Qi Dou

Yitong Jiang, Hongjun Wang, Collin McCarthy et al.

Vision foundation models are bottlenecked by the quadratic cost of self-attention, which limits usable resolution and increases the cost of large-scale pretraining. Subquadratic alternatives such as linear attention and state-space models reduce this cost, but often serialize images into 1D token streams and weaken the 2D spatial structure important for vision. Generalized Spatial Propagation Networks (GSPN) instead propagate context directly on the 2D grid through line-scan recurrences, achieving near-linear complexity without positional embeddings, but have seen little use as foundation-scale encoders. We present C-GSPN, a foundation-scale vision encoder based on 2D spatial propagation. C-GSPN makes the operator practical through three improvements: (1) a fast GSPN CUDA kernel that fuses per-step launches into a single warp-specialized implementation with shared-memory tiling, coalesced access, and a compact multi-channel propagation, reaching over 90% of peak memory bandwidth and running up to 40--52x faster than the original GSPN implementation; (2) a compressed latent-space propagation block with fused normalization, which turns kernel-level speed into block- and model-level efficiency; and (3) a two-stage cross-operator distillation recipe that trains the new architecture from an attention teacher without the cost of from-scratch foundation-scale training. Distilled with 600M image-text pairs, C-GSPN matches an isomorphic ViT baseline with 15% fewer parameters, improves ADE20K segmentation by +2.1%, transfers to high resolution with a fraction of the data needed from scratch, and delivers a 4x end-to-end block speedup at 2K with single-pass, tiling-free inference.

Shizhan Gong, Yuan Zhong, Wenao Ma et al.

Despite that the segment anything model (SAM) achieved impressive results on general-purpose semantic segmentation with strong generalization ability on daily images, its demonstrated performance on medical image segmentation is less precise and not stable, especially when dealing with tumor segmentation tasks that involve objects of small sizes, irregular shapes, and low contrast. Notably, the original SAM architecture is designed for 2D natural images, therefore would not be able to extract the 3D spatial information from volumetric medical data effectively. In this paper, we propose a novel adaptation method for transferring SAM from 2D to 3D for promptable medical image segmentation. Through a holistically designed scheme for architecture modification, we transfer the SAM to support volumetric inputs while retaining the majority of its pre-trained parameters for reuse. The fine-tuning process is conducted in a parameter-efficient manner, wherein most of the pre-trained parameters remain frozen, and only a few lightweight spatial adapters are introduced and tuned. Regardless of the domain gap between natural and medical data and the disparity in the spatial arrangement between 2D and 3D, the transformer trained on natural images can effectively capture the spatial patterns present in volumetric medical images with only lightweight adaptations. We conduct experiments on four open-source tumor segmentation datasets, and with a single click prompt, our model can outperform domain state-of-the-art medical image segmentation models on 3 out of 4 tasks, specifically by 8.25%, 29.87%, and 10.11% for kidney tumor, pancreas tumor, colon cancer segmentation, and achieve similar performance for liver tumor segmentation. We also compare our adaptation method with existing popular adapters, and observed significant performance improvement on most datasets.

Hongzheng Yang, Cheng Chen, Meirui Jiang et al.

Test-time adaptation (TTA) has increasingly been an important topic to efficiently tackle the cross-domain distribution shift at test time for medical images from different institutions. Previous TTA methods have a common limitation of using a fixed learning rate for all the test samples. Such a practice would be sub-optimal for TTA, because test data may arrive sequentially therefore the scale of distribution shift would change frequently. To address this problem, we propose a novel dynamic learning rate adjustment method for test-time adaptation, called DLTTA, which dynamically modulates the amount of weights update for each test image to account for the differences in their distribution shift. Specifically, our DLTTA is equipped with a memory bank based estimation scheme to effectively measure the discrepancy of a given test sample. Based on this estimated discrepancy, a dynamic learning rate adjustment strategy is then developed to achieve a suitable degree of adaptation for each test sample. The effectiveness and general applicability of our DLTTA is extensively demonstrated on three tasks including retinal optical coherence tomography (OCT) segmentation, histopathological image classification, and prostate 3D MRI segmentation. Our method achieves effective and fast test-time adaptation with consistent performance improvement over current state-of-the-art test-time adaptation methods. Code is available at: https://github.com/med-air/DLTTA.

Zhao Wang, Chang Liu, Shaoting Zhang et al.

Foundation models have exhibited remarkable success in various applications, such as disease diagnosis and text report generation. To date, a foundation model for endoscopic video analysis is still lacking. In this paper, we propose Endo-FM, a foundation model specifically developed using massive endoscopic video data. First, we build a video transformer, which captures both local and global long-range dependencies across spatial and temporal dimensions. Second, we pre-train our transformer model using global and local views via a self-supervised manner, aiming to make it robust to spatial-temporal variations and discriminative across different scenes. To develop the foundation model, we construct a large-scale endoscopy video dataset by combining 9 publicly available datasets and a privately collected dataset from Baoshan Branch of Renji Hospital in Shanghai, China. Our dataset overall consists of over 33K video clips with up to 5 million frames, encompassing various protocols, target organs, and disease types. Our pre-trained Endo-FM can be easily adopted for a given downstream task via fine-tuning by serving as the backbone. With experiments on 3 different types of downstream tasks, including classification, segmentation, and detection, our Endo-FM surpasses the current state-of-the-art (SOTA) self-supervised pre-training and adapter-based transfer learning methods by a significant margin, such as VCL (3.1% F1, 4.8% Dice, and 5.5% F1 for classification, segmentation, and detection) and ST-Adapter (5.9% F1, 9.6% Dice, and 9.9% F1 for classification, segmentation, and detection). Code, datasets, and models are released at https://github.com/med-air/Endo-FM.

Karim Lekadir, Aasa Feragen, Abdul Joseph Fofanah et al. · eth-zurich

Despite major advances in artificial intelligence (AI) for medicine and healthcare, the deployment and adoption of AI technologies remain limited in real-world clinical practice. In recent years, concerns have been raised about the technical, clinical, ethical and legal risks associated with medical AI. To increase real world adoption, it is essential that medical AI tools are trusted and accepted by patients, clinicians, health organisations and authorities. This work describes the FUTURE-AI guideline as the first international consensus framework for guiding the development and deployment of trustworthy AI tools in healthcare. The FUTURE-AI consortium was founded in 2021 and currently comprises 118 inter-disciplinary experts from 51 countries representing all continents, including AI scientists, clinicians, ethicists, and social scientists. Over a two-year period, the consortium defined guiding principles and best practices for trustworthy AI through an iterative process comprising an in-depth literature review, a modified Delphi survey, and online consensus meetings. The FUTURE-AI framework was established based on 6 guiding principles for trustworthy AI in healthcare, i.e. Fairness, Universality, Traceability, Usability, Robustness and Explainability. Through consensus, a set of 28 best practices were defined, addressing technical, clinical, legal and socio-ethical dimensions. The recommendations cover the entire lifecycle of medical AI, from design, development and validation to regulation, deployment, and monitoring. FUTURE-AI is a risk-informed, assumption-free guideline which provides a structured approach for constructing medical AI tools that will be trusted, deployed and adopted in real-world practice. Researchers are encouraged to take the recommendations into account in proof-of-concept stages to facilitate future translation towards clinical practice of medical AI.

