Mu Zhou

Kexin Ding, Mu Zhou, Dimitris N. Metaxas et al.

Survival outcome assessment is challenging and inherently associated with multiple clinical factors (e.g., imaging and genomics biomarkers) in cancer. Enabling multimodal analytics promises to reveal novel predictive patterns of patient outcomes. In this study, we propose a multimodal transformer (PathOmics) integrating pathology and genomics insights into colon-related cancer survival prediction. We emphasize the unsupervised pretraining to capture the intrinsic interaction between tissue microenvironments in gigapixel whole slide images (WSIs) and a wide range of genomics data (e.g., mRNA-sequence, copy number variant, and methylation). After the multimodal knowledge aggregation in pretraining, our task-specific model finetuning could expand the scope of data utility applicable to both multi- and single-modal data (e.g., image- or genomics-only). We evaluate our approach on both TCGA colon and rectum cancer cohorts, showing that the proposed approach is competitive and outperforms state-of-the-art studies. Finally, our approach is desirable to utilize the limited number of finetuned samples towards data-efficient analytics for survival outcome prediction. The code is available at https://github.com/Cassie07/PathOmics.

Yunkun Zhang, Jin Gao, Mu Zhou et al.

The recent surge of foundation models in computer vision and natural language processing opens up perspectives in utilizing multi-modal clinical data to train large models with strong generalizability. Yet pathological image datasets often lack biomedical text annotation and enrichment. Guiding data-efficient image diagnosis from the use of biomedical text knowledge becomes a substantial interest. In this paper, we propose to Connect Image and Text Embeddings (CITE) to enhance pathological image classification. CITE injects text insights gained from language models pre-trained with a broad range of biomedical texts, leading to adapt foundation models towards pathological image understanding. Through extensive experiments on the PatchGastric stomach tumor pathological image dataset, we demonstrate that CITE achieves leading performance compared with various baselines especially when training data is scarce. CITE offers insights into leveraging in-domain text knowledge to reinforce data-efficient pathological image classification. Code is available at https://github.com/Yunkun-Zhang/CITE.

Shaokai Ye, Jessy Lauer, Mu Zhou et al.

The process of quantifying and analyzing animal behavior involves translating the naturally occurring descriptive language of their actions into machine-readable code. Yet, codifying behavior analysis is often challenging without deep understanding of animal behavior and technical machine learning knowledge. To limit this gap, we introduce AmadeusGPT: a natural language interface that turns natural language descriptions of behaviors into machine-executable code. Large-language models (LLMs) such as GPT3.5 and GPT4 allow for interactive language-based queries that are potentially well suited for making interactive behavior analysis. However, the comprehension capability of these LLMs is limited by the context window size, which prevents it from remembering distant conversations. To overcome the context window limitation, we implement a novel dual-memory mechanism to allow communication between short-term and long-term memory using symbols as context pointers for retrieval and saving. Concretely, users directly use language-based definitions of behavior and our augmented GPT develops code based on the core AmadeusGPT API, which contains machine learning, computer vision, spatio-temporal reasoning, and visualization modules. Users then can interactively refine results, and seamlessly add new behavioral modules as needed. We benchmark AmadeusGPT and show we can produce state-of-the-art performance on the MABE 2022 behavior challenge tasks. Note, an end-user would not need to write any code to achieve this. Thus, collectively AmadeusGPT presents a novel way to merge deep biological knowledge, large-language models, and core computer vision modules into a more naturally intelligent system. Code and demos can be found at: https://github.com/AdaptiveMotorControlLab/AmadeusGPT.

Mu Zhou, Lucas Stoffl, Mackenzie Weygandt Mathis et al.

