To contribute to automating the medical vision-language model, we propose a novel Chest-Xray Different Visual Question Answering (VQA) task. Given a pair of main and reference images, this task attempts to answer several questions on both diseases and, more importantly, the differences between them. This is consistent with the radiologist's diagnosis practice that compares the current image with the reference before concluding the report. We collect a new dataset, namely MIMIC-Diff-VQA, including 700,703 QA pairs from 164,324 pairs of main and reference images. Compared to existing medical VQA datasets, our questions are tailored to the Assessment-Diagnosis-Intervention-Evaluation treatment procedure used by clinical professionals. Meanwhile, we also propose a novel expert knowledge-aware graph representation learning model to address this task. The proposed baseline model leverages expert knowledge such as anatomical structure prior, semantic, and spatial knowledge to construct a multi-relationship graph, representing the image differences between two images for the image difference VQA task. The dataset and code can be found at https://github.com/Holipori/MIMIC-Diff-VQA. We believe this work would further push forward the medical vision language model.

In medical image analysis, we often need to build an image recognition system for a target scenario with the access to small labeled data and abundant unlabeled data, as well as multiple related models pretrained on different source scenarios. This presents the combined challenges of multi-source-free domain adaptation and semi-supervised learning simultaneously. However, both problems are typically studied independently in the literature, and how to effectively combine existing methods is non-trivial in design. In this work, we introduce a novel MetaTeacher framework with three key components: (1) A learnable coordinating scheme for adaptive domain adaptation of individual source models, (2) A mutual feedback mechanism between the target model and source models for more coherent learning, and (3) A semi-supervised bilevel optimization algorithm for consistently organizing the adaption of source models and the learning of target model. It aims to leverage the knowledge of source models adaptively whilst maximize their complementary benefits collectively to counter the challenge of limited supervision. Extensive experiments on five chest x-ray image datasets show that our method outperforms clearly all the state-of-the-art alternatives. The code is available at https://github.com/wongzbb/metateacher.

The current unsupervised cross-domain detection methods need source domain data to retrain the detection model in target domain. However, the source domain data may be unavailable due to privacy, decentralization, or computation resource restrictions. A natural idea is to optimize the parameters of the source domain model by self-supervised learning based on pseudo labels. We propose another approach from the viewpoint of noise perturbation without pseudo-labeling. It can be assumed that the source and target domains are actually derived from a domain invariant space through domain-specific perturbations, respectively. A super target domain can be constructed by augmenting more target domain perturbations to the target domain images. The optimal direction of the target domain to the domain invariant space can be approximated as the alignment direction from the super target domain to the target domain. Based on this idea, we propose a novel method called SOAP (SOurce data-free domain Adaptation through domain Perturbation) which can remove domain perturbation from the target domain. The image-level, instance-level, and category consistency regularizations based on Mean Teacher structure are proposed to learn the correct alignment direction. Specifically, the category consistency can also further improve the classification accuracy. Extensive experiments on multiple domain adaptation scenarios demonstrate that SOAP achieves better performance surpassing the baseline (Faster R-CNN) and multiple state-of-the-art domain adaptation methods which need to access source domain data.

OBJECTIVE: Reticular pseudodrusen (RPD), a key feature of age-related macular degeneration (AMD), are poorly detected by human experts on standard color fundus photography (CFP) and typically require advanced imaging modalities such as fundus autofluorescence (FAF). The objective was to develop and evaluate the performance of a novel multimodal, multitask, multiattention (M3) deep learning framework on RPD detection. MATERIALS AND METHODS: A deep learning framework (M3) was developed to detect RPD presence accurately using CFP alone, FAF alone, or both, employing >8000 CFP-FAF image pairs obtained prospectively (Age-Related Eye Disease Study 2). The M3 framework includes multimodal (detection from single or multiple image modalities), multitask (training different tasks simultaneously to improve generalizability), and multiattention (improving ensembled feature representation) operation. Performance on RPD detection was compared with state-of-the-art deep learning models and 13 ophthalmologists; performance on detection of 2 other AMD features (geographic atrophy and pigmentary abnormalities) was also evaluated. RESULTS: For RPD detection, M3 achieved an area under the receiver-operating characteristic curve (AUROC) of 0.832, 0.931, and 0.933 for CFP alone, FAF alone, and both, respectively. M3 performance on CFP was very substantially superior to human retinal specialists (median F1 score = 0.644 vs 0.350). External validation (the Rotterdam Study) demonstrated high accuracy on CFP alone (AUROC, 0.965). The M3 framework also accurately detected geographic atrophy and pigmentary abnormalities (AUROC, 0.909 and 0.912, respectively), demonstrating its generalizability. CONCLUSIONS: This study demonstrates the successful development, robust evaluation, and external validation of a novel deep learning framework that enables accessible, accurate, and automated AMD diagnosis and prognosis.

