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Text-to-Image (T2I) diffusion models have achieved remarkable success in image generation. Despite their progress, challenges remain in both prompt-following ability, image quality and lack of high-quality datasets, which are essential for refining these models. As acquiring labeled data is costly, we introduce AGFSync, a framework that enhances T2I diffusion models through Direct Preference Optimization (DPO) in a fully AI-driven approach. AGFSync utilizes Vision-Language Models (VLM) to assess image quality across style, coherence, and aesthetics, generating feedback data within an AI-driven loop. By applying AGFSync to leading T2I models such as SD v1.4, v1.5, and SDXL, our extensive experiments on the TIFA dataset demonstrate notable improvements in VQA scores, aesthetic evaluations, and performance on the HPSv2 benchmark, consistently outperforming the base models. AGFSync's method of refining T2I diffusion models paves the way for scalable alignment techniques.

UNet and its variants have been widely used in medical image segmentation. However, these models, especially those based on Transformer architectures, pose challenges due to their large number of parameters and computational loads, making them unsuitable for mobile health applications. Recently, State Space Models (SSMs), exemplified by Mamba, have emerged as competitive alternatives to CNN and Transformer architectures. Building upon this, we employ Mamba as a lightweight substitute for CNN and Transformer within UNet, aiming at tackling challenges stemming from computational resource limitations in real medical settings. To this end, we introduce the Lightweight Mamba UNet (LightM-UNet) that integrates Mamba and UNet in a lightweight framework. Specifically, LightM-UNet leverages the Residual Vision Mamba Layer in a pure Mamba fashion to extract deep semantic features and model long-range spatial dependencies, with linear computational complexity. Extensive experiments conducted on two real-world 2D/3D datasets demonstrate that LightM-UNet surpasses existing state-of-the-art literature. Notably, when compared to the renowned nnU-Net, LightM-UNet achieves superior segmentation performance while drastically reducing parameter and computation costs by 116x and 21x, respectively. This highlights the potential of Mamba in facilitating model lightweighting. Our code implementation is publicly available at https://github.com/MrBlankness/LightM-UNet.

The integration of multimodal Electronic Health Records (EHR) data has significantly improved clinical predictive capabilities. Leveraging clinical notes and multivariate time-series EHR, existing models often lack the medical context relevent to clinical tasks, prompting the incorporation of external knowledge, particularly from the knowledge graph (KG). Previous approaches with KG knowledge have primarily focused on structured knowledge extraction, neglecting unstructured data modalities and semantic high dimensional medical knowledge. In response, we propose REALM, a Retrieval-Augmented Generation (RAG) driven framework to enhance multimodal EHR representations that address these limitations. Firstly, we apply Large Language Model (LLM) to encode long context clinical notes and GRU model to encode time-series EHR data. Secondly, we prompt LLM to extract task-relevant medical entities and match entities in professionally labeled external knowledge graph (PrimeKG) with corresponding medical knowledge. By matching and aligning with clinical standards, our framework eliminates hallucinations and ensures consistency. Lastly, we propose an adaptive multimodal fusion network to integrate extracted knowledge with multimodal EHR data. Our extensive experiments on MIMIC-III mortality and readmission tasks showcase the superior performance of our REALM framework over baselines, emphasizing the effectiveness of each module. REALM framework contributes to refining the use of multimodal EHR data in healthcare and bridging the gap with nuanced medical context essential for informed clinical predictions.

Conventional domain adaptation typically transfers knowledge from a source domain to a stationary target domain. However, in many real-world cases, target data usually emerge sequentially and have continuously evolving distributions. Restoring and adapting to such target data results in escalating computational and resource consumption over time. Hence, it is vital to devise algorithms to address the evolving domain adaptation (EDA) problem, \emph{i.e.,} adapting models to evolving target domains without access to historic target domains. To achieve this goal, we propose a simple yet effective approach, termed progressive conservative adaptation (PCAda). To manage new target data that diverges from previous distributions, we fine-tune the classifier head based on the progressively updated class prototypes. Moreover, as adjusting to the most recent target domain can interfere with the features learned from previous target domains, we develop a conservative sparse attention mechanism. This mechanism restricts feature adaptation within essential dimensions, thus easing the inference related to historical knowledge. The proposed PCAda is implemented with a meta-learning framework, which achieves the fast adaptation of the classifier with the help of the progressively updated class prototypes in the inner loop and learns a generalized feature without severely interfering with the historic knowledge via the conservative sparse attention in the outer loop. Experiments on Rotated MNIST, Caltran, and Portraits datasets demonstrate the effectiveness of our method., Comment: 7 pages, 5 figures

