Federated continual learning (FCL) offers an emerging pattern to facilitate the applicability of federated learning (FL) in real-world scenarios, where tasks evolve dynamically and asynchronously across clients, especially in medical scenario. Existing server-side FCL methods in nature domain construct a continually learnable server model by client aggregation on all-involved tasks. However, they are challenged by: (1) Catastrophic forgetting for previously learned tasks, leading to error accumulation in server model, making it difficult to sustain comprehensive knowledge across all tasks. (2) Biased optimization due to asynchronous tasks handled across different clients, leading to the collision of optimization targets of different clients at the same time steps. In this work, we take the first step to propose a novel server-side FCL pattern in medical domain, Dynamic Allocation Hypernetwork with adaptive model recalibration (\textbf{FedDAH}). It is to facilitate collaborative learning under the distinct and dynamic task streams across clients. To alleviate the catastrophic forgetting, we propose a dynamic allocation hypernetwork (DAHyper) where a continually updated hypernetwork is designed to manage the mapping between task identities and their associated model parameters, enabling the dynamic allocation of the model across clients. For the biased optimization, we introduce a novel adaptive model recalibration (AMR) to incorporate the candidate changes of historical models into current server updates, and assign weights to identical tasks across different time steps based on the similarity for continual optimization. Extensive experiments on the AMOS dataset demonstrate the superiority of our FedDAH to other FCL methods on sites with different task streams. The code is available:https://github.com/jinlab-imvr/FedDAH.

Recent advancements in ophthalmology foundation models such as RetFound have demonstrated remarkable diagnostic capabilities but require massive datasets for effective pre-training, creating significant barriers for development and deployment. To address this critical challenge, we propose FundusGAN, a novel hierarchical feature-aware generative framework specifically designed for high-fidelity fundus image synthesis. Our approach leverages a Feature Pyramid Network within its encoder to comprehensively extract multi-scale information, capturing both large anatomical structures and subtle pathological features. The framework incorporates a modified StyleGAN-based generator with dilated convolutions and strategic upsampling adjustments to preserve critical retinal structures while enhancing pathological detail representation. Comprehensive evaluations on the DDR, DRIVE, and IDRiD datasets demonstrate that FundusGAN consistently outperforms state-of-the-art methods across multiple metrics (SSIM: 0.8863, FID: 54.2, KID: 0.0436 on DDR). Furthermore, disease classification experiments reveal that augmenting training data with FundusGAN-generated images significantly improves diagnostic accuracy across multiple CNN architectures (up to 6.49\% improvement with ResNet50). These results establish FundusGAN as a valuable foundation model component that effectively addresses data scarcity challenges in ophthalmological AI research, enabling more robust and generalizable diagnostic systems while reducing dependency on large-scale clinical data collection.

Personalized federated learning (PFL) studies effective model personalization to address the data heterogeneity issue among clients in traditional federated learning (FL). Existing PFL approaches mainly generate personalized models by relying solely on the clients' latest updated models while ignoring their previous updates, which may result in suboptimal personalized model learning. To bridge this gap, we propose a novel framework termed pFedSeq, designed for personalizing adapters to fine-tune a foundation model in FL. In pFedSeq, the server maintains and trains a sequential learner, which processes a sequence of past adapter updates from clients and generates calibrations for personalized adapters. To effectively capture the cross-client and cross-step relations hidden in previous updates and generate high-performing personalized adapters, pFedSeq adopts the powerful selective state space model (SSM) as the architecture of sequential learner. Through extensive experiments on four public benchmark datasets, we demonstrate the superiority of pFedSeq over state-of-the-art PFL methods.

Medical Visual Question Answering (VQA) is an essential technology that integrates computer vision and natural language processing to automatically respond to clinical inquiries about medical images. However, current medical VQA datasets exhibit two significant limitations: (1) they often lack visual and textual explanations for answers, which impedes their ability to satisfy the comprehension needs of patients and junior doctors; (2) they typically offer a narrow range of question formats, inadequately reflecting the diverse requirements encountered in clinical scenarios. These limitations pose significant challenges to the development of a reliable and user-friendly Med-VQA system. To address these challenges, we introduce a large-scale, Groundable, and Explainable Medical VQA benchmark for chest X-ray diagnosis (GEMeX), featuring several innovative components: (1) A multi-modal explainability mechanism that offers detailed visual and textual explanations for each question-answer pair, thereby enhancing answer comprehensibility; (2) Four distinct question types, open-ended, closed-ended, single-choice, and multiple-choice, that better reflect diverse clinical needs. We evaluated 10 representative large vision language models on GEMeX and found that they underperformed, highlighting the dataset's complexity. However, after fine-tuning a baseline model using the training set, we observed a significant performance improvement, demonstrating the dataset's effectiveness. The project is available at www.med-vqa.com/GEMeX.

Out-of-distribution (OOD) detection is crucial for ensuring reliable deployment of machine learning models. Recent advancements focus on utilizing easily accessible auxiliary outliers (e.g., data from the web or other datasets) in training. However, we experimentally reveal that these methods still struggle to generalize their detection capabilities to unknown OOD data, due to the limited diversity of the auxiliary outliers collected. Therefore, we thoroughly examine this problem from the generalization perspective and demonstrate that a more diverse set of auxiliary outliers is essential for enhancing the detection capabilities. However, in practice, it is difficult and costly to collect sufficiently diverse auxiliary outlier data. Therefore, we propose a simple yet practical approach with a theoretical guarantee, termed Diversity-induced Mixup for OOD detection (diverseMix), which enhances the diversity of auxiliary outlier set for training in an efficient way. Extensive experiments show that diverseMix achieves superior performance on commonly used and recent challenging large-scale benchmarks, which further confirm the importance of the diversity of auxiliary outliers.