Nan Lu, Zhao Wang, Xiaoxiao Li et al.

Supervised federated learning (FL) enables multiple clients to share the trained model without sharing their labeled data. However, potential clients might even be reluctant to label their own data, which could limit the applicability of FL in practice. In this paper, we show the possibility of unsupervised FL whose model is still a classifier for predicting class labels, if the class-prior probabilities are shifted while the class-conditional distributions are shared among the unlabeled data owned by the clients. We propose federation of unsupervised learning (FedUL), where the unlabeled data are transformed into surrogate labeled data for each of the clients, a modified model is trained by supervised FL, and the wanted model is recovered from the modified model. FedUL is a very general solution to unsupervised FL: it is compatible with many supervised FL methods, and the recovery of the wanted model can be theoretically guaranteed as if the data have been labeled. Experiments on benchmark and real-world datasets demonstrate the effectiveness of FedUL. Code is available at https://github.com/lunanbit/FedUL.

Meirui Jiang, Hongzheng Yang, Xiaoxiao Li et al.

Despite recent progress on semi-supervised federated learning (FL) for medical image diagnosis, the problem of imbalanced class distributions among unlabeled clients is still unsolved for real-world use. In this paper, we study a practical yet challenging problem of class imbalanced semi-supervised FL (imFed-Semi), which allows all clients to have only unlabeled data while the server just has a small amount of labeled data. This imFed-Semi problem is addressed by a novel dynamic bank learning scheme, which improves client training by exploiting class proportion information. This scheme consists of two parts, i.e., the dynamic bank construction to distill various class proportions for each local client, and the sub-bank classification to impose the local model to learn different class proportions. We evaluate our approach on two public real-world medical datasets, including the intracranial hemorrhage diagnosis with 25,000 CT slices and skin lesion diagnosis with 10,015 dermoscopy images. The effectiveness of our method has been validated with significant performance improvements (7.61% and 4.69%) compared with the second-best on the accuracy, as well as comprehensive analytical studies. Code is available at https://github.com/med-air/imFedSemi.

Yuan Zhong, Chenhui Tang, Yumeng Yang et al.

Eye gaze that reveals human observational patterns has increasingly been incorporated into solutions for vision tasks. Despite recent explorations on leveraging gaze to aid deep networks, few studies exploit gaze as an efficient annotation approach for medical image segmentation which typically entails heavy annotating costs. In this paper, we propose to collect dense weak supervision for medical image segmentation with a gaze annotation scheme. To train with gaze, we propose a multi-level framework that trains multiple networks from discriminative human attention, simulated with a set of pseudo-masks derived by applying hierarchical thresholds on gaze heatmaps. Furthermore, to mitigate gaze noise, a cross-level consistency is exploited to regularize overfitting noisy labels, steering models toward clean patterns learned by peer networks. The proposed method is validated on two public medical datasets of polyp and prostate segmentation tasks. We contribute a high-quality gaze dataset entitled GazeMedSeg as an extension to the popular medical segmentation datasets. To the best of our knowledge, this is the first gaze dataset for medical image segmentation. Our experiments demonstrate that gaze annotation outperforms previous label-efficient annotation schemes in terms of both performance and annotation time. Our collected gaze data and code are available at: https://github.com/med-air/GazeMedSeg.

Guangyuan Li, Jun Lv, Yapeng Tian et al.

Magnetic resonance imaging (MRI) can present multi-contrast images of the same anatomical structures, enabling multi-contrast super-resolution (SR) techniques. Compared with SR reconstruction using a single-contrast, multi-contrast SR reconstruction is promising to yield SR images with higher quality by leveraging diverse yet complementary information embedded in different imaging modalities. However, existing methods still have two shortcomings: (1) they neglect that the multi-contrast features at different scales contain different anatomical details and hence lack effective mechanisms to match and fuse these features for better reconstruction; and (2) they are still deficient in capturing long-range dependencies, which are essential for the regions with complicated anatomical structures. We propose a novel network to comprehensively address these problems by developing a set of innovative Transformer-empowered multi-scale contextual matching and aggregation techniques; we call it McMRSR. Firstly, we tame transformers to model long-range dependencies in both reference and target images. Then, a new multi-scale contextual matching method is proposed to capture corresponding contexts from reference features at different scales. Furthermore, we introduce a multi-scale aggregation mechanism to gradually and interactively aggregate multi-scale matched features for reconstructing the target SR MR image. Extensive experiments demonstrate that our network outperforms state-of-the-art approaches and has great potential to be applied in clinical practice. Codes are available at https://github.com/XAIMI-Lab/McMRSR.

Sarthak Pati, Ujjwal Baid, Brandon Edwards et al.

Although machine learning (ML) has shown promise in numerous domains, there are concerns about generalizability to out-of-sample data. This is currently addressed by centrally sharing ample, and importantly diverse, data from multiple sites. However, such centralization is challenging to scale (or even not feasible) due to various limitations. Federated ML (FL) provides an alternative to train accurate and generalizable ML models, by only sharing numerical model updates. Here we present findings from the largest FL study to-date, involving data from 71 healthcare institutions across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, utilizing the largest dataset of such patients ever used in the literature (25,256 MRI scans from 6,314 patients). We demonstrate a 33% improvement over a publicly trained model to delineate the surgically targetable tumor, and 23% improvement over the tumor's entire extent. We anticipate our study to: 1) enable more studies in healthcare informed by large and diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further quantitative analyses for glioblastoma via performance optimization of our consensus model for eventual public release, and 3) demonstrate the effectiveness of FL at such scale and task complexity as a paradigm shift for multi-site collaborations, alleviating the need for data sharing.

Tianpeng Deng, Yanqi Huang, Guoqiang Han et al.

Histopathological tissue classification is a fundamental task in computational pathology. Deep learning-based models have achieved superior performance but centralized training with data centralization suffers from the privacy leakage problem. Federated learning (FL) can safeguard privacy by keeping training samples locally, but existing FL-based frameworks require a large number of well-annotated training samples and numerous rounds of communication which hinder their practicability in the real-world clinical scenario. In this paper, we propose a universal and lightweight federated learning framework, named Federated Deep-Broad Learning (FedDBL), to achieve superior classification performance with limited training samples and only one-round communication. By simply associating a pre-trained deep learning feature extractor, a fast and lightweight broad learning inference system and a classical federated aggregation approach, FedDBL can dramatically reduce data dependency and improve communication efficiency. Five-fold cross-validation demonstrates that FedDBL greatly outperforms the competitors with only one-round communication and limited training samples, while it even achieves comparable performance with the ones under multiple-round communications. Furthermore, due to the lightweight design and one-round communication, FedDBL reduces the communication burden from 4.6GB to only 276.5KB per client using the ResNet-50 backbone at 50-round training. Since no data or deep model sharing across different clients, the privacy issue is well-solved and the model security is guaranteed with no model inversion attack risk. Code is available at https://github.com/tianpeng-deng/FedDBL.

Wenao Ma, Cheng Chen, Jill Abrigo et al.

