Noel Codella

Mingyu Ding, Bin Xiao, Noel Codella et al.

In this work, we introduce Dual Attention Vision Transformers (DaViT), a simple yet effective vision transformer architecture that is able to capture global context while maintaining computational efficiency. We propose approaching the problem from an orthogonal angle: exploiting self-attention mechanisms with both "spatial tokens" and "channel tokens". With spatial tokens, the spatial dimension defines the token scope, and the channel dimension defines the token feature dimension. With channel tokens, we have the inverse: the channel dimension defines the token scope, and the spatial dimension defines the token feature dimension. We further group tokens along the sequence direction for both spatial and channel tokens to maintain the linear complexity of the entire model. We show that these two self-attentions complement each other: (i) since each channel token contains an abstract representation of the entire image, the channel attention naturally captures global interactions and representations by taking all spatial positions into account when computing attention scores between channels; (ii) the spatial attention refines the local representations by performing fine-grained interactions across spatial locations, which in turn helps the global information modeling in channel attention. Extensive experiments show our DaViT achieves state-of-the-art performance on four different tasks with efficient computations. Without extra data, DaViT-Tiny, DaViT-Small, and DaViT-Base achieve 82.8%, 84.2%, and 84.6% top-1 accuracy on ImageNet-1K with 28.3M, 49.7M, and 87.9M parameters, respectively. When we further scale up DaViT with 1.5B weakly supervised image and text pairs, DaViT-Gaint reaches 90.4% top-1 accuracy on ImageNet-1K. Code is available at https://github.com/dingmyu/davit.

Yucheng Zhao, Chong Luo, Chuanxin Tang et al.

Video understanding tasks have traditionally been modeled by two separate architectures, specially tailored for two distinct tasks. Sequence-based video tasks, such as action recognition, use a video backbone to directly extract spatiotemporal features, while frame-based video tasks, such as multiple object tracking (MOT), rely on single fixed-image backbone to extract spatial features. In contrast, we propose to unify video understanding tasks into one novel streaming video architecture, referred to as Streaming Vision Transformer (S-ViT). S-ViT first produces frame-level features with a memory-enabled temporally-aware spatial encoder to serve the frame-based video tasks. Then the frame features are input into a task-related temporal decoder to obtain spatiotemporal features for sequence-based tasks. The efficiency and efficacy of S-ViT is demonstrated by the state-of-the-art accuracy in the sequence-based action recognition task and the competitive advantage over conventional architecture in the frame-based MOT task. We believe that the concept of streaming video model and the implementation of S-ViT are solid steps towards a unified deep learning architecture for video understanding. Code will be available at https://github.com/yuzhms/Streaming-Video-Model.

Zhecan Wang, Noel Codella, Yen-Chun Chen et al. · microsoft-research

Cross-modal encoders for vision-language (VL) tasks are often pretrained with carefully curated vision-language datasets. While these datasets reach an order of 10 million samples, the labor cost is prohibitive to scale further. Conversely, unimodal encoders are pretrained with simpler annotations that are less cost-prohibitive, achieving scales of hundreds of millions to billions. As a result, unimodal encoders have achieved state-of-art (SOTA) on many downstream tasks. However, challenges remain when applying to VL tasks. The pretraining data is not optimal for cross-modal architectures and requires heavy computational resources. In addition, unimodal architectures lack cross-modal interactions that have demonstrated significant benefits for VL tasks. Therefore, how to best leverage pretrained unimodal encoders for VL tasks is still an area of active research. In this work, we propose a method to leverage unimodal vision and text encoders for VL tasks that augment existing VL approaches while conserving computational complexity. Specifically, we propose Multimodal Adaptive Distillation (MAD), which adaptively distills useful knowledge from pretrained encoders to cross-modal VL encoders. Second, to better capture nuanced impacts on VL task performance, we introduce an evaluation protocol that includes Visual Commonsense Reasoning (VCR), Visual Entailment (SNLI-VE), and Visual Question Answering (VQA), across a variety of data constraints and conditions of domain shift. Experiments demonstrate that MAD leads to consistent gains in the low-shot, domain-shifted, and fully-supervised conditions on VCR, SNLI-VE, and VQA, achieving SOTA performance on VCR compared to other single models pretrained with image-text data. Finally, MAD outperforms concurrent works utilizing pretrained vision encoder from CLIP. Code will be made available.

