Reinforcement Learning from Human Feedback (RLHF) is crucial for aligning Large Language Models (LLMs) with human values. However, RLHF has been continuously challenged by its high complexity in implementation and computation consumption. Even with recent simplifications, such as Direct Preference Optimization (DPO) and Advantage Leftover Lunch (A-LoL), the problems of over-fitting and training instability remain hindering the alignment process from the expected optimal performance. To address the existing challenges, we propose a novel simplification of RLHF from the perspective of variational inference, called $\textbf{V}$ariational $\textbf{A}$lignment with $\textbf{R}$e-weighting ($\textbf{VAR}$). More specifically, by directly minimizing the distribution gap between the learning LLM policy and the optimal solution of RLHF, we transform the alignment objective into a reward-driven re-weighted supervised fine-tuning (SFT) form, which only requires minor adjustment on the SFT loss to obtain noticeable improvement on training stability and effectiveness. On comprehensive alignment and generation benchmarks, our VAR method has numerically achieved competitive performance in LLM alignment helpfulness and harmlessness.

Reinforcement learning tasks in real-world scenarios often involve large, high-dimensional action spaces, leading to challenges such as convergence difficulties, instability, and high computational complexity. It is widely acknowledged that traditional value-based reinforcement learning algorithms struggle to address these issues effectively. A prevalent approach involves generating independent sub-actions within each dimension of the action space. However, this method introduces bias, hindering the learning of optimal policies. In this paper, we propose an advantage-based optimization method and an algorithm named Advantage Branching Dueling Q-network (ABQ). ABQ incorporates a baseline mechanism to tune the action value of each dimension, leveraging the advantage relationship across different sub-actions. With this approach, the learned policy can be optimized for each dimension. Empirical results demonstrate that ABQ outperforms BDQ, achieving 3%, 171%, and 84% more cumulative rewards in HalfCheetah, Ant, and Humanoid environments, respectively. Furthermore, ABQ exhibits competitive performance when compared against two continuous action benchmark algorithms, DDPG and TD3.

Recent advances in artificial intelligence have witnessed the emergence of large-scale deep learning models capable of interpreting and generating both textual and imaging data. Such models, typically referred to as foundation models, are trained on extensive corpora of unlabeled data and demonstrate high performance across various tasks. Foundation models have recently received extensive attention from academic, industry, and regulatory bodies. Given the potentially transformative impact that foundation models can have on the field of radiology, this review aims to establish a standardized terminology concerning foundation models, with a specific focus on the requirements of training data, model training paradigms, model capabilities, and evaluation strategies. We further outline potential pathways to facilitate the training of radiology-specific foundation models, with a critical emphasis on elucidating both the benefits and challenges associated with such models. Overall, we envision that this review can unify technical advances and clinical needs in the training of foundation models for radiology in a safe and responsible manner, for ultimately benefiting patients, providers, and radiologists.

Fine-tuned vision-language models (VLMs) often capture spurious correlations between image features and textual attributes, resulting in degraded zero-shot performance at test time. Existing approaches for addressing spurious correlations (i) primarily operate at the global image-level rather than intervening directly on fine-grained image features and (ii) are predominantly designed for unimodal settings. In this work, we present RaVL, which takes a fine-grained perspective on VLM robustness by discovering and mitigating spurious correlations using local image features rather than operating at the global image level. Given a fine-tuned VLM, RaVL first discovers spurious correlations by leveraging a region-level clustering approach to identify precise image features contributing to zero-shot classification errors. Then, RaVL mitigates the identified spurious correlation with a novel region-aware loss function that enables the VLM to focus on relevant regions and ignore spurious relationships during fine-tuning. We evaluate RaVL on 654 VLMs with various model architectures, data domains, and learned spurious correlations. Our results show that RaVL accurately discovers (191% improvement over the closest baseline) and mitigates (8.2% improvement on worst-group image classification accuracy) spurious correlations. Qualitative evaluations on general-domain and medical-domain VLMs confirm our findings.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Recent developments in natural language generation have tremendous implications for healthcare. For instance, state-of-the-art systems could automate the generation of sections in clinical reports to alleviate physician workload and streamline hospital documentation. To explore these applications, we present a shared task consisting of two subtasks: (1) Radiology Report Generation (RRG24) and (2) Discharge Summary Generation ("Discharge Me!"). RRG24 involves generating the 'Findings' and 'Impression' sections of radiology reports given chest X-rays. "Discharge Me!" involves generating the 'Brief Hospital Course' and 'Discharge Instructions' sections of discharge summaries for patients admitted through the emergency department. "Discharge Me!" submissions were subsequently reviewed by a team of clinicians. Both tasks emphasize the goal of reducing clinician burnout and repetitive workloads by generating documentation. We received 201 submissions from across 8 teams for RRG24, and 211 submissions from across 16 teams for "Discharge Me!".

