Multidisciplinary tumor boards (MTBs) bring specialists together to identify therapies for complex cancer cases, but preparing for them is time-intensive. Clinicians must extract key details from extensive records and evaluate treatment options. While large language models (LLMs) show promise in medicine for basic tasks like summarizing notes, little is known about their role in high-stakes tasks like MTB preparation. We conducted a mixed-methods study with 16 oncologists using two AI systems to prepare patient cases for MTB: an off-the-shelf assistant (Copilot) and a task-specific multi-agent system (Healthcare Agent Orchestrator, HAO). We analyzed oncologist prompts, AI responses, and oncologists’ perception of AI. Participants showed greater willingness to adopt HAO but were often overconfident in AI summaries and skeptical of AI-recommended therapies. Trust calibration strategies, such as source links and agent-trajectories, failed to align trust with system capabilities. We conclude with how AI systems should be built to support clinicians in high-stakes tasks.

Detecting and segmenting small objects, such as lung nodules and tumor lesions, remains a critical challenge in image analysis. These objects often occupy less than 0.1% of an image, making traditional transformer architectures inefficient and prone to performance degradation due to redundant attention computations on irrelevant regions. Existing sparse attention mechanisms rely on rigid hierarchical structures, which are poorly suited for detecting small, variable, and uncertain object locations. In this paper, we propose BoltzFormer, a novel transformer-based architecture designed to address these challenges through dynamic sparse attention. BoltzFormer identifies and focuses attention on relevant areas by modeling uncertainty using a Boltzmann distribution with an annealing schedule. Initially, a higher temperature allows broader area sampling in early layers, when object location uncertainty is greatest. As the temperature decreases in later layers, attention becomes more focused, enhancing efficiency and accuracy. BoltzFormer seamlessly integrates into existing transformer architectures via a modular Boltzmann attention sampling mechanism. Comprehensive evaluations on benchmark datasets demonstrate that BoltzFormer significantly improves segmentation performance for small objects while reducing attention computation by an order of magnitude compared to previous state-of-the-art methods.

Qianchu Liu, Stephanie Hyland, Shruthi Bannur, Kenza Bouzid, Daniel Castro, Maria Wetscherek, Robert Tinn, Harshita Sharma, Fernando Pérez-García, Anton Schwaighofer, Pranav Rajpurkar, Sameer Khanna, Hoifung Poon, Naoto Usuyama, Anja Thieme, Aditya Nori, Matthew Lungren, Ozan Oktay, Javier Alvarez-Valle. Proceedings of the 2023 Conference on Empirical Methods in Natural Language Processing. 2023.

Conversational generative AI has demonstrated remarkable promise for empowering biomedical practitioners, but current investigations focus on unimodal text. Multimodal conversational AI has seen rapid progress by leveraging billions of image-text pairs from the public web, but such general-domain vision-language models still lack sophistication in understanding and conversing about biomedical images. In this paper, we propose a cost-efficient approach for training a vision-language conversational assistant that can answer open-ended research questions of biomedical images. The key idea is to leverage a large-scale, broad-coverage biomedical figure-caption dataset extracted from PubMed Central, use GPT-4 to self-instruct open-ended instruction-following data from the captions, and then fine-tune a large general-domain vision-language model using a novel curriculum learning method. Specifically, the model first learns to align biomedical vocabulary using the figure-caption pairs as is, then learns to master open-ended conversational semantics using GPT-4 generated instruction-following data, broadly mimicking how a layperson gradually acquires biomedical knowledge. This enables us to train a Large Language and Vision Assistant for BioMedicine (LLaVA-Med) in less than 15 hours (with eight A100s). LLaVA-Med exhibits excellent multimodal conversational capability and can follow open-ended instruction to assist with inquiries about a biomedical image. On three standard biomedical visual question answering datasets, LLaVA-Med outperforms previous supervised state-of-the-art on certain metrics. To facilitate biomedical multimodal research, we will release our instruction-following data and the LLaVA-Med model.

Abstract Label scarcity is a bottleneck for improving task performance in specialized domains. We propose a novel compositional transfer learning framework (DoT51) for zero-shot domain transfer. Without access to in-domain labels, DoT5 jointly learns domain knowledge (from masked language modelling of unlabelled in-domain free text) and task knowledge (from task training on more readily available general-domain data) in a multi-task manner. To improve the transferability of task training, we design a strategy named NLGU: We simultaneously train natural language generation (NLG) for in-domain label-to-data generation, which enables data augmentation for self-finetuning and natural language understanding (NLU) for label prediction. We evaluate DoT5 on the biomedical domain and the resource-lean subdomain of radiology, focusing on natural language inference, text summarization, and embedding learning. DoT5 demonstrates the effectiveness of compositional transfer learning through multi-task learning. In particular, DoT5 outperforms the current state-of-the-art in zero-shot transfer by over 7 absolute points in accuracy on RadNLI. We validate DoT5 with ablations and a case study demonstrating its ability to solve challenging NLI examples requiring in-domain expertise.