Intracerebral hemorrhage (ICH) is the second most common and deadliest form of stroke. Despite medical advances, predicting treat ment outcomes for ICH remains a challenge. This paper proposes a novel prognostic model that utilizes both imaging and tabular data to predict treatment outcome for ICH. Our model is trained on observational data collected from non-randomized controlled trials, providing reliable predictions of treatment success. Specifically, we propose to employ a variational autoencoder model to generate a low-dimensional prognostic score, which can effectively address the selection bias resulting from the non-randomized controlled trials. Importantly, we develop a variational distributions combination module that combines the information from imaging data, non-imaging clinical data, and treatment assignment to accurately generate the prognostic score. We conducted extensive experiments on a real-world clinical dataset of intracerebral hemorrhage. Our proposed method demonstrates a substantial improvement in treatment outcome prediction compared to existing state-of-the-art approaches. Code is available at https://github.com/med-air/TOP-GPM

Yuehao Wang, Yonghao Long, Siu Hin Fan et al.

Reconstruction of the soft tissues in robotic surgery from endoscopic stereo videos is important for many applications such as intra-operative navigation and image-guided robotic surgery automation. Previous works on this task mainly rely on SLAM-based approaches, which struggle to handle complex surgical scenes. Inspired by recent progress in neural rendering, we present a novel framework for deformable tissue reconstruction from binocular captures in robotic surgery under the single-viewpoint setting. Our framework adopts dynamic neural radiance fields to represent deformable surgical scenes in MLPs and optimize shapes and deformations in a learning-based manner. In addition to non-rigid deformations, tool occlusion and poor 3D clues from a single viewpoint are also particular challenges in soft tissue reconstruction. To overcome these difficulties, we present a series of strategies of tool mask-guided ray casting, stereo depth-cueing ray marching and stereo depth-supervised optimization. With experiments on DaVinci robotic surgery videos, our method significantly outperforms the current state-of-the-art reconstruction method for handling various complex non-rigid deformations. To our best knowledge, this is the first work leveraging neural rendering for surgical scene 3D reconstruction with remarkable potential demonstrated. Code is available at: https://github.com/med-air/EndoNeRF.

Cheng Xue, Lequan Yu, Pengfei Chen et al.

Deep neural networks have achieved remarkable success in a wide variety of natural image and medical image computing tasks. However, these achievements indispensably rely on accurately annotated training data. If encountering some noisy-labeled images, the network training procedure would suffer from difficulties, leading to a sub-optimal classifier. This problem is even more severe in the medical image analysis field, as the annotation quality of medical images heavily relies on the expertise and experience of annotators. In this paper, we propose a novel collaborative training paradigm with global and local representation learning for robust medical image classification from noisy-labeled data to combat the lack of high quality annotated medical data. Specifically, we employ the self-ensemble model with a noisy label filter to efficiently select the clean and noisy samples. Then, the clean samples are trained by a collaborative training strategy to eliminate the disturbance from imperfect labeled samples. Notably, we further design a novel global and local representation learning scheme to implicitly regularize the networks to utilize noisy samples in a self-supervised manner. We evaluated our proposed robust learning strategy on four public medical image classification datasets with three types of label noise,ie,random noise, computer-generated label noise, and inter-observer variability noise. Our method outperforms other learning from noisy label methods and we also conducted extensive experiments to analyze each component of our method.

Tao Huang, Kai Chen, Bin Li et al.

Task automation of surgical robot has the potentials to improve surgical efficiency. Recent reinforcement learning (RL) based approaches provide scalable solutions to surgical automation, but typically require extensive data collection to solve a task if no prior knowledge is given. This issue is known as the exploration challenge, which can be alleviated by providing expert demonstrations to an RL agent. Yet, how to make effective use of demonstration data to improve exploration efficiency still remains an open challenge. In this work, we introduce Demonstration-guided EXploration (DEX), an efficient reinforcement learning algorithm that aims to overcome the exploration problem with expert demonstrations for surgical automation. To effectively exploit demonstrations, our method estimates expert-like behaviors with higher values to facilitate productive interactions, and adopts non-parametric regression to enable such guidance at states unobserved in demonstration data. Extensive experiments on $10$ surgical manipulation tasks from SurRoL, a comprehensive surgical simulation platform, demonstrate significant improvements in the exploration efficiency and task success rates of our method. Moreover, we also deploy the learned policies to the da Vinci Research Kit (dVRK) platform to show the effectiveness on the real robot. Code is available at https://github.com/med-air/DEX.

Jiaqi Xu, Xiaowei Hu, Lei Zhu et al.

Video dehazing aims to recover haze-free frames with high visibility and contrast. This paper presents a novel framework to effectively explore the physical haze priors and aggregate temporal information. Specifically, we design a memory-based physical prior guidance module to encode the prior-related features into long-range memory. Besides, we formulate a multi-range scene radiance recovery module to capture space-time dependencies in multiple space-time ranges, which helps to effectively aggregate temporal information from adjacent frames. Moreover, we construct the first large-scale outdoor video dehazing benchmark dataset, which contains videos in various real-world scenarios. Experimental results on both synthetic and real conditions show the superiority of our proposed method.

Quande Liu, Cheng Chen, Qi Dou et al.

Domain generalization typically requires data from multiple source domains for model learning. However, such strong assumption may not always hold in practice, especially in medical field where the data sharing is highly concerned and sometimes prohibitive due to privacy issue. This paper studies the important yet challenging single domain generalization problem, in which a model is learned under the worst-case scenario with only one source domain to directly generalize to different unseen target domains. We present a novel approach to address this problem in medical image segmentation, which extracts and integrates the semantic shape prior information of segmentation that are invariant across domains and can be well-captured even from single domain data to facilitate segmentation under distribution shifts. Besides, a test-time adaptation strategy with dual-consistency regularization is further devised to promote dynamic incorporation of these shape priors under each unseen domain to improve model generalizability. Extensive experiments on two medical image segmentation tasks demonstrate the consistent improvements of our method across various unseen domains, as well as its superiority over state-of-the-art approaches in addressing domain generalization under the worst-case scenario.

Yonghao Long, Wang Wei, Tao Huang et al.

Surgical robot automation has attracted increasing research interest over the past decade, expecting its potential to benefit surgeons, nurses and patients. Recently, the learning paradigm of embodied intelligence has demonstrated promising ability to learn good control policies for various complex tasks, where embodied AI simulators play an essential role to facilitate relevant research. However, existing open-sourced simulators for surgical robot are still not sufficiently supporting human interactions through physical input devices, which further limits effective investigations on how the human demonstrations would affect policy learning. In this work, we study human-in-the-loop embodied intelligence with a new interactive simulation platform for surgical robot learning. Specifically, we establish our platform based on our previously released SurRoL simulator with several new features co-developed to allow high-quality human interaction via an input device. We showcase the improvement of our simulation environment with the designed new features, and validate effectiveness of incorporating human factors in embodied intelligence through the use of human demonstrations and reinforcement learning as a representative example. Promising results are obtained in terms of learning efficiency. Lastly, five new surgical robot training tasks are developed and released, with which we hope to pave the way for future research on surgical embodied intelligence. Our learning platform is publicly released and will be continuously updated in the website: https://med-air.github.io/SurRoL.

Ziyi Wang, Bo Lu, Yonghao Long et al.