Ziyi Yang, Yuwei Fang, Chenguang Zhu et al. · gatech, stanford

Human intelligence is multimodal; we integrate visual, linguistic, and acoustic signals to maintain a holistic worldview. Most current pretraining methods, however, are limited to one or two modalities. We present i-Code, a self-supervised pretraining framework where users may flexibly combine the modalities of vision, speech, and language into unified and general-purpose vector representations. In this framework, data from each modality are first given to pretrained single-modality encoders. The encoder outputs are then integrated with a multimodal fusion network, which uses novel attention mechanisms and other architectural innovations to effectively combine information from the different modalities. The entire system is pretrained end-to-end with new objectives including masked modality unit modeling and cross-modality contrastive learning. Unlike previous research using only video for pretraining, the i-Code framework can dynamically process single, dual, and triple-modality data during training and inference, flexibly projecting different combinations of modalities into a single representation space. Experimental results demonstrate how i-Code can outperform state-of-the-art techniques on five video understanding tasks and the GLUE NLP benchmark, improving by as much as 11% and demonstrating the power of integrative multimodal pretraining.

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.

Haoxuan You, Luowei Zhou, Bin Xiao et al.

Large-scale multi-modal contrastive pre-training has demonstrated great utility to learn transferable features for a range of downstream tasks by mapping multiple modalities into a shared embedding space. Typically, this has employed separate encoders for each modality. However, recent work suggests that transformers can support learning across multiple modalities and allow knowledge sharing. Inspired by this, we investigate a variety of Modality-Shared Contrastive Language-Image Pre-training (MS-CLIP) frameworks. More specifically, we question how many parameters of a transformer model can be shared across modalities during contrastive pre-training, and rigorously examine architectural design choices that position the proportion of parameters shared along a spectrum. In studied conditions, we observe that a mostly unified encoder for vision and language signals outperforms all other variations that separate more parameters. Additionally, we find that light-weight modality-specific parallel modules further improve performance. Experimental results show that the proposed MS-CLIP approach outperforms vanilla CLIP by up to 13\% relative in zero-shot ImageNet classification (pre-trained on YFCC-100M), while simultaneously supporting a reduction of parameters. In addition, our approach outperforms vanilla CLIP by 1.6 points in linear probing on a collection of 24 downstream vision tasks. Furthermore, we discover that sharing parameters leads to semantic concepts from different modalities being encoded more closely in the embedding space, facilitating the transferring of common semantic structure (e.g., attention patterns) from language to vision. Code is available at \href{https://github.com/Hxyou/MSCLIP}{URL}.

Zhecan Wang, Rui Sun, Haoxuan You et al.

Vision-language tasks, such as VQA, SNLI-VE, and VCR are challenging because they require the model's reasoning ability to understand the semantics of the visual world and natural language. Supervised methods working for vision-language tasks have been well-studied. However, solving these tasks in a zero-shot setting is less explored. Since Contrastive Language-Image Pre-training (CLIP) has shown remarkable zero-shot performance on image-text matching, previous works utilized its strong zero-shot ability by converting vision-language tasks into an image-text matching problem, and they mainly consider global-level matching (e.g., the whole image or sentence). However, we find visual and textual fine-grained information, e.g., keywords in the sentence and objects in the image, can be fairly informative for semantics understanding. Inspired by this, we propose a unified framework to take advantage of the fine-grained information for zero-shot vision-language learning, covering multiple tasks such as VQA, SNLI-VE, and VCR. Our experiments show that our framework outperforms former zero-shot methods on VQA and achieves substantial improvement on SNLI-VE and VCR. Furthermore, our ablation studies confirm the effectiveness and generalizability of our proposed method.

Asma Ben Abacha, Alberto Santamaria-Pang, Ho Hin Lee et al.

The increasing use of medical imaging in healthcare settings presents a significant challenge due to the increasing workload for radiologists, yet it also offers opportunity for enhancing healthcare outcomes if effectively leveraged. 3D image retrieval holds potential to reduce radiologist workloads by enabling clinicians to efficiently search through diagnostically similar or otherwise relevant cases, resulting in faster and more precise diagnoses. However, the field of 3D medical image retrieval is still emerging, lacking established evaluation benchmarks, comprehensive datasets, and thorough studies. This paper attempts to bridge this gap by introducing a novel benchmark for 3D Medical Image Retrieval (3D-MIR) that encompasses four different anatomies imaged with computed tomography. Using this benchmark, we explore a diverse set of search strategies that use aggregated 2D slices, 3D volumes, and multi-modal embeddings from popular multi-modal foundation models as queries. Quantitative and qualitative assessments of each approach are provided alongside an in-depth discussion that offers insight for future research. To promote the advancement of this field, our benchmark, dataset, and code are made publicly available.

Chongyan Chen, Mengchen Liu, Noel Codella et al.

