Sotirios A. Tsaftaris

Walter H. L. Pinaya, Mark S. Graham, Eric Kerfoot et al.

Recent advances in generative AI have brought incredible breakthroughs in several areas, including medical imaging. These generative models have tremendous potential not only to help safely share medical data via synthetic datasets but also to perform an array of diverse applications, such as anomaly detection, image-to-image translation, denoising, and MRI reconstruction. However, due to the complexity of these models, their implementation and reproducibility can be difficult. This complexity can hinder progress, act as a use barrier, and dissuade the comparison of new methods with existing works. In this study, we present MONAI Generative Models, a freely available open-source platform that allows researchers and developers to easily train, evaluate, and deploy generative models and related applications. Our platform reproduces state-of-art studies in a standardised way involving different architectures (such as diffusion models, autoregressive transformers, and GANs), and provides pre-trained models for the community. We have implemented these models in a generalisable fashion, illustrating that their results can be extended to 2D or 3D scenarios, including medical images with different modalities (like CT, MRI, and X-Ray data) and from different anatomical areas. Finally, we adopt a modular and extensible approach, ensuring long-term maintainability and the extension of current applications for future features.

Lena Maier-Hein, Annika Reinke, Patrick Godau et al. · utoronto

Increasing evidence shows that flaws in machine learning (ML) algorithm validation are an underestimated global problem. Particularly in automatic biomedical image analysis, chosen performance metrics often do not reflect the domain interest, thus failing to adequately measure scientific progress and hindering translation of ML techniques into practice. To overcome this, our large international expert consortium created Metrics Reloaded, a comprehensive framework guiding researchers in the problem-aware selection of metrics. Following the convergence of ML methodology across application domains, Metrics Reloaded fosters the convergence of validation methodology. The framework was developed in a multi-stage Delphi process and is based on the novel concept of a problem fingerprint - a structured representation of the given problem that captures all aspects that are relevant for metric selection, from the domain interest to the properties of the target structure(s), data set and algorithm output. Based on the problem fingerprint, users are guided through the process of choosing and applying appropriate validation metrics while being made aware of potential pitfalls. Metrics Reloaded targets image analysis problems that can be interpreted as a classification task at image, object or pixel level, namely image-level classification, object detection, semantic segmentation, and instance segmentation tasks. To improve the user experience, we implemented the framework in the Metrics Reloaded online tool, which also provides a point of access to explore weaknesses, strengths and specific recommendations for the most common validation metrics. The broad applicability of our framework across domains is demonstrated by an instantiation for various biological and medical image analysis use cases.

Pedro Sanchez, Antanas Kascenas, Xiao Liu et al.

Reducing the requirement for densely annotated masks in medical image segmentation is important due to cost constraints. In this paper, we consider the problem of inferring pixel-level predictions of brain lesions by only using image-level labels for training. By leveraging recent advances in generative diffusion probabilistic models (DPM), we synthesize counterfactuals of "How would a patient appear if X pathology was not present?". The difference image between the observed patient state and the healthy counterfactual can be used for inferring the location of pathology. We generate counterfactuals that correspond to the minimal change of the input such that it is transformed to healthy domain. This requires training with healthy and unhealthy data in DPMs. We improve on previous counterfactual DPMs by manipulating the generation process with implicit guidance along with attention conditioning instead of using classifiers. Code is available at https://github.com/vios-s/Diff-SCM.

Raman Dutt, Ondrej Bohdal, Sotirios A. Tsaftaris et al.

Training models with robust group fairness properties is crucial in ethically sensitive application areas such as medical diagnosis. Despite the growing body of work aiming to minimise demographic bias in AI, this problem remains challenging. A key reason for this challenge is the fairness generalisation gap: High-capacity deep learning models can fit all training data nearly perfectly, and thus also exhibit perfect fairness during training. In this case, bias emerges only during testing when generalisation performance differs across subgroups. This motivates us to take a bi-level optimisation perspective on fair learning: Optimising the learning strategy based on validation fairness. Specifically, we consider the highly effective workflow of adapting pre-trained models to downstream medical imaging tasks using parameter-efficient fine-tuning (PEFT) techniques. There is a trade-off between updating more parameters, enabling a better fit to the task of interest vs. fewer parameters, potentially reducing the generalisation gap. To manage this tradeoff, we propose FairTune, a framework to optimise the choice of PEFT parameters with respect to fairness. We demonstrate empirically that FairTune leads to improved fairness on a range of medical imaging datasets. The code is available at https://github.com/Raman1121/FairTune

Pedro Sanchez, Xiao Liu, Alison Q O'Neil et al.

Discovering causal relations from observational data becomes possible with additional assumptions such as considering the functional relations to be constrained as nonlinear with additive noise (ANM). Even with strong assumptions, causal discovery involves an expensive search problem over the space of directed acyclic graphs (DAGs). \emph{Topological ordering} approaches reduce the optimisation space of causal discovery by searching over a permutation rather than graph space. For ANMs, the \emph{Hessian} of the data log-likelihood can be used for finding leaf nodes in a causal graph, allowing its topological ordering. However, existing computational methods for obtaining the Hessian still do not scale as the number of variables and the number of samples increase. Therefore, inspired by recent innovations in diffusion probabilistic models (DPMs), we propose \emph{DiffAN}\footnote{Implementation is available at \url{https://github.com/vios-s/DiffAN} .}, a topological ordering algorithm that leverages DPMs for learning a Hessian function. We introduce theory for updating the learned Hessian without re-training the neural network, and we show that computing with a subset of samples gives an accurate approximation of the ordering, which allows scaling to datasets with more samples and variables. We show empirically that our method scales exceptionally well to datasets with up to $500$ nodes and up to $10^5$ samples while still performing on par over small datasets with state-of-the-art causal discovery methods. Implementation is available at https://github.com/vios-s/DiffAN .

Xiao Liu, Spyridon Thermos, Pedro Sanchez et al.

Training medical image segmentation models usually requires a large amount of labeled data. By contrast, humans can quickly learn to accurately recognise anatomy of interest from medical (e.g. MRI and CT) images with some limited guidance. Such recognition ability can easily generalise to new images from different clinical centres. This rapid and generalisable learning ability is mostly due to the compositional structure of image patterns in the human brain, which is less incorporated in medical image segmentation. In this paper, we model the compositional components (i.e. patterns) of human anatomy as learnable von-Mises-Fisher (vMF) kernels, which are robust to images collected from different domains (e.g. clinical centres). The image features can be decomposed to (or composed by) the components with the composing operations, i.e. the vMF likelihoods. The vMF likelihoods tell how likely each anatomical part is at each position of the image. Hence, the segmentation mask can be predicted based on the vMF likelihoods. Moreover, with a reconstruction module, unlabeled data can also be used to learn the vMF kernels and likelihoods by recombining them to reconstruct the input image. Extensive experiments show that the proposed vMFNet achieves improved generalisation performance on two benchmarks, especially when annotations are limited. Code is publicly available at: https://github.com/vios-s/vMFNet.