The inherent complexity of structured longitudinal Electronic Health Records (EHR) data poses a significant challenge when integrated with Large Language Models (LLMs), which are traditionally tailored for natural language processing. Motivated by the urgent need for swift decision-making during new disease outbreaks, where traditional predictive models often fail due to a lack of historical data, this research investigates the adaptability of LLMs, like GPT-4, to EHR data. We particularly focus on their zero-shot capabilities, which enable them to make predictions in scenarios in which they haven't been explicitly trained. In response to the longitudinal, sparse, and knowledge-infused nature of EHR data, our prompting approach involves taking into account specific EHR characteristics such as units and reference ranges, and employing an in-context learning strategy that aligns with clinical contexts. Our comprehensive experiments on the MIMIC-IV and TJH datasets demonstrate that with our elaborately designed prompting framework, LLMs can improve prediction performance in key tasks such as mortality, length-of-stay, and 30-day readmission by about 35\%, surpassing ML models in few-shot settings. Our research underscores the potential of LLMs in enhancing clinical decision-making, especially in urgent healthcare situations like the outbreak of emerging diseases with no labeled data. The code is publicly available at https://github.com/yhzhu99/llm4healthcare for reproducibility.

Coronary microvascular disease constitutes a substantial risk to human health. Employing computer-aided analysis and diagnostic systems, medical professionals can intervene early in disease progression, with 3D vessel segmentation serving as a crucial component. Nevertheless, conventional U-Net architectures tend to yield incoherent and imprecise segmentation outcomes, particularly for small vessel structures. While models with attention mechanisms, such as Transformers and large convolutional kernels, demonstrate superior performance, their extensive computational demands during training and inference lead to increased time complexity. In this study, we leverage Fourier domain learning as a substitute for multi-scale convolutional kernels in 3D hierarchical segmentation models, which can reduce computational expenses while preserving global receptive fields within the network. Furthermore, a zero-parameter frequency domain fusion method is designed to improve the skip connections in U-Net architecture. Experimental results on a public dataset and an in-house dataset indicate that our novel Fourier transformation-based network achieves remarkable dice performance (84.37\% on ASACA500 and 80.32\% on ImageCAS) in tubular vessel segmentation tasks and substantially reduces computational requirements without compromising global receptive fields.

Security concerns related to Large Language Models (LLMs) have been extensively explored, yet the safety implications for Multimodal Large Language Models (MLLMs), particularly in medical contexts (MedMLLMs), remain insufficiently studied. This paper delves into the underexplored security vulnerabilities of MedMLLMs, especially when deployed in clinical environments where the accuracy and relevance of question-and-answer interactions are critically tested against complex medical challenges. By combining existing clinical medical data with atypical natural phenomena, we redefine two types of attacks: mismatched malicious attack (2M-attack) and optimized mismatched malicious attack (O2M-attack). Using our own constructed voluminous 3MAD dataset, which covers a wide range of medical image modalities and harmful medical scenarios, we conduct a comprehensive analysis and propose the MCM optimization method, which significantly enhances the attack success rate on MedMLLMs. Evaluations with this dataset and novel attack methods, including white-box attacks on LLaVA-Med and transfer attacks on four other state-of-the-art models, indicate that even MedMLLMs designed with enhanced security features are vulnerable to security breaches. Our work underscores the urgent need for a concerted effort to implement robust security measures and enhance the safety and efficacy of open-source MedMLLMs, particularly given the potential severity of jailbreak attacks and other malicious or clinically significant exploits in medical settings. For further research and replication, anonymous access to our code is available at https://github.com/dirtycomputer/O2M_attack. Warning: Medical large model jailbreaking may generate content that includes unverified diagnoses and treatment recommendations. Always consult professional medical advice.

