Zhihong Chen

Zunnan Xu, Zhihong Chen, Yong Zhang et al. · tsinghua

Parameter Efficient Tuning (PET) has gained attention for reducing the number of parameters while maintaining performance and providing better hardware resource savings, but few studies investigate dense prediction tasks and interaction between modalities. In this paper, we do an investigation of efficient tuning problems on referring image segmentation. We propose a novel adapter called Bridger to facilitate cross-modal information exchange and inject task-specific information into the pre-trained model. We also design a lightweight decoder for image segmentation. Our approach achieves comparable or superior performance with only 1.61\% to 3.38\% backbone parameter updates, evaluated on challenging benchmarks. The code is available at \url{https://github.com/kkakkkka/ETRIS}.

Zhihong Chen, Yuhao Du, Jinpeng Hu et al.

Medical vision-and-language pre-training provides a feasible solution to extract effective vision-and-language representations from medical images and texts. However, few studies have been dedicated to this field to facilitate medical vision-and-language understanding. In this paper, we propose a self-supervised learning paradigm with multi-modal masked autoencoders (M$^3$AE), which learn cross-modal domain knowledge by reconstructing missing pixels and tokens from randomly masked images and texts. There are three key designs to make this simple approach work. First, considering the different information densities of vision and language, we adopt different masking ratios for the input image and text, where a considerably larger masking ratio is used for images. Second, we use visual and textual features from different layers to perform the reconstruction to deal with different levels of abstraction in visual and language. Third, we develop different designs for vision and language decoders (i.e., a Transformer for vision and a multi-layer perceptron for language). To perform a comprehensive evaluation and facilitate further research, we construct a medical vision-and-language benchmark including three tasks. Experimental results demonstrate the effectiveness of our approach, where state-of-the-art results are achieved on all downstream tasks. Besides, we conduct further analysis to better verify the effectiveness of different components of our approach and various settings of pre-training. The source code is available at~\url{https://github.com/zhjohnchan/M3AE}.

Zhihong Chen, Ruifei Zhang, Yibing Song et al.

Visual grounding (VG) aims to establish fine-grained alignment between vision and language. Ideally, it can be a testbed for vision-and-language models to evaluate their understanding of the images and texts and their reasoning abilities over their joint space. However, most existing VG datasets are constructed using simple description texts, which do not require sufficient reasoning over the images and texts. This has been demonstrated in a recent study~\cite{luo2022goes}, where a simple LSTM-based text encoder without pretraining can achieve state-of-the-art performance on mainstream VG datasets. Therefore, in this paper, we propose a novel benchmark of \underline{S}cene \underline{K}nowledge-guided \underline{V}isual \underline{G}rounding (SK-VG), where the image content and referring expressions are not sufficient to ground the target objects, forcing the models to have a reasoning ability on the long-form scene knowledge. To perform this task, we propose two approaches to accept the triple-type input, where the former embeds knowledge into the image features before the image-query interaction; the latter leverages linguistic structure to assist in computing the image-text matching. We conduct extensive experiments to analyze the above methods and show that the proposed approaches achieve promising results but still leave room for improvement, including performance and interpretability. The dataset and code are available at \url{https://github.com/zhjohnchan/SK-VG}.

Justin Xu, Zhihong Chen, Andrew Johnston et al. · oxford, stanford

Recent developments in natural language generation have tremendous implications for healthcare. For instance, state-of-the-art systems could automate the generation of sections in clinical reports to alleviate physician workload and streamline hospital documentation. To explore these applications, we present a shared task consisting of two subtasks: (1) Radiology Report Generation (RRG24) and (2) Discharge Summary Generation ("Discharge Me!"). RRG24 involves generating the 'Findings' and 'Impression' sections of radiology reports given chest X-rays. "Discharge Me!" involves generating the 'Brief Hospital Course' and 'Discharge Instructions' sections of discharge summaries for patients admitted through the emergency department. "Discharge Me!" submissions were subsequently reviewed by a team of clinicians. Both tasks emphasize the goal of reducing clinician burnout and repetitive workloads by generating documentation. We received 201 submissions from across 8 teams for RRG24, and 211 submissions from across 16 teams for "Discharge Me!".

Zhihong Chen, Yaling Shen, Yan Song et al.

Medical imaging plays a significant role in clinical practice of medical diagnosis, where the text reports of the images are essential in understanding them and facilitating later treatments. By generating the reports automatically, it is beneficial to help lighten the burden of radiologists and significantly promote clinical automation, which already attracts much attention in applying artificial intelligence to medical domain. Previous studies mainly follow the encoder-decoder paradigm and focus on the aspect of text generation, with few studies considering the importance of cross-modal mappings and explicitly exploit such mappings to facilitate radiology report generation. In this paper, we propose a cross-modal memory networks (CMN) to enhance the encoder-decoder framework for radiology report generation, where a shared memory is designed to record the alignment between images and texts so as to facilitate the interaction and generation across modalities. Experimental results illustrate the effectiveness of our proposed model, where state-of-the-art performance is achieved on two widely used benchmark datasets, i.e., IU X-Ray and MIMIC-CXR. Further analyses also prove that our model is able to better align information from radiology images and texts so as to help generating more accurate reports in terms of clinical indicators.