Yuyang Xue, Junyu Yan, Raman Dutt et al.

Developing models with robust group fairness properties is paramount, particularly in ethically sensitive domains such as medical diagnosis. Recent approaches to achieving fairness in machine learning require a substantial amount of training data and depend on model retraining, which may not be practical in real-world scenarios. To mitigate these challenges, we propose Bias-based Weight Masking Fine-Tuning (BMFT), a novel post-processing method that enhances the fairness of a trained model in significantly fewer epochs without requiring access to the original training data. BMFT produces a mask over model parameters, which efficiently identifies the weights contributing the most towards biased predictions. Furthermore, we propose a two-step debiasing strategy, wherein the feature extractor undergoes initial fine-tuning on the identified bias-influenced weights, succeeded by a fine-tuning phase on a reinitialised classification layer to uphold discriminative performance. Extensive experiments across four dermatological datasets and two sensitive attributes demonstrate that BMFT outperforms existing state-of-the-art (SOTA) techniques in both diagnostic accuracy and fairness metrics. Our findings underscore the efficacy and robustness of BMFT in advancing fairness across various out-of-distribution (OOD) settings. Our code is available at: https://github.com/vios-s/BMFT

Annika Reinke, Minu D. Tizabi, Michael Baumgartner et al.

Validation metrics are key for the reliable tracking of scientific progress and for bridging the current chasm between artificial intelligence (AI) research and its translation into practice. However, increasing evidence shows that particularly in image analysis, metrics are often chosen inadequately in relation to the underlying research problem. This could be attributed to a lack of accessibility of metric-related knowledge: While taking into account the individual strengths, weaknesses, and limitations of validation metrics is a critical prerequisite to making educated choices, the relevant knowledge is currently scattered and poorly accessible to individual researchers. Based on a multi-stage Delphi process conducted by a multidisciplinary expert consortium as well as extensive community feedback, the present work provides the first reliable and comprehensive common point of access to information on pitfalls related to validation metrics in image analysis. Focusing on biomedical image analysis but with the potential of transfer to other fields, the addressed pitfalls generalize across application domains and are categorized according to a newly created, domain-agnostic taxonomy. To facilitate comprehension, illustrations and specific examples accompany each pitfall. As a structured body of information accessible to researchers of all levels of expertise, this work enhances global comprehension of a key topic in image analysis validation.

Pedro Sanchez, Jeremy P. Voisey, Tian Xia et al.

Causal machine learning (CML) has experienced increasing popularity in healthcare. Beyond the inherent capabilities of adding domain knowledge into learning systems, CML provides a complete toolset for investigating how a system would react to an intervention (e.g.\ outcome given a treatment). Quantifying effects of interventions allows actionable decisions to be made whilst maintaining robustness in the presence of confounders. Here, we explore how causal inference can be incorporated into different aspects of clinical decision support (CDS) systems by using recent advances in machine learning. Throughout this paper, we use Alzheimer's disease (AD) to create examples for illustrating how CML can be advantageous in clinical scenarios. Furthermore, we discuss important challenges present in healthcare applications such as processing high-dimensional and unstructured data, generalisation to out-of-distribution samples, and temporal relationships, that despite the great effort from the research community remain to be solved. Finally, we review lines of research within causal representation learning, causal discovery and causal reasoning which offer the potential towards addressing the aforementioned challenges.

Antanas Kascenas, Pedro Sanchez, Patrick Schrempf et al.

Pathological brain lesions exhibit diverse appearance in brain images, in terms of intensity, texture, shape, size, and location. Comprehensive sets of data and annotations are difficult to acquire. Therefore, unsupervised anomaly detection approaches have been proposed using only normal data for training, with the aim of detecting outlier anomalous voxels at test time. Denoising methods, for instance classical denoising autoencoders (DAEs) and more recently emerging diffusion models, are a promising approach, however naive application of pixelwise noise leads to poor anomaly detection performance. We show that optimization of the spatial resolution and magnitude of the noise improves the performance of different model training regimes, with similar noise parameter adjustments giving good performance for both DAEs and diffusion models. Visual inspection of the reconstructions suggests that the training noise influences the trade-off between the extent of the detail that is reconstructed and the extent of erasure of anomalies, both of which contribute to better anomaly detection performance. We validate our findings on two real-world datasets (tumor detection in brain MRI and hemorrhage/ischemia/tumor detection in brain CT), showing good detection on diverse anomaly appearances. Overall, we find that a DAE trained with coarse noise is a fast and simple method that gives state-of-the-art accuracy. Diffusion models applied to anomaly detection are as yet in their infancy and provide a promising avenue for further research.

Virginia Fernandez, Pedro Sanchez, Walter Hugo Lopez Pinaya et al.

Knowledge distillation in neural networks refers to compressing a large model or dataset into a smaller version of itself. We introduce Privacy Distillation, a framework that allows a text-to-image generative model to teach another model without exposing it to identifiable data. Here, we are interested in the privacy issue faced by a data provider who wishes to share their data via a multimodal generative model. A question that immediately arises is ``How can a data provider ensure that the generative model is not leaking identifiable information about a patient?''. Our solution consists of (1) training a first diffusion model on real data (2) generating a synthetic dataset using this model and filtering it to exclude images with a re-identifiability risk (3) training a second diffusion model on the filtered synthetic data only. We showcase that datasets sampled from models trained with privacy distillation can effectively reduce re-identification risk whilst maintaining downstream performance.

Brennan Nichyporuk, Jillian Cardinell, Justin Szeto et al.

Generalization is an important attribute of machine learning models, particularly for those that are to be deployed in a medical context, where unreliable predictions can have real world consequences. While the failure of models to generalize across datasets is typically attributed to a mismatch in the data distributions, performance gaps are often a consequence of biases in the 'ground-truth' label annotations. This is particularly important in the context of medical image segmentation of pathological structures (e.g. lesions), where the annotation process is much more subjective, and affected by a number underlying factors, including the annotation protocol, rater education/experience, and clinical aims, among others. In this paper, we show that modeling annotation biases, rather than ignoring them, poses a promising way of accounting for differences in annotation style across datasets. To this end, we propose a generalized conditioning framework to (1) learn and account for different annotation styles across multiple datasets using a single model, (2) identify similar annotation styles across different datasets in order to permit their effective aggregation, and (3) fine-tune a fully trained model to a new annotation style with just a few samples. Next, we present an image-conditioning approach to model annotation styles that correlate with specific image features, potentially enabling detection biases to be more easily identified.

