Yong Xia

Pedro R. A. S. Bassi, Wenxuan Li, Yucheng Tang et al.

How can we test AI performance? This question seems trivial, but it isn't. Standard benchmarks often have problems such as in-distribution and small-size test sets, oversimplified metrics, unfair comparisons, and short-term outcome pressure. As a consequence, good performance on standard benchmarks does not guarantee success in real-world scenarios. To address these problems, we present Touchstone, a large-scale collaborative segmentation benchmark of 9 types of abdominal organs. This benchmark is based on 5,195 training CT scans from 76 hospitals around the world and 5,903 testing CT scans from 11 additional hospitals. This diverse test set enhances the statistical significance of benchmark results and rigorously evaluates AI algorithms across various out-of-distribution scenarios. We invited 14 inventors of 19 AI algorithms to train their algorithms, while our team, as a third party, independently evaluated these algorithms on three test sets. In addition, we also evaluated pre-existing AI frameworks--which, differing from algorithms, are more flexible and can support different algorithms--including MONAI from NVIDIA, nnU-Net from DKFZ, and numerous other open-source frameworks. We are committed to expanding this benchmark to encourage more innovation of AI algorithms for the medical domain.

Xiaoyu Bai, Yong Xia

Medical images like CT and MRI provide detailed information about the internal structure of the body, and identifying key anatomical structures from these images plays a crucial role in clinical workflows. Current methods treat it as a registration or key-point regression task, which has limitations in accurate matching and can only handle predefined landmarks. Recently, some methods have been introduced to address these limitations. One such method, called SAM, proposes using a dense self-supervised approach to learn a distinct embedding for each point on the CT image and achieving promising results. Nonetheless, SAM may still face difficulties when dealing with structures that have similar appearances but different semantic meanings or similar semantic meanings but different appearances. To overcome these limitations, we propose SAM++, a framework that simultaneously learns appearance and semantic embeddings with a novel fixed-points matching mechanism. We tested the SAM++ framework on two challenging tasks, demonstrating a significant improvement over the performance of SAM and outperforming other existing methods.

Zehui Liao, Shishuai Hu, Ke Zou et al.

Multimodal large language models (MLLMs) have demonstrated significant potential in medical Visual Question Answering (VQA). Yet, they remain prone to hallucinations-incorrect responses that contradict input images, posing substantial risks in clinical decision-making. Detecting these hallucinations is essential for establishing trust in MLLMs among clinicians and patients, thereby enabling their real-world adoption. Current hallucination detection methods, especially semantic entropy (SE), have demonstrated promising hallucination detection capacity for LLMs. However, adapting SE to medical MLLMs by incorporating visual perturbations presents a dilemma. Weak perturbations preserve image content and ensure clinical validity, but may be overlooked by medical MLLMs, which tend to over rely on language priors. In contrast, strong perturbations can distort essential diagnostic features, compromising clinical interpretation. To address this issue, we propose Vision Amplified Semantic Entropy (VASE), which incorporates weak image transformations and amplifies the impact of visual input, to improve hallucination detection in medical VQA. We first estimate the semantic predictive distribution under weak visual transformations to preserve clinical validity, and then amplify visual influence by contrasting this distribution with that derived from a distorted image. The entropy of the resulting distribution is estimated as VASE. Experiments on two medical open-ended VQA datasets demonstrate that VASE consistently outperforms existing hallucination detection methods.

Ziyang Chen, Yiwen Ye, Feilong Tang et al.

