Rheumatic heart disease (RHD) represents a significant global health challenge, disproportionately affecting over 40 million people in low- and middle-income countries. Early detection through color Doppler echocardiography is crucial for treating RHD, but it requires specialized physicians who are often scarce in resource-limited settings. To address this disparity, artificial intelligence (AI)-driven tools for RHD screening can provide scalable, autonomous solutions to improve access to critical healthcare services in underserved regions. This paper introduces RADAR (Rapid AI-Assisted Echocardiography Detection and Analysis of RHD), a novel and generalizable AI approach for end-to-end spatiotemporal analysis of color Doppler echocardiograms, aimed at detecting early RHD in resource-limited settings. RADAR identifies key imaging views and employs convolutional neural networks to analyze diagnostically relevant phases of the cardiac cycle. It also localizes essential anatomical regions and examines blood flow patterns. It then integrates all findings into a cohesive analytical framework. RADAR was trained and validated on 1,022 echocardiogram videos from 511 Ugandan children, acquired using standard portable ultrasound devices. An independent set of 318 cases, acquired using a handheld ultrasound device with diverse imaging characteristics, was also tested. On the validation set, RADAR outperformed existing methods, achieving an average accuracy of 0.92, sensitivity of 0.94, and specificity of 0.90. In independent testing, it maintained high, clinically acceptable performance, with an average accuracy of 0.79, sensitivity of 0.87, and specificity of 0.70. These results highlight RADAR's potential to improve RHD detection and promote health equity for vulnerable children by enhancing timely, accurate diagnoses in underserved regions.

Foundation models for interactive segmentation in 2D natural images and videos have sparked significant interest in building 3D foundation models for medical imaging. However, the domain gaps and clinical use cases for 3D medical imaging require a dedicated model that diverges from existing 2D solutions. Specifically, such foundation models should support a full workflow that can actually reduce human effort. Treating 3D medical images as sequences of 2D slices and reusing interactive 2D foundation models seems straightforward, but 2D annotation is too time-consuming for 3D tasks. Moreover, for large cohort analysis, it’s the highly accurate automatic segmentation models that reduce the most human effort. However, these models lack support for interactive corrections and lack zero-shot ability for novel structures, which is a key feature of "foundation". While reusing pre-trained 2D backbones in 3D enhances zero-shot potential, their performance on complex 3D structures still lags behind leading 3D models. To address these issues, we present VISTA3D, Versatile Imaging SegmenTation and Annotation model, that targets to solve all these challenges and requirements with one unified foundation model. VISTA3D is built on top of the well-established 3D segmentation pipeline, and it is the first model to achieve state-of-the-art performance in both 3D automatic (supporting 127 classes) and 3D interactive segmentation, even when compared with top 3D expert models on large and diverse benchmarks. Additionally, VISTA3D’s 3D interactive design allows efficient human correction, and a novel 3D supervoxel method that distills 2D pre-trained backbones grants VISTA3D top 3D zero-shot performance. We believe the model, recipe, and insights represent a promising step towards a clinically useful 3D foundation model. Code and weights are publicly available at https://github.com/Project-MONAI/VISTA.

Generalist vision language models (VLMs) have made significant strides in computer vision, but they fall short in specialized fields like healthcare, where expert knowledge is essential. Current large multimodal models like Gemini and GPT-4o are insufficient for medical tasks due to their reliance on memorized internet knowledge rather than the nuanced expertise required in healthcare. Meanwhile, existing medical VLMs (e.g. Med-Gemini) often lack expert consultation as part of their design, and many rely on outdated, static datasets that were not created with modern, large deep learning models in mind. VLMs are usually trained in three stages: vision pre-training, vision-language pre-training, and instruction fine-tuning (IFT). IFT has been typically applied using a mixture of generic and healthcare data. In contrast, we propose that for medical VLMs, a fourth stage of specialized IFT is necessary, which focuses on medical data and includes information from domain expert models. Domain expert models developed for medical use are crucial because they are specifically trained for certain clinical tasks, e.g. to detect tumors and classify abnormalities through segmentation and classification, which learn fine-grained features of medical data−features that are often too intricate for a VLM to capture effectively. This paper introduces a new framework, VILA-M3, for medical VLMs that utilizes domain knowledge via expert models. We argue that generic VLM architectures alone are not viable for real-world clinical applications and on-demand usage of domain-specialized expert model knowledge is critical for advancing AI in healthcare. Through our experiments, we show an improved state-of-the-art (SOTA) performance with an average improvement of ~9% over the prior SOTA model Med-Gemini and ~6% over models trained on the specific tasks. Our approach emphasizes the importance of domain expertise in creating precise, reliable VLMs for medical applications.