Tian Xia, Pedro Sanchez, Chen Qin et al.

Due to the limited availability of medical data, deep learning approaches for medical image analysis tend to generalise poorly to unseen data. Augmenting data during training with random transformations has been shown to help and became a ubiquitous technique for training neural networks. Here, we propose a novel adversarial counterfactual augmentation scheme that aims at finding the most \textit{effective} synthesised images to improve downstream tasks, given a pre-trained generative model. Specifically, we construct an adversarial game where we update the input \textit{conditional factor} of the generator and the downstream \textit{classifier} with gradient backpropagation alternatively and iteratively. This can be viewed as finding the `\textit{weakness}' of the classifier and purposely forcing it to \textit{overcome} its weakness via the generative model. To demonstrate the effectiveness of the proposed approach, we validate the method with the classification of Alzheimer's Disease (AD) as a downstream task. The pre-trained generative model synthesises brain images using age as conditional factor. Extensive experiments and ablation studies have been performed to show that the proposed approach improves classification performance and has potential to alleviate spurious correlations and catastrophic forgetting. Code will be released upon acceptance.

Yuning Du, Yuyang Xue, Rohan Dharmakumar et al.

Deep learning (DL) reconstruction particularly of MRI has led to improvements in image fidelity and reduction of acquisition time. In neuroimaging, DL methods can reconstruct high-quality images from undersampled data. However, it is essential to consider fairness in DL algorithms, particularly in terms of demographic characteristics. This study presents the first fairness analysis in a DL-based brain MRI reconstruction model. The model utilises the U-Net architecture for image reconstruction and explores the presence and sources of unfairness by implementing baseline Empirical Risk Minimisation (ERM) and rebalancing strategies. Model performance is evaluated using image reconstruction metrics. Our findings reveal statistically significant performance biases between the gender and age subgroups. Surprisingly, data imbalance and training discrimination are not the main sources of bias. This analysis provides insights of fairness in DL-based image reconstruction and aims to improve equity in medical AI applications.

Konstantinos Vilouras, Xiao Liu, Pedro Sanchez et al.

Knowledge distillation enables fast and effective transfer of features learned from a bigger model to a smaller one. However, distillation objectives are susceptible to sub-population shifts, a common scenario in medical imaging analysis which refers to groups/domains of data that are underrepresented in the training set. For instance, training models on health data acquired from multiple scanners or hospitals can yield subpar performance for minority groups. In this paper, inspired by distributionally robust optimization (DRO) techniques, we address this shortcoming by proposing a group-aware distillation loss. During optimization, a set of weights is updated based on the per-group losses at a given iteration. This way, our method can dynamically focus on groups that have low performance during training. We empirically validate our method, GroupDistil on two benchmark datasets (natural images and cardiac MRIs) and show consistent improvement in terms of worst-group accuracy.

Yuyang Xue, Yuning Du, Gianluca Carloni et al.

Cine Magnetic Resonance Imaging (MRI) allows for understanding of the heart's function and condition in a non-invasive manner. Undersampling of the $k$-space is employed to reduce the scan duration, thus increasing patient comfort and reducing the risk of motion artefacts, at the cost of reduced image quality. In this challenge paper, we investigate the use of a convolutional recurrent neural network (CRNN) architecture to exploit temporal correlations in supervised cine cardiac MRI reconstruction. This is combined with a single-image super-resolution refinement module to improve single coil reconstruction by 4.4\% in structural similarity and 3.9\% in normalised mean square error compared to a plain CRNN implementation. We deploy a high-pass filter to our $\ell_1$ loss to allow greater emphasis on high-frequency details which are missing in the original data. The proposed model demonstrates considerable enhancements compared to the baseline case and holds promising potential for further improving cardiac MRI reconstruction.

Xiao Liu, Pedro Sanchez, Spyridon Thermos et al.

Deep learning models often need sufficient supervision (i.e. labelled data) in order to be trained effectively. By contrast, humans can swiftly learn to identify important anatomy in medical images like MRI and CT scans, with minimal guidance. This recognition capability easily generalises to new images from different medical facilities and to new tasks in different settings. This rapid and generalisable learning ability is largely due to the compositional structure of image patterns in the human brain, which are not well represented in current medical models. In this paper, we study the utilisation of compositionality in learning more interpretable and generalisable representations for medical image segmentation. Overall, we propose that the underlying generative factors that are used to generate the medical images satisfy compositional equivariance property, where each factor is compositional (e.g. corresponds to the structures in human anatomy) and also equivariant to the task. Hence, a good representation that approximates well the ground truth factor has to be compositionally equivariant. By modelling the compositional representations with learnable von-Mises-Fisher (vMF) kernels, we explore how different design and learning biases can be used to enforce the representations to be more compositionally equivariant under un-, weakly-, and semi-supervised settings. Extensive results show that our methods achieve the best performance over several strong baselines on the task of semi-supervised domain-generalised medical image segmentation. Code will be made publicly available upon acceptance at https://github.com/vios-s.

Ruolin Su, Xiao Liu, Sotirios A. Tsaftaris

Rights provisioned within data protection regulations, permit patients to request that knowledge about their information be eliminated by data holders. With the advent of AI learned on data, one can imagine that such rights can extent to requests for forgetting knowledge of patient's data within AI models. However, forgetting patients' imaging data from AI models, is still an under-explored problem. In this paper, we study the influence of patient data on model performance and formulate two hypotheses for a patient's data: either they are common and similar to other patients or form edge cases, i.e. unique and rare cases. We show that it is not possible to easily forget patient data. We propose a targeted forgetting approach to perform patient-wise forgetting. Extensive experiments on the benchmark Automated Cardiac Diagnosis Challenge dataset showcase the improved performance of the proposed targeted forgetting approach as opposed to a state-of-the-art method.

Avinash Kori, Pedro Sanchez, Konstantinos Vilouras et al.

Unsupervised representation learning with variational inference relies heavily on independence assumptions over latent variables. Causal representation learning (CRL), however, argues that factors of variation in a dataset are, in fact, causally related. Allowing latent variables to be correlated, as a consequence of causal relationships, is more realistic and generalisable. So far, provably identifiable methods rely on: auxiliary information, weak labels, and interventional or even counterfactual data. Inspired by causal discovery with functional causal models, we propose a fully unsupervised representation learning method that considers a data generation process with a latent additive noise model (ANM). We encourage the latent space to follow a causal ordering via loss function based on the Hessian of the latent distribution.

