Fairness remains a critical concern in healthcare, where unequal access to services and treatment outcomes can adversely affect patient health. While Federated Learning (FL) presents a collaborative and privacy-preserving approach to model training, ensuring fairness is challenging due to heterogeneous data across institutions, and current research primarily addresses non-medical applications. To fill this gap, we establish the first experimental benchmark for fairness in medical FL, evaluating six representative FL methods across diverse demographic attributes and imaging modalities. We introduce FairFedMed, the first medical FL dataset specifically designed to study group fairness (i.e., consistent performance across demographic groups). It comprises two parts: FairFedMed-Oph, featuring 2D fundus and 3D OCT ophthalmology samples with six demographic attributes; and FairFedMed-Chest, which simulates real cross-institutional FL using subsets of CheXpert and MIMIC-CXR. Together, they support both simulated and real-world FL across diverse medical modalities and demographic groups. Existing FL models often underperform on medical images and overlook fairness across demographic groups. To address this, we propose FairLoRA, a fairness-aware FL framework based on SVD-based low-rank approximation. It customizes singular value matrices per demographic group while sharing singular vectors, ensuring both fairness and efficiency. Experimental results on the FairFedMed dataset demonstrate that FairLoRA not only achieves state-of-the-art performance in medical image classification but also significantly improves fairness across diverse populations. Our code and dataset can be accessible via GitHub link: https://github.com/Harvard-AI-and-Robotics-Lab/FairFedMed.

3D medical image segmentation methods have been successful, but their dependence on large amounts of voxel-level annotated data is a disadvantage that needs to be addressed given the high cost to obtain such annotation. Semi-supervised learning (SSL) solves this issue by training models with a large unlabelled and a small labelled dataset. The most successful SSL approaches are based on consistency learning that minimises the distance between model responses obtained from perturbed views of the unlabelled data. These perturbations usually keep the spatial input context between views fairly consistent, which may cause the model to learn segmentation patterns from the spatial input contexts instead of the foreground objects. In this paper, we introduce the Translation Consistent Co-training (TraCoCo) which is a consistency learning SSL method that perturbs the input data views by varying their spatial input context, allowing the model to learn segmentation patterns from foreground objects. Furthermore, we propose a new Confident Regional Cross entropy (CRC) loss, which improves training convergence and keeps the robustness to co-training pseudo-labelling mistakes. Our method yields state-of-the-art (SOTA) results for several 3D data benchmarks, such as the Left Atrium (LA), Pancreas-CT (Pancreas), and Brain Tumor Segmentation (BraTS19). Our method also attains best results on a 2D-slice benchmark, namely the Automated Cardiac Diagnosis Challenge (ACDC), further demonstrating its effectiveness. Our code, training logs and checkpoints are available at https://github.com/yyliu01/ TraCoCo.

Identifying unexpected domain-shifted instances in natural language processing is crucial in real-world applications. Previous works identify the out-of-distribution (OOD) instance by leveraging a single global feature embedding to represent the sentence, which cannot characterize subtle OOD patterns well. Another major challenge current OOD methods face is learning effective low-dimensional sentence representations to identify the hard OOD instances that are semantically similar to the in-distribution (ID) data. In this paper, we propose a new unsupervised OOD detection method, namely Semantic Role Labeling Guided Out-of-distribution Detection (SRLOOD), that separates, extracts, and learns the semantic role labeling (SRL) guided fine-grained local feature representations from different arguments of a sentence and the global feature representations of the full sentence using a margin-based contrastive loss. A novel self-supervised approach is also introduced to enhance such global-local feature learning by predicting the SRL extracted role. The resulting model achieves SOTA performance on four OOD benchmarks, indicating the effectiveness of our approach. The code is publicly accessible via https://github.com/cytai/SRLOOD.