Computer-assisted minimally invasive surgery has great potential in benefiting modern operating theatres. The video data streamed from the endoscope provides rich information to support context-awareness for next-generation intelligent surgical systems. To achieve accurate perception and automatic manipulation during the procedure, learning based technique is a promising way, which enables advanced image analysis and scene understanding in recent years. However, learning such models highly relies on large-scale, high-quality, and multi-task labelled data. This is currently a bottleneck for the topic, as available public dataset is still extremely limited in the field of CAI. In this paper, we present and release the first integrated dataset (named AutoLaparo) with multiple image-based perception tasks to facilitate learning-based automation in hysterectomy surgery. Our AutoLaparo dataset is developed based on full-length videos of entire hysterectomy procedures. Specifically, three different yet highly correlated tasks are formulated in the dataset, including surgical workflow recognition, laparoscope motion prediction, and instrument and key anatomy segmentation. In addition, we provide experimental results with state-of-the-art models as reference benchmarks for further model developments and evaluations on this dataset. The dataset is available at https://autolaparo.github.io.

Kai Chen, Rui Cao, Stephen James et al.

In this paper, we propose an iterative self-training framework for sim-to-real 6D object pose estimation to facilitate cost-effective robotic grasping. Given a bin-picking scenario, we establish a photo-realistic simulator to synthesize abundant virtual data, and use this to train an initial pose estimation network. This network then takes the role of a teacher model, which generates pose predictions for unlabeled real data. With these predictions, we further design a comprehensive adaptive selection scheme to distinguish reliable results, and leverage them as pseudo labels to update a student model for pose estimation on real data. To continuously improve the quality of pseudo labels, we iterate the above steps by taking the trained student model as a new teacher and re-label real data using the refined teacher model. We evaluate our method on a public benchmark and our newly-released dataset, achieving an ADD(-S) improvement of 11.49% and 22.62% respectively. Our method is also able to improve robotic bin-picking success by 19.54%, demonstrating the potential of iterative sim-to-real solutions for robotic applications.

Xiao Gu, Yao Guo, Zeju Li et al. · oxford

Machine learning models fail to perform well on real-world applications when 1) the category distribution P(Y) of the training dataset suffers from long-tailed distribution and 2) the test data is drawn from different conditional distributions P(X|Y). Existing approaches cannot handle the scenario where both issues exist, which however is common for real-world applications. In this study, we took a step forward and looked into the problem of long-tailed classification under domain shifts. We designed three novel core functional blocks including Distribution Calibrated Classification Loss, Visual-Semantic Mapping and Semantic-Similarity Guided Augmentation. Furthermore, we adopted a meta-learning framework which integrates these three blocks to improve domain generalization on unseen target domains. Two new datasets were proposed for this problem, named AWA2-LTS and ImageNet-LTS. We evaluated our method on the two datasets and extensive experimental results demonstrate that our proposed method can achieve superior performance over state-of-the-art long-tailed/domain generalization approaches and the combinations. Source codes and datasets can be found at our project page https://xiaogu.site/LTDS.

Carole H. Sudre, Kimberlin Van Wijnen, Florian Dubost et al.

Imaging markers of cerebral small vessel disease provide valuable information on brain health, but their manual assessment is time-consuming and hampered by substantial intra- and interrater variability. Automated rating may benefit biomedical research, as well as clinical assessment, but diagnostic reliability of existing algorithms is unknown. Here, we present the results of the \textit{VAscular Lesions DetectiOn and Segmentation} (\textit{Where is VALDO?}) challenge that was run as a satellite event at the international conference on Medical Image Computing and Computer Aided Intervention (MICCAI) 2021. This challenge aimed to promote the development of methods for automated detection and segmentation of small and sparse imaging markers of cerebral small vessel disease, namely enlarged perivascular spaces (EPVS) (Task 1), cerebral microbleeds (Task 2) and lacunes of presumed vascular origin (Task 3) while leveraging weak and noisy labels. Overall, 12 teams participated in the challenge proposing solutions for one or more tasks (4 for Task 1 - EPVS, 9 for Task 2 - Microbleeds and 6 for Task 3 - Lacunes). Multi-cohort data was used in both training and evaluation. Results showed a large variability in performance both across teams and across tasks, with promising results notably for Task 1 - EPVS and Task 2 - Microbleeds and not practically useful results yet for Task 3 - Lacunes. It also highlighted the performance inconsistency across cases that may deter use at an individual level, while still proving useful at a population level.

Kai Chen, Stephen James, Congying Sui et al.

Most existing methods for category-level pose estimation rely on object point clouds. However, when considering transparent objects, depth cameras are usually not able to capture meaningful data, resulting in point clouds with severe artifacts. Without a high-quality point cloud, existing methods are not applicable to challenging transparent objects. To tackle this problem, we present StereoPose, a novel stereo image framework for category-level object pose estimation, ideally suited for transparent objects. For a robust estimation from pure stereo images, we develop a pipeline that decouples category-level pose estimation into object size estimation, initial pose estimation, and pose refinement. StereoPose then estimates object pose based on representation in the normalized object coordinate space~(NOCS). To address the issue of image content aliasing, we further define a back-view NOCS map for the transparent object. The back-view NOCS aims to reduce the network learning ambiguity caused by content aliasing, and leverage informative cues on the back of the transparent object for more accurate pose estimation. To further improve the performance of the stereo framework, StereoPose is equipped with a parallax attention module for stereo feature fusion and an epipolar loss for improving the stereo-view consistency of network predictions. Extensive experiments on the public TOD dataset demonstrate the superiority of the proposed StereoPose framework for category-level 6D transparent object pose estimation.

Minghui Chen, Meirui Jiang, Qi Dou et al.

Cross-silo federated learning (FL) enables the development of machine learning models on datasets distributed across data centers such as hospitals and clinical research laboratories. However, recent research has found that current FL algorithms face a trade-off between local and global performance when confronted with distribution shifts. Specifically, personalized FL methods have a tendency to overfit to local data, leading to a sharp valley in the local model and inhibiting its ability to generalize to out-of-distribution data. In this paper, we propose a novel federated model soup method (i.e., selective interpolation of model parameters) to optimize the trade-off between local and global performance. Specifically, during the federated training phase, each client maintains its own global model pool by monitoring the performance of the interpolated model between the local and global models. This allows us to alleviate overfitting and seek flat minima, which can significantly improve the model's generalization performance. We evaluate our method on retinal and pathological image classification tasks, and our proposed method achieves significant improvements for out-of-distribution generalization. Our code is available at https://github.com/ubc-tea/FedSoup.

Meirui Jiang, Holger R Roth, Wenqi Li et al.

How to ensure fairness is an important topic in federated learning (FL). Recent studies have investigated how to reward clients based on their contribution (collaboration fairness), and how to achieve uniformity of performance across clients (performance fairness). Despite achieving progress on either one, we argue that it is critical to consider them together, in order to engage and motivate more diverse clients joining FL to derive a high-quality global model. In this work, we propose a novel method to optimize both types of fairness simultaneously. Specifically, we propose to estimate client contribution in gradient and data space. In gradient space, we monitor the gradient direction differences of each client with respect to others. And in data space, we measure the prediction error on client data using an auxiliary model. Based on this contribution estimation, we propose a FL method, federated training via contribution estimation (FedCE), i.e., using estimation as global model aggregation weights. We have theoretically analyzed our method and empirically evaluated it on two real-world medical datasets. The effectiveness of our approach has been validated with significant performance improvements, better collaboration fairness, better performance fairness, and comprehensive analytical studies.