Domain generalization (DG) aims to enhance the ability of models trained on source domains to generalize effectively to unseen domains. Recently, Sharpness-Aware Minimization (SAM) has shown promise in this area by reducing the sharpness of the loss landscape to obtain more generalized models. However, SAM and its variants sometimes fail to guide the model toward a flat minimum, and their training processes exhibit limitations, hindering further improvements in model generalization. In this paper, we first propose an improved model training process aimed at encouraging the model to converge to a flat minima. To achieve this, we design a curvature metric that has a minimal effect when the model is far from convergence but becomes increasingly influential in indicating the curvature of the minima as the model approaches a local minimum. Then we derive a novel algorithm from this metric, called Meta Curvature-Aware Minimization (MeCAM), to minimize the curvature around the local minima. Specifically, the optimization objective of MeCAM simultaneously minimizes the regular training loss, the surrogate gap of SAM, and the surrogate gap of meta-learning. We provide theoretical analysis on MeCAM's generalization error and convergence rate, and demonstrate its superiority over existing DG methods through extensive experiments on five benchmark DG datasets, including PACS, VLCS, OfficeHome, TerraIncognita, and DomainNet. Code will be available on GitHub.

Yong Xia, Jingxuan Li, YeTeng Sun et al.

Large Language Models (LLMs) hold significant promise for electrocardiogram (ECG) analysis, yet challenges remain regarding transferability, time-scale information learning, and interpretability. Current methods suffer from model-specific ECG encoders, hindering transfer across LLMs. Furthermore, LLMs struggle to capture crucial time-scale information inherent in ECGs due to Transformer limitations. And their black-box nature limits clinical adoption. To address these limitations, we introduce ECG-aBcDe, a novel ECG encoding method that transforms ECG signals into a universal ECG language readily interpretable by any LLM. By constructing a hybrid dataset of ECG language and natural language, ECG-aBcDe enables direct fine-tuning of pre-trained LLMs without architectural modifications, achieving "construct once, use anywhere" capability. Moreover, the bidirectional convertibility between ECG and ECG language of ECG-aBcDe allows for extracting attention heatmaps from ECG signals, significantly enhancing interpretability. Finally, ECG-aBcDe explicitly represents time-scale information, mitigating Transformer limitations. This work presents a new paradigm for integrating ECG analysis with LLMs. Compared with existing methods, our method achieves competitive performance on ROUGE-L and METEOR. Notably, it delivers significant improvements in the BLEU-4, with improvements of 2.8 times and 3.9 times in in-dataset and cross-dataset evaluations, respectively, reaching scores of 42.58 and 30.76. These results provide strong evidence for the feasibility of the new paradigm.

Xinke Ma, Yibo Yang, Yong Xia et al.

Deformable image registration is able to achieve fast and accurate alignment between a pair of images and thus plays an important role in many medical image studies. The current deep learning (DL)-based image registration approaches directly learn the spatial transformation from one image to another by leveraging a convolutional neural network, requiring ground truth or similarity metric. Nevertheless, these methods only use a global similarity energy function to evaluate the similarity of a pair of images, which ignores the similarity of regions of interest (ROIs) within images. Moreover, DL-based methods often estimate global spatial transformations of image directly, which never pays attention to region spatial transformations of ROIs within images. In this paper, we present a novel dual-flow transformation network with region consistency constraint which maximizes the similarity of ROIs within a pair of images and estimates both global and region spatial transformations simultaneously. Experiments on four public 3D MRI datasets show that the proposed method achieves the best registration performance in accuracy and generalization compared with other state-of-the-art methods.

Bolin Lai, Yuhsuan Wu, Xiaoyu Bai et al.

Using radiological scans to identify liver tumors is crucial for proper patient treatment. This is highly challenging, as top radiologists only achieve F1 scores of roughly 80% (hepatocellular carcinoma (HCC) vs. others) with only moderate inter-rater agreement, even when using multi-phase magnetic resonance (MR) imagery. Thus, there is great impetus for computer-aided diagnosis (CAD) solutions. A critical challenge is to robustly parse a 3D MR volume to localize diagnosable regions of interest (ROI), especially for edge cases. In this paper, we break down this problem using a key-slice parser (KSP), which emulates physician workflows by first identifying key slices and then localizing their corresponding key ROIs. To achieve robustness, the KSP also uses curve-parsing and detection confidence re-weighting. We evaluate our approach on the largest multi-phase MR liver lesion test dataset to date (430 biopsy-confirmed patients). Experiments demonstrate that our KSP can localize diagnosable ROIs with high reliability: 87% patients have an average 3D overlap of >= 40% with the ground truth compared to only 79% using the best tested detector. When coupled with a classifier, we achieve an HCC vs. others F1 score of 0.801, providing a fully-automated CAD performance comparable to top human physicians.