The integration of multimodal Electronic Health Records (EHR) data has notably advanced clinical predictive capabilities. However, current models that utilize clinical notes and multivariate time-series EHR data often lack the necessary medical context for precise clinical tasks. Previous methods using knowledge graphs (KGs) primarily focus on structured knowledge extraction. To address this, we propose EMERGE, a Retrieval-Augmented Generation (RAG) driven framework aimed at enhancing multimodal EHR predictive modeling. Our approach extracts entities from both time-series data and clinical notes by prompting Large Language Models (LLMs) and aligns them with professional PrimeKG to ensure consistency. Beyond triplet relationships, we include entities' definitions and descriptions to provide richer semantics. The extracted knowledge is then used to generate task-relevant summaries of patients' health statuses. These summaries are fused with other modalities utilizing an adaptive multimodal fusion network with cross-attention. Extensive experiments on the MIMIC-III and MIMIC-IV datasets for in-hospital mortality and 30-day readmission tasks demonstrate the superior performance of the EMERGE framework compared to baseline models. Comprehensive ablation studies and analyses underscore the efficacy of each designed module and the framework's robustness to data sparsity. EMERGE significantly enhances the use of multimodal EHR data in healthcare, bridging the gap with nuanced medical contexts crucial for informed clinical predictions., Comment: arXiv admin note: text overlap with arXiv:2402.07016

Vessel segmentation is widely used to help with vascular disease diagnosis. Vessels reconstructed using existing methods are often not sufficiently accurate to meet clinical use standards. This is because 3D vessel structures are highly complicated and exhibit unique characteristics, including sparsity and anisotropy. In this paper, we propose a novel hybrid deep neural network for vessel segmentation. Our network consists of two cascaded subnetworks performing initial and refined segmentation respectively. The second subnetwork further has two tightly coupled components, a traditional CNN-based U-Net and a graph U-Net. Cross-network multi-scale feature fusion is performed between these two U-shaped networks to effectively support high-quality vessel segmentation. The entire cascaded network can be trained from end to end. The graph in the second subnetwork is constructed according to a vessel probability map as well as appearance and semantic similarities in the original CT volume. To tackle the challenges caused by the sparsity and anisotropy of vessels, a higher percentage of graph nodes are distributed in areas that potentially contain vessels while a higher percentage of edges follow the orientation of potential nearbyvessels. Extensive experiments demonstrate our deep network achieves state-of-the-art 3D vessel segmentation performance on multiple public and in-house datasets.

In the data-driven artificial intelligence paradigm, models heavily rely on large amounts of training data. However, factors like sampling distribution imbalance can lead to issues of bias and unfairness in healthcare data. Sensitive attributes, such as race, gender, age, and medical condition, are characteristics of individuals that are commonly associated with discrimination or bias. In healthcare AI, these attributes can play a significant role in determining the quality of care that individuals receive. For example, minority groups often receive fewer procedures and poorer-quality medical care than white individuals in US. Therefore, detecting and mitigating bias in data is crucial to enhancing health equity. Bias mitigation methods include pre-processing, in-processing, and post-processing. Among them, Reweighting (RW) is a widely used pre-processing method that performs well in balancing machine learning performance and fairness performance. RW adjusts the weights for samples within each (group, label) combination, where these weights are utilized in loss functions. However, RW is limited to considering only a single sensitive attribute when mitigating bias and assumes that each sensitive attribute is equally important. This may result in potential inaccuracies when addressing intersectional bias. To address these limitations, we propose M3Fair, a multi-level and multi-sensitive-attribute reweighting method by extending the RW method to multiple sensitive attributes at multiple levels. Our experiments on real-world datasets show that the approach is effective, straightforward, and generalizable in addressing the healthcare fairness issues., Comment: 4 pages, 1 table, Beijing Health Data Science Summit 2023

Electronic Health Records (EHRs) contain a wealth of patient data; however, the sparsity of EHRs data often presents significant challenges for predictive modeling. Conventional imputation methods inadequately distinguish between real and imputed data, leading to potential inaccuracies of patient representations. To address these issues, we introduce PRISM, a framework that indirectly imputes data by leveraging prototype representations of similar patients, thus ensuring compact representations that preserve patient information. PRISM also includes a feature confidence learner module, which evaluates the reliability of each feature considering missing statuses. Additionally, PRISM introduces a new patient similarity metric that accounts for feature confidence, avoiding overreliance on imprecise imputed values. Our extensive experiments on the MIMIC-III, MIMIC-IV, PhysioNet Challenge 2012, eICU datasets demonstrate PRISM's superior performance in predicting in-hospital mortality and 30-day readmission tasks, showcasing its effectiveness in handling EHR data sparsity. For the sake of reproducibility and further research, we have made the code publicly available at https://github.com/yhzhu99/PRISM.