Large vision-language models (LVLMs) have shown premise in a broad range of vision-language tasks with their strong reasoning and generalization capabilities. However, they require considerable computational resources for training and deployment. This study aims to bridge the performance gap between traditional-scale LVLMs and resource-friendly lite versions by adopting high-quality training data. To this end, we propose a comprehensive pipeline for generating a synthetic dataset. The key idea is to leverage strong proprietary models to generate (i) fine-grained image annotations for vision-language alignment and (ii) complex reasoning visual question-answering pairs for visual instruction fine-tuning, yielding 1.3M samples in total. We train a series of lite VLMs on the synthetic dataset and experimental results demonstrate the effectiveness of the proposed scheme, where they achieve competitive performance on 17 benchmarks among 4B LVLMs, and even perform on par with 7B/13B-scale models on various benchmarks. This work highlights the feasibility of adopting high-quality data in crafting more efficient LVLMs. We name our dataset \textit{ALLaVA}, and open-source it to research community for developing better resource-efficient LVLMs for wider usage.

Over 85 million computed tomography (CT) scans are performed annually in the US, of which approximately one quarter focus on the abdomen. Given the current radiologist shortage, there is a large impetus to use artificial intelligence to alleviate the burden of interpreting these complex imaging studies. Prior state-of-the-art approaches for automated medical image interpretation leverage vision language models (VLMs). However, current medical VLMs are generally limited to 2D images and short reports, and do not leverage electronic health record (EHR) data for supervision. We introduce Merlin - a 3D VLM that we train using paired CT scans (6+ million images from 15,331 CTs), EHR diagnosis codes (1.8+ million codes), and radiology reports (6+ million tokens). We evaluate Merlin on 6 task types and 752 individual tasks. The non-adapted (off-the-shelf) tasks include zero-shot findings classification (31 findings), phenotype classification (692 phenotypes), and zero-shot cross-modal retrieval (image to findings and image to impressions), while model adapted tasks include 5-year disease prediction (6 diseases), radiology report generation, and 3D semantic segmentation (20 organs). We perform internal validation on a test set of 5,137 CTs, and external validation on 7,000 clinical CTs and on two public CT datasets (VerSe, TotalSegmentator). Beyond these clinically-relevant evaluations, we assess the efficacy of various network architectures and training strategies to depict that Merlin has favorable performance to existing task-specific baselines. We derive data scaling laws to empirically assess training data needs for requisite downstream task performance. Furthermore, unlike conventional VLMs that require hundreds of GPUs for training, we perform all training on a single GPU.

Since the release of the original CheXpert paper five years ago, CheXpert has become one of the most widely used and cited clinical AI datasets. The emergence of vision language models has sparked an increase in demands for sharing reports linked to CheXpert images, along with a growing interest among AI fairness researchers in obtaining demographic data. To address this, CheXpert Plus serves as a new collection of radiology data sources, made publicly available to enhance the scaling, performance, robustness, and fairness of models for all subsequent machine learning tasks in the field of radiology. CheXpert Plus is the largest text dataset publicly released in radiology, with a total of 36 million text tokens, including 13 million impression tokens. To the best of our knowledge, it represents the largest text de-identification effort in radiology, with almost 1 million PHI spans anonymized. It is only the second time that a large-scale English paired dataset has been released in radiology, thereby enabling, for the first time, cross-institution training at scale. All reports are paired with high-quality images in DICOM format, along with numerous image and patient metadata covering various clinical and socio-economic groups, as well as many pathology labels and RadGraph annotations. We hope this dataset will boost research for AI models that can further assist radiologists and help improve medical care. Data is available at the following URL: https://stanfordaimi.azurewebsites.net/datasets/5158c524-d3ab-4e02-96e9-6ee9efc110a1 Models are available at the following URL: https://github.com/Stanford-AIMI/chexpert-plus

Machine learning has enabled great progress in the automatic interpretation of images, where vision language models (VLMs) translate features of images into text (Radford et al., 2021; Liu et al., 2024). In the medical domain, patient images are interpreted by radiologists, Evaluating radiology reports is a challenging which is referred to as radiology report generation problem as factual correctness is extremely important (RRG). Automated and high-quality RRG has due to the need for accurate medical the potential to greatly reduce the repetitive work of communication about medical images. Existing radiologists, alleviate burdens arising from shortage automatic evaluation metrics either suffer of radiologists, generally improve clinical communication from failing to consider factual correctness (Kahn Jr et al., 2009), and increase the accuracy (e.g., BLEU and ROUGE) or are limited of radiology reports (Rajpurkar and Lungren, 2023). in their interpretability (e.g., F1CheXpert Commonly used evaluation metrics in RRG literature and F1RadGraph). In this paper, we introduce (Lin, 2004; Zhang et al., 2019; Smit et al., 2020; GREEN (Generative Radiology Report Evaluation Delbrouck et al., 2022) seek to evaluate a generated and Error Notation), a radiology report radiology report against a reference report written by generation metric that leverages the natural language a radiologist by leveraging simple n-grams overlap, understanding of language models to general language similarity, pathology identification identify and explain clinically significant errors within specific imaging modalities and disease classes, in candidate reports, both quantitatively and commercially-available large language models.