ABSTRACT The emergence of large-scale pre-trained vision foundation models has greatly advanced the medical imaging field through the pre-training and fine-tuning paradigm. However, selecting appropriate medical data for downstream fine-tuning remains a significant challenge considering its annotation cost, privacy concerns, and the detrimental effects of confounding variables. In this work, we present a confounder-aware medical data selection approach for medical dataset curation aiming to select minimal representative data by strategically mitigating the undesirable impact of confounding variables while preserving the natural distribution of the dataset. Our approach first identifies confounding variables within data and then develops a distance-based data selection strategy for confounder-aware sampling with a constrained budget in the data size. We validate the superiority of our approach through extensive experiments across diverse medical imaging modalities, highlighting its effectiveness in addressing the substantial impact of confounding variables and enhancing the fine-tuning efficiency in the medical imaging domain, compared to other data selection approaches.

With the recent advancements in vision-language models (VLMs) driven by large language models (LLMs), many researchers have focused on models that comprised of an image encoder, an image-to-language projection layer, and a text decoder architectures, leading to the emergence of works like LLava-Med. However, these works primarily operate at the whole-image level, aligning general information from 2D medical images without attending to finer details. As a result, these models often provide irrelevant or non-clinically valuable information while missing critical details. Medical vision-language tasks differ significantly from general images, particularly in their focus on fine-grained details, while excluding irrelevant content. General domain VLMs tend to prioritize global information due to their design, which compresses the entire image into a multi-token representation that is passed into the LLM decoder. Therefore, current VLMs all lack the capability to restrict their attention to particular areas. To address this critical issue in the medical domain, we introduce MedVP, an visual prompt generation and fine-tuning framework, which involves extract medical entities, generate visual prompts, and adapt datasets for visual prompt guided fine-tuning. To the best of our knowledge, this is the first work to explicitly introduce visual prompt into medical VLMs, and we successfully outperform recent state-of-the-art large models across multiple medical VQA datasets. Extensive experiments are conducted to analyze the impact of different visual prompt forms and how they contribute to performance improvement. The results demonstrate both the effectiveness and clinical significance of our approach

There is growing research interest in measuring the statistical heterogeneity of clients' local datasets. Such measurements are used to estimate the suitability for collaborative training of personalized federated learning (PFL) models. Currently, these research endeavors are taking place in silos and there is a lack of a unified benchmark to provide a fair and convenient comparison among various approaches in common settings. We aim to bridge this important gap in this paper. The proposed benchmarking framework currently includes six representative approaches. Extensive experiments have been conducted to compare these approaches under five standard non-IID FL settings, providing much needed insights into which approaches are advantageous under which settings. The proposed framework offers useful guidance on the suitability of various data divergence measures in FL systems. It is beneficial for keeping related research activities on the right track in terms of: (i) designing PFL schemes, (ii) selecting appropriate data heterogeneity evaluation approaches for specific FL application scenarios, and (iii) addressing fairness issues in collaborative model training.

Federated learning (FL) is a machine learning paradigm that allows multiple FL participants (FL-PTs) to collaborate on training models without sharing private data. Due to data heterogeneity, negative transfer may occur in the FL training process. This necessitates FL-PT selection based on their data complementarity. In cross-silo FL, organizations that engage in business activities are key sources of FL-PTs. The resulting FL ecosystem has two features: (i) self-interest, and (ii) competition among FL-PTs. This requires the desirable FL-PT selection strategy to simultaneously mitigate the problems of free riders and conflicts of interest among competitors. To this end, we propose an optimal FL collaboration formation strategy -- FedEgoists -- which ensures that: (1) a FL-PT can benefit from FL if and only if it benefits the FL ecosystem, and (2) a FL-PT will not contribute to its competitors or their supporters. It provides an efficient clustering solution to group FL-PTs into coalitions, ensuring that within each coalition, FL-PTs share the same interest. We theoretically prove that the FL-PT coalitions formed are optimal since no coalitions can collaborate together to improve the utility of any of their members. Extensive experiments on widely adopted benchmark datasets demonstrate the effectiveness of FedEgoists compared to nine state-of-the-art baseline methods, and its ability to establish efficient collaborative networks in cross-silos FL with FL-PTs that engage in business activities.