Fairness is a critical concern in deep learning, especially in healthcare, where these models influence diagnoses and treatment decisions. Although fairness has been investigated in the vision-only domain, the fairness of medical vision-language (VL) models remains unexplored due to the scarcity of medical VL datasets for studying fairness. To bridge this research gap, we introduce the first fair vision-language medical dataset (Harvard-FairVLMed) that provides detailed demographic attributes, ground-truth labels, and clinical notes to facilitate an in-depth examination of fairness within VL foundation models. Using Harvard-FairVLMed, we conduct a comprehensive fairness analysis of two widely-used VL models (CLIP and BLIP2), pre-trained on both natural and medical domains, across four different protected attributes. Our results highlight significant biases in all VL models, with Asian, Male, Non-Hispanic, and Spanish being the preferred subgroups across the protected attributes of race, gender, ethnicity, and language, respectively. In order to alleviate these biases, we propose FairCLIP an optimal-transport-based approach that achieves a favorable trade-off between performance and fairness by reducing the Sinkhorn distance between the overall sample distribution and the distributions corresponding to each demographic group. As the first VL dataset of its kind, Harvard-FairVLMed holds the potential to catalyze advancements in the development of machine learning models that are both ethically aware and clinically effective. Our dataset and code are available at https://ophai.hms.harvard.edu/datasets/harvard-fairvlmed10k.

Open-set supervised anomaly detection (OSAD) - a recently emerging anomaly detection area - aims at utilizing a few samples of anomaly classes seen during training to de-tect unseen anomalies (i.e., samples from open-set anomaly classes), while effectively identifying the seen anomalies. Benefiting from the prior knowledge illustrated by the seen anomalies, current OSAD methods can often largely reduce false positive errors. However, these methods are trained in a closed-set setting and treat the anomaly examples as from a homogeneous distribution, rendering them less effective in generalizing to unseen anomalies that can be drawn from any distribution. This paper proposes to learn heterogeneous anomaly distributions using the limited anomaly examples to address this issue. To this end, we introduce a novel approach, namely Anomaly Heterogeneity Learning (AHL), that simulates a diverse set of heterogeneous anomaly distributions and then utilizes them to learn a unified heterogeneous abnormality model in surrogate open-set environments. Further, AHL is a generic framework that existing OSAD models can plug and play for enhancing their abnormality modeling. Extensive experiments on nine real-world anomaly detection datasets show that AHL can 1) substantially enhance different state-of-the-art OSAD models in detecting seen and unseen anomalies, and 2) effectively generalize to unseen anomalies in new domains. Code is available at https://github.com/mala-lab/AHL.

Fairness in artificial intelligence models has gained significantly more attention in recent years, especially in the area of medicine, as fairness in medical models is critical to people's well-being and lives. High-quality medical fairness datasets are needed to promote fairness learning research. Existing medical fairness datasets are all for classification tasks, and no fairness datasets are available for medical segmentation, while medical segmentation is an equally important clinical task as classifications, which can provide detailed spatial information on organ abnormalities ready to be assessed by clinicians. In this paper, we propose the first fairness dataset for medical segmentation named Harvard-FairSeg with 10,000 subject samples. In addition, we propose a fair error-bound scaling approach to reweight the loss function with the upper error-bound in each identity group, using the segment anything model (SAM). We anticipate that the segmentation performance equity can be improved by explicitly tackling the hard cases with high training errors in each identity group. To facilitate fair comparisons, we utilize a novel equity-scaled segmentation performance metric to compare segmentation metrics in the context of fairness, such as the equity-scaled Dice coefficient. Through comprehensive experiments, we demonstrate that our fair error-bound scaling approach either has superior or comparable fairness performance to the state-of-the-art fairness learning models. The dataset and code are publicly accessible via https://ophai.hms.harvard.edu/datasets/harvard-fairseg10k.

Zero-shot anomaly detection (ZSAD) requires detection models trained using auxiliary data to detect anomalies without any training sample in a target dataset. It is a crucial task when training data is not accessible due to various concerns, e.g., data privacy, yet it is challenging since the models need to generalize to anomalies across different domains where the appearance of foreground objects, abnormal regions, and background features, such as defects/tumors on different products/ organs, can vary significantly. Recently large pre-trained vision-language models (VLMs), such as CLIP, have demonstrated strong zero-shot recognition ability in various vision tasks, including anomaly detection. However, their ZSAD performance is weak since the VLMs focus more on modeling the class semantics of the foreground objects rather than the abnormality/normality in the images. In this paper we introduce a novel approach, namely AnomalyCLIP, to adapt CLIP for accurate ZSAD across different domains. The key insight of AnomalyCLIP is to learn object-agnostic text prompts that capture generic normality and abnormality in an image regardless of its foreground objects. This allows our model to focus on the abnormal image regions rather than the object semantics, enabling generalized normality and abnormality recognition on diverse types of objects. Large-scale experiments on 17 real-world anomaly detection datasets show that AnomalyCLIP achieves superior zero-shot performance of detecting and segmenting anomalies in datasets of highly diverse class semantics from various defect inspection and medical imaging domains. Code will be made available at https://github.com/zqhang/AnomalyCLIP.

