Anja Thieme

Shruthi Bannur, Stephanie Hyland, Qianchu Liu et al. · cambridge, microsoft-research

Self-supervised learning in vision-language processing exploits semantic alignment between imaging and text modalities. Prior work in biomedical VLP has mostly relied on the alignment of single image and report pairs even though clinical notes commonly refer to prior images. This does not only introduce poor alignment between the modalities but also a missed opportunity to exploit rich self-supervision through existing temporal content in the data. In this work, we explicitly account for prior images and reports when available during both training and fine-tuning. Our approach, named BioViL-T, uses a CNN-Transformer hybrid multi-image encoder trained jointly with a text model. It is designed to be versatile to arising challenges such as pose variations and missing input images across time. The resulting model excels on downstream tasks both in single- and multi-image setups, achieving state-of-the-art performance on (I) progression classification, (II) phrase grounding, and (III) report generation, whilst offering consistent improvements on disease classification and sentence-similarity tasks. We release a novel multi-modal temporal benchmark dataset, MS-CXR-T, to quantify the quality of vision-language representations in terms of temporal semantics. Our experimental results show the advantages of incorporating prior images and reports to make most use of the data.

Qianchu Liu, Stephanie Hyland, Shruthi Bannur et al. · cambridge, microsoft-research

The recent success of general-domain large language models (LLMs) has significantly changed the natural language processing paradigm towards a unified foundation model across domains and applications. In this paper, we focus on assessing the performance of GPT-4, the most capable LLM so far, on the text-based applications for radiology reports, comparing against state-of-the-art (SOTA) radiology-specific models. Exploring various prompting strategies, we evaluated GPT-4 on a diverse range of common radiology tasks and we found GPT-4 either outperforms or is on par with current SOTA radiology models. With zero-shot prompting, GPT-4 already obtains substantial gains ($\approx$ 10% absolute improvement) over radiology models in temporal sentence similarity classification (accuracy) and natural language inference ($F_1$). For tasks that require learning dataset-specific style or schema (e.g. findings summarisation), GPT-4 improves with example-based prompting and matches supervised SOTA. Our extensive error analysis with a board-certified radiologist shows GPT-4 has a sufficient level of radiology knowledge with only occasional errors in complex context that require nuanced domain knowledge. For findings summarisation, GPT-4 outputs are found to be overall comparable with existing manually-written impressions.

Stephanie L. Hyland, Shruthi Bannur, Kenza Bouzid et al. · cambridge, microsoft-research

We present a radiology-specific multimodal model for the task for generating radiological reports from chest X-rays (CXRs). Our work builds on the idea that large language model(s) can be equipped with multimodal capabilities through alignment with pre-trained vision encoders. On natural images, this has been shown to allow multimodal models to gain image understanding and description capabilities. Our proposed model (MAIRA-1) leverages a CXR-specific image encoder in conjunction with a fine-tuned large language model based on Vicuna-7B, and text-based data augmentation, to produce reports with state-of-the-art quality. In particular, MAIRA-1 significantly improves on the radiologist-aligned RadCliQ metric and across all lexical metrics considered. Manual review of model outputs demonstrates promising fluency and accuracy of generated reports while uncovering failure modes not captured by existing evaluation practices. More information and resources can be found on the project website: https://aka.ms/maira.

Nari Johnson, Deepthi Sudharsan, Hamna et al.

Measurement is essential to improving AI performance and mitigating harms for marginalized groups. As generative AI systems are rapidly deployed across geographies and contexts, AI measurement practices must be designed to support repeatable, automatable application across different models, datasets, and evaluation settings. But the drive to automate measurement can be in tension with the ability for measurement instruments to capture the expertise and perspectives of communities impacted by AI. Recent work advocates for breaking measurement into several key stages: first moving from an abstract concept to be measured into a precise, "systematized" concept; next operationalizing the systematized concept into a concrete measurement instrument; and finally applying the measurement instrument on data to produce measurements. This opens up an opportunity to concentrate community engagement in the systematization phase before operationalizing and applying measurement instruments. In this paper, we explore how to involve communities in systematizing the concept of "cultural appropriateness" in text-to-image models' representation of culturally significant artifacts through case studies with three communities: blind and low vision individuals residing in the UK, residents of Kerala, and residents of Tamil Nadu. Our systematized concepts reflect community members' lived experiences interacting with each artifact and how they want their material culture to be depicted, demonstrating the value of community involvement in defining valid measures. We explore how these systematized concepts can be operationalized into automated measurement instruments that could be applied using a multimodal LLM-as-a-judge approach and challenges that remain. We reflect on the benefits and limitations of such approaches.