Visual Question Answering (VQA) entails answering questions about images. We introduce the first VQA dataset in which all contents originate from an authentic use case. Sourced from online question answering community forums, we call it VQAonline. We characterize this dataset and how it relates to eight mainstream VQA datasets. Observing that answers in our dataset tend to be much longer (i.e., a mean of 173 words) and so incompatible with standard VQA evaluation metrics, we instead utilize popular metrics for longer text evaluation for evaluating six state-of-the-art VQA models on VQAonline and report where they struggle most. Finally, we analyze which evaluation metrics align best with human judgments. To facilitate future extensions, we publicly-share the dataset at: https://vqaonline.github.io/.

Lingting Zhu, Noel Codella, Dongdong Chen et al.

The limited availability of 3D medical image datasets, due to privacy concerns and high collection or annotation costs, poses significant challenges in the field of medical imaging. While a promising alternative is the use of synthesized medical data, there are few solutions for realistic 3D medical image synthesis due to difficulties in backbone design and fewer 3D training samples compared to 2D counterparts. In this paper, we propose GEM-3D, a novel generative approach to the synthesis of 3D medical images and the enhancement of existing datasets using conditional diffusion models. Our method begins with a 2D slice, noted as the informed slice to serve the patient prior, and propagates the generation process using a 3D segmentation mask. By decomposing the 3D medical images into masks and patient prior information, GEM-3D offers a flexible yet effective solution for generating versatile 3D images from existing datasets. GEM-3D can enable dataset enhancement by combining informed slice selection and generation at random positions, along with editable mask volumes to introduce large variations in diffusion sampling. Moreover, as the informed slice contains patient-wise information, GEM-3D can also facilitate counterfactual image synthesis and dataset-level de-enhancement with desired control. Experiments on brain MRI and abdomen CT images demonstrate that GEM-3D is capable of synthesizing high-quality 3D medical images with volumetric consistency, offering a straightforward solution for dataset enhancement during inference. The code is available at https://github.com/HKU-MedAI/GEM-3D.

Fernando Pérez-García, Harshita Sharma, Sam Bond-Taylor et al.

Language-supervised pre-training has proven to be a valuable method for extracting semantically meaningful features from images, serving as a foundational element in multimodal systems within the computer vision and medical imaging domains. However, the computed features are limited by the information contained in the text, which is particularly problematic in medical imaging, where the findings described by radiologists focus on specific observations. This challenge is compounded by the scarcity of paired imaging-text data due to concerns over leakage of personal health information. In this work, we fundamentally challenge the prevailing reliance on language supervision for learning general-purpose biomedical imaging encoders. We introduce RAD-DINO, a biomedical image encoder pre-trained solely on unimodal biomedical imaging data that obtains similar or greater performance than state-of-the-art biomedical language-supervised models on a diverse range of benchmarks. Specifically, the quality of learned representations is evaluated on standard imaging tasks (classification and semantic segmentation), and a vision-language alignment task (text report generation from images). To further demonstrate the drawback of language supervision, we show that features from RAD-DINO correlate with other medical records (e.g., sex or age) better than language-supervised models, which are generally not mentioned in radiology reports. Finally, we conduct a series of ablations determining the factors in RAD-DINO's performance; notably, we observe that RAD-DINO's downstream performance scales well with the quantity and diversity of training data, demonstrating that image-only supervision is a scalable approach for training a foundational biomedical image encoder. Model weights of RAD-DINO trained on publicly available datasets are available at https://huggingface.co/microsoft/rad-dino.

Yiwu Zhong, Jianwei Yang, Pengchuan Zhang et al.

Contrastive language-image pretraining (CLIP) using image-text pairs has achieved impressive results on image classification in both zero-shot and transfer learning settings. However, we show that directly applying such models to recognize image regions for object detection leads to poor performance due to a domain shift: CLIP was trained to match an image as a whole to a text description, without capturing the fine-grained alignment between image regions and text spans. To mitigate this issue, we propose a new method called RegionCLIP that significantly extends CLIP to learn region-level visual representations, thus enabling fine-grained alignment between image regions and textual concepts. Our method leverages a CLIP model to match image regions with template captions and then pretrains our model to align these region-text pairs in the feature space. When transferring our pretrained model to the open-vocabulary object detection tasks, our method significantly outperforms the state of the art by 3.8 AP50 and 2.2 AP for novel categories on COCO and LVIS datasets, respectively. Moreoever, the learned region representations support zero-shot inference for object detection, showing promising results on both COCO and LVIS datasets. Our code is available at https://github.com/microsoft/RegionCLIP.

Yu Gu, Jingjing Fu, Xiaodong Liu et al.

