Learning from noisy labels remains a major challenge in medical image analysis, where annotation demands expert knowledge and substantial inter-observer variability often leads to inconsistent or erroneous labels. Despite extensive research on learning with noisy labels (LNL), the robustness of existing methods in medical imaging has not been systematically assessed. To address this gap, we introduce LNMBench, a comprehensive benchmark for Label Noise in Medical imaging. LNMBench encompasses \textbf{10} representative methods evaluated across 7 datasets, 6 imaging modalities, and 3 noise patterns, establishing a unified and reproducible framework for robustness evaluation under realistic conditions. Comprehensive experiments reveal that the performance of existing LNL methods degrades substantially under high and real-world noise, highlighting the persistent challenges of class imbalance and domain variability in medical data. Motivated by these findings, we further propose a simple yet effective improvement to enhance model robustness under such conditions. The LNMBench codebase is publicly released to facilitate standardized evaluation, promote reproducible research, and provide practical insights for developing noise-resilient algorithms in both research and real-world medical applications.The codebase is publicly available on https://github.com/myyy777/LNMBench.

Existing semi-supervised learning (SSL) approaches follow the idealized closed-world assumption, neglecting the challenges present in realistic medical scenarios, such as open-set distribution and imbalanced class distribution. Although some methods in natural domains attempt to address the open-set problem, they are insufficient for medical domains, where intertwined challenges like class imbalance and small inter-class lesion discrepancies persist. Thus, this paper presents a novel self-recalibrated semantic training framework, which is tailored for SSL in medical imaging by ingeniously harvesting realistic unlabeled samples. Inspired by the observation that certain open-set samples share some similar disease-related representations with in-distribution samples, we first propose an informative sample selection strategy that identifies high-value samples to serve as augmentations, thereby effectively enriching the semantics of known categories. Furthermore, we adopt a compact semantic clustering strategy to address the semantic confusion raised by the above newly introduced open-set semantics. Moreover, to mitigate the interference of class imbalance in open-set SSL, we introduce a less biased dual-balanced classifier with similarity pseudo-label regularization and category-customized regularization. Extensive experiments on a variety of medical image datasets demonstrate the superior performance of our proposed method over state-of-the-art Closed-set and Open-set SSL methods.

Object categories are typically organized into a multi-granularity taxonomic hierarchy. When classifying categories at different hierarchy levels, traditional uni-modal approaches focus primarily on image features, revealing limitations in complex scenarios. Recent studies integrating Vision-Language Models (VLMs) with class hierarchies have shown promise, yet they fall short of fully exploiting the hierarchical relationships. These efforts are constrained by their inability to perform effectively across varied granularity of categories. To tackle this issue, we propose a novel framework (HGCLIP) that effectively combines CLIP with a deeper exploitation of the Hierarchical class structure via Graph representation learning. We explore constructing the class hierarchy into a graph, with its nodes representing the textual or image features of each category. After passing through a graph encoder, the textual features incorporate hierarchical structure information, while the image features emphasize class-aware features derived from prototypes through the attention mechanism. Our approach demonstrates significant improvements on 11 diverse visual recognition benchmarks. Our codes are fully available at https://github.com/richard-peng-xia/HGCLIP.

Deep learning models for medical image analysis easily suffer from distribution shifts caused by dataset artifact bias, camera variations, differences in the imaging station, etc., leading to unreliable diagnoses in real-world clinical settings. Domain generalization (DG) methods, which aim to train models on multiple domains to perform well on unseen domains, offer a promising direction to solve the problem. However, existing DG methods assume domain labels of each image are available and accurate, which is typically feasible for only a limited number of medical datasets. To address these challenges, we propose a unified DG framework for medical image classification without relying on domain labels, called Prompt-driven Latent Domain Generalization (PLDG). PLDG consists of unsupervised domain discovery and prompt learning. This framework first discovers pseudo domain labels by clustering the bias-associated style features, then leverages collaborative domain prompts to guide a Vision Transformer to learn knowledge from discovered diverse domains. To facilitate cross-domain knowledge learning between different prompts, we introduce a domain prompt generator that enables knowledge sharing between domain prompts and a shared prompt. A domain mixup strategy is additionally employed for more flexible decision margins and mitigates the risk of incorrect domain assignments. Extensive experiments on three medical image classification tasks and one debiasing task demonstrate that our method can achieve comparable or even superior performance than conventional DG algorithms without relying on domain labels. Our code is publicly available at https://github.com/SiyuanYan1/PLDG/tree/main.

