation model (CheXagent). We systematically demonstrated competitive performance across eight distinct task types on our novel evaluation benchmark (CheXbench). Beyond technical validation, we assessed the real-world utility of CheXagent in directly drafting radiology reports. Our clinical assessment with eight radiologists revealed a 36% time saving for residents using CheXagent-drafted reports, while attending radiologists showed no significant time difference editing resident-drafted or CheXagent-drafted reports. The CheXagent-drafted reports improved the writing efficiency of both radiology residents and attending radiologists in 81% and 61% of cases, respectively, without loss of quality. Overall, we demonstrate that CheXagent can effectively perform a variety of CXR interpretation tasks and holds potential to assist radiologists in routine clinical workflows.

Magdalini Paschali, Zhihong Chen, Louis Blankemeier et al. · stanford

Recent advances in artificial intelligence have witnessed the emergence of large-scale deep learning models capable of interpreting and generating both textual and imaging data. Such models, typically referred to as foundation models, are trained on extensive corpora of unlabeled data and demonstrate high performance across various tasks. Foundation models have recently received extensive attention from academic, industry, and regulatory bodies. Given the potentially transformative impact that foundation models can have on the field of radiology, this review aims to establish a standardized terminology concerning foundation models, with a specific focus on the requirements of training data, model training paradigms, model capabilities, and evaluation strategies. We further outline potential pathways to facilitate the training of radiology-specific foundation models, with a critical emphasis on elucidating both the benefits and challenges associated with such models. Overall, we envision that this review can unify technical advances and clinical needs in the training of foundation models for radiology in a safe and responsible manner, for ultimately benefiting patients, providers, and radiologists.

Francesca De Benetti, Walter Simson, Magdalini Paschali et al.

Dynamic positron emission tomography imaging (dPET) provides temporally resolved images of a tracer enabling a quantitative measure of physiological processes. Voxel-wise physiologically-based pharmacokinetic (PBPK) modeling of the time activity curves (TAC) can provide relevant diagnostic information for clinical workflow. Conventional fitting strategies for TACs are slow and ignore the spatial relation between neighboring voxels. We train a spatio-temporal UNet to estimate the kinetic parameters given TAC from F-18-fluorodeoxyglucose (FDG) dPET. This work introduces a self-supervised loss formulation to enforce the similarity between the measured TAC and those generated with the learned kinetic parameters. Our method provides quantitatively comparable results at organ-level to the significantly slower conventional approaches, while generating pixel-wise parametric images which are consistent with expected physiology. To the best of our knowledge, this is the first self-supervised network that allows voxel-wise computation of kinetic parameters consistent with a non-linear kinetic model. The code will become publicly available upon acceptance.

Michelle Xiao-Lin Foo, Seong Tae Kim, Magdalini Paschali et al.

Consistent segmentation of COVID-19 patient's CT scans across multiple time points is essential to assess disease progression and response to therapy accurately. Existing automatic and interactive segmentation models for medical images only use data from a single time point (static). However, valuable segmentation information from previous time points is often not used to aid the segmentation of a patient's follow-up scans. Also, fully automatic segmentation techniques frequently produce results that would need further editing for clinical use. In this work, we propose a new single network model for interactive segmentation that fully utilizes all available past information to refine the segmentation of follow-up scans. In the first segmentation round, our model takes 3D volumes of medical images from two-time points (target and reference) as concatenated slices with the additional reference time point segmentation as a guide to segment the target scan. In subsequent segmentation refinement rounds, user feedback in the form of scribbles that correct the segmentation and the target's previous segmentation results are additionally fed into the model. This ensures that the segmentation information from previous refinement rounds is retained. Experimental results on our in-house multiclass longitudinal COVID-19 dataset show that the proposed model outperforms its static version and can assist in localizing COVID-19 infections in patient's follow-up scans.

Matthias Keicher, Hendrik Burwinkel, David Bani-Harouni et al.

During the first wave of COVID-19, hospitals were overwhelmed with the high number of admitted patients. An accurate prediction of the most likely individual disease progression can improve the planning of limited resources and finding the optimal treatment for patients. However, when dealing with a newly emerging disease such as COVID-19, the impact of patient- and disease-specific factors (e.g. body weight or known co-morbidities) on the immediate course of disease is by and large unknown. In the case of COVID-19, the need for intensive care unit (ICU) admission of pneumonia patients is often determined only by acute indicators such as vital signs (e.g. breathing rate, blood oxygen levels), whereas statistical analysis and decision support systems that integrate all of the available data could enable an earlier prognosis. To this end, we propose a holistic graph-based approach combining both imaging and non-imaging information. Specifically, we introduce a multimodal similarity metric to build a population graph for clustering patients and an image-based end-to-end Graph Attention Network to process this graph and predict the COVID-19 patient outcomes: admission to ICU, need for ventilation and mortality. Additionally, the network segments chest CT images as an auxiliary task and extracts image features and radiomics for feature fusion with the available metadata. Results on a dataset collected in Klinikum rechts der Isar in Munich, Germany show that our approach outperforms single modality and non-graph baselines. Moreover, our clustering and graph attention allow for increased understanding of the patient relationships within the population graph and provide insight into the network's decision-making process.