Madhav Agarwal, Sotirios A. Tsaftaris, Laura Sevilla-Lara et al.

Understanding emotions is a fundamental ability for intelligent systems to be able to interact with humans. Vision-language models (VLMs) have made tremendous progress in the last few years for many visual tasks, potentially offering a promising solution for understanding emotions. However, it is surprising that even the most sophisticated contemporary VLMs struggle to recognize human emotions or to outperform even specialized vision-only classifiers. In this paper we ask the question "Why do VLMs struggle to recognize human emotions?", and observe that the inherently continuous and dynamic task of facial expression recognition (DFER) exposes two critical VLM vulnerabilities. First, emotion datasets are naturally long-tailed, and the web-scale data used to pre-train VLMs exacerbates this head-class bias, causing them to systematically collapse rare, under-represented emotions into common categories. We propose alternative sampling strategies that prevent favoring common concepts. Second, temporal information is critical for understanding emotions. However, VLMs are unable to represent temporal information over dense frame sequences, as they are limited by context size and the number of tokens that can fit in memory, which poses a clear challenge for emotion recognition. We demonstrate that the sparse temporal sampling strategy used in VLMs is inherently misaligned with the fleeting nature of micro-expressions (0.25-0.5 seconds), which are often the most critical affective signal. As a diagnostic probe, we propose a multi-stage context enrichment strategy that utilizes the information from "in-between" frames by first converting them into natural language summaries. This enriched textual context is provided as input to the VLM alongside sparse keyframes, preventing attentional dilution from excessive visual data while preserving the emotional trajectory.

Anjun Hu, Jean-Pierre R. Falet, Brennan S. Nichyporuk et al.

We propose a hierarchically structured variational inference model for accurately disentangling observable evidence of disease (e.g. brain lesions or atrophy) from subject-specific anatomy in brain MRIs. With flexible, partially autoregressive priors, our model (1) addresses the subtle and fine-grained dependencies that typically exist between anatomical and pathological generating factors of an MRI to ensure the clinical validity of generated samples; (2) preserves and disentangles finer pathological details pertaining to a patient's disease state. Additionally, we experiment with an alternative training configuration where we provide supervision to a subset of latent units. It is shown that (1) a partially supervised latent space achieves a higher degree of disentanglement between evidence of disease and subject-specific anatomy; (2) when the prior is formulated with an autoregressive structure, knowledge from the supervision can propagate to the unsupervised latent units, resulting in more informative latent representations capable of modelling anatomy-pathology interdependencies.

Xiao Liu, Antanas Kascenas, Hannah Watson et al.

For brain tumour segmentation, deep learning models can achieve human expert-level performance given a large amount of data and pixel-level annotations. However, the expensive exercise of obtaining pixel-level annotations for large amounts of data is not always feasible, and performance is often heavily reduced in a low-annotated data regime. To tackle this challenge, we adapt a mixed supervision framework, vMFNet, to learn robust compositional representations using unsupervised learning and weak supervision alongside non-exhaustive pixel-level pathology labels. In particular, we use the BraTS dataset to simulate a collection of 2-point expert pathology annotations indicating the top and bottom slice of the tumour (or tumour sub-regions: peritumoural edema, GD-enhancing tumour, and the necrotic / non-enhancing tumour) in each MRI volume, from which weak image-level labels that indicate the presence or absence of the tumour (or the tumour sub-regions) in the image are constructed. Then, vMFNet models the encoded image features with von-Mises-Fisher (vMF) distributions, via learnable and compositional vMF kernels which capture information about structures in the images. We show that good tumour segmentation performance can be achieved with a large amount of weakly labelled data but only a small amount of fully-annotated data. Interestingly, emergent learning of anatomical structures occurs in the compositional representation even given only supervision relating to pathology (tumour).

Xiao Liu, Spyridon Thermos, Pedro Sanchez et al.

Learning disentangled representations requires either supervision or the introduction of specific model designs and learning constraints as biases. InfoGAN is a popular disentanglement framework that learns unsupervised disentangled representations by maximising the mutual information between latent representations and their corresponding generated images. Maximisation of mutual information is achieved by introducing an auxiliary network and training with a latent regression loss. In this short exploratory paper, we study the use of the Hilbert-Schmidt Independence Criterion (HSIC) to approximate mutual information between latent representation and image, termed HSIC-InfoGAN. Directly optimising the HSIC loss avoids the need for an additional auxiliary network. We qualitatively compare the level of disentanglement in each model, suggest a strategy to tune the hyperparameters of HSIC-InfoGAN, and discuss the potential of HSIC-InfoGAN for medical applications.

John Hartley, Sotirios A. Tsaftaris

Neural networks pose a privacy risk due to their propensity to memorise and leak training data. We show that unique features occurring only once in training data are memorised by discriminative multi-layer perceptrons and convolutional neural networks trained on benchmark imaging datasets. We design our method for settings where sensitive training data is not available, for example medical imaging. Our setting knows the unique feature, but not the training data, model weights or the unique feature's label. We develop a score estimating a model's sensitivity to a unique feature by comparing the KL divergences of the model's output distributions given modified out-of-distribution images. We find that typical strategies to prevent overfitting do not prevent unique feature memorisation. And that images containing a unique feature are highly influential, regardless of the influence the images's other features. We also find a significant variation in memorisation with training seed. These results imply that neural networks pose a privacy risk to rarely occurring private information. This risk is more pronounced in healthcare applications since sensitive patient information can be memorised when it remains in training data due to an imperfect data sanitisation process.

Kurt Butler, Damian Machlanski, Panagiotis Dimitrakopoulos et al.

Causal discovery problems use a set of observations to deduce causality between variables in the real world, typically to answer questions about biological or physical systems. These observations are often recorded at regular time intervals, determined by a user or a machine, depending on the experiment design. There is generally no guarantee that the timing of these recordings matches the timing of the underlying biological or physical events. In this paper, we examine the sensitivity of causal discovery methods to this potential mismatch. We consider empirical and theoretical evidence to understand how causal discovery performance is impacted by changes of sampling rate and window length. We demonstrate that both classical and recent causal discovery methods exhibit sensitivity to these hyperparameters, and we discuss how ideas from signal processing may help us understand these phenomena.

Robert Cronshaw, Konstantinos Vilouras, Junyu Yan et al.

