Medical Imaging

With the rise of medical foundation models and the growing availability of imaging data, scalable pretraining techniques offer a promising way to identify imaging biomarkers predictive of future disease risk. While current self-supervised methods for 3D medical imaging models capture local structural features like organ morphology, they fail to link pixel biomarkers with long-term health outcomes due to a missing context problem. Current approaches lack the temporal context necessary to identify biomarkers correlated with disease progression, as they rely on supervision derived only from images and concurrent text descriptions. To address this, we introduce time-to-event pretraining, a pretraining framework for 3D medical imaging models that leverages large-scale temporal supervision from paired, longitudinal electronic health records (EHRs). Using a dataset of 18,945 CT scans (4.2 million 2D images) and time-to-event distributions across thousands of EHR-derived tasks, our method improves outcome prediction, achieving an average AUROC increase of 23.7% and a 29.4% gain in Harrell’s C-index across 8 benchmark tasks. Importantly, these gains are achieved without sacrificing diagnostic classification performance. This study lays the foundation for integrating longitudinal EHR and 3D imaging data to advance clinical risk prediction.

Over recent years, deep learning based image registration has achieved impressive accuracy in many domains, including medical imaging and, specifically, human neuroimaging with magnetic resonance imaging (MRI). However, the uncertainty estimation associated with these methods has been largely limited to the application of generic techniques (e.g., Monte Carlo dropout) that do not exploit the peculiarities of the problem domain, particularly spatial modeling. Here, we propose a principled way to propagate uncertainties (epistemic or aleatoric) estimated at the level of spatial location by these methods, to the level of global transformation models, and further to downstream tasks. Specifically, we justify the choice of a Gaussian distribution for the local uncertainty modeling, and then propose a framework where uncertainties spread across hierarchical levels, depending on the choice of transformation model. Experiments on publicly available data sets show that Monte Carlo dropout correlates very poorly with the reference registration error, whereas our uncertainty estimates correlate much better. Crucially, the results also show that uncertainty-aware fitting of transformations improves the registration accuracy of brain MRI scans. Finally, we illustrate how sampling from the posterior distribution of the transformations can be used to propagate uncertainties to downstream neuroimaging tasks. Code is available at: https://github.com/HuXiaoling/Regre4Regis.

Magnetic resonance imaging (MRI) is a powerful noninvasive diagnostic imaging tool that provides unparalleled soft tissue contrast and anatomical detail. Noise contamination, especially in accelerated and/or low-field acquisitions, can significantly degrade image quality and diagnostic accuracy. Supervised learning based denoising approaches have achieved impressive performance but require high signal-to-noise ratio (SNR) labels, which are often unavailable. Self-supervised learning holds promise to address the label scarcity issue, but existing self-supervised denoising methods tend to oversmooth fine spatial features and often yield inferior performance than supervised methods. We introduce Corruption2Self (C2S), a novel score-based self-supervised framework for MRI denoising. At the core of C2S is a generalized denoising score matching (GDSM) loss, which extends denoising score matching to work directly with noisy observations by modeling the conditional expectation of higher-SNR images given further corrupted observations. This allows the model to effectively learn denoising across multiple noise levels directly from noisy data. Additionally, we incorporate a reparameterization of noise levels to stabilize training and enhance convergence, and introduce a detail refinement extension to balance noise reduction with the preservation of fine spatial features. Moreover, C2S can be extended to multi-contrast denoising by leveraging complementary information across different MRI contrasts. We demonstrate that our method achieves state-of-the-art performance among self-supervised methods and competitive results compared to supervised counterparts across varying noise conditions and MRI contrasts on the M4Raw and fastMRI dataset. The project website is available at: https://jiachentu.github.io/Corruption2Self-Self-Supervised-Denoising/.

We present RASO, a foundation model designed to Recognize Any Surgical Object, offering robust open-set recognition capabilities across a broad range of surgical procedures and object classes, in both surgical images and videos. RASO leverages a novel weakly-supervised learning framework that generates tag-image-text pairs automatically from large-scale unannotated surgical lecture videos, significantly reducing the need for manual annotations. Our scalable data generation pipeline gathers 2,200 surgical procedures and produces 3.6 million tag annotations across 2,066 unique surgical tags. Our experiments show that RASO achieves improvements of 2.9 mAP, 4.5 mAP, 10.6 mAP, and 7.2 mAP on four standard surgical benchmarks respectively in zero-shot settings, and surpasses state-of-the-art models in supervised surgical action recognition tasks. We will open-source our code, model, and dataset to facilitate further research.

Mastering medical knowledge is crucial for medical-specific LLMs. However, despite the existence of medical benchmarks like MedQA, a unified framework that fully leverages existing knowledge bases to evaluate LLMs' mastery of medical knowledge is still lacking. We propose PretexEval, a novel framework that dynamically generates reliable and diverse test samples to evaluate LLMs for any given medical knowledge base. We notice that test samples produced directly from knowledge bases by templates or LLMs may introduce factual errors and also lack diversity. To address these issues, our framework employs predicate equivalence transformations to produce a series of variants for any given medical knowledge point. Finally, these produced predicate variants are converted into textual language, resulting in a series of reliable and diverse test samples. Here, we use our proposed framework to systematically investigate the mastery of medical factual knowledge of 12 well-known LLMs, based on two knowledge bases that are crucial for clinical diagnosis and treatment. The evaluation results illustrate that current LLMs still exhibit significant deficiencies in fully mastering medical knowledge, despite achieving considerable success on some famous public benchmarks. These new findings provide valuable insights for developing medical-specific LLMs, highlighting that current LLMs urgently need to strengthen their comprehensive and in-depth mastery of medical knowledge before being applied to real-world medical scenarios.

