As artificial intelligence and digital medicine increasingly permeate healthcare systems, robust governance frameworks are essential to ensure ethical, secure, and effective implementation. In this context, medical image retrieval becomes a critical component of clinical data management, playing a vital role in decision-making and safeguarding patient information. Existing methods usually learn hash functions using bottleneck features, which fail to produce representative hash codes from blended embeddings. Although contrastive hashing has shown superior performance, current approaches often treat image retrieval as a classification task, using category labels to create positive/negative pairs. Moreover, many methods fail to address the out-of-distribution (OOD) issue when models encounter external OOD queries or adversarial attacks. In this work, we propose a novel method to consolidate knowledge of hierarchical features and optimisation functions. We formulate the knowledge consolidation by introducing Depth-aware Representation Fusion (DaRF) and Structure-aware Contrastive Hashing (SCH). DaRF adaptively integrates shallow and deep representations into blended features, and SCH incorporates image fingerprints to enhance the adaptability of positive/negative pairings. These blended features further facilitate OOD detection and content-based recommendation, contributing to a secure AI-driven healthcare environment. Moreover, we present a content-guided ranking to improve the robustness and reproducibility of retrieval results. Our comprehensive assessments demonstrate that the proposed method could effectively recognise OOD samples and significantly outperform existing approaches in medical image retrieval (p<0.05). In particular, our method achieves a 5.6-38.9% improvement in mean Average Precision on the anatomical radiology dataset.

In the realm of pulmonary tracheal segmentation, the scarcity of annotated data stands as a prevalent pain point in most medical segmentation endeavors. Concurrently, most Deep Learning (DL) methodologies employed in this domain invariably grapple with other dual challenges: the inherent opacity of'black box' models and the ongoing pursuit of performance enhancement. In response to these intertwined challenges, the core concept of our Human-Computer Interaction (HCI) based learning models (RS_UNet, LC_UNet, UUNet and WD_UNet) hinge on the versatile combination of diverse query strategies and an array of deep learning models. We train four HCI models based on the initial training dataset and sequentially repeat the following steps 1-4: (1) Query Strategy: Our proposed HCI models selects those samples which contribute the most additional representative information when labeled in each iteration of the query strategy (showing the names and sequence numbers of the samples to be annotated). Additionally, in this phase, the model selects the unlabeled samples with the greatest predictive disparity by calculating the Wasserstein Distance, Least Confidence, Entropy Sampling, and Random Sampling.

In medical imaging, particularly in early disease detection and prognosis tasks, discerning the rationale behind an AI model's predictions is crucial for evaluating the reliability of its decisions. Conventional explanation methods face challenges in identifying discernible decisive features in medical image classifications, where discriminative features are subtle or not immediately apparent. To bridge this gap, we propose an explainable model that is equipped with both decision reasoning and feature identification capabilities. Our approach not only detects influential image patterns but also uncovers the decisive features that drive the model's final predictions. By implementing our method, we can efficiently identify and visualise class-specific features leveraged by the data-driven model, providing insights into the decision-making processes of deep learning models. We validated our model in the demanding realm of medical prognosis task, demonstrating its efficacy and potential in enhancing the reliability of AI in healthcare and in discovering new knowledge in diseases where prognostic understanding is limited.

Generative artificial intelligence (AI) technologies and large models are producing realistic outputs across various domains, such as images, text, speech, and music. Creating these advanced generative models requires significant resources, particularly large and high-quality datasets. To minimize training expenses, many algorithm developers use data created by the models themselves as a cost-effective training solution. However, not all synthetic data effectively improve model performance, necessitating a strategic balance in the use of real versus synthetic data to optimize outcomes. Currently, the previously well-controlled integration of real and synthetic data is becoming uncontrollable. The widespread and unregulated dissemination of synthetic data online leads to the contamination of datasets traditionally compiled through web scraping, now mixed with unlabeled synthetic data. This trend portends a future where generative AI systems may increasingly rely blindly on consuming self-generated data, raising concerns about model performance and ethical issues. What will happen if generative AI continuously consumes itself without discernment? What measures can we take to mitigate the potential adverse effects? There is a significant gap in the scientific literature regarding the impact of synthetic data use in generative AI, particularly in terms of the fusion of multimodal information. To address this research gap, this review investigates the consequences of integrating synthetic data blindly on training generative AI on both image and text modalities and explores strategies to mitigate these effects. The goal is to offer a comprehensive view of synthetic data's role, advocating for a balanced approach to its use and exploring practices that promote the sustainable development of generative AI technologies in the era of large models.

Airway-related quantitative imaging biomarkers are crucial for examination, diagnosis, and prognosis in pulmonary diseases. However, the manual delineation of airway trees remains prohibitively time-consuming. While significant efforts have been made towards enhancing airway modelling, current public-available datasets concentrate on lung diseases with moderate morphological variations. The intricate honeycombing patterns present in the lung tissues of fibrotic lung disease patients exacerbate the challenges, often leading to various prediction errors. To address this issue, the 'Airway-Informed Quantitative CT Imaging Biomarker for Fibrotic Lung Disease 2023' (AIIB23) competition was organized in conjunction with the official 2023 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). The airway structures were meticulously annotated by three experienced radiologists. Competitors were encouraged to develop automatic airway segmentation models with high robustness and generalization abilities, followed by exploring the most correlated QIB of mortality prediction. A training set of 120 high-resolution computerised tomography (HRCT) scans were publicly released with expert annotations and mortality status. The online validation set incorporated 52 HRCT scans from patients with fibrotic lung disease and the offline test set included 140 cases from fibrosis and COVID-19 patients. The results have shown that the capacity of extracting airway trees from patients with fibrotic lung disease could be enhanced by introducing voxel-wise weighted general union loss and continuity loss. In addition to the competitive image biomarkers for prognosis, a strong airway-derived biomarker (Hazard ratio>1.5, p<0.0001) was revealed for survival prognostication compared with existing clinical measurements, clinician assessment and AI-based biomarkers.