Large frontier models like GPT-5 now achieve top scores on medical benchmarks. But our stress tests tell a different story. Leading systems often guess correctly even when key inputs like images are removed, flip answers under trivial prompt changes, and fabricate convincing yet flawed reasoning. These aren't glitches; they expose how today's benchmarks reward test-taking tricks over medical understanding. We evaluate six flagship models across six widely used benchmarks and find that high leaderboard scores hide brittleness and shortcut learning. Through clinician-guided rubric evaluation, we show that benchmarks vary widely in what they truly measure yet are treated interchangeably, masking failure modes. We caution that medical benchmark scores do not directly reflect real-world readiness. If we want AI to earn trust in healthcare, we must demand more than leaderboard wins and must hold systems accountable for robustness, sound reasoning, and alignment with real medical demands.

Tassilo Wald, Ibrahim Ethem Hamamci, Yuan Gao et al.

Vision-language pre-training, i.e., aligning images with paired text, is a powerful paradigm to create encoders that can be directly used for tasks such as classification and retrieval, and for downstream tasks such as segmentation and report generation. In the 3D medical image domain, these capabilities allow vision-language encoders (VLEs) to support radiologists by retrieving patients with similar abnormalities or predicting likelihoods of abnormality. While the methodology holds promise, data availability limits the capabilities of current 3D VLEs. In this paper, we alleviate the lack of data by injecting additional inductive biases: introducing a report generation objective and pairing vision-language pre-training with vision-only pre-training. This allows us to leverage both image-only and paired image-text 3D datasets, increasing the total amount of data to which our model is exposed. Through these additional inductive biases, paired with best practices of the 3D medical imaging domain, we develop the Comprehensive Language-image Pre-training (COLIPRI) encoder family. Our COLIPRI encoders achieve state-of-the-art performance in report generation, classification probing, and zero-shot classification, and remain competitive for semantic segmentation.

Maximilian Ilse, Harshita Sharma, Anton Schwaighofer et al.

Foundation vision encoders such as CLIP and DINOv2, trained on web-scale data, exhibit strong transfer performance across tasks and datasets. However, medical imaging foundation models remain constrained by smaller datasets, limiting our understanding of how data scale and pretraining paradigms affect performance in this setting. In this work, we systematically study continual pretraining of two vision encoders, MedImageInsight (MI2) and RAD-DINO representing the two major encoder paradigms CLIP and DINOv2, on up to 3.5M chest x-rays from a single institution, holding compute and evaluation protocols constant. We evaluate on classification (radiology findings, lines and tubes), segmentation (lines and tubes), and radiology report generation. While prior work has primarily focused on tasks related to radiology findings, we include lines and tubes tasks to counterbalance this bias and evaluate a model's ability to extract features that preserve continuity along elongated structures. Our experiments show that MI2 scales more effectively for finding-related tasks, while RAD-DINO is stronger on tube-related tasks. Surprisingly, continually pretraining MI2 with both reports and structured labels using UniCL improves performance, underscoring the value of structured supervision at scale. We further show that for some tasks, as few as 30k in-domain samples are sufficient to surpass open-weights foundation models. These results highlight the utility of center-specific continual pretraining, enabling medical institutions to derive significant performance gains by utilizing in-domain data.

Alyssa Unell, Noel C. F. Codella, Sam Preston et al.

The National Comprehensive Cancer Network (NCCN) provides evidence-based guidelines for cancer treatment. Translating complex patient presentations into guideline-compliant treatment recommendations is time-intensive, requires specialized expertise, and is prone to error. Advances in large language model (LLM) capabilities promise to reduce the time required to generate treatment recommendations and improve accuracy. We present an LLM agent-based approach to automatically generate guideline-concordant treatment trajectories for patients with non-small cell lung cancer (NSCLC). Our contributions are threefold. First, we construct a novel longitudinal dataset of 121 cases of NSCLC patients that includes clinical encounters, diagnostic results, and medical histories, each expertly annotated with the corresponding NCCN guideline trajectories by board-certified oncologists. Second, we demonstrate that existing LLMs possess domain-specific knowledge that enables high-quality proxy benchmark generation for both model development and evaluation, achieving strong correlation (Spearman coefficient r=0.88, RMSE = 0.08) with expert-annotated benchmarks. Third, we develop a hybrid approach combining expensive human annotations with model consistency information to create both the agent framework that predicts the relevant guidelines for a patient, as well as a meta-classifier that verifies prediction accuracy with calibrated confidence scores for treatment recommendations (AUROC=0.800), a critical capability for communicating the accuracy of outputs, custom-tailoring tradeoffs in performance, and supporting regulatory compliance. This work establishes a framework for clinically viable LLM-based guideline adherence systems that balance accuracy, interpretability, and regulatory requirements while reducing annotation costs, providing a scalable pathway toward automated clinical decision support.