Frequent interactions between individuals are a fundamental challenge for pose estimation algorithms. Current pipelines either use an object detector together with a pose estimator (top-down approach), or localize all body parts first and then link them to predict the pose of individuals (bottom-up). Yet, when individuals closely interact, top-down methods are ill-defined due to overlapping individuals, and bottom-up methods often falsely infer connections to distant bodyparts. Thus, we propose a novel pipeline called bottom-up conditioned top-down pose estimation (BUCTD) that combines the strengths of bottom-up and top-down methods. Specifically, we propose to use a bottom-up model as the detector, which in addition to an estimated bounding box provides a pose proposal that is fed as condition to an attention-based top-down model. We demonstrate the performance and efficiency of our approach on animal and human pose estimation benchmarks. On CrowdPose and OCHuman, we outperform previous state-of-the-art models by a significant margin. We achieve 78.5 AP on CrowdPose and 48.5 AP on OCHuman, an improvement of 8.6% and 7.8% over the prior art, respectively. Furthermore, we show that our method strongly improves the performance on multi-animal benchmarks involving fish and monkeys. The code is available at https://github.com/amathislab/BUCTD

Yunhe Gao, Zhuowei Li, Di Liu et al.

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.

Di Liu, Yunhe Gao, Qilong Zhangli et al.

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.

Qi Chang, Zhennan Yan, Mu Zhou et al.

Joint 2D cardiac segmentation and 3D volume reconstruction are fundamental to building statistical cardiac anatomy models and understanding functional mechanisms from motion patterns. However, due to the low through-plane resolution of cine MR and high inter-subject variance, accurately segmenting cardiac images and reconstructing the 3D volume are challenging. In this study, we propose an end-to-end latent-space-based framework, DeepRecon, that generates multiple clinically essential outcomes, including accurate image segmentation, synthetic high-resolution 3D image, and 3D reconstructed volume. Our method identifies the optimal latent representation of the cine image that contains accurate semantic information for cardiac structures. In particular, our model jointly generates synthetic images with accurate semantic information and segmentation of the cardiac structures using the optimal latent representation. We further explore downstream applications of 3D shape reconstruction and 4D motion pattern adaptation by the different latent-space manipulation strategies.The simultaneously generated high-resolution images present a high interpretable value to assess the cardiac shape and motion.Experimental results demonstrate the effectiveness of our approach on multiple fronts including 2D segmentation, 3D reconstruction, downstream 4D motion pattern adaption performance.

Qilong Zhangli, Jingru Yi, Di Liu et al.

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.

Yang Zhou, Zihan Dong, Zhenting Wang et al.

Agent skills can remarkably improve task success rates by using human-written procedural documents, but their quality is difficult to assess without environment-grounded verification. Existing skill generation methods heavily rely on preference logs rather than direct environment interaction, often yielding negligible or even degraded gains. We identify that it is a fundamental timing bottleneck: robust skills should be posterior-based, distilled from empirical environment interaction rather than prior plans. In this study, we introduce the Posterior Distillation Index (PDI), a trajectory-level metric that quantifies how well a distilled skill is grounded in the task-environment evidence. To operationalize PDI, we present SPARK (Structured Pipelines for Autonomous Runnable tasKs and sKill generation) for preserving task execution evidence towards full trajectory-level analysis. SPARK generates environment-verified trajectories used to compute PDI, and it applies PDI as an online diagnostic and intervention signal to ensure posterior skill formation. Across 86 runnable tasks, SPARK-generated skills consistently surpass no-skill baselines and outperform human-written skills on student models (inference cost up to 1,000x cheaper than teacher models). These findings show that PDI-guided distillation produces efficient and transferable skills grounded in the task-environment interaction. We release our code at https://github.com/EtaYang10th/spark-skills .

Yunkun Zhang, Jin Gao, Zheling Tan et al.

The advent of foundation models (FMs) as an emerging suite of AI techniques has struck a wave of opportunities in computational healthcare. The interactive nature of these models, guided by pre-training data and human instructions, has ignited a data-centric AI paradigm that emphasizes better data characterization, quality, and scale. In healthcare AI, obtaining and processing high-quality clinical data records has been a longstanding challenge, ranging from data quantity, annotation, patient privacy, and ethics. In this survey, we investigate a wide range of data-centric approaches in the FM era (from model pre-training to inference) towards improving the healthcare workflow. We discuss key perspectives in AI security, assessment, and alignment with human values. Finally, we offer a promising outlook of FM-based analytics to enhance the performance of patient outcome and clinical workflow in the evolving landscape of healthcare and medicine. We provide an up-to-date list of healthcare-related foundation models and datasets at https://github.com/Yunkun-Zhang/Data-Centric-FM-Healthcare .