Christoph Berger, Magdalini Paschali, Ben Glocker et al.

Image classification models deployed in the real world may receive inputs outside the intended data distribution. For critical applications such as clinical decision making, it is important that a model can detect such out-of-distribution (OOD) inputs and express its uncertainty. In this work, we assess the capability of various state-of-the-art approaches for confidence-based OOD detection through a comparative study and in-depth analysis. First, we leverage a computer vision benchmark to reproduce and compare multiple OOD detection methods. We then evaluate their capabilities on the challenging task of disease classification using chest X-rays. Our study shows that high performance in a computer vision task does not directly translate to accuracy in a medical imaging task. We analyse factors that affect performance of the methods between the two tasks. Our results provide useful insights for developing the next generation of OOD detection methods.

Maria Tirindelli, Christine Eilers, Walter Simson et al.

Medical Ultrasound (US), despite its wide use, is characterized by artifacts and operator dependency. Those attributes hinder the gathering and utilization of US datasets for the training of Deep Neural Networks used for Computer-Assisted Intervention Systems. Data augmentation is commonly used to enhance model generalization and performance. However, common data augmentation techniques, such as affine transformations do not align with the physics of US and, when used carelessly can lead to unrealistic US images. To this end, we propose a set of physics-inspired transformations, including deformation, reverb and Signal-to-Noise Ratio, that we apply on US B-mode images for data augmentation. We evaluate our method on a new spine US dataset for the tasks of bone segmentation and classification.

Seong Tae Kim, Leili Goli, Magdalini Paschali et al.

Chest computed tomography (CT) has played an essential diagnostic role in assessing patients with COVID-19 by showing disease-specific image features such as ground-glass opacity and consolidation. Image segmentation methods have proven to help quantify the disease burden and even help predict the outcome. The availability of longitudinal CT series may also result in an efficient and effective method to reliably assess the progression of COVID-19, monitor the healing process and the response to different therapeutic strategies. In this paper, we propose a new framework to identify infection at a voxel level (identification of healthy lung, consolidation, and ground-glass opacity) and visualize the progression of COVID-19 using sequential low-dose non-contrast CT scans. In particular, we devise a longitudinal segmentation network that utilizes the reference scan information to improve the performance of disease identification. Experimental results on a clinical longitudinal dataset collected in our institution show the effectiveness of the proposed method compared to the static deep neural networks for disease quantification.

Tobias Czempiel, Magdalini Paschali, Daniel Ostler et al.

In this paper we introduce OperA, a transformer-based model that accurately predicts surgical phases from long video sequences. A novel attention regularization loss encourages the model to focus on high-quality frames during training. Moreover, the attention weights are utilized to identify characteristic high attention frames for each surgical phase, which could further be used for surgery summarization. OperA is thoroughly evaluated on two datasets of laparoscopic cholecystectomy videos, outperforming various state-of-the-art temporal refinement approaches.

Hannes Hase, Mohammad Farid Azampour, Maria Tirindelli et al.

In this paper we introduce the first reinforcement learning (RL) based robotic navigation method which utilizes ultrasound (US) images as an input. Our approach combines state-of-the-art RL techniques, specifically deep Q-networks (DQN) with memory buffers and a binary classifier for deciding when to terminate the task. Our method is trained and evaluated on an in-house collected data-set of 34 volunteers and when compared to pure RL and supervised learning (SL) techniques, it performs substantially better, which highlights the suitability of RL navigation for US-guided procedures. When testing our proposed model, we obtained a 82.91% chance of navigating correctly to the sacrum from 165 different starting positions on 5 different unseen simulated environments.

Tobias Czempiel, Magdalini Paschali, Matthias Keicher et al.

Automatic surgical phase recognition is a challenging and crucial task with the potential to improve patient safety and become an integral part of intra-operative decision-support systems. In this paper, we propose, for the first time in workflow analysis, a Multi-Stage Temporal Convolutional Network (MS-TCN) that performs hierarchical prediction refinement for surgical phase recognition. Causal, dilated convolutions allow for a large receptive field and online inference with smooth predictions even during ambiguous transitions. Our method is thoroughly evaluated on two datasets of laparoscopic cholecystectomy videos with and without the use of additional surgical tool information. Outperforming various state-of-the-art LSTM approaches, we verify the suitability of the proposed causal MS-TCN for surgical phase recognition.

Paolo Notaro, Magdalini Paschali, Carsten Hopke et al.

Radar pulse streams exhibit increasingly complex temporal patterns and can no longer rely on a purely value-based analysis of the pulse attributes for the purpose of emitter classification. In this paper, we employ Recurrent Neural Networks (RNNs) to efficiently model and exploit the temporal dependencies present inside pulse streams. With the purpose of enhancing the network prediction capability, we introduce two novel techniques: a per-sequence normalization, able to mine the useful temporal patterns; and attribute-specific RNN processing, capable of processing the extracted information effectively. The new techniques are evaluated with an ablation study and the proposed solution is compared to previous Deep Learning (DL) approaches. Finally, a comparative study on the robustness of the same approaches is conducted and its results are presented.