Large Vision-Language Models (LVLMs) have shown significant potential in assisting medical diagnosis by leveraging extensive biomedical datasets. However, the advancement of medical image understanding and reasoning critically depends on building high-quality visual instruction data, which is costly and labor-intensive to obtain, particularly in the medical domain. To mitigate this data-starving issue, we introduce Self-Training Large Language and Vision Assistant for Medical (STLLaVA-Med). The proposed method is designed to train a policy model (an LVLM) capable of auto-generating medical visual instruction data to improve data efficiency, guided through Direct Preference Optimization (DPO). Specifically, a more powerful and larger LVLM (e.g., GPT-4o) is involved as a biomedical expert to oversee the DPO fine-tuning process on the auto-generated data, encouraging the policy model to align efficiently with human preferences. We validate the efficacy and data efficiency of STLLaVA-Med across three major medical Visual Question Answering (VQA) benchmarks, demonstrating competitive zero-shot performance with the utilization of only 9% of the medical data.

Inability to express the confidence level and detect unseen classes has limited the clinical implementation of artificial intelligence in the real-world. We developed a foundation model with uncertainty estimation (FMUE) to detect 11 retinal conditions on optical coherence tomography (OCT). In the internal test set, FMUE achieved a higher F1 score of 96.76% than two state-of-the-art algorithms, RETFound and UIOS, and got further improvement with thresholding strategy to 98.44%. In the external test sets obtained from other OCT devices, FMUE achieved an accuracy of 88.75% and 92.73% before and after thresholding. Our model is superior to two ophthalmologists with a higher F1 score (95.17% vs. 61.93% &71.72%). Besides, our model correctly predicts high uncertainty scores for samples with ambiguous features, of non-target-category diseases, or with low-quality to prompt manual checks and prevent misdiagnosis. FMUE provides a trustworthy method for automatic retinal anomalies detection in the real-world clinical open set environment.

Federated Learning (FL) has evolved as a powerful tool for collaborative model training across multiple entities, ensuring data privacy in sensitive sectors such as healthcare and finance. However, the introduction of the Right to Be Forgotten (RTBF) poses new challenges, necessitating federated unlearning to delete data without full model retraining. Traditional FL unlearning methods, not originally designed with domain specificity in mind, inadequately address the complexities of multi-domain scenarios, often affecting the accuracy of models in non-targeted domains or leading to uniform forgetting across all domains. Our work presents the first comprehensive empirical study on Federated Domain Unlearning, analyzing the characteristics and challenges of current techniques in multi-domain contexts. We uncover that these methods falter, particularly because they neglect the nuanced influences of domain-specific data, which can lead to significant performance degradation and inaccurate model behavior. Our findings reveal that unlearning disproportionately affects the model's deeper layers, erasing critical representational subspaces acquired during earlier training phases. In response, we propose novel evaluation methodologies tailored for Federated Domain Unlearning, aiming to accurately assess and verify domain-specific data erasure without compromising the model's overall integrity and performance. This investigation not only highlights the urgent need for domain-centric unlearning strategies in FL but also sets a new precedent for evaluating and implementing these techniques effectively.

Deep learning models are widely recognized for their effectiveness in identifying medical image findings in disease classification. However, their limitations become apparent in the dynamic and ever-changing clinical environment, characterized by the continuous influx of newly annotated medical data from diverse sources. In this context, the need for continual learning becomes particularly paramount, not only to adapt to evolving medical scenarios but also to ensure the privacy of healthcare data. In our research, we emphasize the utilization of a network comprising expert classifiers, where a new expert classifier is added each time a new task is introduced. We present CTP, a task-id predictor that utilizes confidence scores, leveraging the probability distribution (logits) of the classifier to accurately determine the task-id at inference time. Logits are adjusted to ensure that classifiers yield a high-entropy distribution for data associated with tasks other than their own. By defining a noise region in the distribution and computing confidence scores, CTP achieves superior performance when compared to other relevant continual learning methods. Additionally, the performance of CTP can be further improved by providing it with a continuum of data at the time of inference.

Recent advancements in pre-trained large foundation models (LFM) have yielded significant breakthroughs across various domains, including natural language processing and computer vision. These models have been particularly impactful in the domain of medical diagnostic tasks. With abundant unlabeled data, an LFM has been developed for fundus images using the Vision Transformer (VIT) and a self-supervised learning framework. This LFM has shown promising performance in fundus disease diagnosis across multiple datasets. On the other hand, deep learning models have long been challenged by dataset quality issues, such as image quality and dataset bias. To investigate the influence of data quality on LFM, we conducted explorations in two fundus diagnosis tasks using datasets of varying quality. Specifically, we explored the following questions: Is LFM more robust to image quality? Is LFM affected by dataset bias? Can fine-tuning techniques alleviate these effects? Our investigation found that LFM exhibits greater resilience to dataset quality issues, including image quality and dataset bias, compared to typical convolutional networks. Furthermore, we discovered that overall fine-tuning is an effective adapter for LFM to mitigate the impact of dataset quality issues.