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Addressing Asynchronicity in Clinical Multimodal Fusion via Individualized Chest X-ray Generation

Neural Information Processing Systems

Integrating multi-modal clinical data, such as electronic health records (EHR) and chest X-ray images (CXR), is particularly beneficial for clinical prediction tasks. However, in a temporal setting, multi-modal data are often inherently asynchronous. EHR can be continuously collected but CXR is generally taken with a much longer interval due to its high cost and radiation dose. When clinical prediction is needed, the last available CXR image might have been outdated, leading to suboptimal predictions. To address this challenge, we propose DDL-CXR, a method that dynamically generates an up-to-date latent representation of the individualized CXR images. Our approach leverages latent diffusion models for patient-specific generation strategically conditioned on a previous CXR image and EHR time series, providing information regarding anatomical structures and disease progressions, respectively. In this way, the interaction across modalities could be better captured by the latent CXR generation process, ultimately improving the prediction performance. Experiments using MIMIC datasets show that the proposed model could effectively address asynchronicity in multimodal fusion and consistently outperform existing methods.




CXR-TFT: Multi-Modal Temporal Fusion Transformer for Predicting Chest X-ray Trajectories

Arora, Mehak, Ali, Ayman, Wu, Kaiyuan, Davis, Carolyn, Shimazui, Takashi, Alwakeel, Mahmoud, Moas, Victor, Yang, Philip, Esper, Annette, Kamaleswaran, Rishikesan

arXiv.org Artificial Intelligence

In intensive care units (ICUs), patients with complex clinical conditions require vigilant monitoring and prompt interventions. Chest X-rays (CXRs) are a vital diagnostic tool, providing insights into clinical trajectories, but their irregular acquisition limits their utility. Existing tools for CXR interpretation are constrained by cross-sectional analysis, failing to capture temporal dynamics. To address this, we introduce CXR-TFT, a novel multi-modal framework that integrates temporally sparse CXR imaging and radiology reports with high-frequency clinical data, such as vital signs, laboratory values, and respiratory flow sheets, to predict the trajectory of CXR findings in critically ill patients. CXR-TFT leverages latent embeddings from a vision encoder that are temporally aligned with hourly clinical data through interpolation. A transformer model is then trained to predict CXR embeddings at each hour, conditioned on previous embeddings and clinical measurements. In a retrospective study of 20,000 ICU patients, CXR-TFT demonstrated high accuracy in forecasting abnormal CXR findings up to 12 hours before they became radiographically evident. This predictive capability in clinical data holds significant potential for enhancing the management of time-sensitive conditions like acute respiratory distress syndrome, where early intervention is crucial and diagnoses are often delayed. By providing distinctive temporal resolution in prognostic CXR analysis, CXR-TFT offers actionable 'whole patient' insights that can directly improve clinical outcomes.


Addressing Asynchronicity in Clinical Multimodal Fusion via Individualized Chest X-ray Generation

Neural Information Processing Systems

Integrating multi-modal clinical data, such as electronic health records (EHR) and chest X-ray images (CXR), is particularly beneficial for clinical prediction tasks. However, in a temporal setting, multi-modal data are often inherently asynchronous. EHR can be continuously collected but CXR is generally taken with a much longer interval due to its high cost and radiation dose. When clinical prediction is needed, the last available CXR image might have been outdated, leading to suboptimal predictions. To address this challenge, we propose DDL-CXR, a method that dynamically generates an up-to-date latent representation of the individualized CXR images.