Matthias Blondeel, Noel Codella, Sam Preston et al.

Molecular Tumor Boards (MTBs) are multidisciplinary forums where oncology specialists collaboratively assess complex patient cases to determine optimal treatment strategies. A central element of this process is the patient summary, typically compiled by a medical oncologist, radiation oncologist, or surgeon, or their trained medical assistant, who distills heterogeneous medical records into a concise narrative to facilitate discussion. This manual approach is often labor-intensive, subjective, and prone to omissions of critical information. To address these limitations, we introduce the Healthcare Agent Orchestrator (HAO), a Large Language Model (LLM)-driven AI agent that coordinates a multi-agent clinical workflow to generate accurate and comprehensive patient summaries for MTBs. Evaluating predicted patient summaries against ground truth presents additional challenges due to stylistic variation, ordering, synonym usage, and phrasing differences, which complicate the measurement of both succinctness and completeness. To overcome these evaluation hurdles, we propose TBFact, a ``model-as-a-judge'' framework designed to assess the comprehensiveness and succinctness of generated summaries. Using a benchmark dataset derived from de-identified tumor board discussions, we applied TBFact to evaluate our Patient History agent. Results show that the agent captured 94% of high-importance information (including partial entailments) and achieved a TBFact recall of 0.84 under strict entailment criteria. We further demonstrate that TBFact enables a data-free evaluation framework that institutions can deploy locally without sharing sensitive clinical data. Together, HAO and TBFact establish a robust foundation for delivering reliable and scalable support to MTBs.

Ziyi Yang, Mahmoud Khademi, Yichong Xu et al.

The convergence of text, visual, and audio data is a key step towards human-like artificial intelligence, however the current Vision-Language-Speech landscape is dominated by encoder-only models which lack generative abilities. We propose closing this gap with i-Code V2, the first model capable of generating natural language from any combination of Vision, Language, and Speech data. i-Code V2 is an integrative system that leverages state-of-the-art single-modality encoders, combining their outputs with a new modality-fusing encoder in order to flexibly project combinations of modalities into a shared representational space. Next, language tokens are generated from these representations via an autoregressive decoder. The whole framework is pretrained end-to-end on a large collection of dual- and single-modality datasets using a novel text completion objective that can be generalized across arbitrary combinations of modalities. i-Code V2 matches or outperforms state-of-the-art single- and dual-modality baselines on 7 multimodal tasks, demonstrating the power of generative multimodal pretraining across a diversity of tasks and signals.

Zhecan Wang, Noel Codella, Yen-Chun Chen et al.

Contrastive language-image pretraining (CLIP) links vision and language modalities into a unified embedding space, yielding the tremendous potential for vision-language (VL) tasks. While early concurrent works have begun to study this potential on a subset of tasks, important questions remain: 1) What is the benefit of CLIP on unstudied VL tasks? 2) Does CLIP provide benefit in low-shot or domain-shifted scenarios? 3) Can CLIP improve existing approaches without impacting inference or pretraining complexity? In this work, we seek to answer these questions through two key contributions. First, we introduce an evaluation protocol that includes Visual Commonsense Reasoning (VCR), Visual Entailment (SNLI-VE), and Visual Question Answering (VQA), across a variety of data availability constraints and conditions of domain shift. Second, we propose an approach, named CLIP Targeted Distillation (CLIP-TD), to intelligently distill knowledge from CLIP into existing architectures using a dynamically weighted objective applied to adaptively selected tokens per instance. Experiments demonstrate that our proposed CLIP-TD leads to exceptional gains in the low-shot (up to 51.9%) and domain-shifted (up to 71.3%) conditions of VCR, while simultaneously improving performance under standard fully-supervised conditions (up to 2%), achieving state-of-art performance on VCR compared to other single models that are pretrained with image-text data only. On SNLI-VE, CLIP-TD produces significant gains in low-shot conditions (up to 6.6%) as well as fully supervised (up to 3%). On VQA, CLIP-TD provides improvement in low-shot (up to 9%), and in fully-supervised (up to 1.3%). Finally, CLIP-TD outperforms concurrent works utilizing CLIP for finetuning, as well as baseline naive distillation approaches. Code will be made available.

Lu Yuan, Dongdong Chen, Yi-Ling Chen et al.

