Zitao Shuai

Chenwei Wu, David Restrepo, Zitao Shuai et al.

In-context learning (ICL) with Large Vision Models (LVMs) presents a promising avenue in medical image segmentation by reducing the reliance on extensive labeling. However, the ICL performance of LVMs highly depends on the choices of visual prompts and suffers from domain shifts. While existing works leveraging LVMs for medical tasks have focused mainly on model-centric approaches like fine-tuning, we study an orthogonal data-centric perspective on how to select good visual prompts to facilitate generalization to medical domain. In this work, we propose a label-efficient in-context medical segmentation method by introducing a novel Meta-driven Visual Prompt Selection mechanism (MVPS), where a prompt retriever obtained from a meta-learning framework actively selects the optimal images as prompts to promote model performance and generalizability. Evaluated on 8 datasets and 4 tasks across 3 medical imaging modalities, our proposed approach demonstrates consistent gains over existing methods under different scenarios, improving both computational and label efficiency. Finally, we show that MVPS is a flexible, finetuning-free module that could be easily plugged into different backbones and combined with other model-centric approaches.

David Restrepo, Chenwei Wu, Zhengxu Tang et al.

Current ophthalmology clinical workflows are plagued by over-referrals, long waits, and complex and heterogeneous medical records. Large language models (LLMs) present a promising solution to automate various procedures such as triaging, preliminary tests like visual acuity assessment, and report summaries. However, LLMs have demonstrated significantly varied performance across different languages in natural language question-answering tasks, potentially exacerbating healthcare disparities in Low and Middle-Income Countries (LMICs). This study introduces the first multilingual ophthalmological question-answering benchmark with manually curated questions parallel across languages, allowing for direct cross-lingual comparisons. Our evaluation of 6 popular LLMs across 7 different languages reveals substantial bias across different languages, highlighting risks for clinical deployment of LLMs in LMICs. Existing debiasing methods such as Translation Chain-of-Thought or Retrieval-augmented generation (RAG) by themselves fall short of closing this performance gap, often failing to improve performance across all languages and lacking specificity for the medical domain. To address this issue, We propose CLARA (Cross-Lingual Reflective Agentic system), a novel inference time de-biasing method leveraging retrieval augmented generation and self-verification. Our approach not only improves performance across all languages but also significantly reduces the multilingual bias gap, facilitating equitable LLM application across the globe.

Zitao Shuai, Chenwei Wu, Zhengxu Tang et al.

Vision-language pre-training (VLP) has emerged as an effective scheme for multimodal representation learning, but its reliance on large-scale multimodal data poses significant challenges for medical applications. Federated learning (FL) offers a promising solution to scale up the dataset for medical VLP while preserving data privacy. However, we observe that client data heterogeneity in real-world scenarios could cause models to learn biased cross-modal alignment during local pre-training. This would limit the transferability of the federally learned representation model on downstream tasks. To address this challenge, we propose Federated Distributionally Robust Alignment (FedDRA), a framework for federated VLP that achieves robust vision-language alignment under heterogeneous conditions. Based on client datasets, we construct a distribution family that encompasses potential test-time domains, and apply a distributionally robust framework to optimize the pre-trained model's performance across this distribution space. This approach bridges the gap between pre-training samples and downstream applications. To avoid over-fitting on client-specific information, we use anchor representation from the global model to guide the local training, and adopt a two-stage approach to first tune deeper layers before updating the entire network. Extensive experiments on real-world datasets demonstrate FedDRA's effectiveness in enhancing medical federated VLP under data heterogeneity. Our method also adapts well to various medical pre-training methods.