Text-to-image generation has been increasingly applied in medical domains for various purposes such as data augmentation and education. Evaluating the quality and clinical reliability of these generated images is essential. However, existing methods mainly assess image realism or diversity, while failing to capture whether the generated images reflect the intended clinical semantics, such as anatomical location and pathology. In this study, we propose the Clinical Semantics Evaluator (CSEval), a framework that leverages language models to assess clinical semantic alignment between the generated images and their conditioning prompts. Our experiments show that CSEval identifies semantic inconsistencies overlooked by other metrics and correlates with expert judgment. CSEval provides a scalable and clinically meaningful complement to existing evaluation methods, supporting the safe adoption of generative models in healthcare.

Thomas Melistas, Nikos Spyrou, Nefeli Gkouti et al.

Generative AI has revolutionised visual content editing, empowering users to effortlessly modify images and videos. However, not all edits are equal. To perform realistic edits in domains such as natural image or medical imaging, modifications must respect causal relationships inherent to the data generation process. Such image editing falls into the counterfactual image generation regime. Evaluating counterfactual image generation is substantially complex: not only it lacks observable ground truths, but also requires adherence to causal constraints. Although several counterfactual image generation methods and evaluation metrics exist, a comprehensive comparison within a unified setting is lacking. We present a comparison framework to thoroughly benchmark counterfactual image generation methods. We integrate all models that have been used for the task at hand and expand them to novel datasets and causal graphs, demonstrating the superiority of Hierarchical VAEs across most datasets and metrics. Our framework is implemented in a user-friendly Python package that can be extended to incorporate additional SCMs, causal methods, generative models, and datasets for the community to build on. Code: https://github.com/gulnazaki/counterfactual-benchmark.

Raman Dutt, Pedro Sanchez, Ondrej Bohdal et al.

In this work, we present compelling evidence that controlling model capacity during fine-tuning can effectively mitigate memorization in diffusion models. Specifically, we demonstrate that adopting Parameter-Efficient Fine-Tuning (PEFT) within the pre-train fine-tune paradigm significantly reduces memorization compared to traditional full fine-tuning approaches. Our experiments utilize the MIMIC dataset, which comprises image-text pairs of chest X-rays and their corresponding reports. The results, evaluated through a range of memorization and generation quality metrics, indicate that PEFT not only diminishes memorization but also enhances downstream generation quality. Additionally, PEFT methods can be seamlessly combined with existing memorization mitigation techniques for further improvement. The code for our experiments is available at: https://github.com/Raman1121/Diffusion_Memorization_HPO

Konstantinos Vilouras, Ilias Stogiannidis, Junyu Yan et al.

Latent Diffusion Models have shown remarkable results in text-guided image synthesis in recent years. In the domain of natural (RGB) images, recent works have shown that such models can be adapted to various vision-language downstream tasks with little to no supervision involved. On the contrary, text-to-image Latent Diffusion Models remain relatively underexplored in the field of medical imaging, primarily due to limited data availability (e.g., due to privacy concerns). In this work, focusing on the chest X-ray modality, we first demonstrate that a standard text-conditioned Latent Diffusion Model has not learned to align clinically relevant information in free-text radiology reports with the corresponding areas of the given scan. Then, to alleviate this issue, we propose a fine-tuning framework to improve multi-modal alignment in a pre-trained model such that it can be efficiently repurposed for downstream tasks such as phrase grounding. Our method sets a new state-of-the-art on a standard benchmark dataset (MS-CXR), while also exhibiting robust performance on out-of-distribution data (VinDr-CXR). Our code will be made publicly available.

Yuning Du, Jingshuai Liu, Rohan Dharmakumar et al.

Despite the superior diagnostic capability of Magnetic Resonance Imaging (MRI), its use as a Point-of-Care (PoC) device remains limited by high cost and complexity. To enable such a future by reducing the magnetic field strength, one key approach will be to improve sampling strategies. Previous work has shown that it is possible to make diagnostic decisions directly from k-space with fewer samples. Such work shows that single diagnostic decisions can be made, but if we aspire to see MRI as a true PoC, multiple and sequential decisions are necessary while minimizing the number of samples acquired. We present a novel multi-objective reinforcement learning framework enabling comprehensive, sequential, diagnostic evaluation from undersampled k-space data. Our approach during inference actively adapts to sequential decisions to optimally sample. To achieve this, we introduce a training methodology that identifies the samples that contribute the best to each diagnostic objective using a step-wise weighting reward function. We evaluate our approach in two sequential knee pathology assessment tasks: ACL sprain detection and cartilage thickness loss assessment. Our framework achieves diagnostic performance competitive with various policy-based benchmarks on disease detection, severity quantification, and overall sequential diagnosis, while substantially saving k-space samples. Our approach paves the way for the future of MRI as a comprehensive and affordable PoC device. Our code is publicly available at https://github.com/vios-s/MRI_Sequential_Active_Sampling

Feng Chen, Sotirios A. Tsaftaris, Mario Valerio Giuffrida

Leaf instance segmentation is a challenging multi-instance segmentation task, aiming to separate and delineate each leaf in an image of a plant. Accurate segmentation of each leaf is crucial for plant-related applications such as the fine-grained monitoring of plant growth and crop yield estimation. This task is challenging because of the high similarity (in shape and colour), great size variation, and heavy occlusions among leaf instances. Furthermore, the typically small size of annotated leaf datasets makes it more difficult to learn the distinctive features needed for precise segmentation. We hypothesise that the key to overcoming the these challenges lies in the specific spatial patterns of leaf distribution. In this paper, we propose the Guided Mask Transformer (GMT), which leverages and integrates leaf spatial distribution priors into a Transformer-based segmentor. These spatial priors are embedded in a set of guide functions that map leaves at different positions into a more separable embedding space. Our GMT consistently outperforms the state-of-the-art on three public plant datasets. Our code is available at https://github.com/vios-s/gmt-leaf-ins-seg.

Ilias Stogiannidis, Steven McDonagh, Sotirios A. Tsaftaris

Vision-Language Models (VLMs) have recently emerged as powerful tools, excelling in tasks that integrate visual and textual comprehension, such as image captioning, visual question answering, and image-text retrieval. However, existing benchmarks for VLMs include spatial components, which often fail to isolate spatial reasoning from related tasks such as object detection or semantic comprehension. In this paper, we address these deficiencies with a multi-faceted approach towards understanding spatial reasoning. Informed by the diverse and multi-dimensional nature of human spatial reasoning abilities, we present a detailed analysis that first delineates the core elements of spatial reasoning: spatial relations, orientation and navigation, mental rotation, and spatial visualization, and then assesses the performance of these models in both synthetic and real-world images, bridging controlled and naturalistic contexts. We analyze 13 state-of-the-art Vision-Language Models, uncovering pivotal insights into their spatial reasoning performance. Our results reveal profound shortcomings in current VLMs, with average accuracy across the 13 models approximating random chance, highlighting spatial reasoning as a persistent obstacle. This work not only exposes the pressing need to advance spatial reasoning within VLMs but also establishes a solid platform for future exploration. Code available on GitHub (https://github.com/stogiannidis/srbench) and dataset available on HuggingFace (https://huggingface.co/datasets/stogiannidis/srbench).