Annotation ambiguity due to inherent data uncertainties such as blurred boundaries in medical scans and different observer expertise and preferences has become a major ob-stacle for training deep-learning based medical image segmentation models. To address it, the common practice is to gather multiple annotations from different experts, leading to the setting of multi-rater medical image segmentation. Existing works aim to either merge different annotations into the “groundtruth” that is often unattainable in numerous medical contexts, or generate diverse results, or produce personalized results corresponding to individ-ual expert raters. Here, we bring up a more ambitious goal for multi-rater medical image segmentation, i.e., obtaining both diversified and personalized results. Specifi-cally, we propose a two-stage framework named D-Persona (first Diversification and then Personalization). In Stage I, we exploit multiple given annotations to train a Proba-bilistic U-Net model, with a bound-constrained loss to improve the prediction diversity. In this way, a common latent space is constructed in Stage I, where different latent codes denote diversified expert opinions. Then, in Stage II, we design multiple attention-based projection heads to adaptively query the corresponding expert prompts from the shared latent space, and then perform the personalized medical image segmentation. We evaluated the proposed model on our in-house Nasopharyngeal Carcinoma dataset and the public lung nodule dataset (i.e., LIDC-IDRI). Ex-tensive experiments demonstrated our D-Persona can provide diversified and personalized results at the same time, achieving new SOTA performance for multi-rater medical image segmentation. Our code will be released at https://github.com/ycwu1997/D-Persona.

In the real world, medical datasets often exhibit a long-tailed data distribution (i.e., a few classes occupy the majority of the data, while most classes have only a limited number of samples), which results in a challenging long-tailed learning scenario. Some recently published datasets in ophthalmology AI consist of more than 40 kinds of retinal diseases with complex abnormalities and variable morbidity. Nevertheless, more than 30 conditions are rarely seen in global patient cohorts. From a modeling perspective, most deep learning models trained on these datasets may lack the ability to generalize to rare diseases where only a few available samples are presented for training. In addition, there may be more than one disease for the presence of the retina, resulting in a challenging label co-occurrence scenario, also known as multi-label, which can cause problems when some re-sampling strategies are applied during training. To address the above two major challenges, this paper presents a novel method that enables the deep neural network to learn from a long-tailed fundus database for various retinal disease recognition. Firstly, we exploit the prior knowledge in ophthalmology to improve the feature representation using a hierarchy-aware pre-training. Secondly, we adopt an instance-wise class-balanced sampling strategy to address the label co-occurrence issue under the long-tailed medical dataset scenario. Thirdly, we introduce a novel hybrid knowledge distillation to train a less biased representation and classifier. We conducted extensive experiments on four databases, including two public datasets and two in-house databases with more than one million fundus images. The experimental results demonstrate the superiority of our proposed methods with recognition accuracy outperforming the state-of-the-art competitors, especially for these rare diseases.

Generalizing a deep learning model to new domains is crucial for computer-aided medical diagnosis systems. Most existing unsupervised domain adaptation methods have made significant progress in reducing the domain distribution gap through adversarial training. However, these methods may still produce overconfident but erroneous results on unseen target images. This paper proposes a new unsupervised domain adaptation framework for cross-modality medical image segmentation. Specifically, We first introduce two data augmentation approaches to generate two sets of semantics-preserving augmented images. Based on the model's predictive consistency on these two sets of augmented images, we identify reliable and unreliable pixels. We then perform a selective entropy constraint: we minimize the entropy of reliable pixels to increase their confidence while maximizing the entropy of unreliable pixels to reduce their confidence. Based on the identified reliable and unreliable pixels, we further propose an adaptive semantic alignment module which performs class-level distribution adaptation by minimizing the distance between same class prototypes between domains, where unreliable pixels are removed to derive more accurate prototypes. We have conducted extensive experiments on the cross-modality cardiac structure segmentation task. The experimental results show that the proposed method significantly outperforms the state-of-the-art comparison algorithms. Our code and data are available at https://github.com/fengweie/SE_ASA.