Fairness (also known as equity interchangeably) in machine learning is important for societal well-being, but limited public datasets hinder its progress. Currently, no dedicated public medical datasets with imaging data for fairness learning are available, though underrepresented groups suffer from more health issues. To address this gap, we introduce Harvard Glaucoma Fairness (Harvard-GF), a retinal nerve disease dataset including 3,300 subjects with both 2D and 3D imaging data and balanced racial groups for glaucoma detection. Glaucoma is the leading cause of irreversible blindness globally with Blacks having doubled glaucoma prevalence than other races. We also propose a fair identity normalization (FIN) approach to equalize the feature importance between different identity groups. Our FIN approach is compared with various state-of-the-art fairness learning methods with superior performance in the racial, gender, and ethnicity fairness tasks with 2D and 3D imaging data, demonstrating the utilities of our dataset Harvard-GF for fairness learning. To facilitate fairness comparisons between different models, we propose an equity-scaled performance measure, which can be flexibly used to compare all kinds of performance metrics in the context of fairness. The dataset and code are publicly accessible via https://ophai.hms.harvard.edu/datasets/harvard-gf3300/.

Deep learning methods have shown outstanding classification accuracy in medical imaging problems, which is largely attributed to the availability of large-scale datasets manually annotated with clean labels. However, given the high cost of such manual annotation, new medical imaging classification problems may need to rely on machine-generated noisy labels extracted from radiology reports. Indeed, many Chest X-Ray (CXR) classifiers have been modelled from datasets with noisy labels, but their training procedure is in general not robust to noisy-label samples, leading to sub-optimal models. Furthermore, CXR datasets are mostly multi-label, so current multi-class noisy-label learning methods cannot be easily adapted. In this paper, we propose a new method designed for noisy multi-label CXR learning, which detects and smoothly re-labels noisy samples from the dataset to be used in the training of common multi-label classifiers. The proposed method optimises a bag of multi-label descriptors (BoMD) to promote their similarity with the semantic descriptors produced by language models from multi-label image annotations. Our experiments on noisy multi-label training sets and clean testing sets show that our model has state-of-the-art accuracy and robustness in many CXR multi-label classification benchmarks, including a new benchmark that we propose to systematically assess noisy multi-label methods. Code is available at https://github.com/cyh-0/BoMD.

Semantic segmentation models classify pixels into a set of known ("in-distribution") visual classes. When deployed in an open world, the reliability of these models depends on their ability to not only classify in-distribution pixels but also to detect out-of-distribution (OoD) pixels. Historically, the poor OoD detection performance of these models has motivated the design of methods based on model re-training using synthetic training images that include OoD visual objects. Although successful, these re-trained methods have two issues: 1) their in-distribution segmentation accuracy may drop during re-training, and 2) their OoD detection accuracy does not generalise well to new contexts outside the training set (e.g., from city to country context). In this paper, we mitigate these issues with: (i) a new residual pattern learning (RPL) module that assists the segmentation model to detect OoD pixels with minimal deterioration to inlier segmentation accuracy; and (ii) a novel context-robust contrastive learning (CoroCL) that enforces RPL to robustly detect OoD pixels in various contexts. Our approach improves by around 10% FPR and 7% AuPRC previous state-of-the-art in Fishyscapes, Segment-Me-If-You-Can, and RoadAnomaly datasets.

