Radiology report generation from chest X-rays is an important task in artificial intelligence with the potential to greatly reduce radiologists' workload and shorten patient wait times. Despite recent advances, existing approaches often lack sufficient disease-awareness in visual representations and adequate vision-language alignment to meet the specialized requirements of medical image analysis. As a result, these models usually overlook critical pathological features on chest X-rays and struggle to generate clinically accurate reports. To address these limitations, we propose a novel dual-stage disease-aware framework for chest X-ray report generation. In Stage 1, our model learns Disease-Aware Semantic Tokens (DASTs) corresponding to specific pathology categories through cross-attention mechanisms and multi-label classification, while simultaneously aligning vision and language representations via contrastive learning. In Stage 2, we introduce a Disease-Visual Attention Fusion (DVAF) module to integrate disease-aware representations with visual features, along with a Dual-Modal Similarity Retrieval (DMSR) mechanism that combines visual and disease-specific similarities to retrieve relevant exemplars, providing contextual guidance during report generation. Extensive experiments on benchmark datasets (i.e., CheXpert Plus, IU X-ray, and MIMIC-CXR) demonstrate that our disease-aware framework achieves state-of-the-art performance in chest X-ray report generation, with significant improvements in clinical accuracy and linguistic quality.

Large Language Models (LLMs) have demonstrated significant potential in Medical Report Generation (MRG), yet their development requires large amounts of medical image-report pairs, which are commonly scattered across multiple centers. Centralizing these data is exceptionally challenging due to privacy regulations, thereby impeding model development and broader adoption of LLM-driven MRG models. To address this challenge, we present FedMRG, the first framework that leverages Federated Learning (FL) to enable privacy-preserving, multi-center development of LLM-driven MRG models, specifically designed to overcome the critical challenge of communication-efficient LLM training under multi-modal data heterogeneity. To start with, our framework tackles the fundamental challenge of communication overhead in federated LLM tuning by employing low-rank factorization to efficiently decompose parameter updates, significantly reducing gradient transmission costs and making LLM-driven MRG feasible in bandwidth-constrained FL settings. Furthermore, we observed the dual heterogeneity in MRG under the FL scenario: varying image characteristics across medical centers, as well as diverse reporting styles and terminology preferences. To address the data heterogeneity, we further enhance FedMRG with (1) client-aware contrastive learning in the MRG encoder, coupled with diagnosis-driven prompts, which capture both globally generalizable and locally distinctive features while maintaining diagnostic accuracy; and (2) a dual-adapter mutual boosting mechanism in the MRG decoder that harmonizes generic and specialized adapters to address variations in reporting styles and terminology. Through extensive evaluation of our established FL-MRG benchmark, we demonstrate the generalizability and adaptability of FedMRG, underscoring its potential in harnessing multi-center data and generating clinically accurate reports while maintaining communication efficiency.

Recently, the advent of Vision Transformer (ViT) has brought substantial advancements in 3D benchmarks, particularly in 3D volumetric medical image segmentation (Vol-MedSeg). Concurrently, multi-layer perceptron (MLP) network has regained popularity among researchers due to their comparable results to ViT, albeit with the exclusion of the resource-intensive self-attention module. In this work, we propose a novel permutable hybrid network for Vol-MedSeg, named PHNet, which capitalizes on the strengths of both convolution neural networks (CNNs) and MLP. PHNet addresses the intrinsic anisotropy problem of 3D volumetric data by employing a combination of 2D and 3D CNNs to extract local features. Besides, we propose an efficient multi-layer permute perceptron (MLPP) module that captures long-range dependence while preserving positional information. This is achieved through an axis decomposition operation that permutes the input tensor along different axes, thereby enabling the separate encoding of the positional information. Furthermore, MLPP tackles the resolution sensitivity issue of MLP in Vol-MedSeg with a token segmentation operation, which divides the feature into smaller tokens and processes them individually. Extensive experimental results validate that PHNet outperformed the state-of-the-art methods with lower computational costs on the widely-used yet challenging COVID-19-20, Synapse, LiTS and MSD BraTS benchmarks. The ablation study also demonstrated the effectiveness of PHNet in harnessing the strengths of both CNNs and MLP. The code is available on Github: https://github.com/xiaofang007/PHNet.

Medical image segmentation demands the aggregation of global and local feature representations, posing a challenge for current methodologies in handling both long-range and short-range feature interactions. Recently, vision mamba (ViM) models have emerged as promising solutions for addressing model complexities by excelling in long-range feature iterations with linear complexity. However, existing ViM approaches overlook the importance of preserving short-range local dependencies by directly flattening spatial tokens and are constrained by fixed scanning patterns that limit the capture of dynamic spatial context information. To address these challenges, we introduce a simple yet effective method named context clustering ViM (CCViM), which incorporates a context clustering module within the existing ViM models to segment image tokens into distinct windows for adaptable local clustering. Our method effectively combines long-range and short-range feature interactions, thereby enhancing spatial contextual representations for medical image segmentation tasks. Extensive experimental evaluations on diverse public datasets, i.e., Kumar, CPM17, ISIC17, ISIC18, and Synapse, demonstrate the superior performance of our method compared to current state-of-the-art methods. Our code can be found at https://github.com/zymissy/CCViM.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and disease identification. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnosis unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