Pedro Sanchez, Sotirios A. Tsaftaris

We consider the task of counterfactual estimation from observational imaging data given a known causal structure. In particular, quantifying the causal effect of interventions for high-dimensional data with neural networks remains an open challenge. Herein we propose Diff-SCM, a deep structural causal model that builds on recent advances of generative energy-based models. In our setting, inference is performed by iteratively sampling gradients of the marginal and conditional distributions entailed by the causal model. Counterfactual estimation is achieved by firstly inferring latent variables with deterministic forward diffusion, then intervening on a reverse diffusion process using the gradients of an anti-causal predictor w.r.t the input. Furthermore, we propose a metric for evaluating the generated counterfactuals. We find that Diff-SCM produces more realistic and minimal counterfactuals than baselines on MNIST data and can also be applied to ImageNet data. Code is available https://github.com/vios-s/Diff-SCM.

Grzegorz Jacenków, Alison Q. O'Neil, Sotirios A. Tsaftaris

When a clinician refers a patient for an imaging exam, they include the reason (e.g. relevant patient history, suspected disease) in the scan request; this appears as the indication field in the radiology report. The interpretation and reporting of the image are substantially influenced by this request text, steering the radiologist to focus on particular aspects of the image. We use the indication field to drive better image classification, by taking a transformer network which is unimodally pre-trained on text (BERT) and fine-tuning it for multimodal classification of a dual image-text input. We evaluate the method on the MIMIC-CXR dataset, and present ablation studies to investigate the effect of the indication field on the classification performance. The experimental results show our approach achieves 87.8 average micro AUROC, outperforming the state-of-the-art methods for unimodal (84.4) and multimodal (86.0) classification. Our code is available at https://github.com/jacenkow/mmbt.

Gabriele Valvano, Andrea Leo, Sotirios A. Tsaftaris

Thanks to their ability to learn flexible data-driven losses, Generative Adversarial Networks (GANs) are an integral part of many semi- and weakly-supervised methods for medical image segmentation. GANs jointly optimise a generator and an adversarial discriminator on a set of training data. After training is complete, the discriminator is usually discarded, and only the generator is used for inference. But should we discard discriminators? In this work, we argue that training stable discriminators produces expressive loss functions that we can re-use at inference to detect and \textit{correct} segmentation mistakes. First, we identify key challenges and suggest possible solutions to make discriminators re-usable at inference. Then, we show that we can combine discriminators with image reconstruction costs (via decoders) to endow a causal perspective to test-time training and further improve the model. Our method is simple and improves the test-time performance of pre-trained GANs. Moreover, we show that it is compatible with standard post-processing techniques and it has the potential to be used for Online Continual Learning. With our work, we open new research avenues for re-using adversarial discriminators at inference. Our code is available at https://vios-s.github.io/adversarial-test-time-training.

Spyridon Thermos, Xiao Liu, Alison O'Neil et al.

Acquiring annotated data at scale with rare diseases or conditions remains a challenge. It would be extremely useful to have a method that controllably synthesizes images that can correct such underrepresentation. Assuming a proper latent representation, the idea of a "latent vector arithmetic" could offer the means of achieving such synthesis. A proper representation must encode the fidelity of the input data, preserve invariance and equivariance, and permit arithmetic operations. Motivated by the ability to disentangle images into spatial anatomy (tensor) factors and accompanying imaging (vector) representations, we propose a framework termed "disentangled anatomy arithmetic", in which a generative model learns to combine anatomical factors of different input images such that when they are re-entangled with the desired imaging modality (e.g. MRI), plausible new cardiac images are created with the target characteristics. To encourage a realistic combination of anatomy factors after the arithmetic step, we propose a localized noise injection network that precedes the generator. Our model is used to generate realistic images, pathology labels, and segmentation masks that are used to augment the existing datasets and subsequently improve post-hoc classification and segmentation tasks. Code is publicly available at https://github.com/vios-s/DAA-GAN.

Grzegorz Jacenków, Alison Q. O'Neil, Brian Mohr et al.

We consider the problem of integrating non-imaging information into segmentation networks to improve performance. Conditioning layers such as FiLM provide the means to selectively amplify or suppress the contribution of different feature maps in a linear fashion. However, spatial dependency is difficult to learn within a convolutional paradigm. In this paper, we propose a mechanism to allow for spatial localisation conditioned on non-imaging information, using a feature-wise attention mechanism comprising a differentiable parametrised function (e.g. Gaussian), prior to applying the feature-wise modulation. We name our method INstance modulation with SpatIal DEpendency (INSIDE). The conditioning information might comprise any factors that relate to spatial or spatio-temporal information such as lesion location, size, and cardiac cycle phase. Our method can be trained end-to-end and does not require additional supervision. We evaluate the method on two datasets: a new CLEVR-Seg dataset where we segment objects based on location, and the ACDC dataset conditioned on cardiac phase and slice location within the volume. Code and the CLEVR-Seg dataset are available at https://github.com/jacenkow/inside.

Tian Xia, Agisilaos Chartsias, Sotirios A. Tsaftaris

Pseudo-healthy synthesis is the task of creating a subject-specific `healthy' image from a pathological one. Such images can be helpful in tasks such as anomaly detection and understanding changes induced by pathology and disease. In this paper, we present a model that is encouraged to disentangle the information of pathology from what seems to be healthy. We disentangle what appears to be healthy and where disease is as a segmentation map, which are then recombined by a network to reconstruct the input disease image. We train our models adversarially using either paired or unpaired settings, where we pair disease images and maps when available. We quantitatively and subjectively, with a human study, evaluate the quality of pseudo-healthy images using several criteria. We show in a series of experiments, performed on ISLES, BraTS and Cam-CAN datasets, that our method is better than several baselines and methods from the literature. We also show that due to better training processes we could recover deformations, on surrounding tissue, caused by disease. Our implementation is publicly available at https://github.com/xiat0616/pseudo-healthy-synthesis. This paper has been accepted by Medical Image Analysis: https://doi.org/10.1016/j.media.2020.101719.

Hao Chen, Mario Valerio Giuffrida, Peter Doerner et al.