Yidan Feng, Biqi Yang, Xianzhi Li et al.

Industrial bin picking is a challenging task that requires accurate and robust segmentation of individual object instances. Particularly, industrial objects can have irregular shapes, that is, thin and concave, whereas in bin-picking scenarios, objects are often closely packed with strong occlusion. To address these challenges, we formulate a novel part-aware instance segmentation pipeline. The key idea is to decompose industrial objects into correlated approximate convex parts and enhance the object-level segmentation with part-level segmentation. We design a part-aware network to predict part masks and part-to-part offsets, followed by a part aggregation module to assemble the recognized parts into instances. To guide the network learning, we also propose an automatic label decoupling scheme to generate ground-truth part-level labels from instance-level labels. Finally, we contribute the first instance segmentation dataset, which contains a variety of industrial objects that are thin and have non-trivial shapes. Extensive experimental results on various industrial objects demonstrate that our method can achieve the best segmentation results compared with the state-of-the-art approaches.

Matthias Eisenmann, Annika Reinke, Vivienn Weru et al.

International benchmarking competitions have become fundamental for the comparative performance assessment of image analysis methods. However, little attention has been given to investigating what can be learnt from these competitions. Do they really generate scientific progress? What are common and successful participation strategies? What makes a solution superior to a competing method? To address this gap in the literature, we performed a multi-center study with all 80 competitions that were conducted in the scope of IEEE ISBI 2021 and MICCAI 2021. Statistical analyses performed based on comprehensive descriptions of the submitted algorithms linked to their rank as well as the underlying participation strategies revealed common characteristics of winning solutions. These typically include the use of multi-task learning (63%) and/or multi-stage pipelines (61%), and a focus on augmentation (100%), image preprocessing (97%), data curation (79%), and postprocessing (66%). The "typical" lead of a winning team is a computer scientist with a doctoral degree, five years of experience in biomedical image analysis, and four years of experience in deep learning. Two core general development strategies stood out for highly-ranked teams: the reflection of the metrics in the method design and the focus on analyzing and handling failure cases. According to the organizers, 43% of the winning algorithms exceeded the state of the art but only 11% completely solved the respective domain problem. The insights of our study could help researchers (1) improve algorithm development strategies when approaching new problems, and (2) focus on open research questions revealed by this work.

Wenao Ma, Cheng Chen, Shuang Zheng et al.

Class distribution plays an important role in learning deep classifiers. When the proportion of each class in the test set differs from the training set, the performance of classification nets usually degrades. Such a label distribution shift problem is common in medical diagnosis since the prevalence of disease vary over location and time. In this paper, we propose the first method to tackle label shift for medical image classification, which effectively adapt the model learned from a single training label distribution to arbitrary unknown test label distribution. Our approach innovates distribution calibration to learn multiple representative classifiers, which are capable of handling different one-dominating-class distributions. When given a test image, the diverse classifiers are dynamically aggregated via the consistency-driven test-time adaptation, to deal with the unknown test label distribution. We validate our method on two important medical image classification tasks including liver fibrosis staging and COVID-19 severity prediction. Our experiments clearly show the decreased model performance under label shift. With our method, model performance significantly improves on all the test datasets with different label shifts for both medical image diagnosis tasks.

Tao Huang, Kai Chen, Wang Wei et al.

Reinforcement learning is still struggling with solving long-horizon surgical robot tasks which involve multiple steps over an extended duration of time due to the policy exploration challenge. Recent methods try to tackle this problem by skill chaining, in which the long-horizon task is decomposed into multiple subtasks for easing the exploration burden and subtask policies are temporally connected to complete the whole long-horizon task. However, smoothly connecting all subtask policies is difficult for surgical robot scenarios. Not all states are equally suitable for connecting two adjacent subtasks. An undesired terminate state of the previous subtask would make the current subtask policy unstable and result in a failed execution. In this work, we introduce value-informed skill chaining (ViSkill), a novel reinforcement learning framework for long-horizon surgical robot tasks. The core idea is to distinguish which terminal state is suitable for starting all the following subtask policies. To achieve this target, we introduce a state value function that estimates the expected success probability of the entire task given a state. Based on this value function, a chaining policy is learned to instruct subtask policies to terminate at the state with the highest value so that all subsequent policies are more likely to be connected for accomplishing the task. We demonstrate the effectiveness of our method on three complex surgical robot tasks from SurRoL, a comprehensive surgical simulation platform, achieving high task success rates and execution efficiency. Code is available at $\href{https://github.com/med-air/ViSkill}{\text{https://github.com/med-air/ViSkill}}$.

Yang Yu, Zixu Zhao, Yueming Jin et al.

Surgical scene segmentation is fundamentally crucial for prompting cognitive assistance in robotic surgery. However, pixel-wise annotating surgical video in a frame-by-frame manner is expensive and time consuming. To greatly reduce the labeling burden, in this work, we study semi-supervised scene segmentation from robotic surgical video, which is practically essential yet rarely explored before. We consider a clinically suitable annotation situation under the equidistant sampling. We then propose PGV-CL, a novel pseudo-label guided cross-video contrast learning method to boost scene segmentation. It effectively leverages unlabeled data for a trusty and global model regularization that produces more discriminative feature representation. Concretely, for trusty representation learning, we propose to incorporate pseudo labels to instruct the pair selection, obtaining more reliable representation pairs for pixel contrast. Moreover, we expand the representation learning space from previous image-level to cross-video, which can capture the global semantics to benefit the learning process. We extensively evaluate our method on a public robotic surgery dataset EndoVis18 and a public cataract dataset CaDIS. Experimental results demonstrate the effectiveness of our method, consistently outperforming the state-of-the-art semi-supervised methods under different labeling ratios, and even surpassing fully supervised training on EndoVis18 with 10.1% labeling.

Huizi Yu, Jiayan Zhou, Lingyao Li et al. · harvard

Background: Simulated patient systems are important in medical education and research, providing safe, integrative training environments and supporting clinical decision making. Advances in artificial intelligence (AI), especially large language models (LLMs), can enhance simulated patients by replicating medical conditions and doctor patient interactions with high fidelity and at low cost, but effectiveness and trustworthiness remain open challenges. Methods: We developed AIPatient, a simulated patient system powered by LLM based AI agents. The system uses a retrieval augmented generation (RAG) framework with six task specific agents for complex reasoning. To improve realism, it is linked to the AIPatient knowledge graph built from de identified real patient data in the MIMIC III intensive care database. Results: We evaluated electronic health record (EHR) based medical question answering (QA), readability, robustness, stability, and user experience. AIPatient reached 94.15 percent QA accuracy when all six agents were enabled, outperforming versions with partial or no agent integration. The knowledge base achieved an F1 score of 0.89. Readability scores showed a median Flesch Reading Ease of 68.77 and a median Flesch Kincaid Grade of 6.4, indicating accessibility for most medical trainees and clinicians. Robustness and stability were supported by non significant variance in repeated trials (analysis of variance F value 0.61, p greater than 0.1; F value 0.78, p greater than 0.1). A user study with medical students showed that AIPatient provides high fidelity, usability, and educational value, comparable to or better than human simulated patients for history taking. Conclusions: LLM based simulated patient systems can deliver accurate, readable, and reliable medical encounters and show strong potential to transform medical education.