The application of deep learning to nursing procedure activity understanding has the potential to greatly enhance the quality and safety of nurse-patient interactions. By utilizing the technique, we can facilitate training and education, improve quality control, and enable operational compliance monitoring. However, the development of automatic recognition systems in this field is currently hindered by the scarcity of appropriately labeled datasets. The existing video datasets pose several limitations: 1) these datasets are small-scale in size to support comprehensive investigations of nursing activity; 2) they primarily focus on single procedures, lacking expert-level annotations for various nursing procedures and action steps; and 3) they lack temporally localized annotations, which prevents the effective localization of targeted actions within longer video sequences. To mitigate these limitations, we propose NurViD, a large video dataset with expert-level annotation for nursing procedure activity understanding. NurViD consists of over 1.5k videos totaling 144 hours, making it approximately four times longer than the existing largest nursing activity datasets. Notably, it encompasses 51 distinct nursing procedures and 177 action steps, providing a much more comprehensive coverage compared to existing datasets that primarily focus on limited procedures. To evaluate the efficacy of current deep learning methods on nursing activity understanding, we establish three benchmarks on NurViD: procedure recognition on untrimmed videos, procedure and action recognition on trimmed videos, and action detection. Our benchmark and code will be available at https://github.com/minghu0830/NurViD-benchmark.

Deep neural networks are known to be data-driven and label noise can have a marked impact on model performance. Recent studies have shown great robustness to classic image recognition even under a high noisy rate. In medical applications, learning from datasets with label noise is more challenging since medical imaging datasets tend to have instance-dependent noise (IDN) and suffer from high observer variability. In this paper, we systematically discuss the two common types of label noise in medical images - disagreement label noise from inconsistency expert opinions and single-target label noise from biased aggregation of individual annotations. We then propose an uncertainty estimation-based framework to handle these two label noise amid the medical image classification task. We design a dual-uncertainty estimation approach to measure the disagreement label noise and single-target label noise via improved Direct Uncertainty Prediction and Monte-Carlo-Dropout. A boosting-based curriculum training procedure is later introduced for robust learning. We demonstrate the effectiveness of our method by conducting extensive experiments on three different diseases with synthesized and real-world label noise: skin lesions, prostate cancer, and retinal diseases. We also release a large re-engineered database that consists of annotations from more than ten ophthalmologists with an unbiased golden standard dataset for evaluation and benchmarking. The dataset is available at https://mmai.group/peoples/julie/.

The need for comprehensive and automated screening methods for retinal image classification has long been recognized. Well-qualified doctors annotated images are very expensive and only a limited amount of data is available for various retinal diseases such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). Some studies show that some retinal diseases such as DR and AMD share some common features like haemorrhages and exudation but most classification algorithms only train those disease models independently when the only single label for one image is available. Inspired by multi-task learning where additional monitoring signals from various sources is beneficial to train a robust model. We propose a method called synergic adversarial label learning (SALL) which leverages relevant retinal disease labels in both semantic and feature space as additional signals and train the model in a collaborative manner using knowledge distillation. Our experiments on DR and AMD fundus image classification task demonstrate that the proposed method can significantly improve the accuracy of the model for grading diseases by 5.91% and 3.69% respectively. In addition, we conduct additional experiments to show the effectiveness of SALL from the aspects of reliability and interpretability in the context of medical imaging application.

Recently, ultra-widefield (UWF) 200° fundus imaging by Optos cameras has gradually been introduced because of its broader insights for detecting more information on the fundus than regular 30° - 60° fundus cameras. Compared with UWF fundus images, regular fundus images contain a large amount of high-quality and well-annotated data. Due to the domain gap, models trained by regular fundus images to recognize UWF fundus images perform poorly. Hence, given that annotating medical data is labor intensive and time consuming, in this paper, we explore how to leverage regular fundus images to improve the limited UWF fundus data and annotations for more efficient training. We propose the use of a modified cycle generative adversarial network (CycleGAN) model to bridge the gap between regular and UWF fundus and generate additional UWF fundus images for training. A consistency regularization term is proposed in the loss of the GAN to improve and regulate the quality of the generated data. Our method does not require that images from the two domains be paired or even that the semantic labels be the same, which provides great convenience for data collection. Furthermore, we show that our method is robust to noise and errors introduced by the generated unlabeled data with the pseudo-labeling technique. We evaluated the effectiveness of our methods on several common fundus diseases and tasks, such as diabetic retinopathy (DR) classification, lesion detection and tessellated fundus segmentation. The experimental results demonstrate that our proposed method simultaneously achieves superior generalizability of the learned representations and performance improvements in multiple tasks.