Stefano Gasperini, Magdalini Paschali, Carsten Hopke et al.

Radar signals have been dramatically increasing in complexity, limiting the source separation ability of traditional approaches. In this paper we propose a Deep Learning-based clustering method, which encodes concurrent signals into images, and, for the first time, tackles clustering with image segmentation. Novel loss functions are introduced to optimize a Neural Network to separate the input pulses into pure and non-fragmented clusters. Outperforming a variety of baselines, the proposed approach is capable of clustering inputs directly with a Neural Network, in an end-to-end fashion.

Walter Simson, Rüdiger Göbl, Magdalini Paschali et al.

Ultrasound imaging is caught between the quest for the highest image quality, and the necessity for clinical usability. Our contribution is two-fold: First, we propose a novel fully convolutional neural network for ultrasound reconstruction. Second, a custom loss function tailored to the modality is employed for end-to-end training of the network. We demonstrate that training a network to map time-delayed raw data to a minimum variance ground truth offers performance increases in a clinical environment. In doing so, a path is explored towards improved clinically viable ultrasound reconstruction. The proposed method displays both promising image reconstruction quality and acquisition frequency when integrated for live ultrasound scanning. A clinical evaluation is conducted to verify the diagnostic usefulness of the proposed method in a clinical setting.

Magdalini Paschali, Muhammad Ferjad Naeem, Walter Simson et al.

In this paper, we propose a novel interpretation method tailored to histological Whole Slide Image (WSI) processing. A Deep Neural Network (DNN), inspired by Bag-of-Features models is equipped with a Multiple Instance Learning (MIL) branch and trained with weak supervision for WSI classification. MIL avoids label ambiguity and enhances our model's expressive power without guiding its attention. We utilize a fine-grained logit heatmap of the models activations to interpret its decision-making process. The proposed method is quantitatively and qualitatively evaluated on two challenging histology datasets, outperforming a variety of baselines. In addition, two expert pathologists were consulted regarding the interpretability provided by our method and acknowledged its potential for integration into several clinical applications.

Magdalini Paschali, Stefano Gasperini, Abhijit Guha Roy et al.

Model architectures have been dramatically increasing in size, improving performance at the cost of resource requirements. In this paper we propose 3DQ, a ternary quantization method, applied for the first time to 3D Fully Convolutional Neural Networks (F-CNNs), enabling 16x model compression while maintaining performance on par with full precision models. We extensively evaluate 3DQ on two datasets for the challenging task of whole brain segmentation. Additionally, we showcase our method's ability to generalize on two common 3D architectures, namely 3D U-Net and V-Net. Outperforming a variety of baselines, the proposed method is capable of compressing large 3D models to a few MBytes, alleviating the storage needs in space critical applications.

Magdalini Paschali, Walter Simson, Abhijit Guha Roy et al.

In this paper we propose a novel augmentation technique that improves not only the performance of deep neural networks on clean test data, but also significantly increases their robustness to random transformations, both affine and projective. Inspired by ManiFool, the augmentation is performed by a line-search manifold-exploration method that learns affine geometric transformations that lead to the misclassification on an image, while ensuring that it remains on the same manifold as the training data. This augmentation method populates any training dataset with images that lie on the border of the manifolds between two-classes and maximizes the variance the network is exposed to during training. Our method was thoroughly evaluated on the challenging tasks of fine-grained skin lesion classification from limited data, and breast tumor classification of mammograms. Compared with traditional augmentation methods, and with images synthesized by Generative Adversarial Networks our method not only achieves state-of-the-art performance but also significantly improves the network's robustness.

Magdalini Paschali, Sailesh Conjeti, Fernando Navarro et al.

In this paper, for the first time, we propose an evaluation method for deep learning models that assesses the performance of a model not only in an unseen test scenario, but also in extreme cases of noise, outliers and ambiguous input data. To this end, we utilize adversarial examples, images that fool machine learning models, while looking imperceptibly different from original data, as a measure to evaluate the robustness of a variety of medical imaging models. Through extensive experiments on skin lesion classification and whole brain segmentation with state-of-the-art networks such as Inception and UNet, we show that models that achieve comparable performance regarding generalizability may have significant variations in their perception of the underlying data manifold, leading to an extensive performance gap in their robustness.

Sailesh Conjeti, Magdalini Paschali, Amin Katouzian et al.

In this paper, for the first time, we introduce a multiple instance (MI) deep hashing technique for learning discriminative hash codes with weak bag-level supervision suited for large-scale retrieval. We learn such hash codes by aggregating deeply learnt hierarchical representations across bag members through a dedicated MI pool layer. For better trainability and retrieval quality, we propose a two-pronged approach that includes robust optimization and training with an auxiliary single instance hashing arm which is down-regulated gradually. We pose retrieval for tumor assessment as an MI problem because tumors often coexist with benign masses and could exhibit complementary signatures when scanned from different anatomical views. Experimental validations on benchmark mammography and histology datasets demonstrate improved retrieval performance over the state-of-the-art methods.