Several imaging applications (vessels, retina, plant roots, road networks from satellites) require the accurate segmentation of thin structures for subsequent analysis. Discontinuities (gaps) in the extracted foreground may hinder down-stream image-based analysis of biomarkers, organ structure and topology. In this paper, we propose a general post-processing technique to recover such gaps in large-scale segmentation masks. We cast this problem as a blind inpainting task, where the regions of missing lines in the segmentation masks are not known to the algorithm, which we solve with an adversarially trained neural network. One challenge of using large images is the memory capacity of current GPUs. The typical approach of dividing a large image into smaller patches to train the network does not guarantee global coherence of the reconstructed image that preserves structure and topology. We use adversarial training and reinforcement learning (Policy Gradient) to endow the model with both global context and local details. We evaluate our method in several datasets in medical imaging, plant science, and remote sensing. Our experiments demonstrate that our model produces the most realistic and complete inpainted results, outperforming other approaches. In a dedicated study on plant roots we find that our approach is also comparable to human performance. Implementation available at \url{https://github.com/Hhhhhhhhhhao/Thin-Structure-Inpainting}.

Tian Xia, Agisilaos Chartsias, Chengjia Wang et al.

How will my face look when I get older? Or, for a more challenging question: How will my brain look when I get older? To answer this question one must devise (and learn from data) a multivariate auto-regressive function which given an image and a desired target age generates an output image. While collecting data for faces may be easier, collecting longitudinal brain data is not trivial. We propose a deep learning-based method that learns to simulate subject-specific brain ageing trajectories without relying on longitudinal data. Our method synthesises images conditioned on two factors: age (a continuous variable), and status of Alzheimer's Disease (AD, an ordinal variable). With an adversarial formulation we learn the joint distribution of brain appearance, age and AD status, and define reconstruction losses to address the challenging problem of preserving subject identity. We compare with several benchmarks using two widely used datasets. We evaluate the quality and realism of synthesised images using ground-truth longitudinal data and a pre-trained age predictor. We show that, despite the use of cross-sectional data, our model learns patterns of gray matter atrophy in the middle temporal gyrus in patients with AD. To demonstrate generalisation ability, we train on one dataset and evaluate predictions on the other. In conclusion, our model shows an ability to separate age, disease influence and anatomy using only 2D cross-sectional data that should be useful in large studies into neurodegenerative disease, that aim to combine several data sources. To facilitate such future studies by the community at large our code is made available at https://github.com/xiat0616/BrainAgeing.

Agisilaos Chartsias, Giorgos Papanastasiou, Chengjia Wang et al.

Magnetic resonance (MR) protocols rely on several sequences to assess pathology and organ status properly. Despite advances in image analysis, we tend to treat each sequence, here termed modality, in isolation. Taking advantage of the common information shared between modalities (an organ's anatomy) is beneficial for multi-modality processing and learning. However, we must overcome inherent anatomical misregistrations and disparities in signal intensity across the modalities to obtain this benefit. We present a method that offers improved segmentation accuracy of the modality of interest (over a single input model), by learning to leverage information present in other modalities, even if few (semi-supervised) or no (unsupervised) annotations are available for this specific modality. Core to our method is learning a disentangled decomposition into anatomical and imaging factors. Shared anatomical factors from the different inputs are jointly processed and fused to extract more accurate segmentation masks. Image misregistrations are corrected with a Spatial Transformer Network, which non-linearly aligns the anatomical factors. The imaging factor captures signal intensity characteristics across different modality data and is used for image reconstruction, enabling semi-supervised learning. Temporal and slice pairing between inputs are learned dynamically. We demonstrate applications in Late Gadolinium Enhanced (LGE) and Blood Oxygenation Level Dependent (BOLD) cardiac segmentation, as well as in T2 abdominal segmentation. Code is available at https://github.com/vios-s/multimodal_segmentation.

Gabriele Valvano, Agisilaos Chartsias, Andrea Leo et al.

There has been an increasing focus in learning interpretable feature representations, particularly in applications such as medical image analysis that require explainability, whilst relying less on annotated data (since annotations can be tedious and costly). Here we build on recent innovations in style-content representations to learn anatomy, imaging characteristics (appearance) and temporal correlations. By introducing a self-supervised objective of predicting future cardiac phases we improve disentanglement. We propose a temporal transformer architecture that given an image conditioned on phase difference, it predicts a future frame. This forces the anatomical decomposition to be consistent with the temporal cardiac contraction in cine MRI and to have semantic meaning with less need for annotations. We demonstrate that using this regularization, we achieve competitive results and improve semi-supervised segmentation, especially when very few labelled data are available. Specifically, we show Dice increase of up to 19\% and 7\% compared to supervised and semi-supervised approaches respectively on the ACDC dataset. Code is available at: https://github.com/gvalvano/sdtnet .

Agisilaos Chartsias, Thomas Joyce, Giorgos Papanastasiou et al.

Typically, a medical image offers spatial information on the anatomy (and pathology) modulated by imaging specific characteristics. Many imaging modalities including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) can be interpreted in this way. We can venture further and consider that a medical image naturally factors into some spatial factors depicting anatomy and factors that denote the imaging characteristics. Here, we explicitly learn this decomposed (disentangled) representation of imaging data, focusing in particular on cardiac images. We propose Spatial Decomposition Network (SDNet), which factorises 2D medical images into spatial anatomical factors and non-spatial modality factors. We demonstrate that this high-level representation is ideally suited for several medical image analysis tasks, such as semi-supervised segmentation, multi-task segmentation and regression, and image-to-image synthesis. Specifically, we show that our model can match the performance of fully supervised segmentation models, using only a fraction of the labelled images. Critically, we show that our factorised representation also benefits from supervision obtained either when we use auxiliary tasks to train the model in a multi-task setting (e.g. regressing to known cardiac indices), or when aggregating multimodal data from different sources (e.g. pooling together MRI and CT data). To explore the properties of the learned factorisation, we perform latent-space arithmetic and show that we can synthesise CT from MR and vice versa, by swapping the modality factors. We also demonstrate that the factor holding image specific information can be used to predict the input modality with high accuracy. Code will be made available at https://github.com/agis85/anatomy_modality_decomposition.

Agisilaos Chartsias, Thomas Joyce, Giorgos Papanastasiou et al.

The success and generalisation of deep learning algorithms heavily depend on learning good feature representations. In medical imaging this entails representing anatomical information, as well as properties related to the specific imaging setting. Anatomical information is required to perform further analysis, whereas imaging information is key to disentangle scanner variability and potential artefacts. The ability to factorise these would allow for training algorithms only on the relevant information according to the task. To date, such factorisation has not been attempted. In this paper, we propose a methodology of latent space factorisation relying on the cycle-consistency principle. As an example application, we consider cardiac MR segmentation, where we separate information related to the myocardium from other features related to imaging and surrounding substructures. We demonstrate the proposed method's utility in a semi-supervised setting: we use very few labelled images together with many unlabelled images to train a myocardium segmentation neural network. Specifically, we achieve comparable performance to fully supervised networks using a fraction of labelled images in experiments on ACDC and a dataset from Edinburgh Imaging Facility QMRI. Code will be made available at https://github.com/agis85/spatial_factorisation.