The latest threat to global health is the COVID-19 outbreak. Although there exist large datasets of chest X-rays (CXR) and computed tomography (CT) scans, few COVID-19 image collections are currently available due to patient privacy. At the same time, there is a rapid growth of COVID-19-relevant articles in the biomedical literature, including those that report findings on radiographs. Here, we present COVID-19-CT-CXR, a public database of COVID-19 CXR and CT images, which are automatically extracted from COVID-19-relevant articles from the PubMed Central Open Access (PMC-OA) Subset. We extracted figures, associated captions, and relevant figure descriptions in the article and separated compound figures into subfigures. Because a large portion of figures in COVID-19 articles are not CXR or CT, we designed a deep-learning model to distinguish them from other figure types and to classify them accordingly. The final database includes 1,327 CT and 263 CXR images (as of May 9, 2020) with their relevant text. To demonstrate the utility of COVID-19-CT-CXR, we conducted four case studies. (1) We show that COVID-19-CT-CXR, when used as additional training data, is able to contribute to improved deep-learning (DL) performance for the classification of COVID-19 and non-COVID-19 CT. (2) We collected CT images of influenza, another common infectious respiratory illness that may present similarly to COVID-19, and fine-tuned a baseline deep neural network to distinguish a diagnosis of COVID-19, influenza, or normal or other types of diseases on CT. (3) We fine-tuned an unsupervised one-class classifier from non-COVID-19 CXR and performed anomaly detection to detect COVID-19 CXR. (4) From text-mined captions and figure descriptions, we compared 15 clinical symptoms and 20 clinical findings of COVID-19 versus those of influenza to demonstrate the disease differences in the scientific publications. Our database is unique, as the figures are retrieved along with relevant text with fine-grained descriptions, and it can be extended easily in the future. We believe that our work is complementary to existing resources and hope that it will contribute to medical image analysis of the COVID-19 pandemic. The dataset, code, and DL models are publicly available at https://github.com/ncbi-nlp/COVID-19-CT-CXR.

Hyper-graph techniques have been widely investigated in computer vision and medical imaging applications, showing superior performance for modeling complex subject-wise relationships and sufficient flexibility to deal with missing data from multi-modal neuroimaging data. Existing hyper-graph methods, however, are inadequate for two reasons. First, representations are generated only from the observed imaging data, a process that is completely independent of the subsequent data label inference/ classification step. Thus, hyper-graph results constructed in this way may not be consistent with phenotype data such as clinical labels or scores. More critically, it might generate sub-optimal predictions in relation to clinical labels/scores. Second, current hyper-graph inference methods rely on two sequential steps: 1) building the hyper-graph for each individual modality and then predicted latent labels for new subjects upon each constructed hyper-graph and 2) a voting procedure to incorporate inference results across different hyper-graphs. This approach, however, is limited by failing to consider the complex and complementary relationships of multi-modal imaging data with respect to hyper-graph inference procedure. To address these two issues, we propose a novel dynamic hyper-graph inference method supported by a semi-supervised framework. Our method iteratively estimates and adjusts the hyper-graph structures from multi-modal imaging data until consistency between the learned hyper-graph and the observed clinical labels and scores is achieved. This hyper-graph inference framework also eases the integration process of classification (identifying individuals having neurodegenerative disease) and regression (predicting the clinical scores) within the same framework. The experimental results on identifying mild cognition impairment (MCI) subjects and the fine grained recognition of MCI progression stages show improved performance using our proposed hyper-graph inference method compared with conventional methods.