Vision-and-language pretraining (VLP) in medicine leverages contrastive learning on image-text pairs, often enhanced with masked modeling.However, existing methods face two challenges: difficulty reconstructing key pathological features due to limited data, and reliance on either paired or image-only datasets without combining both.To address this, we propose MMCLIP (Masked Medical Contrastive Language-Image Pre-training), which introduces two modules: AttMIM, masking image features highly correlated with text to improve reconstruction of fine medical details, and EntMLM, masking key medical entities in text and reconstructing them using visual cues.Furthermore, MMCLIP incorporates unpaired data through disease-kind prompts, achieving state-of-the-art performance in zero-shot and fine-tuning across five benchmarks.Code

Prostate cancer, a growing global health concern, necessitates precise diagnostic tools, with Magnetic Resonance Imaging (MRI) offering high-resolution soft tissue imaging that significantly enhances diagnostic accuracy. Recent advancements in explainable AI and representation learning have significantly improved prostate cancer diagnosis by enabling automated and precise lesion classification. However, existing explainable AI methods, particularly those based on frameworks like generative adversarial networks (GANs), are predominantly developed for natural image generation, and their application to medical imaging often leads to suboptimal performance due to the unique characteristics and complexity of medical image. To address these challenges, our paper introduces three key contributions. First, we propose ProjectedEx, a generative framework that provides interpretable, multi-attribute explanations, effectively linking medical image features to classifier decisions. Second, we enhance the encoder module by incorporating feature pyramids, which enables multiscale feedback to refine the latent space and improves the quality of generated explanations. Additionally, we conduct comprehensive experiments on both the generator and classifier, demonstrating the clinical relevance and effectiveness of ProjectedEx in enhancing interpretability and supporting the adoption of AI in medical settings. Code will be released at https://github.com/Richardqiyi/ProjectedEx.

The ability to interpret and intervene model decisions is important for the adoption of computer-aided diagnosis methods in clinical workflows. Recent concept-based methods link the model predictions with interpretable concepts and modify their activation scores to interact with the model. However, these concepts are at the image level, which hinders the model from pinpointing the exact patches the concepts are activated. Alternatively, prototype-based methods learn representations from training image patches and compare these with test image patches, using the similarity scores for final class prediction. However, interpreting the underlying concepts of these patches can be challenging and often necessitates post-hoc guesswork. To address this issue, this paper introduces the novel Concept-based Similarity Reasoning network (CSR), which offers (i) patch-level prototype with intrinsic concept interpretation, and (ii) spatial interactivity. First, the proposed CSR provides localized explanation by grounding prototypes of each concept on image regions. Second, our model introduces novel spatial-level interaction, allowing doctors to engage directly with specific image areas, making it an intuitive and transparent tool for medical imaging. CSR improves upon prior state-of-the-art interpretable methods by up to 4.5% across three biomedical datasets. Our code is released at https://github.com/tadeephuy/InteractCSR.

Counterfactual explanations (CFE) for deep image classifiers aim to reveal how minimal input changes lead to different model decisions, providing critical insights for model interpretation and improvement. However, existing CFE methods often rely on additional image encoders and generative models to create plausible images, neglecting the classifier's own feature space and decision boundaries. As such, they do not explain the intrinsic feature space and decision boundaries learned by the classifier. To address this limitation, we propose Mirror-CFE, a novel method that generates faithful counterfactual explanations by operating directly in the classifier's feature space, treating decision boundaries as mirrors that ``reflect'' feature representations in the mirror. Mirror-CFE learns a mapping function from feature space to image space while preserving distance relationships, enabling smooth transitions between source images and their counterfactuals. Through extensive experiments on four image datasets, we demonstrate that Mirror-CFE achieves superior performance in validity while maintaining input resemblance compared to state-of-the-art explanation methods. Finally, mirror-CFE provides interpretable visualization of the classifier's decision process by generating step-wise transitions that reveal how features evolve as classification confidence changes.

Visual grounding (VG) is the capability to identify the specific regions in an image associated with a particular text description. In medical imaging, VG enhances interpretability by highlighting relevant pathological features corresponding to textual descriptions, improving model transparency and trustworthiness for wider adoption of deep learning models in clinical practice. Current models struggle to associate textual descriptions with disease regions due to inefficient attention mechanisms and a lack of fine-grained token representations. In this paper, we empirically demonstrate two key observations. First, current VLMs assign high norms to background tokens, diverting the model's attention from regions of disease. Second, the global tokens used for cross-modal learning are not representative of local disease tokens. This hampers identifying correlations between the text and disease tokens. To address this, we introduce simple, yet effective Disease-Aware Prompting (DAP) process, which uses the explainability map of a VLM to identify the appropriate image features. This simple strategy amplifies disease-relevant regions while suppressing background interference. Without any additional pixel-level annotations, DAP improves visual grounding accuracy by 20.74% compared to state-of-the-art methods across three major chest X-ray datasets.