Zhihong Chen, Guanbin Li, Xiang Wan

Medical vision-and-language pre-training (Med-VLP) has received considerable attention owing to its applicability to extracting generic vision-and-language representations from medical images and texts. Most existing methods mainly contain three elements: uni-modal encoders (i.e., a vision encoder and a language encoder), a multi-modal fusion module, and pretext tasks, with few studies considering the importance of medical domain expert knowledge and explicitly exploiting such knowledge to facilitate Med-VLP. Although there exist knowledge-enhanced vision-and-language pre-training (VLP) methods in the general domain, most require off-the-shelf toolkits (e.g., object detectors and scene graph parsers), which are unavailable in the medical domain. In this paper, we propose a systematic and effective approach to enhance Med-VLP by structured medical knowledge from three perspectives. First, considering knowledge can be regarded as the intermediate medium between vision and language, we align the representations of the vision encoder and the language encoder through knowledge. Second, we inject knowledge into the multi-modal fusion model to enable the model to perform reasoning using knowledge as the supplementation of the input image and text. Third, we guide the model to put emphasis on the most critical information in images and texts by designing knowledge-induced pretext tasks. To perform a comprehensive evaluation and facilitate further research, we construct a medical vision-and-language benchmark including three tasks. Experimental results illustrate the effectiveness of our approach, where state-of-the-art performance is achieved on all downstream tasks. Further analyses explore the effects of different components of our approach and various settings of pre-training.

Zhihong Chen, Shizhe Diao, Benyou Wang et al.

Medical vision-and-language pre-training (Med-VLP) has shown promising improvements on many downstream medical tasks owing to its applicability to extracting generic representations from medical images and texts. Practically, there exist two typical types, \textit{i.e.}, the fusion-encoder type and the dual-encoder type, depending on whether a heavy fusion module is used. The former is superior at multi-modal tasks owing to the sufficient interaction between modalities; the latter is good at uni-modal and cross-modal tasks due to the single-modality encoding ability. To take advantage of these two types, we propose an effective yet straightforward scheme named PTUnifier to unify the two types. We first unify the input format by introducing visual and textual prompts, which serve as a feature bank that stores the most representative images/texts. By doing so, a single model could serve as a \textit{foundation model} that processes various tasks adopting different input formats (\textit{i.e.}, image-only, text-only, and image-text-pair). Furthermore, we construct a prompt pool (instead of static ones) to improve diversity and scalability. Experimental results show that our approach achieves state-of-the-art results on a broad range of tasks, spanning uni-modal tasks (\textit{i.e.}, image/text classification and text summarization), cross-modal tasks (\textit{i.e.}, image-to-text generation and image-text/text-image retrieval), and multi-modal tasks (\textit{i.e.}, visual question answering), demonstrating the effectiveness of our approach. Note that the adoption of prompts is orthogonal to most existing Med-VLP approaches and could be a beneficial and complementary extension to these approaches.

Zhihong Chen, Guiming Hardy Chen, Shizhe Diao et al.

Masked language modeling (MLM) has been one of the most popular pretraining recipes in natural language processing, e.g., BERT, one of the representative models. Recently, contrastive language-image pretraining (CLIP) has also attracted attention, especially its vision models that achieve excellent performance on a broad range of vision tasks. However, few studies are dedicated to studying the text encoders learned by CLIP. In this paper, we analyze the difference between BERT-style and CLIP-style text encoders from three experiments: (i) general text understanding, (ii) vision-centric text understanding, and (iii) text-to-image generation. Experimental analyses show that although CLIP-style text encoders underperform BERT-style ones for general text understanding tasks, they are equipped with a unique ability, i.e., synesthesia, for the cross-modal association, which is more similar to the senses of humans.

Wentao Ge, Shunian Chen, Guiming Hardy Chen et al.

Multimodal large language models (MLLMs) have broadened the scope of AI applications. Existing automatic evaluation methodologies for MLLMs are mainly limited in evaluating queries without considering user experiences, inadequately addressing the nuances of creative and associative multimodal tasks. However, the open-ended and subjective nature of such tasks poses a significant challenge to the evaluation methodology, where it is difficult to define the ground-truth answers for them. To this end, in our paper, we propose a new evaluation paradigm for MLLMs, which is evaluating MLLMs with per-sample criteria using potent MLLM as the judge. To validate the feasibility and effectiveness of this paradigm, we design a benchmark, dubbed MLLM-Bench, by curating the evaluation samples across six comprehensive cognitive levels. We benchmark 21 popular MLLMs in a pairwise-comparison fashion, showing diverse performance across models. Moreover, the validity of our benchmark manifests itself in reaching 88.02% agreement with human evaluation. We contend that the proposed paradigm explores the potential of MLLMs as effective evaluation tools with the help of per-sample criteria. See online leaderboard at \url{https://mllm-bench.llmzoo.com}.

Louis Blankemeier, Ashwin Kumar, Joseph Paul Cohen et al.