Although deep learning algorithms have been intensively developed for computer-aided tuberculosis diagnosis (CTD), they mainly depend on carefully annotated datasets, leading to much time and resource consumption. Weakly supervised learning (WSL), which leverages coarse-grained labels to accomplish fine-grained tasks, has the potential to solve this problem. In this paper, we first propose a new large-scale tuberculosis (TB) chest X-ray dataset, namely the tuberculosis chest X-ray attribute dataset (TBX-Att), and then establish an attribute-assisted weakly-supervised framework to classify and localize TB by leveraging the attribute information to overcome the insufficiency of supervision in WSL scenarios. Specifically, first, the TBX-Att dataset contains 2000 X-ray images with seven kinds of attributes for TB relational reasoning, which are annotated by experienced radiologists. It also includes the public TBX11K dataset with 11200 X-ray images to facilitate weakly supervised detection. Second, we exploit a multi-scale feature interaction model for TB area classification and detection with attribute relational reasoning. The proposed model is evaluated on the TBX-Att dataset and will serve as a solid baseline for future research. The code and data will be available at https://github.com/GangmingZhao/tb-attribute-weak-localization., Comment: Provisionally Accepted for Medical Image Computing and Computer Assisted Interventions 2022 (MICCAI 2022). arXiv admin note: text overlap with arXiv:2010.04483

Locating diseases in chest X-ray images with few careful annotations saves large human effort. Recent works approached this task with innovative weakly-supervised algorithms such as multi-instance learning (MIL) and class activation maps (CAM), however, these methods often yield inaccurate or incomplete regions. One of the reasons is the neglection of the pathological implications hidden in the relationship across anatomical regions within each image and the relationship across images. In this paper, we argue that the cross-region and cross-image relationship, as contextual and compensating information, is vital to obtain more consistent and integral regions. To model the relationship, we propose the Graph Regularized Embedding Network (GREN), which leverages the intra-image and inter-image information to locate diseases on chest X-ray images. GREN uses a pre-trained U-Net to segment the lung lobes, and then models the intra-image relationship between the lung lobes using an intra-image graph to compare different regions. Meanwhile, the relationship between in-batch images is modeled by an inter-image graph to compare multiple images. This process mimics the training and decision-making process of a radiologist: comparing multiple regions and images for diagnosis. In order for the deep embedding layers of the neural network to retain structural information (important in the localization task), we use the Hash coding and Hamming distance to compute the graphs, which are used as regularizers to facilitate training. By means of this, our approach achieves the state-of-the-art result on NIH chest X-ray dataset for weakly-supervised disease localization. Our codes are accessible online (https://github.com/qibaolian/GREN)., Comment: Accepted in IEEE Journal of Biomedical and Health Informatics (JBHI)

The midline related pathological image features are crucial for evaluating the severity of brain compression caused by stroke or traumatic brain injury (TBI). The automated midline delineation not only improves the assessment and clinical decision making for patients with stroke symptoms or head trauma but also reduces the time of diagnosis. Nevertheless, most of the previous methods model the midline by localizing the anatomical points, which are hard to detect or even missing in severe cases. In this paper, we formulate the brain midline delineation as a segmentation task and propose a three-stage framework. The proposed framework firstly aligns an input CT image into the standard space. Then, the aligned image is processed by a midline detection network (MD-Net) integrated with the CoordConv Layer and Cascade AtrousCconv Module to obtain the probability map. Finally, we formulate the optimal midline selection as a pathfinding problem to solve the problem of the discontinuity of midline delineation. Experimental results show that our proposed framework can achieve superior performance on one in-house dataset and one public dataset.