Medical Large Multi-modal Models (LMMs) have demonstrated remarkable capabilities in medical data interpretation. However, these models frequently generate hallucinations contradicting source evidence, particularly due to inadequate localization reasoning. This work reveals a critical limitation in current medical LMMs: instead of analyzing relevant pathological regions, they often rely on linguistic patterns or attend to irrelevant image areas when responding to disease-related queries. To address this, we introduce HEAL-MedVQA (Hallucination Evaluation via Localization MedVQA), a comprehensive benchmark designed to evaluate LMMs' localization abilities and hallucination robustness. HEAL-MedVQA features (i) two innovative evaluation protocols to assess visual and textual shortcut learning, and (ii) a dataset of 67K VQA pairs, with doctor-annotated anatomical segmentation masks for pathological regions. To improve visual reasoning, we propose the Localize-before-Answer (LobA) framework, which trains LMMs to localize target regions of interest and self-prompt to emphasize segmented pathological areas, generating grounded and reliable answers. Experimental results demonstrate that our approach significantly outperforms state-of-the-art biomedical LMMs on the challenging HEAL-MedVQA benchmark, advancing robustness in medical VQA.

Class-incremental semantic segmentation (CSS) requires that a model learn to segment new classes without forgetting how to segment previous ones: this is typically achieved by distilling the current knowledge and incorporating the latest data. However, bypassing iterative distillation by directly transferring outputs of initial classes to the current learning task is not supported in existing class-specific CSS methods. Via Softmax, they enforce dependency between classes and adjust the output distribution at each learning step, resulting in a large probability distribution gap between initial and current tasks. We introduce a simple, yet effective Class Independent Transformation (CIT) that converts the outputs of existing semantic segmentation models into class-independent forms with negligible cost or performance loss. By utilizing class-independent predictions facilitated by CIT, we establish an accumulative distillation framework, ensuring equitable incorporation of all class information. We conduct extensive experiments on various segmentation architectures, including DeepLabV3, Mask2Former, and SegViTv2. Results from these experiments show minimal task forgetting across different datasets, with less than 5% for ADE20K in the most challenging 11 task configurations and less than 1% across all configurations for the PASCAL VOC 2012 dataset. • Softmax interdependency causes incremental forgetting in continual learning. • We introduce a class-independent transformation (CIT) to reduce forgetting. • CIT reformulates segmentation as class-agnostic, enhancing CSS training pipelines. • Our method significantly reduces forgetting on ADE20K compared to CSS baselines. • CIT achieves near-zero forgetting ( ≤ 1%) in Pascal-VOC 2012 settings.

Deep Neural Networks (DNNs) are widely used for visual classification tasks, but their complex computation process and black-box nature hinder decision transparency and interpretability. Class activation maps (CAMs) and recent variants provide ways to visually explain the DNN decision-making process by displaying ‘attention’ heatmaps of the DNNs. Nevertheless, the CAM explanation only offers relative attention information, that is, on an attention heatmap, we can interpret which image region is more or less important than the others. However, these regions cannot be meaningfully compared across classes, and the contribution of each region to the model's class prediction is not revealed. To address these challenges that ultimately lead to better DNN Interpretation, in this paper, we propose CAPE, a novel reformulation of CAM that provides a unified and probabilistically meaningful assessment of the contributions of image regions. We quantitatively and qualitatively compare CAPE with state-of-the-art CAM methods on CUB and ImageNet benchmark datasets to demonstrate enhanced interpretability. We also test on a cytology imaging dataset depicting a challenging Chronic Myelomonocytic Leukemia (CMML) diagnosis problem. Code is available at: https://github.com/AIML-MED/CAPE.

Medical vision language pre-training (VLP) has emerged as a frontier of research, enabling zero-shot pathological recognition by comparing the query image with the textual descriptions for each disease. Due to the complex semantics of biomedical texts, current methods struggle to align medical images with key pathological findings in un-structured reports. This leads to the misalignment with the target disease's textual representation. In this paper, we introduce a novel VLP framework designed to dissect disease descriptions into their fundamental aspects, leveraging prior knowledge about the visual manifestations of pathologies. This is achieved by consulting a large language model and medical experts. Integrating a Transformer module, our approach aligns an input image with the diverse elements of a disease, generating aspect-centric image representations. By consolidating the matches from each aspect, we improve the compatibility between an image and its associated disease. Additionally, capitalizing on the aspect-oriented representations, we present a dual-head Transformer tailored to process known and unknown diseases, optimizing the comprehensive detection efficacy. Conducting experiments on seven downstream datasets, ours improves the accuracy of recent methods by up to 8.56% and 17.26% for seen and unseen categories, respectively. Our code is released at https://github.com/HieuPhan33/MAVL.