Automated visual understanding of our diverse and open world demands computer vision models to generalize well with minimal customization for specific tasks, similar to human vision. Computer vision foundation models, which are trained on diverse, large-scale dataset and can be adapted to a wide range of downstream tasks, are critical for this mission to solve real-world computer vision applications. While existing vision foundation models such as CLIP, ALIGN, and Wu Dao 2.0 focus mainly on mapping images and textual representations to a cross-modal shared representation, we introduce a new computer vision foundation model, Florence, to expand the representations from coarse (scene) to fine (object), from static (images) to dynamic (videos), and from RGB to multiple modalities (caption, depth). By incorporating universal visual-language representations from Web-scale image-text data, our Florence model can be easily adapted for various computer vision tasks, such as classification, retrieval, object detection, VQA, image caption, video retrieval and action recognition. Moreover, Florence demonstrates outstanding performance in many types of transfer learning: fully sampled fine-tuning, linear probing, few-shot transfer and zero-shot transfer for novel images and objects. All of these properties are critical for our vision foundation model to serve general purpose vision tasks. Florence achieves new state-of-the-art results in majority of 44 representative benchmarks, e.g., ImageNet-1K zero-shot classification with top-1 accuracy of 83.74 and the top-5 accuracy of 97.18, 62.4 mAP on COCO fine tuning, 80.36 on VQA, and 87.8 on Kinetics-600.

Veronica Rotemberg, Nicholas Kurtansky, Brigid Betz-Stablein et al.

Prior skin image datasets have not addressed patient-level information obtained from multiple skin lesions from the same patient. Though artificial intelligence classification algorithms have achieved expert-level performance in controlled studies examining single images, in practice dermatologists base their judgment holistically from multiple lesions on the same patient. The 2020 SIIM-ISIC Melanoma Classification challenge dataset described herein was constructed to address this discrepancy between prior challenges and clinical practice, providing for each image in the dataset an identifier allowing lesions from the same patient to be mapped to one another. This patient-level contextual information is frequently used by clinicians to diagnose melanoma and is especially useful in ruling out false positives in patients with many atypical nevi. The dataset represents 2,056 patients from three continents with an average of 16 lesions per patient, consisting of 33,126 dermoscopic images and 584 histopathologically confirmed melanomas compared with benign melanoma mimickers.

Yunhui Guo, Noel C. Codella, Leonid Karlinsky et al.

Recent progress on few-shot learning largely relies on annotated data for meta-learning: base classes sampled from the same domain as the novel classes. However, in many applications, collecting data for meta-learning is infeasible or impossible. This leads to the cross-domain few-shot learning problem, where there is a large shift between base and novel class domains. While investigations of the cross-domain few-shot scenario exist, these works are limited to natural images that still contain a high degree of visual similarity. No work yet exists that examines few-shot learning across different imaging methods seen in real world scenarios, such as aerial and medical imaging. In this paper, we propose the Broader Study of Cross-Domain Few-Shot Learning (BSCD-FSL) benchmark, consisting of image data from a diverse assortment of image acquisition methods. This includes natural images, such as crop disease images, but additionally those that present with an increasing dissimilarity to natural images, such as satellite images, dermatology images, and radiology images. Extensive experiments on the proposed benchmark are performed to evaluate state-of-art meta-learning approaches, transfer learning approaches, and newer methods for cross-domain few-shot learning. The results demonstrate that state-of-art meta-learning methods are surprisingly outperformed by earlier meta-learning approaches, and all meta-learning methods underperform in relation to simple fine-tuning by 12.8% average accuracy. Performance gains previously observed with methods specialized for cross-domain few-shot learning vanish in this more challenging benchmark. Finally, accuracy of all methods tend to correlate with dataset similarity to natural images, verifying the value of the benchmark to better represent the diversity of data seen in practice and guiding future research.

Newton M. Kinyanjui, Timothy Odonga, Celia Cintas et al.

Recent advances in computer vision and deep learning have led to breakthroughs in the development of automated skin image analysis. In particular, skin cancer classification models have achieved performance higher than trained expert dermatologists. However, no attempt has been made to evaluate the consistency in performance of machine learning models across populations with varying skin tones. In this paper, we present an approach to estimate skin tone in benchmark skin disease datasets, and investigate whether model performance is dependent on this measure. Specifically, we use individual typology angle (ITA) to approximate skin tone in dermatology datasets. We look at the distribution of ITA values to better understand skin color representation in two benchmark datasets: 1) the ISIC 2018 Challenge dataset, a collection of dermoscopic images of skin lesions for the detection of skin cancer, and 2) the SD-198 dataset, a collection of clinical images capturing a wide variety of skin diseases. To estimate ITA, we first develop segmentation models to isolate non-diseased areas of skin. We find that the majority of the data in the the two datasets have ITA values between 34.5° and 48°, which are associated with lighter skin, and is consistent with under-representation of darker skinned populations in these datasets. We also find no measurable correlation between performance of machine learning model and ITA values, though more comprehensive data is needed for further validation.