Pretraining large neural language models, such as BERT, has led to impressive gains on many natural language processing (NLP) tasks. However, most pretraining efforts focus on general domain corpora, such as newswire and Web. A prevailing assumption is that even domain-specific pretraining can benefit by starting from general-domain language models. In this article, we challenge this assumption by showing that for domains with abundant unlabeled text, such as biomedicine, pretraining language models from scratch results in substantial gains over continual pretraining of general-domain language models. To facilitate this investigation, we compile a comprehensive biomedical NLP benchmark from publicly available datasets. Our experiments show that domain-specific pretraining serves as a solid foundation for a wide range of biomedical NLP tasks, leading to new state-of-the-art results across the board. Further, in conducting a thorough evaluation of modeling choices, both for pretraining and task-specific fine-tuning, we discover that some common practices are unnecessary with BERT models, such as using complex tagging schemes in named entity recognition. To help accelerate research in biomedical NLP, we have released our state-of-the-art pretrained and task-specific models for the community, and created a leaderboard featuring our BLURB benchmark (short for Biomedical Language Understanding & Reasoning Benchmark) at https://aka.ms/BLURB .

Extracting relations across large text spans has been relatively underexplored in NLP, but it is particularly important for high-value domains such as biomedicine, where obtaining high recall of the latest findings is crucial for practical applications.Compared to conventional information extraction confined to short text spans, document-level relation extraction faces additional challenges in both inference and learning.Given longer text spans, state-of-the-art neural architectures are less effective and taskspecific self-supervision such as distant supervision becomes very noisy.In this paper, we propose decomposing document-level relation extraction into relation detection and argument resolution, taking inspiration from Davidsonian semantics.This enables us to incorporate explicit discourse modeling and leverage modular self-supervision for each sub-problem, which is less noise-prone and can be further refined end-to-end via variational EM.We conduct a thorough evaluation in biomedical machine reading for precision oncology, where cross-paragraph relation mentions are prevalent.Our method outperforms prior state of the art, such as multi-scale learning and graph neural networks, by over 20 absolute F1 points.The gain is particularly pronounced among the most challenging relation instances whose arguments never co-occur in a paragraph.

Information overload is a prevalent challenge in many high-value domains. A prominent case in point is the explosion of the biomedical literature on COVID-19, which swelled to hundreds of thousands of papers in a matter of months. In general, biomedical literature expands by two papers every minute, totalling over a million new papers every year. Search in the biomedical realm, and many other vertical domains is challenging due to the scarcity of direct supervision from click logs. Self-supervised learning has emerged as a promising direction to overcome the annotation bottleneck. We propose a general approach for vertical search based on domain-specific pretraining and present a case study for the biomedical domain. Despite being substantially simpler and not using any relevance labels for training or development, our method performs comparably or better than the best systems in the official TREC-COVID evaluation, a COVID-related biomedical search competition. Using distributed computing in modern cloud infrastructure, our system can scale to tens of millions of articles on PubMed and has been deployed as Microsoft Biomedical Search, a new search experience for biomedical literature: https://aka.ms/biomedsearch.

MOTIVATION: Identifying somatic changes from tumor and matched normal sequences has become a standard approach in cancer research. More specifically, this requires accurate detection of somatic point mutations with low allele frequencies in impure and heterogeneous cancer samples. Although haplotype phasing information derived by using heterozygous germ line variants near candidate mutations would improve accuracy, no somatic mutation caller that uses such information is currently available. RESULTS: We propose a Bayesian hierarchical method, termed HapMuC, in which power is increased by using available information on heterozygous germ line variants located near candidate mutations. We first constructed two generative models (the mutation model and the error model). In the generative models, we prepared candidate haplotypes, considering a heterozygous germ line variant if available, and the observed reads were realigned to the haplotypes. We then inferred the haplotype frequencies and computed the marginal likelihoods using a variational Bayesian algorithm. Finally, we derived a Bayes factor for evaluating the possibility of the existence of somatic mutations. We also demonstrated that our algorithm has superior specificity and sensitivity compared with existing methods, as determined based on a simulation, the TCGA Mutation Calling Benchmark 4 datasets and data from the COLO-829 cell line. AVAILABILITY AND IMPLEMENTATION: The HapMuC source code is available from http://github.com/usuyama/hapmuc.