Medical imaging analysis faces challenges such as data scarcity, high annotation costs, and privacy concerns. This paper introduces the Medical AI for Synthetic Imaging (MAISI), an innovative approach using the diffusion model to generate synthetic 3D computed tomography (CT) images to address those challenges. MAISI leverages the foundation volume compression network and the latent diffusion model to produce high-resolution CT images (up to a landmark volume dimension of 512 × 512 × 768) with flexible volume dimensions and voxel spacing. By incorporating ControlNet, MAISI can process organ segmentation, including 127 anatomical structures, as additional conditions and enables the generation of accurately annotated synthetic images that can be used for various downstream tasks. Our experiment results show that MAISI's capabilities in generating realistic, anatomically accurate images for diverse regions and conditions reveal its promising potential to mitigate challenges using synthetic data.

Accelerated magnetic resonance imaging (MRI) aims to reconstruct high-quality MR images from a set of under-sampled measurements. State-of-the-art methods for this task use deep learning, which offers high reconstruction accuracy and fast runtimes. In this work, we propose a new state-of-the-art reconstruction model for accelerated MRI reconstruction. Our model is the first to combine the power of deep neural networks with iterative refinement for this task. For the neural network component of our method, we utilize a transformer-based architecture as transformers are state-of-the-art in various image reconstruction tasks. However, a major drawback of transformers which has limited their emergence among the state-of-the-art MRI models is that they are often memory inefficient for high-resolution inputs. To address this limitation, we propose a transformer-based model which uses parameter-free Fourier-based attention modules, achieving 2× more memory efficiency. We evaluate our model on the largest publicly available MRI dataset, the fastMRI dataset [46], and achieve on-par performance with other state-of-the-art1methods on the dataset’s leaderboard2.

How to ensure fairness is an important topic in federated learning (FL). Recent studies have investigated how to reward clients based on their contribution (collaboration fairness), and how to achieve uniformity of performance across clients (performance fairness). Despite achieving progress on either one, we argue that it is critical to consider them together, in order to engage and motivate more diverse clients joining FL to derive a high-quality global model. In this work, we propose a novel method to optimize both types of fairness simultaneously. Specifically, we propose to estimate client contribution in gradient and data space. In gradient space, we monitor the gradient direction differences of each client with respect to others. And in data space, we measure the prediction error on client data using an auxiliary model. Based on this contribution estimation, we propose a FL method, federated training via contribution estimation (FedCE), i.e., using estimation as global model aggregation weights. We have theoretically analyzed our method and empirically evaluated it on two real-world medical datasets. The effectiveness of our approach has been validated with significant performance improvements, better collaboration fairness, better performance fairness, and comprehensive analytical studies. Code is available at https://nvidia.github.io/NVFlare/research/fed-ce

Federated learning is a popular collaborative learning approach that enables clients to train a global model without sharing their local data. Vertical federated learning (VFL) deals with scenarios in which the data on clients have different feature spaces but share some overlapping samples. Existing VFL approaches suffer from high communication costs and cannot deal efficiently with limited overlapping samples commonly seen in the real world. We propose a practical VFL framework called one-shot VFL that can solve the communication bottleneck and the problem of limited overlapping samples simultaneously based on semi-supervised learning. We also propose few-shot VFL to improve the accuracy further with just one more communication round between the server and the clients. In our proposed framework, the clients only need to communicate with the server once or only a few times. We evaluate the proposed VFL framework on both image and tabular datasets. Our methods can improve the accuracy by more than 46.5% and reduce the communication cost by more than 330× compared with state-of-the-art VFL methods when evaluated on CIFAR-10. Our code is available at https://nvidia.github.io/NVFlare/research/one-shot-vfl.

Semantic segmentation of 3D medical images is a challenging task due to the high variability of the shape and pattern of objects (such as organs or tumors). Given the recent success of deep learning in medical image segmentation, Neural Architecture Search (NAS) has been introduced to find high-performance 3D segmentation network architectures. However, because of the massive computational requirements of 3D data and the discrete optimization nature of architecture search, previous NAS methods require a long search time or necessary continuous relaxation, and commonly lead to sub-optimal network architectures. While one-shot NAS can potentially address these disadvantages, its application in the segmentation domain has not been well studied in the expansive multi-scale multi-path search space. To enable one-shot NAS for medical image segmentation, our method, named HyperSegNAS, introduces a HyperNet to assist super-net training by incorporating architecture topology information. Such a HyperNet can be removed once the super-net is trained and introduces no overhead during architecture search. We show that HyperSegNAS yields better performing and more intuitive architectures compared to the previous state-of-the-art (SOTA) segmentation networks; furthermore, it can quickly and accurately find good architecture candidates under different computing constraints. Our method is evaluated on public datasets from the Medical Segmentation Decathlon (MSD) challenge, and achieves SOTA performances.