Konstantinos Vilouras, Pedro Sanchez, Alison Q. O'Neil et al.

Localizing the exact pathological regions in a given medical scan is an important imaging problem that traditionally requires a large amount of bounding box ground truth annotations to be accurately solved. However, there exist alternative, potentially weaker, forms of supervision, such as accompanying free-text reports, which are readily available. The task of performing localization with textual guidance is commonly referred to as phrase grounding. In this work, we use a publicly available Foundation Model, namely the Latent Diffusion Model, to perform this challenging task. This choice is supported by the fact that the Latent Diffusion Model, despite being generative in nature, contains cross-attention mechanisms that implicitly align visual and textual features, thus leading to intermediate representations that are suitable for the task at hand. In addition, we aim to perform this task in a zero-shot manner, i.e., without any training on the target task, meaning that the model's weights remain frozen. To this end, we devise strategies to select features and also refine them via post-processing without extra learnable parameters. We compare our proposed method with state-of-the-art approaches which explicitly enforce image-text alignment in a joint embedding space via contrastive learning. Results on a popular chest X-ray benchmark indicate that our method is competitive with SOTA on different types of pathology, and even outperforms them on average in terms of two metrics (mean IoU and AUC-ROC). Source code will be released upon acceptance at https://github.com/vios-s.

Yuyang Xue, Edward Moroshko, Feng Chen et al.

Text-to-Image diffusion models can produce undesirable content that necessitates concept erasure. However, existing methods struggle with under-erasure, leaving residual traces of targeted concepts, or over-erasure, mistakenly eliminating unrelated but visually similar concepts. To address these limitations, we introduce CRCE, a novel concept erasure framework that leverages Large Language Models to identify both semantically related concepts that should be erased alongside the target and distinct concepts that should be preserved. By explicitly modelling coreferential and retained concepts semantically, CRCE enables more precise concept removal, without unintended erasure. Experiments demonstrate that CRCE outperforms existing methods on diverse erasure tasks, including real-world object, person identities, and abstract intellectual property characteristics. The constructed dataset CorefConcept and the source code will be release upon acceptance.

Nikos Spyrou, Athanasios Vlontzos, Paraskevas Pegios et al.

Adapting text-to-image (T2I) latent diffusion models (LDMs) to video editing has shown strong visual fidelity and controllability, but challenges remain in maintaining causal relationships inherent to the video data generating process. Edits affecting causally dependent attributes often generate unrealistic or misleading outcomes if these relationships are ignored. In this work, we introduce a causally faithful framework for counterfactual video generation, formulated as an Out-of-Distribution (OOD) prediction problem. We embed prior causal knowledge by encoding the relationships specified in a causal graph into text prompts and guide the generation process by optimizing these prompts using a vision-language model (VLM)-based textual loss. This loss encourages the latent space of the LDMs to capture OOD variations in the form of counterfactuals, effectively steering generation toward causally meaningful alternatives. The proposed framework, dubbed CSVC, is agnostic to the underlying video editing system and does not require access to its internal mechanisms or fine-tuning. We evaluate our approach using standard video quality metrics and counterfactual-specific criteria, such as causal effectiveness and minimality. Experimental results show that CSVC generates causally faithful video counterfactuals within the LDM distribution via prompt-based causal steering, achieving state-of-the-art causal effectiveness without compromising temporal consistency or visual quality on real-world facial videos. Due to its compatibility with any black-box video editing system, our framework has significant potential to generate realistic 'what if' hypothetical video scenarios in diverse areas such as digital media and healthcare.

Eva Pachetti, Sotirios A. Tsaftaris, Sara Colantonio

Background and objective: Employing deep learning models in critical domains such as medical imaging poses challenges associated with the limited availability of training data. We present a strategy for improving the performance and generalization capabilities of models trained in low-data regimes. Methods: The proposed method starts with a pre-training phase, where features learned in a self-supervised learning setting are disentangled to improve the robustness of the representations for downstream tasks. We then introduce a meta-fine-tuning step, leveraging related classes between meta-training and meta-testing phases but varying the granularity level. This approach aims to enhance the model's generalization capabilities by exposing it to more challenging classification tasks during meta-training and evaluating it on easier tasks but holding greater clinical relevance during meta-testing. We demonstrate the effectiveness of the proposed approach through a series of experiments exploring several backbones, as well as diverse pre-training and fine-tuning schemes, on two distinct medical tasks, i.e., classification of prostate cancer aggressiveness from MRI data and classification of breast cancer malignity from microscopic images. Results: Our results indicate that the proposed approach consistently yields superior performance w.r.t. ablation experiments, maintaining competitiveness even when a distribution shift between training and evaluation data occurs. Conclusion: Extensive experiments demonstrate the effectiveness and wide applicability of the proposed approach. We hope that this work will add another solution to the arsenal of addressing learning issues in data-scarce imaging domains.

Yuyang Xue, Jingshuai Liu, Steven McDonagh et al.

Machine unlearning is a promising paradigm for removing unwanted data samples from a trained model, towards ensuring compliance with privacy regulations and limiting harmful biases. Although unlearning has been shown in, e.g., classification and recommendation systems, its potential in medical image-to-image translation, specifically in image recon-struction, has not been thoroughly investigated. This paper shows that machine unlearning is possible in MRI tasks and has the potential to benefit for bias removal. We set up a protocol to study how much shared knowledge exists between datasets of different organs, allowing us to effectively quantify the effect of unlearning. Our study reveals that combining training data can lead to hallucinations and reduced image quality in the reconstructed data. We use unlearning to remove hallucinations as a proxy exemplar of undesired data removal. Indeed, we show that machine unlearning is possible without full retraining. Furthermore, our observations indicate that maintaining high performance is feasible even when using only a subset of retain data. We have made our code publicly accessible.

Damian Machlanski, Stephanie Riley, Edward Moroshko et al.

The promise that causal modelling can lead to robust AI generalization has been challenged in recent work on domain generalization (DG) benchmarks. We revisit the claims of the causality and DG literature, reconciling apparent contradictions and advocating for a more nuanced theory of the role of causality in generalization. We also provide an interactive demo at https://chai-uk.github.io/ukairs25-causal-predictors/.