Marc Combalia, Noel C. F. Codella, Veronica Rotemberg et al.

This article summarizes the BCN20000 dataset, composed of 19424 dermoscopic images of skin lesions captured from 2010 to 2016 in the facilities of the Hospital Clínic in Barcelona. With this dataset, we aim to study the problem of unconstrained classification of dermoscopic images of skin cancer, including lesions found in hard-to-diagnose locations (nails and mucosa), large lesions which do not fit in the aperture of the dermoscopy device, and hypo-pigmented lesions. The BCN20000 will be provided to the participants of the ISIC Challenge 2019, where they will be asked to train algorithms to classify dermoscopic images of skin cancer automatically.

Noel C. F. Codella, Michael Hind, Karthikeyan Natesan Ramamurthy et al.

Using machine learning in high-stakes applications often requires predictions to be accompanied by explanations comprehensible to the domain user, who has ultimate responsibility for decisions and outcomes. Recently, a new framework for providing explanations, called TED, has been proposed to provide meaningful explanations for predictions. This framework augments training data to include explanations elicited from domain users, in addition to features and labels. This approach ensures that explanations for predictions are tailored to the complexity expectations and domain knowledge of the consumer. In this paper, we build on this foundational work, by exploring more sophisticated instantiations of the TED framework and empirically evaluate their effectiveness in two diverse domains, chemical odor and skin cancer prediction. Results demonstrate that meaningful explanations can be reliably taught to machine learning algorithms, and in some cases, improving modeling accuracy.

Noel Codella, Veronica Rotemberg, Philipp Tschandl et al.

This work summarizes the results of the largest skin image analysis challenge in the world, hosted by the International Skin Imaging Collaboration (ISIC), a global partnership that has organized the world's largest public repository of dermoscopic images of skin. The challenge was hosted in 2018 at the Medical Image Computing and Computer Assisted Intervention (MICCAI) conference in Granada, Spain. The dataset included over 12,500 images across 3 tasks. 900 users registered for data download, 115 submitted to the lesion segmentation task, 25 submitted to the lesion attribute detection task, and 159 submitted to the disease classification task. Novel evaluation protocols were established, including a new test for segmentation algorithm performance, and a test for algorithm ability to generalize. Results show that top segmentation algorithms still fail on over 10% of images on average, and algorithms with equal performance on test data can have different abilities to generalize. This is an important consideration for agencies regulating the growing set of machine learning tools in the healthcare domain, and sets a new standard for future public challenges in healthcare.

Michael Hind, Dennis Wei, Murray Campbell et al.

Artificial intelligence systems are being increasingly deployed due to their potential to increase the efficiency, scale, consistency, fairness, and accuracy of decisions. However, as many of these systems are opaque in their operation, there is a growing demand for such systems to provide explanations for their decisions. Conventional approaches to this problem attempt to expose or discover the inner workings of a machine learning model with the hope that the resulting explanations will be meaningful to the consumer. In contrast, this paper suggests a new approach to this problem. It introduces a simple, practical framework, called Teaching Explanations for Decisions (TED), that provides meaningful explanations that match the mental model of the consumer. We illustrate the generality and effectiveness of this approach with two different examples, resulting in highly accurate explanations with no loss of prediction accuracy for these two examples.

Noel C. F. Codella, Chung-Ching Lin, Allan Halpern et al.

Automated dermoscopic image analysis has witnessed rapid growth in diagnostic performance. Yet adoption faces resistance, in part, because no evidence is provided to support decisions. In this work, an approach for evidence-based classification is presented. A feature embedding is learned with CNNs, triplet-loss, and global average pooling, and used to classify via kNN search. Evidence is provided as both the discovered neighbors, as well as localized image regions most relevant to measuring distance between query and neighbors. To ensure that results are relevant in terms of both label accuracy and human visual similarity for any skill level, a novel hierarchical triplet logic is implemented to jointly learn an embedding according to disease labels and non-expert similarity. Results are improved over baselines trained on disease labels alone, as well as standard multiclass loss. Quantitative relevance of results, according to non-expert similarity, as well as localized image regions, are also significantly improved.

Noel C. F. Codella, Michael Hind, Karthikeyan Natesan Ramamurthy et al.