Glaucoma is the number one cause of irreversible blindness globally. A major challenge for accurate glaucoma detection and progression forecasting is the bottleneck of limited labeled patients with the state-of-the-art (SOTA) 3D retinal imaging data of optical coherence tomography (OCT). To address the data scarcity issue, this paper proposes two solutions. First, we develop a novel generalization-reinforced semi-supervised learning (SSL) model called pseudo supervisor to optimally utilize unlabeled data. Compared with SOTA models, the proposed pseudo supervisor optimizes the policy of predicting pseudo labels with unlabeled samples to improve empirical generalization. Our pseudo supervisor model is evaluated with two clinical tasks consisting of glaucoma detection and progression forecasting. The progression forecasting task is evaluated both unimodally and multimodally. Our pseudo supervisor model demonstrates superior performance than SOTA SSL comparison models. Moreover, our model also achieves the best results on the publicly available LAG fundus dataset. Second, we introduce the Harvard Glaucoma Detection and Progression (Harvard-GDP) Dataset, a multimodal multitask dataset that includes data from 1,000 patients with OCT imaging data, as well as labels for glaucoma detection and progression. This is the largest glaucoma detection dataset with 3D OCT imaging data and the first glaucoma progression forecasting dataset that is publicly available. Detailed sex and racial analysis are provided, which can be used by interested researchers for fairness learning studies. Our released dataset is benchmarked with several SOTA supervised CNN and transformer deep learning models. The dataset and code are made publicly available via https://ophai.hms.harvard.edu/datasets/harvard-gdp1000.

Prototypical part network (ProtoPNet) methods have been designed to achieve interpretable classification by associating predictions with a set of training prototypes, which we refer to as trivial prototypes because they are trained to lie far from the classification boundary in the feature space. Note that it is possible to make an analogy between ProtoPNet and support vector machine (SVM) given that the classification from both methods relies on computing similarity with a set of training points (i.e., trivial prototypes in ProtoPNet, and support vectors in SVM). However, while trivial prototypes are located far from the classification boundary, support vectors are located close to this boundary, and we argue that this discrepancy with the well-established SVM theory can result in ProtoPNet models with inferior classification accuracy. In this paper, we aim to improve the classification of ProtoPNet with a new method to learn support prototypes that lie near the classification boundary in the feature space, as suggested by the SVM theory. In addition, we target the improvement of classification results with a new model, named ST-ProtoPNet, which exploits our support prototypes and the trivial prototypes to provide more effective classification. Experimental results on CUB-200-2011, Stanford Cars, and Stan-ford Dogs datasets demonstrate that ST-ProtoPNet achieves state-of-the-art classification accuracy and interpretability results. We also show that the proposed support prototypes tend to be better localised in the object of interest rather than in the background region.

Ophthalmic images, along with their derivatives like retinal nerve fiber layer (RNFL) thickness maps, play a crucial role in detecting and monitoring eye diseases such as glaucoma. For computer-aided diagnosis of eye diseases, the key technique is to automatically extract meaningful features from ophthalmic images that can reveal the biomarkers (e.g., RNFL thinning patterns) associated with functional vision loss. However, representation learning from ophthalmic images that links structural retinal damage with human vision loss is non-trivial mostly due to large anatomical variations between patients. This challenge is further amplified by the presence of image artifacts, commonly resulting from image acquisition and automated segmentation issues. In this paper, we present an artifact-tolerant unsupervised learning framework called EyeLearn for learning ophthalmic image representations in glaucoma cases. EyeLearn includes an artifact correction module to learn representations that optimally predict artifact-free images. In addition, EyeLearn adopts a clustering-guided contrastive learning strategy to explicitly capture the affinities within and between images. During training, images are dynamically organized into clusters to form contrastive samples, which encourage learning similar or dissimilar representations for images in the same or different clusters, respectively. To evaluate EyeLearn, we use the learned representations for visual field prediction and glaucoma detection with a real-world dataset of glaucoma patient ophthalmic images. Extensive experiments and comparisons with state-of-the-art methods confirm the effectiveness of EyeLearn in learning optimal feature representations from ophthalmic images.