Since the onset of the COVID-19 pandemic in 2019, there has been a concerted effort to develop cost-effective, non-invasive, and rapid AI-based tools. These tools were intended to alleviate the burden on healthcare systems, control the rapid spread of the virus, and enhance intervention outcomes, all in response to this unprecedented global crisis. As we transition into a post-COVID era, we retrospectively evaluate these proposed studies and offer a review of the techniques employed in AI diagnostic models, with a focus on the solutions proposed for different challenges. This review endeavors to provide insights into the diverse solutions designed to address the multifaceted challenges that arose during the pandemic. By doing so, we aim to prepare the AI community for the development of AI tools tailored to address public health emergencies effectively.

This study aims to develop and evaluate an innovative simulation algorithm for generating thick-slice CT images that closely resemble actual images in the AAPM-Mayo's 2016 Low Dose CT Grand Challenge dataset. The proposed method was evaluated using Peak Signal-to-Noise Ratio (PSNR) and Root Mean Square Error (RMSE) metrics, with the hypothesis that our simulation would produce images more congruent with their real counterparts. Our proposed method demonstrated substantial enhancements in terms of both PSNR and RMSE over other simulation methods. The highest PSNR values were obtained with the proposed method, yielding 49.7369 $\pm$ 2.5223 and 48.5801 $\pm$ 7.3271 for D45 and B30 reconstruction kernels, respectively. The proposed method also registered the lowest RMSE with values of 0.0068 $\pm$ 0.0020 and 0.0108 $\pm$ 0.0099 for D45 and B30, respectively, indicating a distribution more closely aligned with the authentic thick-slice image. Further validation of the proposed simulation algorithm was conducted using the TCIA LDCT-and-Projection-data dataset. The generated images were then leveraged to train four distinct super-resolution (SR) models, which were subsequently evaluated using the real thick-slice images from the 2016 Low Dose CT Grand Challenge dataset. When trained with data produced by our novel algorithm, all four SR models exhibited enhanced performance.

Synthetic images generated from deep generative models have the potential to address data scarcity and data privacy issues. The selection of synthesis models is mostly based on image quality measurements, and most researchers favor synthetic images that produce realistic images, i.e., images with good fidelity scores, such as low Fr\'echet Inception Distance (FID) and high Peak Signal-To-Noise Ratio (PSNR). However, the quality of synthetic images is not limited to fidelity, and a wide spectrum of metrics should be evaluated to comprehensively measure the quality of synthetic images. In addition, quality metrics are not truthful predictors of the utility of synthetic images, and the relations between these evaluation metrics are not yet clear. In this work, we have established a comprehensive set of evaluators for synthetic images, including fidelity, variety, privacy, and utility. By analyzing more than 100k chest X-ray images and their synthetic copies, we have demonstrated that there is an inevitable trade-off between synthetic image fidelity, variety, and privacy. In addition, we have empirically demonstrated that the utility score does not require images with both high fidelity and high variety. For intra- and cross-task data augmentation, mode-collapsed images and low-fidelity images can still demonstrate high utility. Finally, our experiments have also showed that it is possible to produce images with both high utility and privacy, which can provide a strong rationale for the use of deep generative models in privacy-preserving applications. Our study can shore up comprehensive guidance for the evaluation of synthetic images and elicit further developments for utility-aware deep generative models in medical image synthesis.

As a pragmatic data augmentation tool, data synthesis has generally returned dividends in performance for deep learning based medical image analysis. However, generating corresponding segmentation masks for synthetic medical images is laborious and subjective. To obtain paired synthetic medical images and segmentations, conditional generative models that use segmentation masks as synthesis conditions were proposed. However, these segmentation mask-conditioned generative models still relied on large, varied, and labeled training datasets, and they could only provide limited constraints on human anatomical structures, leading to unrealistic image features. Moreover, the invariant pixel-level conditions could reduce the variety of synthetic lesions and thus reduce the efficacy of data augmentation. To address these issues, in this work, we propose a novel strategy for medical image synthesis, namely Unsupervised Mask (UM)-guided synthesis, to obtain both synthetic images and segmentations using limited manual segmentation labels. We first develop a superpixel based algorithm to generate unsupervised structural guidance and then design a conditional generative model to synthesize images and annotations simultaneously from those unsupervised masks in a semi-supervised multi-task setting. In addition, we devise a multi-scale multi-task Fr\'echet Inception Distance (MM-FID) and multi-scale multi-task standard deviation (MM-STD) to harness both fidelity and variety evaluations of synthetic CT images. With multiple analyses on different scales, we could produce stable image quality measurements with high reproducibility. Compared with the segmentation mask guided synthesis, our UM-guided synthesis provided high-quality synthetic images with significantly higher fidelity, variety, and utility ($p<0.05$ by Wilcoxon Signed Ranked test).