Difei Gu, Yunhe Gao, Mu Zhou et al.

Accurate disease interpretation from radiology remains challenging due to imaging heterogeneity. Achieving expert-level diagnostic decisions requires integration of subtle image features with clinical knowledge. Yet major vision-language models (VLMs) treat images as holistic entities and overlook fine-grained image details that are vital for disease diagnosis. Clinicians analyze images by utilizing their prior medical knowledge and identify anatomical structures as important region of interests (ROIs). Inspired from this human-centric workflow, we introduce Anatomy-VLM, a fine-grained, vision-language model that incorporates multi-scale information. First, we design a model encoder to localize key anatomical features from entire medical images. Second, these regions are enriched with structured knowledge for contextually-aware interpretation. Finally, the model encoder aligns multi-scale medical information to generate clinically-interpretable disease prediction. Anatomy-VLM achieves outstanding performance on both in- and out-of-distribution datasets. We also validate the performance of Anatomy-VLM on downstream image segmentation tasks, suggesting that its fine-grained alignment captures anatomical and pathology-related knowledge. Furthermore, the Anatomy-VLM's encoder facilitates zero-shot anatomy-wise interpretation, providing its strong expert-level clinical interpretation capabilities.

Kaitao Chen, Mianxin Liu, Fang Yan et al.

The advent of vision-language models fosters the interactive conversations between AI-enabled models and humans. Yet applying these models into clinics must deal with daunting challenges around large-scale training data, financial, and computational resources. Here we propose a cost-effective instruction learning framework for conversational pathology named as CLOVER. CLOVER only trains a lightweight module and uses instruction tuning while freezing the parameters of the large language model. Instead of using costly GPT-4, we propose well-designed prompts on GPT-3.5 for building generation-based instructions, emphasizing the utility of pathological knowledge derived from the Internet source. To augment the use of instructions, we construct a high-quality set of template-based instructions in the context of digital pathology. From two benchmark datasets, our findings reveal the strength of hybrid-form instructions in the visual question-answer in pathology. Extensive results show the cost-effectiveness of CLOVER in answering both open-ended and closed-ended questions, where CLOVER outperforms strong baselines that possess 37 times more training parameters and use instruction data generated from GPT-4. Through the instruction tuning, CLOVER exhibits robustness of few-shot learning in the external clinical dataset. These findings demonstrate that cost-effective modeling of CLOVER could accelerate the adoption of rapid conversational applications in the landscape of digital pathology.

Difei Gu, Yunhe Gao, Yang Zhou et al.

Automated chest radiographs interpretation requires both accurate disease classification and detailed radiology report generation, presenting a significant challenge in the clinical workflow. Current approaches either focus on classification accuracy at the expense of interpretability or generate detailed but potentially unreliable reports through image captioning techniques. In this study, we present RadAlign, a novel framework that combines the predictive accuracy of vision-language models (VLMs) with the reasoning capabilities of large language models (LLMs). Inspired by the radiologist's workflow, RadAlign first employs a specialized VLM to align visual features with key medical concepts, achieving superior disease classification with an average AUC of 0.885 across multiple diseases. These recognized medical conditions, represented as text-based concepts in the aligned visual-language space, are then used to prompt LLM-based report generation. Enhanced by a retrieval-augmented generation mechanism that grounds outputs in similar historical cases, RadAlign delivers superior report quality with a GREEN score of 0.678, outperforming state-of-the-art methods' 0.634. Our framework maintains strong clinical interpretability while reducing hallucinations, advancing automated medical imaging and report analysis through integrated predictive and generative AI. Code is available at https://github.com/difeigu/RadAlign.

Zhengjie Zhang, Xiaoxie Mao, Qihao Guo et al.