Automatic blood vessel extraction from 3D medical images is crucial for vascular disease diagnoses. Existing methods based on convolutional neural networks (CNNs) may suffer from discontinuities of extracted vessels when segmenting such thin tubular structures from 3D images. We argue that preserving the continuity of extracted vessels requires to take into account the global geometry. However, 3D convolutions are computationally inefficient, which prohibits the 3D CNNs from sufficiently large receptive fields to capture the global cues in the entire image. In this work, we propose a hybrid representation learning approach to address this challenge. The main idea is to use CNNs to learn local appearances of vessels in image crops while using another point-cloud network to learn the global geometry of vessels in the entire image. In inference, the proposed approach extracts local segments of vessels using CNNs, classifies each segment based on global geometry using the point-cloud network, and finally connects all the segments that belong to the same vessel using the shortest-path algorithm. This combination results in an efficient, fully-automatic and template-free approach to centerline extraction from 3D images. We validate the proposed approach on CTA datasets and demonstrate its superior performance compared to both traditional and CNN-based baselines.

Analyzing the morphological attributes of blood vessels plays a critical role in the computer-aided diagnosis of many cardiovascular and ophthalmologic diseases. Although being extensively studied, segmentation of blood vessels, particularly thin vessels and capillaries, remains challenging mainly due to the lack of an effective interaction between local and global features. In this paper, we propose a novel deep learning model called PC-Net to segment retinal vessels and major arteries in 2D fundus image and 3D computed tomography angiography (CTA) scans, respectively. In PC-Net, the pyramid squeeze-and-excitation (PSE) module introduces spatial information to each convolutional block, boosting its ability to extract more effective multi-scale features, and the coarse-to-fine (CF) module replaces the conventional decoder to enhance the details of thin vessels and process hard-to-classify pixels again. We evaluated our PC-Net on the Digital Retinal Images for Vessel Extraction (DRIVE) database and an in-house 3D major artery (3MA) database against several recent methods. Our results not only demonstrate the effectiveness of the proposed PSE module and CF module, but also suggest that our proposed PC-Net sets new state of the art in the segmentation of retinal vessels (AUC: 98.31%) and major arteries (AUC: 98.35%) on both databases, respectively.

Recently 3D volumetric organ segmentation attracts much research interest in medical image analysis due to its significance in computer aided diagnosis. This paper aims to address the pancreas segmentation task in 3D computed tomography volumes. We propose a novel end-to-end network, Globally Guided Progressive Fusion Network, as an effective and efficient solution to volumetric segmentation, which involves both global features and complicated 3D geometric information. A progressive fusion network is devised to extract 3D information from a moderate number of neighboring slices and predict a probability map for the segmentation of each slice. An independent branch for excavating global features from downsampled slices is further integrated into the network. Extensive experimental results demonstrate that our method achieves state-of-the-art performance on two pancreas datasets., Comment: MICCAI2019

Simulation systems have become an essential component in the development and validation of autonomous driving technologies. The prevailing state-of-the-art approach for simulation is to use game engines or high-fidelity computer graphics (CG) models to create driving scenarios. However, creating CG models and vehicle movements (e.g., the assets for simulation) remains a manual task that can be costly and time-consuming. In addition, the fidelity of CG images still lacks the richness and authenticity of real-world images and using these images for training leads to degraded performance. In this paper we present a novel approach to address these issues: Augmented Autonomous Driving Simulation (AADS). Our formulation augments real-world pictures with a simulated traffic flow to create photo-realistic simulation images and renderings. More specifically, we use LiDAR and cameras to scan street scenes. From the acquired trajectory data, we generate highly plausible traffic flows for cars and pedestrians and compose them into the background. The composite images can be re-synthesized with different viewpoints and sensor models. The resulting images are photo-realistic, fully annotated, and ready for end-to-end training and testing of autonomous driving systems from perception to planning. We explain our system design and validate our algorithms with a number of autonomous driving tasks from detection to segmentation and predictions. Compared to traditional approaches, our method offers unmatched scalability and realism. Scalability is particularly important for AD simulation and we believe the complexity and diversity of the real world cannot be realistically captured in a virtual environment. Our augmented approach combines the flexibility in a virtual environment (e.g., vehicle movements) with the richness of the real world to allow effective simulation of anywhere on earth.