ICLR 2023 Papers

Modern studies in radiograph representation learning (R$^2$L) rely on either self-supervision to encode invariant semantics or associated radiology reports to incorporate medical expertise, while the complementarity between them is barely noticed. To explore this, we formulate the self- and report-completion as two complementary objectives and present a unified framework based on masked record modeling (MRM). In practice, MRM reconstructs masked image patches and masked report tokens following a multi-task scheme to learn knowledge-enhanced semantic representations. With MRM pre-training, we obtain pre-trained models that can be well transferred to various radiography tasks. Specifically, we find that MRM offers superior performance in label-efficient fine-tuning. For instance, MRM achieves 88.5% mean AUC on CheXpert using 1% labeled data, outperforming previous R$^2$L methods with 100% labels. On NIH ChestX-ray, MRM outperforms the best performing counterpart by about 3% under small labeling ratios. Besides, MRM surpasses self- and report-supervised pre-training in identifying the pneumonia type and the pneumothorax area, sometimes by large margins.

Multiple instance learning (MIL) is a popular weakly-supervised learning model on the whole slide image (WSI) for AI-assisted pathology diagnosis. The recent advance in attention-based MIL allows the model to find its region-of-interest (ROI) for interpretation by learning the attention weights for image patches of WSI slides. However, we empirically find that the interpretability of some related methods is either untrustworthy as the principle of MIL is violated or unsatisfactory as the high-attention regions are not consistent with experts' annotations. In this paper, we propose Bayes-MIL to address the problem from a probabilistic perspective. The induced patch-level uncertainty is proposed as a new measure of MIL interpretability, which outperforms previous methods in matching doctors annotations. We design a slide-dependent patch regularizer (SDPR) for the attention, imposing constraints derived from the MIL assumption, on the attention distribution. SDPR explicitly constrains the model to generate correct attention values. The spatial information is further encoded by an approximate convolutional conditional random field (CRF), for better interpretability. Experimental results show Bayes-MIL outperforms the related methods in patch-level and slide-level metrics and provides much better interpretable ROI on several large-scale WSI datasets.

The optimal transportation map finds the most economical way to transport one probability measure to another, and it has been applied in a broad range of applications in machine learning and computer vision. By the Brenier theory, computing the optimal transport map is equivalent to solving a Monge-Amp\`ere equation, which is highly non-linear. Therefore, the computation of optimal transportation maps is intrinsically challenging. In this work, we propose a novel and powerful method, the FFT-OT (fast Fourier transform-optimal transport), to compute the 3-dimensional OT problems. The method is based on several key ideas: first, the Monge-Amp\`ere equation is linearized to a sequence of linear elliptic PDEs with spacial and temporal variant coefficients; second, the obliqueness property of optimal transportation maps is reformulated as a Neumann boundary condition; and third, the variant coefficient elliptic PDEs are approximated by constant coefficient elliptic PDEs and solved by FFT on GPUs. We also prove that the algorithm converges linearly, namely the approximation error decreases exponentially fast. Experimental results show that the FFT-OT algorithm is more than a hundred times faster than the conventional methods based on the convex geometry. Furthermore, the method can be directly applied for sampling from complex 3D density functions in machine learning and magnifying the volumetric data in medical imaging.

A multitude of work has shown that machine learning-based medical diagnosis systems can be biased against certain subgroups of people. This has motivated a growing number of bias mitigation algorithms that aim to address fairness issues in machine learning. However, it is difficult to compare their effectiveness in medical imaging for two reasons. First, there is little consensus on the criteria to assess fairness. Second, existing bias mitigation algorithms are developed under different settings, e.g., datasets, model selection strategies, backbones, and fairness metrics, making a direct comparison and evaluation based on existing results impossible. In this work, we introduce MEDFAIR, a framework to benchmark the fairness of machine learning models for medical imaging. MEDFAIR covers eleven algorithms from various categories, ten datasets from different imaging modalities, and three model selection criteria. Through extensive experiments, we find that the under-studied issue of model selection criterion can have a significant impact on fairness outcomes; while in contrast, state-of-the-art bias mitigation algorithms do not significantly improve fairness outcomes over empirical risk minimization (ERM) in both in-distribution and out-of-distribution settings. We evaluate fairness from various perspectives and make recommendations for different medical application scenarios that require different ethical principles. Our framework provides a reproducible and easy-to-use entry point for the development and evaluation of future bias mitigation algorithms in deep learning. Code is available at https://github.com/ys-zong/MEDFAIR.

Dynamic diagnosis is desirable when medical tests are costly or time-consuming. In this work, we use reinforcement learning (RL) to find a dynamic policy that selects lab test panels sequentially based on previous observations, ensuring accurate testing at a low cost. Clinical diagnostic data are often highly imbalanced; therefore, we aim to maximize the F1 score instead of the error rate. However, optimizing the non-concave $F_1$ score is not a classic RL problem, thus invalidating standard RL methods. To remedy this issue, we develop a reward shaping approach, leveraging properties of the $F_1$ score and duality of policy optimization, to provably find the set of all Pareto-optimal policies for budget-constrained $F_1$ score maximization. To handle the combinatorially complex state space, we propose a Semi-Model-based Deep Diagnosis Policy Optimization (SM-DDPO) framework that is compatible with end-to-end training and online learning. SM-DDPO is tested on diverse clinical tasks: ferritin abnormality detection, sepsis mortality prediction, and acute kidney injury diagnosis. Experiments with real-world data validate that SM-DDPO trains efficiently and identify all Pareto-front solutions. Across all tasks, SM-DDPO is able to achieve state-of-the-art diagnosis accuracy (in some cases higher than conventional methods) with up to $85\%$ reduction in testing cost. Core codes are available at https://github.com/Zheng321/Deep-Reinforcement-Learning-for-Cost-Effective-Medical-Diagnosis.