Background: Alzheimer's disease (AD) diagnosis heavily relies on amyloid-beta positron emission tomography (Abeta-PET), which is limited by high cost and limited accessibility. This study explores whether Abeta-PET spatial patterns can be predicted from blood-based biomarkers (BBMs) and MRI scans. Methods: We collected Abeta-PET images, T1-weighted MRI scans, and BBMs from 566 participants. A language-enhanced generative model, driven by a large language model (LLM) and multimodal information fusion, was developed to synthesize PET images. Synthesized images were evaluated for image quality, diagnostic consistency, and clinical applicability within a fully automated diagnostic pipeline. Findings: The synthetic PET images closely resemble real PET scans in both structural details (SSIM = 0.920 +/- 0.003) and regional patterns (Pearson's r = 0.955 +/- 0.007). Diagnostic outcomes using synthetic PET show high agreement with real PET-based diagnoses (accuracy = 0.80). Using synthetic PET, we developed a fully automatic AD diagnostic pipeline integrating PET synthesis and classification. The synthetic PET-based model (AUC = 0.78) outperforms T1-based (AUC = 0.68) and BBM-based (AUC = 0.73) models, while combining synthetic PET and BBMs further improved performance (AUC = 0.79). Ablation analysis supports the advantages of LLM integration and prompt engineering. Interpretation: Our language-enhanced generative model synthesizes realistic PET images, enhancing the utility of MRI and BBMs for Abeta spatial pattern assessment and improving the diagnostic workflow for Alzheimer's disease.

Zheling Tan, Kexin Ding, Jin Gao et al.

Foundational models (FMs) have made significant strides in the healthcare domain. Yet the data silo challenge and privacy concern remain in healthcare systems, hindering safe medical data sharing and collaborative model development among institutions. The collection and curation of scalable clinical datasets increasingly become the bottleneck for training strong FMs. In this study, we propose Medical Foundation Models Merging (MedForge), a cooperative framework enabling a community-driven medical foundation model development, meanwhile preventing the information leakage of raw patient data and mitigating synchronization model development issues across clinical institutions. MedForge offers a bottom-up model construction mechanism by flexibly merging task-specific Low-Rank Adaptation (LoRA) modules, which can adapt to downstream tasks while retaining original model parameters. Through an asynchronous LoRA module integration scheme, the resulting composite model can progressively enhance its comprehensive performance on various clinical tasks. MedForge shows strong performance on multiple clinical datasets (e.g., breast cancer, lung cancer, and colon cancer) collected from different institutions. Our major findings highlight the value of collaborative foundation models in advancing multi-center clinical collaboration effectively and cohesively. Our code is publicly available at https://github.com/TanZheling/MedForge.

Kaitao Chen, Mianxin Liu, Daoming Zong et al.

Complex medical decision-making involves cooperative workflows operated by different clinicians. Designing AI multi-agent systems can expedite and augment human-level clinical decision-making. Existing multi-agent researches primarily focus on language-only tasks, yet their extension to multimodal scenarios remains challenging. A blind combination of diverse vision-language models (VLMs) can amplify an erroneous outcome interpretation. VLMs in general are less capable in instruction following and importantly self-reflection, compared to large language models (LLMs) of comparable sizes. This disparity largely constrains VLMs' ability in cooperative workflows. In this study, we propose MedOrch, a mediator-guided multi-agent collaboration framework for medical multimodal decision-making. MedOrch employs an LLM-based mediator agent that enables multiple VLM-based expert agents to exchange and reflect on their outputs towards collaboration. We utilize multiple open-source general-purpose and domain-specific VLMs instead of costly GPT-series models, revealing the strength of heterogeneous models. We show that the collaboration within distinct VLM-based agents can surpass the capabilities of any individual agent. We validate our approach on five medical vision question answering benchmarks, demonstrating superior collaboration performance without model training. Our findings underscore the value of mediator-guided multi-agent collaboration in advancing medical multimodal intelligence.

Yunhe Gao, Difei Gu, Mu Zhou et al.

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}.

Xiangde Luo, Jia Fu, Yunxin Zhong et al.