Radiation therapy treatment planning requires balancing the delivery of the target dose while sparing normal tissues, making it a complex process. To streamline the planning process and enhance its quality, there is a growing demand for knowledge-based planning (KBP). Ensemble learning has shown impressive power in various deep learning tasks, and it has great potential to improve the performance of KBP. However, the effectiveness of ensemble learning heavily depends on the diversity and individual accuracy of the base learners. Moreover, the complexity of model ensembles is a major concern, as it requires maintaining multiple models during inference, leading to increased computational cost and storage overhead. In this study, we propose a novel learning-based ensemble approach named LENAS, which integrates neural architecture search with knowledge distillation for 3-D radiotherapy dose prediction. Our approach starts by exhaustively searching each block from an enormous architecture space to identify multiple architectures that exhibit promising performance and significant diversity. To mitigate the complexity introduced by the model ensemble, we adopt the teacher-student paradigm, leveraging the diverse outputs from multiple learned networks as supervisory signals to guide the training of the student network. Furthermore, to preserve high-level semantic information, we design a hybrid loss to optimize the student network, enabling it to recover the knowledge embedded within the teacher networks. The proposed method has been evaluated on two public datasets: 1) OpenKBP and 2) AIMIS. Extensive experimental results demonstrate the effectiveness of our method and its superior performance to the state-of-the-art methods. Code: github.com/hust-linyi/LENAS.

Kneeosteoarthritis (KOA), as a leading joint disease, can be decided by examining the shapes of patella to spot potential abnormal variations. To assist doctors in the diagnosis of KOA, a robust automatic patella segmentation method is highly demanded in clinical practice. Deep learning methods, especially convolutional neural networks (CNNs) have been widely applied to medical image segmentation in recent years. Nevertheless, poor image quality and limited data still impose challenges to segmentation via CNNs. On the other hand, statistical shape models (SSMs) can generate shape priors which give anatomically reliable segmentation to varying instances. Thus, in this work, we propose an adaptive fusion framework, explicitly combining deep neural networks and anatomical knowledge from SSM for robust patella segmentation. Our adaptive fusion framework will accordingly adjust the weight of segmentation candidates in fusion based on their segmentation performance. We also propose a voxel-wise refinement strategy to make the segmentation of CNNs more anatomically correct. Extensive experiments and thorough assessment have been conducted on various mainstream CNN backbones for patella segmentation in low-data regimes, which demonstrate that our framework can be flexibly attached to a CNN model, significantly improving its performance when labeled training data are limited and input image data are of poor quality.

Nuclei segmentation is a fundamental prerequisite in the digital pathology workflow. The development of automated methods for nuclei segmentation enables quantitative analysis of the wide existence and large variances in nuclei morphometry in histopathology images. However, manual annotation of tens of thousands of nuclei is tedious and time-consuming, which requires significant amount of human effort and domain-specific expertise. To alleviate this problem, in this paper, we propose a weakly-supervised nuclei segmentation method that only requires partial point labels of nuclei. Specifically, we propose a novel boundary mining framework for nuclei segmentation, named BoNuS, which simultaneously learns nuclei interior and boundary information from the point labels. To achieve this goal, we propose a novel boundary mining loss, which guides the model to learn the boundary information by exploring the pairwise pixel affinity in a multiple-instance learning manner. Then, we consider a more challenging problem, i.e., partial point label, where we propose a nuclei detection module with curriculum learning to detect the missing nuclei with prior morphological knowledge. The proposed method is validated on three public datasets, MoNuSeg, CPM, and CoNIC datasets. Experimental results demonstrate the superior performance of our method to the state-of-the-art weakly-supervised nuclei segmentation methods. Code: https://github.com/hust-linyi/bonus.

Deep learning based methods for medical images can be easily compromised by adversarial examples (AEs), posing a great security flaw in clinical decision-making. It has been discovered that conventional adversarial attacks like PGD which optimize the classification logits, are easy to distinguish in the feature space, resulting in accurate reactive defenses. To better understand this phenomenon and reassess the reliability of the reactive defenses for medical AEs, we thoroughly investigate the characteristic of conventional medical AEs. Specifically, we first theoretically prove that conventional adversarial attacks change the outputs by continuously optimizing vulnerable features in a fixed direction, thereby leading to outlier representations in the feature space. Then, a stress test is conducted to reveal the vulnerability of medical images, by comparing with natural images. Interestingly, this vulnerability is a double-edged sword, which can be exploited to hide AEs. We then propose a simple-yet-effective hierarchical feature constraint (HFC), a novel add-on to conventional white-box attacks, which assists to hide the adversarial feature in the target feature distribution. The proposed method is evaluated on three medical datasets, both 2D and 3D, with different modalities. The experimental results demonstrate the superiority of HFC,i.e., it bypasses an array of state-of-the-art adversarial medical AE detectors more efficiently than competing adaptive attacks1, which reveals the deficiencies of medical reactive defense and allows to develop more robust defenses in future.

In this paper, we propose a bi-modality medical image synthesis approach based on sequential generative adversarial network (GAN) and semi-supervised learning. Our approach consists of two generative modules that synthesize images of the two modalities in a sequential order. A method for measuring the synthesis complexity is proposed to automatically determine the synthesis order in our sequential GAN. Images of the modality with a lower complexity are synthesized first, and the counterparts with a higher complexity are generated later. Our sequential GAN is trained end-to-end in a semi-supervised manner. In supervised training, the joint distribution of bi-modality images are learned from real paired images of the two modalities by explicitly minimizing the reconstruction losses between the real and synthetic images. To avoid overfitting limited training images, in unsupervised training, the marginal distribution of each modality is learned based on unpaired images by minimizing the Wasserstein distance between the distributions of real and fake images. We comprehensively evaluate the proposed model using two synthesis tasks based on three types of evaluate metrics and user studies. Visual and quantitative results demonstrate the superiority of our method to the state-of-the-art methods, and reasonable visual quality and clinical significance. Code is made publicly available at https://github.com/hust- linyi/Multimodal-Medical-Image-Synthesis.