Adapting medical Large Language Models to local languages can reduce barriers to accessing healthcare services, but data scarcity remains a significant challenge, particularly for low-resource languages. To address this, we first construct a high-quality medical dataset and conduct analysis to ensure its quality. In order to leverage the generalization capability of multilingual LLMs to efficiently scale to more resource-constrained languages, we explore the internal information flow of LLMs from a multilingual perspective using Mixture of Experts (MoE) modularity. Technically, we propose a novel MoE routing method that employs language-specific experts and cross-lingual routing. Inspired by circuit theory, our routing analysis revealed a \textit{``Spread Out in the End``} information flow mechanism: while earlier layers concentrate cross-lingual information flow, the later layers exhibit language-specific divergence. This insight directly led to the development of the Post-MoE architecture, which applies sparse routing only in the later layers while maintaining dense others. Experimental results demonstrate that this approach enhances the generalization of multilingual models to other languages while preserving interpretability. Finally, to efficiently scale the model to 50 languages, we introduce the concept of \textit{language family} experts, drawing on linguistic priors, which enables scaling the number of languages without adding additional parameters.

Unsupervised anomaly detection using deep learning has garnered significant research attention due to its broad applicability, particularly in medical imaging where labeled anomalous data are scarce. While earlier approaches leverage generative models like autoencoders and generative adversarial networks (GANs), they often fall short due to overgeneralization. Recent methods explore various strategies, including memory banks, normalizing flows, self-supervised learning, and knowledge distillation, to enhance discrimination. Among these, knowledge distillation, particularly reverse distillation, has shown promise. Following this paradigm, we propose a novel scale-aware contrastive reverse distillation model that addresses two key limitations of existing reverse distillation methods: insufficient feature discriminability and inability to handle anomaly scale variations. Specifically, we introduce a contrastive student-teacher learning approach to derive more discriminative representations by generating and exploring out-of-normal distributions. Further, we design a scale adaptation mechanism to softly weight contrastive distillation losses at different scales to account for the scale variation issue. Extensive experiments on benchmark datasets demonstrate state-of-the-art performance, validating the efficacy of the proposed method. The code will be made publicly available.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Do Large Vision Models (LVMs) extract medically and semantically relevant features similar to those identified by human experts? Currently, only biased, qualitative approaches with limited, small-scale expert evaluations are available to answer this question. In this study, we propose the Boltzmann Semantic Score (BSS), a novel method inspired by state space modeling, to evaluate the encoding space of LVMs from medical images using the encoding space of Large Language Models (LLMs) from medical reports. Through extensive experimentation on 32 datasets from The Cancer Genome Atlas collection using five state-of-the-art LLMs, we first establish a baseline of LLMs' performance in digital pathology and show that LLMs' encoding can be linked to patient outcomes. Then, we compared seven LVMs with BSS and showed that LVMs suffer from poor semantic capability when compared with encoded expert knowledge from pathology reports. We also found statistically significant correlations between BSS (as a measure of structural similarity) and performance in two downstream tasks: information retrieval and survival prediction tasks. Our study also investigates the consensus among LLMs in evaluating LVMs using BSS, indicating that LLMs generally reach substantial consensus in rating LVMs, with some variation dependant on the cancer type. We believe the BSS metric proposed here holds significant potential for application in other domains with similar contexts. Data and code can be found in \footnotesize \url{ https://github.com/AIMLab-UBC/Boltzmann}

Patient data from real-world clinical practice often suffers from data scarcity and long-tail imbalances, leading to biased outcomes or algorithmic unfairness. This study addresses these challenges by generating lesion-containing image-segmentation pairs from lesion-free images. Previous efforts in medical imaging synthesis have struggled with separating lesion information from background, resulting in low-quality backgrounds and limited control over the synthetic output. Inspired by diffusion-based image inpainting, we propose LeFusion, a lesion-focused diffusion model. By redesigning the diffusion learning objectives to focus on lesion areas, we simplify the learning process and improve control over the output while preserving high-fidelity backgrounds by integrating forward-diffused background contexts into the reverse diffusion process. Additionally, we tackle two major challenges in lesion texture synthesis: 1) multi-peak and 2) multi-class lesions. We introduce two effective strategies: histogram-based texture control and multi-channel decomposition, enabling the controlled generation of high-quality lesions in difficult scenarios. Furthermore, we incorporate lesion mask diffusion, allowing control over lesion size, location, and boundary, thus increasing lesion diversity. Validated on 3D cardiac lesion MRI and lung nodule CT datasets, LeFusion-generated data significantly improves the performance of state-of-the-art segmentation models, including nnUNet and SwinUNETR.