CBM-RAG: Demonstrating Enhanced Interpretability in Radiology Report Generation with Multi-Agent RAG and Concept Bottleneck Models

Alam, Hasan Md Tusfiqur, Srivastav, Devansh, Selim, Abdulrahman Mohamed, Kadir, Md Abdul, Shuvo, Md Moktadirul Hoque, Sonntag, Daniel

arXiv.org Artificial Intelligence

Advancements in generative Artificial Intelligence (AI) hold great promise for automating radiology workflows, yet challenges in interpretability and reliability hinder clinical adoption. This paper presents an automated radiology report generation framework that combines Concept Bottleneck Models (CBMs) with a Multi-Agent Retrieval-Augmented Generation (RAG) system to bridge AI performance with clinical explainability. CBMs map chest X-ray features to human-understandable clinical concepts, enabling transparent disease classification. Meanwhile, the RAG system integrates multi-agent collaboration and external knowledge to produce contextually rich, evidence-based reports. Our demonstration showcases the system's ability to deliver interpretable predictions, mitigate hallucinations, and generate high-quality, tailored reports with an interactive interface addressing accuracy, trust, and usability challenges. This framework provides a pathway to improving diagnostic consistency and empowering radiologists with actionable insights.


Meta-Entity Driven Triplet Mining for Aligning Medical Vision-Language Models

Ozturk, Saban, Yilmaz, Melih B., Kara, Muti, Yavuz, M. Talat, Koç, Aykut, Çukur, Tolga

arXiv.org Artificial Intelligence

Diagnostic imaging relies on interpreting both images and radiology reports, but the growing data volumes place significant pressure on medical experts, yielding increased errors and workflow backlogs. Medical vision-language models (med-VLMs) have emerged as a powerful framework to efficiently process multimodal imaging data, particularly in chest X-ray (CXR) evaluations, albeit their performance hinges on how well image and text representations are aligned. Existing alignment methods, predominantly based on contrastive learning, prioritize separation between disease classes over segregation of fine-grained pathology attributes like location, size or severity, leading to suboptimal representations. Here, we propose MedTrim (Meta-entity-driven Triplet mining), a novel method that enhances image-text alignment through multimodal triplet learning synergistically guided by disease class as well as adjectival and directional pathology descriptors. Unlike common alignment methods that separate broad disease classes, MedTrim leverages structured meta-entity information to preserve subtle but clinically significant intra-class variations. For this purpose, we first introduce an ontology-based entity recognition module that extracts pathology-specific meta-entities from CXR reports, as annotations on pathology attributes are rare in public datasets. For refined sample selection in triplet mining, we then introduce a novel score function that captures an aggregate measure of inter-sample similarity based on disease classes and adjectival/directional descriptors. Lastly, we introduce a multimodal triplet alignment objective for explicit within- and cross-modal alignment between samples sharing detailed pathology characteristics. Our demonstrations indicate that MedTrim improves performance in downstream retrieval and classification tasks compared to state-of-the-art alignment methods.


Arbitrary Data as Images: Fusion of Patient Data Across Modalities and Irregular Intervals with Vision Transformers

Tölle, Malte, Scharaf, Mohamad, Fischer, Samantha, Reich, Christoph, Zeid, Silav, Dieterich, Christoph, Meder, Benjamin, Frey, Norbert, Wild, Philipp, Engelhardt, Sandy

arXiv.org Artificial Intelligence

A patient undergoes multiple examinations in each hospital stay, where each provides different facets of the health status. These assessments include temporal data with varying sampling rates, discrete single-point measurements, therapeutic interventions such as medication administration, and images. While physicians are able to process and integrate diverse modalities intuitively, neural networks need specific modeling for each modality complicating the training procedure. We demonstrate that this complexity can be significantly reduced by visualizing all information as images along with unstructured text and subsequently training a conventional vision-text transformer. Our approach, Vision Transformer for irregular sampled Multi-modal Measurements (ViTiMM), not only simplifies data preprocessing and modeling but also outperforms current state-of-the-art methods in predicting in-hospital mortality and phenotyping, as evaluated on 6,175 patients from the MIMIC-IV dataset. The modalities include patient's clinical measurements, medications, X-ray images, and electrocardiography scans. We hope our work inspires advancements in multi-modal medical AI by reducing the training complexity to (visual) prompt engineering, thus lowering entry barriers and enabling no-code solutions for training. The source code will be made publicly available.