The adoption of machine learning in high-stakes applications such as healthcare and law has lagged in part because predictions are not accompanied by explanations comprehensible to the domain user, who often holds the ultimate responsibility for decisions and outcomes. In this paper, we propose an approach to generate such explanations in which training data is augmented to include, in addition to features and labels, explanations elicited from domain users. A joint model is then learned to produce both labels and explanations from the input features. This simple idea ensures that explanations are tailored to the complexity expectations and domain knowledge of the consumer. Evaluation spans multiple modeling techniques on a game dataset, a (visual) aesthetics dataset, a chemical odor dataset and a Melanoma dataset showing that our approach is generalizable across domains and algorithms. Results demonstrate that meaningful explanations can be reliably taught to machine learning algorithms, and in some cases, also improve modeling accuracy.

Noel C. F. Codella, Daren Anderson, Tyler Philips et al.

This work presents the first segmentation study of both diseased and healthy skin in standard camera photographs from a clinical environment. Challenges arise from varied lighting conditions, skin types, backgrounds, and pathological states. For study, 400 clinical photographs (with skin segmentation masks) representing various pathological states of skin are retrospectively collected from a primary care network. 100 images are used for training and fine-tuning, and 300 are used for evaluation. This distribution between training and test partitions is chosen to reflect the difficulty in amassing large quantities of labeled data in this domain. A deep learning approach is used, and 3 public segmentation datasets of healthy skin are collected to study the potential benefits of pre-training. Two variants of U-Net are evaluated: U-Net and Dense Residual U-Net. We find that Dense Residual U-Nets have a 7.8% improvement in Jaccard, compared to classical U-Net architectures (0.55 vs. 0.51 Jaccard), for direct transfer, where fine-tuning data is not utilized. However, U-Net outperforms Dense Residual U-Net for both direct training (0.83 vs. 0.80) and fine-tuning (0.89 vs. 0.88). The stark performance improvement with fine-tuning compared to direct transfer and direct training emphasizes both the need for adequate representative data of diseased skin, and the utility of other publicly available data sources for this task.

Noel C. F. Codella, David Gutman, M. Emre Celebi et al.

This article describes the design, implementation, and results of the latest installment of the dermoscopic image analysis benchmark challenge. The goal is to support research and development of algorithms for automated diagnosis of melanoma, the most lethal skin cancer. The challenge was divided into 3 tasks: lesion segmentation, feature detection, and disease classification. Participation involved 593 registrations, 81 pre-submissions, 46 finalized submissions (including a 4-page manuscript), and approximately 50 attendees, making this the largest standardized and comparative study in this field to date. While the official challenge duration and ranking of participants has concluded, the dataset snapshots remain available for further research and development.

Noel Codella, Quoc-Bao Nguyen, Sharath Pankanti et al.

Melanoma is the deadliest form of skin cancer. While curable with early detection, only highly trained specialists are capable of accurately recognizing the disease. As expertise is in limited supply, automated systems capable of identifying disease could save lives, reduce unnecessary biopsies, and reduce costs. Toward this goal, we propose a system that combines recent developments in deep learning with established machine learning approaches, creating ensembles of methods that are capable of segmenting skin lesions, as well as analyzing the detected area and surrounding tissue for melanoma detection. The system is evaluated using the largest publicly available benchmark dataset of dermoscopic images, containing 900 training and 379 testing images. New state-of-the-art performance levels are demonstrated, leading to an improvement in the area under receiver operating characteristic curve of 7.5% (0.843 vs. 0.783), in average precision of 4% (0.649 vs. 0.624), and in specificity measured at the clinically relevant 95% sensitivity operating point 2.9 times higher than the previous state-of-the-art (36.8% specificity compared to 12.5%). Compared to the average of 8 expert dermatologists on a subset of 100 test images, the proposed system produces a higher accuracy (76% vs. 70.5%), and specificity (62% vs. 59%) evaluated at an equivalent sensitivity (82%).

David Gutman, Noel C. F. Codella, Emre Celebi et al.

In this article, we describe the design and implementation of a publicly accessible dermatology image analysis benchmark challenge. The goal of the challenge is to sup- port research and development of algorithms for automated diagnosis of melanoma, a lethal form of skin cancer, from dermoscopic images. The challenge was divided into sub-challenges for each task involved in image analysis, including lesion segmentation, dermoscopic feature detection within a lesion, and classification of melanoma. Training data included 900 images. A separate test dataset of 379 images was provided to measure resultant performance of systems developed with the training data. Ground truth for both training and test sets was generated by a panel of dermoscopic experts. In total, there were 79 submissions from a group of 38 participants, making this the largest standardized and comparative study for melanoma diagnosis in dermoscopic images to date. While the official challenge duration and ranking of participants has concluded, the datasets remain available for further research and development.