Yutong Xie, Jianpeng Zhang, Zehui Liao et al.

It has been widely recognized that the success of deep learning in image segmentation relies overwhelmingly on a myriad amount of densely annotated training data, which, however, are difficult to obtain due to the tremendous labor and expertise required, particularly for annotating 3D medical images. Although self-supervised learning (SSL) has shown great potential to address this issue, most SSL approaches focus only on image-level global consistency, but ignore the local consistency which plays a pivotal role in capturing structural information for dense prediction tasks such as segmentation. In this paper, we propose a PriorGuided Local (PGL) self-supervised model that learns the region-wise local consistency in the latent feature space. Specifically, we use the spatial transformations, which produce different augmented views of the same image, as a prior to deduce the location relation between two views, which is then used to align the feature maps of the same local region but being extracted on two views. Next, we construct a local consistency loss to minimize the voxel-wise discrepancy between the aligned feature maps. Thus, our PGL model learns the distinctive representations of local regions, and hence is able to retain structural information. This ability is conducive to downstream segmentation tasks. We conducted an extensive evaluation on four public computerized tomography (CT) datasets that cover 11 kinds of major human organs and two tumors. The results indicate that using pre-trained PGL model to initialize a downstream network leads to a substantial performance improvement over both random initialization and the initialization with global consistency-based models. Code and pre-trained weights will be made available at: https://git.io/PGL.

Jianpeng Zhang, Yutong Xie, Yong Xia et al.

Due to the intensive cost of labor and expertise in annotating 3D medical images at a voxel level, most benchmark datasets are equipped with the annotations of only one type of organs and/or tumors, resulting in the so-called partially labeling issue. To address this, we propose a dynamic on-demand network (DoDNet) that learns to segment multiple organs and tumors on partially labeled datasets. DoDNet consists of a shared encoder-decoder architecture, a task encoding module, a controller for generating dynamic convolution filters, and a single but dynamic segmentation head. The information of the current segmentation task is encoded as a task-aware prior to tell the model what the task is expected to solve. Different from existing approaches which fix kernels after training, the kernels in dynamic head are generated adaptively by the controller, conditioned on both input image and assigned task. Thus, DoDNet is able to segment multiple organs and tumors, as done by multiple networks or a multi-head network, in a much efficient and flexible manner. We have created a large-scale partially labeled dataset, termed MOTS, and demonstrated the superior performance of our DoDNet over other competitors on seven organ and tumor segmentation tasks. We also transferred the weights pre-trained on MOTS to a downstream multi-organ segmentation task and achieved state-of-the-art performance. This study provides a general 3D medical image segmentation model that has been pre-trained on a large-scale partially labelled dataset and can be extended (after fine-tuning) to downstream volumetric medical data segmentation tasks. The dataset and code areavailableat: https://git.io/DoDNet

Zhibo Yang, Huanle Xu, Keda Fu et al.

Traditional approaches for handwritten Chinese character recognition suffer in classifying similar characters. In this paper, we propose to discriminate similar handwritten Chinese characters by using weakly supervised learning. Our approach learns a discriminative SVM for each similar pair which simultaneously localizes the discriminative region of similar character and makes the classification. For the first time, similar handwritten Chinese character recognition (SHCCR) is formulated as an optimization problem extended from SVM. We also propose a novel feature descriptor, Gradient Context, and apply bag-of-words model to represent regions with different scales. In our method, we do not need to select a sized-fixed sub-window to differentiate similar characters. The unconstrained property makes our method well adapted to high variance in the size and position of discriminative regions in similar handwritten Chinese characters. We evaluate our proposed approach over the CASIA Chinese character data set and the results show that our method outperforms the state of the art.