Radiation therapy is a primary and effective NasoPharyngeal Carcinoma (NPC) treatment strategy. The precise delineation of Gross Tumor Volumes (GTVs) and Organs-At-Risk (OARs) is crucial in radiation treatment, directly impacting patient prognosis. Previously, the delineation of GTVs and OARs was performed by experienced radiation oncologists. Recently, deep learning has achieved promising results in many medical image segmentation tasks. However, for NPC OARs and GTVs segmentation, few public datasets are available for model development and evaluation. To alleviate this problem, the SegRap2023 challenge was organized in conjunction with MICCAI2023 and presented a large-scale benchmark for OAR and GTV segmentation with 400 Computed Tomography (CT) scans from 200 NPC patients, each with a pair of pre-aligned non-contrast and contrast-enhanced CT scans. The challenge's goal was to segment 45 OARs and 2 GTVs from the paired CT scans. In this paper, we detail the challenge and analyze the solutions of all participants. The average Dice similarity coefficient scores for all submissions ranged from 76.68\% to 86.70\%, and 70.42\% to 73.44\% for OARs and GTVs, respectively. We conclude that the segmentation of large-size OARs is well-addressed, and more efforts are needed for GTVs and small-size or thin-structure OARs. The benchmark will remain publicly available here: https://segrap2023.grand-challenge.org

Yunhe Gao, Di Liu, Zhuowei Li et al.

Medical image segmentation remains challenging due to the vast diversity of anatomical structures, imaging modalities, and segmentation tasks. While deep learning has made significant advances, current approaches struggle to generalize as they require task-specific training or fine-tuning on unseen classes. We present Iris, a novel In-context Reference Image guided Segmentation framework that enables flexible adaptation to novel tasks through the use of reference examples without fine-tuning. At its core, Iris features a lightweight context task encoding module that distills task-specific information from reference context image-label pairs. This rich context embedding information is used to guide the segmentation of target objects. By decoupling task encoding from inference, Iris supports diverse strategies from one-shot inference and context example ensemble to object-level context example retrieval and in-context tuning. Through comprehensive evaluation across twelve datasets, we demonstrate that Iris performs strongly compared to task-specific models on in-distribution tasks. On seven held-out datasets, Iris shows superior generalization to out-of-distribution data and unseen classes. Further, Iris's task encoding module can automatically discover anatomical relationships across datasets and modalities, offering insights into medical objects without explicit anatomical supervision.

Kaitao Chen, Shaohao Rui, Yankai Jiang et al.

Medical vision-language models (VLMs) excel at image-text understanding but typically rely on a single-pass reasoning that neglects localized visual cues. In clinical practice, however, human experts iteratively scan, focus, and refine the regions of interest before reaching a final diagnosis. To narrow this machine-human perception gap, we introduce ViTAR, a novel VLM framework that emulates the iterative reasoning process of human experts through a cognitive chain of "think-act-rethink-answer". ViTAR treats medical images as interactive objects, enabling models to engage multi-step visual reasoning. To support this approach, we curate a high-quality instruction dataset comprising 1K interactive examples that encode expert-like diagnostic behaviors. In addition, a 16K visual question answering training data has been curated towards fine-grained visual diagnosis. We introduce a two-stage training strategy that begins with supervised fine-tuning to guide cognitive trajectories, followed by the reinforcement learning to optimize decision-making. Extensive evaluations demonstrate that ViTAR outperforms strong state-of-the-art models. Visual attention analysis reveals that from the "think" to "rethink" rounds, ViTAR increasingly anchors visual grounding to clinically critical regions and maintains high attention allocation to visual tokens during reasoning, providing mechanistic insight into its improved performance. These findings demonstrate that embedding expert-style iterative thinking chains into VLMs enhances both performance and trustworthiness of medical AI.

Kexin Ding, Mu Zhou, Akshay Chaudhari et al.

The wide exploration of large language models (LLMs) raises the awareness of alignment between healthcare stakeholder preferences and model outputs. This alignment becomes a crucial foundation to empower the healthcare workflow effectively, safely, and responsibly. Yet the varying behaviors of LLMs may not always match with healthcare stakeholders' knowledge, demands, and values. To enable a human-AI alignment, healthcare stakeholders will need to perform essential roles in guiding and enhancing the performance of LLMs. Human professionals must participate in the entire life cycle of adopting LLM in healthcare, including training data curation, model training, and inference. In this review, we discuss the approaches, tools, and applications of alignments between healthcare stakeholders and LLMs. We demonstrate that LLMs can better follow human values by properly enhancing healthcare knowledge integration, task understanding, and human guidance. We provide outlooks on enhancing the alignment between humans and LLMs to build trustworthy real-world healthcare applications.

Yunhe Gao, Mu Zhou, Di Liu et al.