The large volume of abdominal computed tomography (CT) scans coupled with the shortage of radiologists have intensified the need for automated medical image analysis tools. Previous state-of-the-art approaches for automated analysis leverage vision-language models (VLMs) that jointly model images and radiology reports. However, current medical VLMs are generally limited to 2D images and short reports. Here to overcome these shortcomings for abdominal CT interpretation, we introduce Merlin, a 3D VLM that learns from volumetric CT scans, electronic health record data and radiology reports. This approach is enabled by a multistage pretraining framework that does not require additional manual annotations. We trained Merlin using a high-quality clinical dataset of paired CT scans (>6 million images from 15,331 CT scans), diagnosis codes (>1.8 million codes) and radiology reports (>6 million tokens). We comprehensively evaluated Merlin on 6 task types and 752 individual tasks that covered diagnostic, prognostic and quality-related tasks. The non-adapted (off-the-shelf) tasks included zero-shot classification of findings (30 findings), phenotype classification (692 phenotypes) and zero-shot cross-modal retrieval (image-to-findings and image-to-impression). The model-adapted tasks included 5-year chronic disease prediction (6 diseases), radiology report generation and 3D semantic segmentation (20 organs). We validated Merlin at scale, with internal testing on 5,137 CT scans and external testing on 44,098 CT scans from 3 independent sites and 2 public datasets. The results demonstrated high generalization across institutions and anatomies. Merlin outperformed 2D VLMs, CT foundation models and off-the-shelf radiology models. We also release our trained models, code, and dataset, available at: https://github.com/StanfordMIMI/Merlin.

Sophie Ostmeier, Justin Xu, Zhihong Chen et al.

Evaluating radiology reports is a challenging problem as factual correctness is extremely important due to the need for accurate medical communication about medical images. Existing automatic evaluation metrics either suffer from failing to consider factual correctness (e.g., BLEU and ROUGE) or are limited in their interpretability (e.g., F1CheXpert and F1RadGraph). In this paper, we introduce GREEN (Generative Radiology Report Evaluation and Error Notation), a radiology report generation metric that leverages the natural language understanding of language models to identify and explain clinically significant errors in candidate reports, both quantitatively and qualitatively. Compared to current metrics, GREEN offers: 1) a score aligned with expert preferences, 2) human interpretable explanations of clinically significant errors, enabling feedback loops with end-users, and 3) a lightweight open-source method that reaches the performance of commercial counterparts. We validate our GREEN metric by comparing it to GPT-4, as well as to error counts of 6 experts and preferences of 2 experts. Our method demonstrates not only higher correlation with expert error counts, but simultaneously higher alignment with expert preferences when compared to previous approaches.

Zhihong Chen, Maya Varma, Justin Xu et al. · mila, oxford

Over 1.4 billion chest X-rays (CXRs) are performed annually due to their cost-effectiveness as an initial diagnostic test. This scale of radiological studies provides a significant opportunity to streamline CXR interpretation and documentation. While foundation models are a promising solution, the lack of publicly available large-scale datasets and benchmarks inhibits their iterative development and real-world evaluation. To overcome these challenges, we constructed a large-scale dataset (CheXinstruct), which we utilized to train a vision-language foundation model (CheXagent). We systematically demonstrated competitive performance across eight distinct task types on our novel evaluation benchmark (CheXbench). Beyond technical validation, we assessed the real-world utility of CheXagent in directly drafting radiology reports. Our clinical assessment with eight radiologists revealed a 36% time saving for residents using CheXagent-drafted reports, while attending radiologists showed no significant time difference editing resident-drafted or CheXagent-drafted reports. The CheXagent-drafted reports improved the writing efficiency of both radiology residents and attending radiologists in 81% and 61% of cases, respectively, without loss of quality. Overall, we demonstrate that CheXagent can effectively perform a variety of CXR interpretation tasks and holds potential to assist radiologists in routine clinical workflows.

Maya Varma, Jean-Benoit Delbrouck, Zhihong Chen et al.

Fine-tuned vision-language models (VLMs) often capture spurious correlations between image features and textual attributes, resulting in degraded zero-shot performance at test time. Existing approaches for addressing spurious correlations (i) primarily operate at the global image-level rather than intervening directly on fine-grained image features and (ii) are predominantly designed for unimodal settings. In this work, we present RaVL, which takes a fine-grained perspective on VLM robustness by discovering and mitigating spurious correlations using local image features rather than operating at the global image level. Given a fine-tuned VLM, RaVL first discovers spurious correlations by leveraging a region-level clustering approach to identify precise image features contributing to zero-shot classification errors. Then, RaVL mitigates the identified spurious correlation with a novel region-aware loss function that enables the VLM to focus on relevant regions and ignore spurious relationships during fine-tuning. We evaluate RaVL on 654 VLMs with various model architectures, data domains, and learned spurious correlations. Our results show that RaVL accurately discovers (191% improvement over the closest baseline) and mitigates (8.2% improvement on worst-group image classification accuracy) spurious correlations. Qualitative evaluations on general-domain and medical-domain VLMs confirm our findings.

Jean-Benoit Delbrouck, Justin Xu, Johannes Moll et al. · oxford, stanford

Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists' workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT's hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.