Self-supervised learning in vision-language processing (VLP) exploits semantic alignment between imaging and text modalities. Prior work in biomedical VLP has mostly relied on the alignment of single image and report pairs even though clinical notes commonly refer to prior images. This does not only introduce poor alignment between the modalities but also a missed opportunity to exploit rich self-supervision through existing temporal content in the data. In this work, we explicitly account for prior images and reports when available during both training and fine-tuning. Our approach, named BioViL-T, uses a CNN-Transformer hybrid multi-image encoder trained jointly with a text model. It is designed to be versatile to arising challenges such as pose variations and missing input images across time. The resulting model excels on downstream tasks both in single- and multi-image setups, achieving state-of-the-art (SOTA) performance on (I) progression classification, (II) phrase grounding, and (III) report generation, whilst offering consistent improvements on disease classification and sentence-similarity tasks. We release a novel multi-modal temporal benchmark dataset, MS-CXR-T, to quantify the quality of vision-language representations in terms of temporal semantics. Our experimental results show the advantages of incorporating prior images and reports to make most use of the data.

Machine learning models trained with purely observational data and the principle of empirical risk minimization (Vapnik 1992) can fail to generalize to unseen domains. In this paper, we focus on the case where the problem arises through spurious correlation between the observed domains and the actual task labels. We find that many domain generalization methods do not explicitly take this spurious correlation into account. Instead, especially in more application-oriented research areas like medical imaging or robotics, data augmentation techniques that are based on heuristics are used to learn domain invariant features. To bridge the gap between theory and practice, we develop a causal perspective on the problem of domain generalization. We argue that causal concepts can be used to explain the success of data augmentation by describing how they can weaken the spurious correlation between the observed domains and the task labels. We demonstrate that data augmentation can serve as a tool for simulating interventional data. We use these theoretical insights to derive a simple algorithm that is able to select data augmentation techniques that will lead to better domain generalization.

Multiple instance learning (MIL) is a variation of supervised learning where a single class label is assigned to a bag of instances. In this paper, we state the MIL problem as learning the Bernoulli distribution of the bag label where the bag label probability is fully parameterized by neural networks. Furthermore, we propose a neural network-based permutation-invariant aggregation operator that corresponds to the attention mechanism. Notably, an application of the proposed attention-based operator provides insight into the contribution of each instance to the bag label. We show empirically that our approach achieves comparable performance to the best MIL methods on benchmark MIL datasets and it outperforms other methods on a MNIST-based MIL dataset and two real-life histopathology datasets without sacrificing interpretability.