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.

Kexin Ding, Mu Zhou, Zichen Wang et al.

Image-based characterization and disease understanding involve integrative analysis of morphological, spatial, and topological information across biological scales. The development of graph convolutional networks (GCNs) has created the opportunity to address this information complexity via graph-driven architectures, since GCNs can perform feature aggregation, interaction, and reasoning with remarkable flexibility and efficiency. These GCNs capabilities have spawned a new wave of research in medical imaging analysis with the overarching goal of improving quantitative disease understanding, monitoring, and diagnosis. Yet daunting challenges remain for designing the important image-to-graph transformation for multi-modality medical imaging and gaining insights into model interpretation and enhanced clinical decision support. In this review, we present recent GCNs developments in the context of medical image analysis including imaging data from radiology and histopathology. We discuss the fast-growing use of graph network architectures in medical image analysis to improve disease diagnosis and patient outcomes in clinical practice. To foster cross-disciplinary research, we present GCNs technical advancements, emerging medical applications, identify common challenges in the use of image-based GCNs and their extensions in model interpretation, large-scale benchmarks that promise to transform the scope of medical image studies and related graph-driven medical research.

Yunhe Gao, Mu Zhou, Dimitris Metaxas

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.

Lu Xu, Yuwei Zhang, Ying Liu et al.

Low-dose CT has been a key diagnostic imaging modality to reduce the potential risk of radiation overdose to patient health. Despite recent advances, CNN-based approaches typically apply filters in a spatially invariant way and adopt similar pixel-level losses, which treat all regions of the CT image equally and can be inefficient when fine-grained structures coexist with non-uniformly distributed noises. To address this issue, we propose a Structure-preserving Kernel Prediction Network (StructKPN) that combines the kernel prediction network with a structure-aware loss function that utilizes the pixel gradient statistics and guides the model towards spatially-variant filters that enhance noise removal, prevent over-smoothing and preserve detailed structures for different regions in CT imaging. Extensive experiments demonstrated that our approach achieved superior performance on both synthetic and non-synthetic datasets, and better preserves structures that are highly desired in clinical screening and low-dose protocol optimization.

Yunhe Gao, Zhiqiang Tang, Mu Zhou et al.

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.

Shaokai Ye, Kailu Wu, Mu Zhou et al.

Existing domain adaptation methods aim at learning features that can be generalized among domains. These methods commonly require to update source classifier to adapt to the target domain and do not properly handle the trade off between the source domain and the target domain. In this work, instead of training a classifier to adapt to the target domain, we use a separable component called data calibrator to help the fixed source classifier recover discrimination power in the target domain, while preserving the source domain's performance. When the difference between two domains is small, the source classifier's representation is sufficient to perform well in the target domain and outperforms GAN-based methods in digits. Otherwise, the proposed method can leverage synthetic images generated by GANs to boost performance and achieve state-of-the-art performance in digits datasets and driving scene semantic segmentation. Our method empirically reveals that certain intriguing hints, which can be mitigated by adversarial attack to domain discriminators, are one of the sources for performance degradation under the domain shift.

Darvin Yi, Mu Zhou, Zhao Chen et al.

Convolutional Neural Networks (CNN) have emerged as powerful tools for learning discriminative image features. In this paper, we propose a framework of 3-D fully CNN models for Glioblastoma segmentation from multi-modality MRI data. By generalizing CNN models to true 3-D convolutions in learning 3-D tumor MRI data, the proposed approach utilizes a unique network architecture to decouple image pixels. Specifically, we design a convolutional layer with pre-defined Difference- of-Gaussian (DoG) filters to perform true 3-D convolution incorporating local neighborhood information at each pixel. We then use three trained convolutional layers that act to decouple voxels from the initial 3-D convolution. The proposed framework allows identification of high-level tumor structures on MRI. We evaluate segmentation performance on the BRATS segmentation dataset with 274 tumor samples. Extensive experimental results demonstrate encouraging performance of the proposed approach comparing to the state-of-the-art methods. Our data-driven approach achieves a median Dice score accuracy of 89% in whole tumor glioblastoma segmentation, revealing a generalized low-bias possibility to learn from medium-size MRI datasets.