KI) platform, a new benchmark designed to address the unique challenges of integrating medical knowledge into foundation models under privacy constraints.

Scaling up model and data size have demonstrated impressive performance improvement over a wide range of tasks. Despite extensive studies on scaling behaviors for general-purpose tasks, medical images exhibit substantial differences from natural data. It remains unclear the key factors in developing medical vision foundation models at scale due to the absence of an extensive understanding of scaling behavior in the medical domain. In this paper, we explored the scaling behavior across model sizes, training algorithms, data sizes, and imaging modalities in developing scalable medical vision foundation models by self-supervised learning. To support scalable pretraining, we introduce BioVFM-21M, a large-scale biomedical image dataset encompassing a wide range of biomedical image modalities and anatomies. We observed that scaling up does provide benefits but varies across tasks. Additional analysis reveals several factors correlated with scaling benefits. Finally, we propose BioVFM, a large-scale medical vision foundation model pretrained on 21 million biomedical images, which outperforms the previous state-of-the-art foundation models across 12 medical benchmarks. Our results highlight that while scaling up is beneficial for pursuing better performance, task characteristics, data diversity, pretraining methods, and computational efficiency remain critical considerations for developing scalable medical foundation models.

The advent of foundation models (FMs) such as large language models (LLMs) has led to a cultural shift in data science, both in medicine and beyond. This shift involves moving away from specialized predictive models trained for specific, well-defined domain questions to generalist FMs pre-trained on vast amounts of unstructured data, which can then be adapted to various clinical tasks and questions. As a result, the standard data science workflow in medicine has been fundamentally altered; the foundation model lifecycle (FMLC) now includes distinct upstream and downstream processes, in which computational resources, model and data access, and decision-making power are distributed among multiple stakeholders. At their core, FMs are fundamentally statistical models, and this new workflow challenges the principles of Veridical Data Science (VDS), hindering the rigorous statistical analysis expected in transparent and scientifically reproducible data science practices. We critically examine the medical FMLC in light of the core principles of VDS: predictability, computability, and stability (PCS), and explain how it deviates from the standard data science workflow. Finally, we propose recommendations for a reimagined medical FMLC that expands and refines the PCS principles for VDS including considering the computational and accessibility constraints inherent to FMs.

This study introduces the Federated Medical Knowledge Injection (FEDMEKI) platform, a new benchmark designed to address the unique challenges of integrating medical knowledge into foundation models under privacy constraints. By leveraging a cross-silo federated learning approach, FEDMEKI circumvents the issues associated with centralized data collection, which is often prohibited under health regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the USA. The platform is meticulously designed to handle multi-site, multi-modal, and multi-task medical data, which includes 7 medical modalities, including images, signals, texts, laboratory test results, vital signs, input variables, and output variables. The curated dataset to validate FEDMEKI covers 8 medical tasks, including 6 classification tasks (lung opacity detection, COVID-19 detection, electrocardiogram (ECG) abnormal detection, mortality prediction, sepsis prediction, and enlarged cardiomediastinum detection) and 2 generation tasks (medical visual question answering (MedVQA) and ECG noise clarification). This comprehensive dataset is partitioned across several clients to facilitate the decentralized training process under 16 benchmark approaches. FEDMEKI not only preserves data privacy but also enhances the capability of medical foundation models by allowing them to learn from a broader spectrum of medical knowledge without direct data exposure, thereby setting a new benchmark in the application of foundation models within the healthcare sector.

Foundation models have demonstrated remarkable capabilities in handling diverse modalities and tasks, outperforming conventional artificial intelligence (AI) approaches that are highly task-specific and modality-reliant. In the medical domain, however, the development of comprehensive foundation models is constrained by limited access to diverse modalities and stringent privacy regulations. To address these constraints, this study introduces a novel knowledge injection approach, FedKIM, designed to scale the medical foundation model within a federated learning framework. FedKIM leverages lightweight local models to extract healthcare knowledge from private data and integrates this knowledge into a centralized foundation model using a designed adaptive Multitask Multimodal Mixture Of Experts (M3OE) module. This method not only preserves privacy but also enhances the model's ability to handle complex medical tasks involving multiple modalities. Our extensive experiments across twelve tasks in seven modalities demonstrate the effectiveness of FedKIM in various settings, highlighting its potential to scale medical foundation models without direct access to sensitive data.

In this study, we aim to initiate the development of Radiology Foundation Model, termed as RadFM. We consider the construction of foundational models from three perspectives, namely, dataset construction, model design, and thorough evaluation. Our contribution can be concluded as follows: (i), we construct a large-scale Medical Multi-modal Dataset, MedMD, which consists of 16M 2D and 3D medical scans with high-quality text descriptions or reports across various data formats, modalities, and tasks, covering over 5000 distinct diseases. To the best of our knowledge, this is the first large-scale, high-quality, medical visual-language dataset, with both 2D and 3D scans; (ii), we propose an architecture that enables visually conditioned generative pre-training, i.e., allowing for integration of text input with 2D or 3D medical scans, and generate responses for diverse radiologic tasks. The model was initially pre-trained on MedMD and subsequently fine-tuned on the domain-specific dataset, which is a radiologic cleaned version of MedMD, containing 3M radiologic visual-language pairs, termed as RadMD; (iii), we propose a new evaluation benchmark, RadBench, that comprises five tasks, including modality recognition, disease diagnosis, visual question answering, report generation and rationale diagnosis, aiming to comprehensively assess the capability of foundation models in handling practical clinical problems. We conduct both automatic and human evaluation on RadBench, in both cases, RadFM outperforms existing multi-modal foundation models, that are publicaly accessible, including Openflamingo, MedFlamingo, MedVInT and GPT-4V. Additionally, we also adapt RadFM for different public benchmarks, surpassing existing SOTAs on diverse datasets. All codes, data, and model checkpoint will all be made publicly available to promote further research and development in the field.

In healthcare, multimodal data is prevalent and requires to be comprehensively analyzed before diagnostic decisions, including medical images, clinical reports, etc. However, current large-scale artificial intelligence models predominantly focus on single-modal cognitive abilities and neglect the integration of multiple modalities. Therefore, we propose Stone Needle, a general multimodal large-scale model framework tailored explicitly for healthcare applications. Stone Needle serves as a comprehensive medical multimodal model foundation, integrating various modalities such as text, images, videos, and audio to surpass the limitations of single-modal systems. Through the framework components of intent analysis, medical foundation models, prompt manager, and medical language module, our architecture can perform multi-modal interaction in multiple rounds of dialogue. Our method is a general multimodal large-scale model framework, integrating diverse modalities and allowing us to tailor for specific tasks. The experimental results demonstrate the superior performance of our method compared to single-modal systems. The fusion of different modalities and the ability to process complex medical information in Stone Needle benefits accurate diagnosis, treatment recommendations, and patient care.

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.