Yang Yu, Danruo Deng, Furui Liu et al.

Semi-supervised learning (SSL) methods assume that labeled data, unlabeled data and test data are from the same distribution. Open-set semi-supervised learning (Open-set SSL) considers a more practical scenario, where unlabeled data and test data contain new categories (outliers) not observed in labeled data (inliers). Most previous works focused on outlier detection via binary classifiers, which suffer from insufficient scalability and inability to distinguish different types of uncertainty. In this paper, we propose a novel framework, Adaptive Negative Evidential Deep Learning (ANEDL) to tackle these limitations. Concretely, we first introduce evidential deep learning (EDL) as an outlier detector to quantify different types of uncertainty, and design different uncertainty metrics for self-training and inference. Furthermore, we propose a novel adaptive negative optimization strategy, making EDL more tailored to the unlabeled dataset containing both inliers and outliers. As demonstrated empirically, our proposed method outperforms existing state-of-the-art methods across four datasets.

Jiaqi Xu, Mengyang Wu, Xiaowei Hu et al.

This paper addresses the limitations of adverse weather image restoration approaches trained on synthetic data when applied to real-world scenarios. We formulate a semi-supervised learning framework employing vision-language models to enhance restoration performance across diverse adverse weather conditions in real-world settings. Our approach involves assessing image clearness and providing semantics using vision-language models on real data, serving as supervision signals for training restoration models. For clearness enhancement, we use real-world data, utilizing a dual-step strategy with pseudo-labels assessed by vision-language models and weather prompt learning. For semantic enhancement, we integrate real-world data by adjusting weather conditions in vision-language model descriptions while preserving semantic meaning. Additionally, we introduce an effective training strategy to bootstrap restoration performance. Our approach achieves superior results in real-world adverse weather image restoration, demonstrated through qualitative and quantitative comparisons with state-of-the-art works.

Meirui Jiang, Yuan Zhong, Anjie Le et al.

Despite recent progress in enhancing the privacy of federated learning (FL) via differential privacy (DP), the trade-off of DP between privacy protection and performance is still underexplored for real-world medical scenario. In this paper, we propose to optimize the trade-off under the context of client-level DP, which focuses on privacy during communications. However, FL for medical imaging involves typically much fewer participants (hospitals) than other domains (e.g., mobile devices), thus ensuring clients be differentially private is much more challenging. To tackle this problem, we propose an adaptive intermediary strategy to improve performance without harming privacy. Specifically, we theoretically find splitting clients into sub-clients, which serve as intermediaries between hospitals and the server, can mitigate the noises introduced by DP without harming privacy. Our proposed approach is empirically evaluated on both classification and segmentation tasks using two public datasets, and its effectiveness is demonstrated with significant performance improvements and comprehensive analytical studies. Code is available at: https://github.com/med-air/Client-DP-FL.

Ruinan Jin, Zikang Xu, Yuan Zhong et al.

The advent of foundation models (FMs) in healthcare offers unprecedented opportunities to enhance medical diagnostics through automated classification and segmentation tasks. However, these models also raise significant concerns about their fairness, especially when applied to diverse and underrepresented populations in healthcare applications. Currently, there is a lack of comprehensive benchmarks, standardized pipelines, and easily adaptable libraries to evaluate and understand the fairness performance of FMs in medical imaging, leading to considerable challenges in formulating and implementing solutions that ensure equitable outcomes across diverse patient populations. To fill this gap, we introduce FairMedFM, a fairness benchmark for FM research in medical imaging.FairMedFM integrates with 17 popular medical imaging datasets, encompassing different modalities, dimensionalities, and sensitive attributes. It explores 20 widely used FMs, with various usages such as zero-shot learning, linear probing, parameter-efficient fine-tuning, and prompting in various downstream tasks -- classification and segmentation. Our exhaustive analysis evaluates the fairness performance over different evaluation metrics from multiple perspectives, revealing the existence of bias, varied utility-fairness trade-offs on different FMs, consistent disparities on the same datasets regardless FMs, and limited effectiveness of existing unfairness mitigation methods. Checkout FairMedFM's project page and open-sourced codebase, which supports extendible functionalities and applications as well as inclusive for studies on FMs in medical imaging over the long term.

Shizhan Gong, Cheng Chen, Yuqi Gong et al.

Brain midline shift (MLS) is one of the most critical factors to be considered for clinical diagnosis and treatment decision-making for intracranial hemorrhage. Existing computational methods on MLS quantification not only require intensive labeling in millimeter-level measurement but also suffer from poor performance due to their dependence on specific landmarks or simplified anatomical assumptions. In this paper, we propose a novel semi-supervised framework to accurately measure the scale of MLS from head CT scans. We formulate the MLS measurement task as a deformation estimation problem and solve it using a few MLS slices with sparse labels. Meanwhile, with the help of diffusion models, we are able to use a great number of unlabeled MLS data and 2793 non-MLS cases for representation learning and regularization. The extracted representation reflects how the image is different from a non-MLS image and regularization serves an important role in the sparse-to-dense refinement of the deformation field. Our experiment on a real clinical brain hemorrhage dataset has achieved state-of-the-art performance and can generate interpretable deformation fields.

Bingchen Gong, Yuehao Wang, Xiaoguang Han et al.

Radiance fields have gradually become a main representation of media. Although its appearance editing has been studied, how to achieve view-consistent recoloring in an efficient manner is still under explored. We present RecolorNeRF, a novel user-friendly color editing approach for the neural radiance fields. Our key idea is to decompose the scene into a set of pure-colored layers, forming a palette. By this means, color manipulation can be conducted by altering the color components of the palette directly. To support efficient palette-based editing, the color of each layer needs to be as representative as possible. In the end, the problem is formulated as an optimization problem, where the layers and their blending weights are jointly optimized with the NeRF itself. Extensive experiments show that our jointly-optimized layer decomposition can be used against multiple backbones and produce photo-realistic recolored novel-view renderings. We demonstrate that RecolorNeRF outperforms baseline methods both quantitatively and qualitatively for color editing even in complex real-world scenes.

Jiaxin Guo, Jiangliu Wang, Ruofeng Wei et al.

Visualizing surgical scenes is crucial for revealing internal anatomical structures during minimally invasive procedures. Novel View Synthesis is a vital technique that offers geometry and appearance reconstruction, enhancing understanding, planning, and decision-making in surgical scenes. Despite the impressive achievements of Neural Radiance Field (NeRF), its direct application to surgical scenes produces unsatisfying results due to two challenges: endoscopic sparse views and significant photometric inconsistencies. In this paper, we propose uncertainty-aware conditional NeRF for novel view synthesis to tackle the severe shape-radiance ambiguity from sparse surgical views. The core of UC-NeRF is to incorporate the multi-view uncertainty estimation to condition the neural radiance field for modeling the severe photometric inconsistencies adaptively. Specifically, our UC-NeRF first builds a consistency learner in the form of multi-view stereo network, to establish the geometric correspondence from sparse views and generate uncertainty estimation and feature priors. In neural rendering, we design a base-adaptive NeRF network to exploit the uncertainty estimation for explicitly handling the photometric inconsistencies. Furthermore, an uncertainty-guided geometry distillation is employed to enhance geometry learning. Experiments on the SCARED and Hamlyn datasets demonstrate our superior performance in rendering appearance and geometry, consistently outperforming the current state-of-the-art approaches. Our code will be released at https://github.com/wrld/UC-NeRF.