Anja Thieme, Abhijith Rajamohan, Benjamin Cooper et al. · cambridge, microsoft-research

Nasogastric tubes (NGTs) are feeding tubes that are inserted through the nose into the stomach to deliver nutrition or medication. If not placed correctly, they can cause serious harm, even death to patients. Recent AI developments demonstrate the feasibility of robustly detecting NGT placement from Chest X-ray images to reduce risks of sub-optimally or critically placed NGTs being missed or delayed in their detection, but gaps remain in clinical practice integration. In this study, we present a human-centered approach to the problem and describe insights derived following contextual inquiry and in-depth interviews with 15 clinical stakeholders. The interviews helped understand challenges in existing workflows, and how best to align technical capabilities with user needs and expectations. We discovered the trade-offs and complexities that need consideration when choosing suitable workflow stages, target users, and design configurations for different AI proposals. We explored how to balance AI benefits and risks for healthcare staff and patients within broader organizational and medical-legal constraints. We also identified data issues related to edge cases and data biases that affect model training and evaluation; how data documentation practices influence data preparation and labelling; and how to measure relevant AI outcomes reliably in future evaluations. We discuss how our work informs design and development of AI applications that are clinically useful, ethical, and acceptable in real-world healthcare services.

Millicent Ochieng, Anja Thieme, Ignatius Ezeani et al.

Sentiment analysis in low-resource, culturally nuanced contexts challenges conventional NLP approaches that assume fixed labels and universal affective expressions. We present a diagnostic framework that treats sentiment as a context-dependent, culturally embedded construct, and evaluate how large language models (LLMs) reason about sentiment in informal, code-mixed WhatsApp messages from Nairobi youth health groups. Using a combination of human-annotated data, sentiment-flipped counterfactuals, and rubric-based explanation evaluation, we probe LLM interpretability, robustness, and alignment with human reasoning. Framing our evaluation through a social-science measurement lens, we operationalize and interrogate LLMs outputs as an instrument for measuring the abstract concept of sentiment. Our findings reveal significant variation in model reasoning quality, with top-tier LLMs demonstrating interpretive stability, while open models often falter under ambiguity or sentiment shifts. This work highlights the need for culturally sensitive, reasoning-aware AI evaluation in complex, real-world communication.

Shruthi Bannur, Kenza Bouzid, Daniel C. Castro et al.

Radiology reporting is a complex task requiring detailed medical image understanding and precise language generation, for which generative multimodal models offer a promising solution. However, to impact clinical practice, models must achieve a high level of both verifiable performance and utility. We augment the utility of automated report generation by incorporating localisation of individual findings on the image - a task we call grounded report generation - and enhance performance by incorporating realistic reporting context as inputs. We design a novel evaluation framework (RadFact) leveraging the logical inference capabilities of large language models (LLMs) to quantify report correctness and completeness at the level of individual sentences, while supporting the new task of grounded reporting. We develop MAIRA-2, a large radiology-specific multimodal model designed to generate chest X-ray reports with and without grounding. MAIRA-2 achieves state of the art on existing report generation benchmarks and establishes the novel task of grounded report generation.

Anja Thieme

In the context of digital therapy interventions, such as internet-delivered Cognitive Behavioral Therapy (iCBT) for the treatment of depression and anxiety, extensive research has shown how the involvement of a human supporter or coach, who assists the person undergoing treatment, improves user engagement in therapy and leads to more effective health outcomes than unsupported interventions. Seeking to maximize the effects and outcomes of this human support, the research investigates how new opportunities provided through recent advances in the field of AI and machine learning (ML) can contribute useful data insights to effectively support the work practices of iCBT supporters. This paper reports detailed findings of an interview study with 15 iCBT supporters that deepens understanding of their existing work practices and information needs with the aim to meaningfully inform the development of useful, implementable ML applications particularly in the context of iCBT treatment for depression and anxiety. The analysis contributes (1) a set of six themes that summarize the strategies and challenges that iCBT supporters encounter in providing effective, personalized feedback to their mental health clients; and in response to these learnings, (2) presents for each theme concrete opportunities for how methods of ML could help support and address identified challenges and information needs. It closes with reflections on potential social, emotional and pragmatic implications of introducing new machine-generated data insights within supporter-led client review practices.