This study develops and evaluates a novel multimodal medical image zero-shot segmentation algorithm named Text-Visual-Prompt SAM (TV-SAM) without any manual annotations. TV-SAM incorporates and integrates large language model GPT-4, Vision Language Model GLIP, and Segment Anything Model (SAM), to autonomously generate descriptive text prompts and visual bounding box prompts from medical images, thereby enhancing SAM for zero-shot segmentation. Comprehensive evaluations are implemented on seven public datasets encompassing eight imaging modalities to demonstrate that TV-SAM can effectively segment unseen targets across various modalities without additional training, significantly outperforming SAM AUTO and GSAM, closely matching the performance of SAM BBOX with gold standard bounding box prompts, and surpassing the state-of-the-art on specific datasets like ISIC and WBC. The study indicates that TV-SAM serves as an effective multimodal medical image zero-shot segmentation algorithm, highlighting the significant contribution of GPT-4 to zero-shot segmentation. By integrating foundational models such as GPT-4, GLIP, and SAM, it could enhance the capability to address complex problems in specialized domains. The code is available at: https://github.com/JZK00/TV-SAM.

We investigate the explainability of graph neural networks (GNNs) as a step toward elucidating their working mechanisms. While most current methods focus on explaining graph nodes, edges, or features, we argue that, as the inherent functional mechanism of GNNs, message flows are more natural for performing explainability. To this end, we propose a novel method here, known as FlowX, to explain GNNs by identifying important message flows. To quantify the importance of flows, we propose to follow the philosophy of Shapley values from cooperative game theory. To tackle the complexity of computing all coalitions' marginal contributions, we propose a flow sampling scheme to compute Shapley value approximations as initial assessments of further training. We then propose an information-controlled learning algorithm to train flow scores toward diverse explanation targets: necessary or sufficient explanations. Experimental studies on both synthetic and real-world datasets demonstrate that our proposed FlowX and its variants lead to improved explainability of GNNs. The code is available at https://github.com/divelab/DIG.

The Segment Anything Model (SAM) made an eye-catching debut recently and inspired many researchers to explore its potential and limitation in terms of zero-shot generalization capability. As the first promptable foundation model for segmentation tasks, it was trained on a large dataset with an unprecedented number of images and annotations. This large-scale dataset and its promptable nature endow the model with strong zero-shot generalization. Although the SAM has shown competitive performance on several datasets, we still want to investigate its zero-shot generalization on medical images. As we know, the acquisition of medical image annotation usually requires a lot of effort from professional practitioners. Therefore, if there exists a foundation model that can give high-quality mask prediction simply based on a few point prompts, this model will undoubtedly become the game changer for medical image analysis. To evaluate whether SAM has the potential to become the foundation model for medical image segmentation tasks, we collected more than 12 public medical image datasets that cover various organs and modalities. We also explore what kind of prompt can lead to the best zero-shot performance with different modalities. Furthermore, we find that a pattern shows that the perturbation of the box size will significantly change the prediction accuracy. Finally, Extensive experiments show that the predicted mask quality varied a lot among different datasets. And providing proper prompts, such as bounding boxes, to the SAM will significantly increase its performance.

Inevitable domain and task discrepancies in real-world scenarios can impair the generalization performance of the pre-trained deep models for medical data. Therefore, we audaciously propose that we should build a general-purpose medical AI system that can be seamlessly adapted to downstream domains/tasks. Since the domain/task adaption procedures usually involve additional labeling work for the target data, designing a data-efficient adaption algorithm is desired to save the cost of transferring the learned knowledge. Our recent work found that vision-language models (VLMs) are efficient learners with extraordinary cross-domain ability. Therefore, in this work, we further explore the possibility of leveraging pre-trained VLMs as medical foundation models for building general-purpose medical AI, where we thoroughly investigate three machine-learning paradigms, i.e., domain/task-specialized learning, joint learning, and continual learning, for training the VLMs and evaluate their generalization performance on cross-domain and cross-task test sets. To alleviate the catastrophic forgetting during sequential training, we employ rehearsal learning and receive a sharp boost in terms of generalization capability. In a nutshell, our empirical evidence suggests that continual learning may be a practical and efficient learning paradigm for the medical foundation model. And we hope researchers can use our empirical evidence as basement to further explore the path toward medical foundation model.

We present an approach for unsupervised domain adaptation---with a strong focus on practical considerations of within-domain class imbalance and between-domain class distribution shift---from a class-conditioned domain alignment perspective. Current methods for class-conditioned domain alignment aim to explicitly minimize a loss function based on pseudo-label estimations of the target domain. However, these methods suffer from pseudo-label bias in the form of error accumulation. We propose a method that removes the need for explicit optimization of model parameters from pseudo-labels directly. Instead, we present a sampling-based implicit alignment approach, where the sample selection procedure is implicitly guided by the pseudo-labels. Theoretical analysis reveals the existence of a domain-discriminator shortcut in misaligned classes, which is addressed by the proposed implicit alignment approach to facilitate domain-adversarial learning. Empirical results and ablation studies confirm the effectiveness of the proposed approach, especially in the presence of within-domain class imbalance and between-domain class distribution shift.