Wenao Ma, Shuang Zheng, Lei Zhang et al.

Despite the remarkable success on medical image analysis with deep learning, it is still under exploration regarding how to rapidly transfer AI models from one dataset to another for clinical applications. This paper presents a novel and generic human-in-the-loop scheme for efficiently transferring a segmentation model from a small-scale labelled dataset to a larger-scale unlabelled dataset for multi-organ segmentation in CT. To achieve this, we propose to use an igniter network which can learn from a small-scale labelled dataset and generate coarse annotations to start the process of human-machine interaction. Then, we use a sustainer network for our larger-scale dataset, and iteratively updated it on the new annotated data. Moreover, we propose a flexible labelling strategy for the annotator to reduce the initial annotation workload. The model performance and the time cost of annotation in each subject evaluated on our private dataset are reported and analysed. The results show that our scheme can not only improve the performance by 19.7% on Dice, but also expedite the cost time of manual labelling from 13.87 min to 1.51 min per CT volume during the model transfer, demonstrating the clinical usefulness with promising potentials.

Jun Zhou, Kai Chen, Linlin Xu et al.

One critical challenge in 6D object pose estimation from a single RGBD image is efficient integration of two different modalities, i.e., color and depth. In this work, we tackle this problem by a novel Deep Fusion Transformer~(DFTr) block that can aggregate cross-modality features for improving pose estimation. Unlike existing fusion methods, the proposed DFTr can better model cross-modality semantic correlation by leveraging their semantic similarity, such that globally enhanced features from different modalities can be better integrated for improved information extraction. Moreover, to further improve robustness and efficiency, we introduce a novel weighted vector-wise voting algorithm that employs a non-iterative global optimization strategy for precise 3D keypoint localization while achieving near real-time inference. Extensive experiments show the effectiveness and strong generalization capability of our proposed 3D keypoint voting algorithm. Results on four widely used benchmarks also demonstrate that our method outperforms the state-of-the-art methods by large margins.

Hongzheng Yang, Cheng Chen, Yueyao Chen et al.

Uncertainty estimation plays an important role for future reliable deployment of deep segmentation models in safety-critical scenarios such as medical applications. However, existing methods for uncertainty estimation have been limited by the lack of explicit guidance for calibrating the prediction risk and model confidence. In this work, we propose a novel fine-grained reward maximization (FGRM) framework, to address uncertainty estimation by directly utilizing an uncertainty metric related reward function with a reinforcement learning based model tuning algorithm. This would benefit the model uncertainty estimation through direct optimization guidance for model calibration. Specifically, our method designs a new uncertainty estimation reward function using the calibration metric, which is maximized to fine-tune an evidential learning pre-trained segmentation model for calibrating prediction risk. Importantly, we innovate an effective fine-grained parameter update scheme, which imposes fine-grained reward-weighting of each network parameter according to the parameter importance quantified by the fisher information matrix. To the best of our knowledge, this is the first work exploring reward optimization for model uncertainty estimation in safety-critical vision tasks. The effectiveness of our method is demonstrated on two large safety-critical surgical scene segmentation datasets under two different uncertainty estimation settings. With real-time one forward pass at inference, our method outperforms state-of-the-art methods by a clear margin on all the calibration metrics of uncertainty estimation, while maintaining a high task accuracy for the segmentation results. Code is available at \url{https://github.com/med-air/FGRM}.

Yiyao Ma, Kai Chen, Zhongxiang Zhou et al.

Monocular 3D shape recovery is fundamental to geometric understanding, yet achieving robust generalization across arbitrary viewpoints and unseen object categories remains a significant challenge. In this paper, we present a generalizable deformation learning framework that reconstructs 3D objects by explicitly deforming a category-level shape template to match the target observation. To address complex shape variations between the template and the target, we introduce a geometry-guided feature modeling mechanism. This process first enriches foundation features with template topology to yield a geometry-aware representation, which is then explicitly correlated with the target observation to guide precise deformation. Furthermore, to bridge the disparity between the fixed template and arbitrary target views, we propose a view-adaptive feature aggregation module. This module leverages multi-view template features and their corresponding camera poses to enrich the canonical template representation, ensuring robust feature alignment regardless of the target's perspective. Extensive experiments demonstrate that our approach significantly outperforms state-of-the-art methods in handling large shape variations and diverse viewpoints, exhibiting strong generalization to novel categories and effectively supporting downstream real-world dexterous robotic manipulation tasks. Project homepage: https://GODeform.github.io/

Zhitao Zeng, Mengya Xu, Jian Jiang et al.

Surgical intelligence has the potential to improve the safety and consistency of surgical care, yet most existing surgical AI frameworks remain task-specific and struggle to generalize across procedures and institutions. Although multimodal foundation models, particularly multimodal large language models, have demonstrated strong cross-task capabilities across various medical domains, their advancement in surgery remains constrained by the lack of large-scale, systematically curated multimodal data. To address this challenge, we introduce Surg$Σ$, a spectrum of large-scale multimodal data and foundation models for surgical intelligence. At the core of this framework lies Surg$Σ$-DB, a large-scale multimodal data foundation designed to support diverse surgical tasks. Surg$Σ$-DB consolidates heterogeneous surgical data sources (including open-source datasets, curated in-house clinical collections and web-source data) into a unified schema, aiming to improve label consistency and data standardization across heterogeneous datasets. Surg$Σ$-DB spans 6 clinical specialties and diverse surgical types, providing rich image- and video-level annotations across 18 practical surgical tasks covering understanding, reasoning, planning, and generation, at an unprecedented scale (over 5.98M conversations). Beyond conventional multimodal conversations, Surg$Σ$-DB incorporates hierarchical reasoning annotations, providing richer semantic cues to support deeper contextual understanding in complex surgical scenarios. We further provide empirical evidence through recently developed surgical foundation models built upon Surg$Σ$-DB, illustrating the practical benefits of large-scale multimodal annotations, unified semantic design, and structured reasoning annotations for improving cross-task generalization and interpretability.

Junming Chen, Meirui Jiang, Qi Dou et al.

Domain generalization (DG) has been a hot topic in image recognition, with a goal to train a general model that can perform well on unseen domains. Recently, federated learning (FL), an emerging machine learning paradigm to train a global model from multiple decentralized clients without compromising data privacy, brings new challenges, also new possibilities, to DG. In the FL scenario, many existing state-of-the-art (SOTA) DG methods become ineffective, because they require the centralization of data from different domains during training. In this paper, we propose a novel domain generalization method for image recognition under federated learning through cross-client style transfer (CCST) without exchanging data samples. Our CCST method can lead to more uniform distributions of source clients, and thus make each local model learn to fit the image styles of all the clients to avoid the different model biases. Two types of style (single image style and overall domain style) with corresponding mechanisms are proposed to be chosen according to different scenarios. Our style representation is exceptionally lightweight and can hardly be used for the reconstruction of the dataset. The level of diversity is also flexible to be controlled with a hyper-parameter. Our method outperforms recent SOTA DG methods on two DG benchmarks (PACS, OfficeHome) and a large-scale medical image dataset (Camelyon17) in the FL setting. Last but not least, our method is orthogonal to many classic DG methods, achieving additive performance by combined utilization.