One-class classification (OCC) aims to learn an effective data description to enclose all normal training samples and detect anomalies based on the deviation from the data description. Current state-of-the-art OCC models learn a compact normality description by hyper-sphere minimisation, but they often suffer from overfitting the training data, especially when the training set is small or contaminated with anomalous samples. To address this issue, we introduce the interpolated Gaussian descriptor (IGD) method, a novel OCC model that learns a one-class Gaussian anomaly classifier trained with adversarially interpolated training samples. The Gaussian anomaly classifier differentiates the training samples based on their distance to the Gaussian centre and the standard deviation of these distances, offering the model a discriminability w.r.t. the given samples during training. The adversarial interpolation is enforced to consistently learn a smooth Gaussian descriptor, even when the training data is small or contaminated with anomalous samples. This enables our model to learn the data description based on the representative normal samples rather than fringe or anomalous samples, resulting in significantly improved normality description. In extensive experiments on diverse popular benchmarks, including MNIST, Fashion MNIST, CIFAR10, MVTec AD and two medical datasets, IGD achieves better detection accuracy than current state-of-the-art models. IGD also shows better robustness in problems with small or contaminated training sets.

Consistency learning using input image, feature, or network perturbations has shown remarkable results in semi-supervised semantic segmentation, but this approach can be seriously affected by inaccurate predictions of unlabelled training images. There are two consequences of these inaccurate predictions: 1) the training based on the “strict” cross-entropy (CE) loss can easily overfit prediction mistakes, leading to confirmation bias; and 2) the perturbations applied to these inaccurate predictions will use potentially erroneous predictions as training signals, degrading consistency learning. In this paper, we address the prediction accuracy problem of consistency learning methods with novel extensions of the mean-teacher (MT) model, which include a new auxiliary teacher, and the replacement of MT's mean square error (MSE) by a stricter confidence-weighted cross-entropy (Conf-CE) loss. The accurate prediction by this model allows us to use a challenging combination of network, input data and feature perturbations to improve the consistency learning generalisation, where the feature perturbations consist of a new adversarial perturbation. Results on public benchmarks show that our approach achieves remarkable improvements over the previous SOTA methods in the field.11Supported by Australian Research Council through grants DP180103232 and FT190100525. Our code is available at https://github.com/yyliu01/PS-MT.

Effective semi-supervised learning (SSL) in medical image analysis (MIA) must address two challenges: 1) work effectively on both multi-class (e.g., lesion classification) and multi-label (e.g., multiple-disease diagnosis) problems, and 2) handle imbalanced learning (because of the high variance in disease prevalence). One strategy to explore in SSL MIA is based on the pseudo labelling strategy, but it has a few shortcomings. Pseudo-labelling has in general lower accuracy than consistency learning, it is not specifically design for both multi-class and multi-label problems, and it can be challenged by imbalanced learning. In this paper, unlike traditional methods that select confident pseudo label by threshold, we propose a new SSL algorithm, called anti-curriculum pseudo-labelling (ACPL), which introduces novel techniques to select informative unlabelled samples, improving training balance and allowing the model to work for both multi-label and multi-class problems, and to estimate pseudo labels by an accurate ensemble of classifiers (improving pseudo label accuracy). We run extensive experiments to evaluate ACPL on two public medical image classification benchmarks: Chest X-Ray 14 for thorax disease multi-label classification and ISIC2018 for skin lesion multi-class classification. Our method outperforms previous SOTA SSL methods on both datasets11Supported by Australian Research Council through grants DP180103232 and FT190100525.22Code is available at https://github.com/FBLADL/ACPL.

Anomaly detection with weakly supervised video-level labels is typically formulated as a multiple instance learning (MIL) problem, in which we aim to identify snippets containing abnormal events, with each video represented as a bag of video snippets. Although current methods show effective detection performance, their recognition of the positive instances, i.e., rare abnormal snippets in the abnormal videos, is largely biased by the dominant negative instances, especially when the abnormal events are subtle anomalies that exhibit only small differences compared with normal events. This issue is exacerbated in many methods that ignore important video temporal dependencies. To address this issue, we introduce a novel and theoretically sound method, named Robust Temporal Feature Magnitude learning (RTFM), which trains a feature magnitude learning function to effectively recognise the positive instances, substantially improving the robustness of the MIL approach to the negative instances from abnormal videos. RTFM also adapts dilated convolutions and self-attention mechanisms to capture long- and short-range temporal dependencies to learn the feature magnitude more faithfully. Extensive experiments show that the RTFM-enabled MIL model (i) outperforms several state-of-the-art methods by a large margin on four benchmark data sets (ShanghaiTech, UCF-Crime, XD-Violence and UCSD-Peds) and (ii) achieves significantly improved subtle anomaly discriminability and sample efficiency.