Vision Transformers (ViT)s have shown great performance in self-supervised learning of global and local representations that can be transferred to downstream applications. Inspired by these results, we introduce a novel self-supervised learning framework with tailored proxy tasks for medical image analysis. Specifically, we propose: (i) a new 3D transformer-based model, dubbed Swin UNEt TRansformers (Swin UNETR), with a hierarchical encoder for self-supervised pretraining; (ii) tailored proxy tasks for learning the underlying pattern of human anatomy. We demonstrate successful pre-training of the proposed model on 5,050 publicly available computed tomography (CT) images from various body organs. The effectiveness of our approach is validated by fine-tuning the pre-trained models on the Beyond the Cranial Vault (BTCV) Segmentation Challenge with 13 abdominal organs and segmentation tasks from the Medical Segmentation Decathlon (MSD) dataset. Our model is currently the state-of-the-art on the public test leaderboards of both MSD11https://decathlon-10.grand-challenge.org/evaluation/challenge/leaderboard/ and BTCV22https://www.synapse.org/#!Synapse:syn3193805/wiki/217785/ datasets. Code: https://monai.io/research/swin-unetr.

Fully Convolutional Neural Networks (FCNNs) with contracting and expanding paths have shown prominence for the majority of medical image segmentation applications since the past decade. In FCNNs, the encoder plays an integral role by learning both global and local features and contextual representations which can be utilized for semantic output prediction by the decoder. Despite their success, the locality of convolutional layers in FCNNs, limits the capability of learning long-range spatial dependencies. Inspired by the recent success of transformers for Natural Language Processing (NLP) in long-range sequence learning, we reformulate the task of volumetric (3D) medical image segmentation as a sequence-to-sequence prediction problem. We introduce a novel architecture, dubbed as UNEt TRansformers (UNETR), that utilizes a transformer as the encoder to learn sequence representations of the input volume and effectively capture the global multi-scale information, while also following the successful "U-shaped" network design for the encoder and decoder. The transformer encoder is directly connected to a decoder via skip connections at different resolutions to compute the final semantic segmentation output. We have validated the performance of our method on the Multi Atlas Labeling Beyond The Cranial Vault (BTCV) dataset for multi-organ segmentation and the Medical Segmentation Decathlon (MSD) dataset for brain tumor and spleen segmentation tasks. Our benchmarks demonstrate new state-of-the-art performance on the BTCV leaderboard.

Active learning is a unique abstraction of machine learning techniques where the model/algorithm could guide users for annotation of a set of data points that would be beneficial to the model, unlike passive machine learning. The primary advantage being that active learning frameworks select data points that can accelerate the learning process of a model and can reduce the amount of data needed to achieve full accuracy as compared to a model trained on a randomly acquired data set. Multiple frameworks for active learning combined with deep learning have been proposed, and the majority of them are dedicated to classification tasks. Herein, we explore active learning for the task of segmentation of medical imaging data sets. We investigate our proposed framework using two datasets: 1.) MRI scans of the hippocampus, 2.) CT scans of pancreas and tumors. This work presents a query-by-committee approach for active learning where a joint optimizer is used for the committee. At the same time, we propose three new strategies for active learning: 1.) increasing frequency of uncertain data to bias the training data set; 2.) Using mutual information among the input images as a regularizer for acquisition to ensure diversity in the training dataset; 3.) adaptation of Dice log-likelihood for Stein variational gradient descent (SVGD). The results indicate an improvement in terms of data reduction by achieving full accuracy while only using 22.69% and 48.85% of the available data for each dataset, respectively.

Body part regression is a promising new technique that enables content navigation through self-supervised learning. Using this technique, the global quantitative spatial location for each axial view slice is obtained from computed tomography (CT). However, it is challenging to define a unified global coordinate system for body CT scans due to the large variabilities in image resolution, contrasts, sequences, and patient anatomy. Therefore, the widely used supervised learning approach cannot be easily deployed. To address these concerns, we propose an annotation-free method named blind-unsupervised-supervision network (BUSN). The contributions of the work are in four folds: (1) 1030 multi-center CT scans are used in developing BUSN without any manual annotation. (2) the proposed BUSN corrects the predictions from unsupervised learning and uses the corrected results as the new supervision; (3) to improve the consistency of predictions, we propose a novel neighbor message passing (NMP) scheme that is integrated with BUSN as a statistical learning based correction; and (4) we introduce a new pre-processing pipeline with inclusion of the BUSN, which is validated on 3D multi-organ segmentation. The proposed method is trained on 1,030 whole body CT scans (230,650 slices) from five datasets, as well as an independent external validation cohort with 100 scans. From the body part regression results, the proposed BUSN achieved significantly higher median R-squared score (=0.9089) than the state-of-the-art unsupervised method (=0.7153). When introducing BUSN as a preprocessing stage in volumetric segmentation, the proposed pre-processing pipeline using BUSN approach increases the total mean Dice score of the 3D abdominal multi-organ segmentation from 0.7991 to 0.8145.