Meirui Jiang, Hongzheng Yang, Chen Cheng et al.

Federated learning (FL) allows multiple medical institutions to collaboratively learn a global model without centralizing client data. It is difficult, if possible at all, for such a global model to commonly achieve optimal performance for each individual client, due to the heterogeneity of medical images from various scanners and patient demographics. This problem becomes even more significant when deploying the global model to unseen clients outside the FL with unseen distributions not presented during federated training. To optimize the prediction accuracy of each individual client for medical imaging tasks, we propose a novel unified framework for both \textit{Inside and Outside model Personalization in FL} (IOP-FL). Our inside personalization uses a lightweight gradient-based approach that exploits the local adapted model for each client, by accumulating both the global gradients for common knowledge and the local gradients for client-specific optimization. Moreover, and importantly, the obtained local personalized models and the global model can form a diverse and informative routing space to personalize an adapted model for outside FL clients. Hence, we design a new test-time routing scheme using the consistency loss with a shape constraint to dynamically incorporate the models, given the distribution information conveyed by the test data. Our extensive experimental results on two medical image segmentation tasks present significant improvements over SOTA methods on both inside and outside personalization, demonstrating the potential of our IOP-FL scheme for clinical practice.

Qianhan Feng, Zhongzhen Huang, Yakun Zhu et al.

Vision-Language Models (VLMs) show promise in medical diagnosis, yet suffer from reasoning detachment, where linguistically fluent explanations drift from verifiable image evidence, undermining clinical trust. Recent multi-agent frameworks simulate Multidisciplinary Team (MDT) debates to mitigate single-model bias, but open-ended discussions amplify textual noise and computational cost while failing to anchor reasoning to visual evidence, the cornerstone of medical decision-making. We propose UCAgents, a hierarchical multi-agent framework enforcing unidirectional convergence through structured evidence auditing. Inspired by clinical workflows, UCAgents forbids position changes and limits agent interactions to targeted evidence verification, suppressing rhetorical drift while amplifying visual signal extraction. In UCAgents, a one-round inquiry discussion is introduced to uncover potential risks of visual-textual misalignment. This design jointly constrains visual ambiguity and textual noise, a dual-noise bottleneck that we formalize via information theory. Extensive experiments on four medical VQA benchmarks show UCAgents achieves superior accuracy (71.3% on PathVQA, +6.0% over state-of-the-art) with 87.7% lower token cost, the evaluation results further confirm that UCAgents strikes a balance between uncovering more visual evidence and avoiding confusing textual interference. These results demonstrate that UCAgents exhibits both diagnostic reliability and computational efficiency critical for real-world clinical deployment. Code is available at https://github.com/fqhank/UCAgents.

Daiyun Shen, Shuojue Yang, Chang Han Low et al.

Surgical instrument pose estimation provides crucial information for promising applications, including autonomous robotic surgery, skill assessment, and standardization of surgical workflow. However, this task remains highly challenging due to high precision requirements, frequent occlusions, textureless instruments, scarcity of depth information and very limited annotated data. These constraints often lead to unsatisfactory performance when employing general object pose estimation approaches to surgical scenarios. To address these issues, we first construct a new dataset SynSurg6D, to alleviate the data shortage in this task. We further propose SurfSurg6D, a dense-correspondence framework tailored for surgical instrument pose estimation. Experimental results on the SurgRIPE, EndoVis2018 and SurgPose datasets demonstrate that the introduction of our generated dataset SynSurg6D is able to diversify the pose distributions, thus enhancing the performance of existing approaches. Furthermore, SurfSurg6D outperforms existing methods, providing a robust solution for precise and efficient RGB-only pose estimation.

Congzhen Shi, Ryan Rezai, Jiaxi Yang et al.

The rapid advancement of foundation models in medical imaging represents a significant leap toward enhancing diagnostic accuracy and personalized treatment. However, the deployment of foundation models in healthcare necessitates a rigorous examination of their trustworthiness, encompassing privacy, robustness, reliability, explainability, and fairness. The current body of survey literature on foundation models in medical imaging reveals considerable gaps, particularly in the area of trustworthiness. Additionally, existing surveys on the trustworthiness of foundation models do not adequately address their specific variations and applications within the medical imaging domain. This survey aims to fill that gap by presenting a novel taxonomy of foundation models used in medical imaging and analyzing the key motivations for ensuring their trustworthiness. We review current research on foundation models in major medical imaging applications, focusing on segmentation, medical report generation, medical question and answering (Q\&A), and disease diagnosis. These areas are highlighted because they have seen a relatively mature and substantial number of foundation models compared to other applications. We focus on literature that discusses trustworthiness in medical image analysis manuscripts. We explore the complex challenges of building trustworthy foundation models for each application, summarizing current concerns and strategies for enhancing trustworthiness. Furthermore, we examine the potential of these models to revolutionize patient care. Our analysis underscores the imperative for advancing towards trustworthy AI in medical image analysis, advocating for a balanced approach that fosters innovation while ensuring ethical and equitable healthcare delivery.

Wenlong Deng, Yuan Zhong, Qi Dou et al.

Mitigating the discrimination of machine learning models has gained increasing attention in medical image analysis. However, rare works focus on fair treatments for patients with multiple sensitive demographic ones, which is a crucial yet challenging problem for real-world clinical applications. In this paper, we propose a novel method for fair representation learning with respect to multi-sensitive attributes. We pursue the independence between target and multi-sensitive representations by achieving orthogonality in the representation space. Concretely, we enforce the column space orthogonality by keeping target information on the complement of a low-rank sensitive space. Furthermore, in the row space, we encourage feature dimensions between target and sensitive representations to be orthogonal. The effectiveness of the proposed method is demonstrated with extensive experiments on the CheXpert dataset. To our best knowledge, this is the first work to mitigate unfairness with respect to multiple sensitive attributes in the field of medical imaging.

Yonghao Long, Chengkun Li, Qi Dou

With the growing popularity of robotic surgery, education becomes increasingly important and urgently needed for the sake of patient safety. However, experienced surgeons have limited accessibility due to their busy clinical schedule or working in a distant city, thus can hardly provide sufficient education resources for novices. Remote mentoring, as an effective way, can help solve this problem, but traditional methods are limited to plain text, audio, or 2D video, which are not intuitive nor vivid. Augmented reality (AR), a thriving technique being widely used for various education scenarios, is promising to offer new possibilities of visual experience and interactive teaching. In this paper, we propose a novel AR-based robotic surgery remote mentoring system with efficient 3D scene visualization and natural 3D hand interaction. Using a head-mounted display (i.e., HoloLens), the mentor can remotely monitor the procedure streamed from the trainee's operation side. The mentor can also provide feedback directly with hand gestures, which is in-turn transmitted to the trainee and viewed in surgical console as guidance. We comprehensively validate the system on both real surgery stereo videos and ex-vivo scenarios of common robotic training tasks (i.e., peg-transfer and suturing). Promising results are demonstrated regarding the fidelity of streamed scene visualization, the accuracy of feedback with hand interaction, and the low-latency of each component in the entire remote mentoring system. This work showcases the feasibility of leveraging AR technology for reliable, flexible and low-cost solutions to robotic surgical education, and holds great potential for clinical applications.