Daily Papers

Chest X-ray imaging (CXR) is an important diagnostic tool used in hospitals to assess patient conditions and monitor changes over time. Generative models, specifically diffusion-based models, have shown promise in generating realistic synthetic X-rays. However, these models mainly focus on conditional generation using single-time-point data, i.e., typically CXRs taken at a specific time with their corresponding reports, limiting their clinical utility, particularly for capturing temporal changes. To address this limitation, we propose a novel framework, EHRXDiff, which predicts future CXR images by integrating previous CXRs with subsequent medical events, e.g., prescriptions, lab measures, etc. Our framework dynamically tracks and predicts disease progression based on a latent diffusion model, conditioned on the previous CXR image and a history of medical events. We comprehensively evaluate the performance of our framework across three key aspects, including clinical consistency, demographic consistency, and visual realism. We demonstrate that our framework generates high-quality, realistic future images that capture potential temporal changes, suggesting its potential for further development as a clinical simulation tool. This could offer valuable insights for patient monitoring and treatment planning in the medical field.

Quality control is of vital importance during electronics production. As the methods of producing electronic circuits improve, there is an increasing chance of solder defects during assembling the printed circuit board (PCB). Many technologies have been incorporated for inspecting failed soldering, such as X-ray imaging, optical imaging, and thermal imaging. With some advanced algorithms, the new technologies are expected to control the production quality based on the digital images. However, current algorithms sometimes are not accurate enough to meet the quality control. Specialists are needed to do a follow-up checking. For automated X-ray inspection, joint of interest on the X-ray image is located by region of interest (ROI) and inspected by some algorithms. Some incorrect ROIs deteriorate the inspection algorithm. The high dimension of X-ray images and the varying sizes of image dimensions also challenge the inspection algorithms. On the other hand, recent advances on deep learning shed light on image-based tasks and are competitive to human levels. In this paper, deep learning is incorporated in X-ray imaging based quality control during PCB quality inspection. Two artificial intelligence (AI) based models are proposed and compared for joint defect detection. The noised ROI problem and the varying sizes of imaging dimension problem are addressed. The efficacy of the proposed methods are verified through experimenting on a real-world 3D X-ray dataset. By incorporating the proposed methods, specialist inspection workload is largely saved.

The COVID-19 pandemic strained healthcare resources and prompted discussion about how machine learning can alleviate physician burdens and contribute to diagnosis. Chest x-rays (CXRs) are used for diagnosis of COVID-19, but few studies predict the severity of a patient's condition from CXRs. In this study, we produce a large COVID severity dataset by merging three sources and investigate the efficacy of transfer learning using ImageNet- and CXR-pretrained models and vision transformers (ViTs) in both severity regression and classification tasks. A pretrained DenseNet161 model performed the best on the three class severity prediction problem, reaching 80% accuracy overall and 77.3%, 83.9%, and 70% on mild, moderate and severe cases, respectively. The ViT had the best regression results, with a mean absolute error of 0.5676 compared to radiologist-predicted severity scores. The project's source code is publicly available.

Chest X-Ray (CXR) imaging for pulmonary diagnosis raises significant challenges, primarily because bone structures can obscure critical details necessary for accurate diagnosis. Recent advances in deep learning, particularly with diffusion models, offer significant promise for effectively minimizing the visibility of bone structures in CXR images, thereby improving clarity and diagnostic accuracy. Nevertheless, existing diffusion-based methods for bone suppression in CXR imaging struggle to balance the complete suppression of bones with preserving local texture details. Additionally, their high computational demand and extended processing time hinder their practical use in clinical settings. To address these limitations, we introduce a Global-Local Latent Consistency Model (GL-LCM) architecture. This model combines lung segmentation, dual-path sampling, and global-local fusion, enabling fast high-resolution bone suppression in CXR images. To tackle potential boundary artifacts and detail blurring in local-path sampling, we further propose Local-Enhanced Guidance, which addresses these issues without additional training. Comprehensive experiments on a self-collected dataset SZCH-X-Rays, and the public dataset JSRT, reveal that our GL-LCM delivers superior bone suppression and remarkable computational efficiency, significantly outperforming several competitive methods. Our code is available at https://github.com/diaoquesang/GL-LCM.

The rapid and accurate detection of COVID-19 cases is critical for timely treatment and preventing the spread of the disease. In this study, a two-stage feature extraction framework using eight state-of-the-art pre-trained deep Convolutional Neural Networks (CNNs) and an autoencoder is proposed to determine the health conditions of patients (COVID-19, Normal, Viral Pneumonia) based on chest X-rays. The X-ray scans are divided into four equally sized sections and analyzed by deep pre-trained CNNs. Subsequently, an autoencoder with three hidden layers is trained to extract reproductive features from the concatenated ouput of CNNs. To evaluate the performance of the proposed framework, three different classifiers, which are single-layer perceptron (SLP), multi-layer perceptron (MLP), and support vector machine (SVM) are used. Furthermore, the deep CNN architectures are used to create benchmark models and trained on the same dataset for comparision. The proposed framework outperforms other frameworks wih pre-trained feature extractors in binary classification and shows competitive results in three-class classification. The proposed methodology is task-independent and suitable for addressing various problems. The results show that the discriminative features are a subset of the reproductive features, suggesting that extracting task-independent features is superior to the extraction only task-based features. The flexibility and task-independence of the reproductive features make the conceptive information approach more favorable. The proposed methodology is novel and shows promising results for analyzing medical image data.

According to the considerable growth in the avail of chest X-ray images in diagnosing various diseases, as well as gathering extensive datasets, having an automated diagnosis procedure using deep neural networks has occupied the minds of experts. Most of the available methods in computer vision use a CNN backbone to acquire high accuracy on the classification problems. Nevertheless, recent researches show that transformers, established as the de facto method in NLP, can also outperform many CNN-based models in vision. This paper proposes a multi-label classification deep model based on the Swin Transformer as the backbone to achieve state-of-the-art diagnosis classification. It leverages Multi-Layer Perceptron, also known as MLP, for the head architecture. We evaluate our model on one of the most widely-used and largest x-ray datasets called "Chest X-ray14," which comprises more than 100,000 frontal/back-view images from over 30,000 patients with 14 famous chest diseases. Our model has been tested with several number of MLP layers for the head setting, each achieves a competitive AUC score on all classes. Comprehensive experiments on Chest X-ray14 have shown that a 3-layer head attains state-of-the-art performance with an average AUC score of 0.810, compared to the former SOTA average AUC of 0.799. We propose an experimental setup for the fair benchmarking of existing methods, which could be used as a basis for the future studies. Finally, we followed up our results by confirming that the proposed method attends to the pathologically relevant areas of the chest.

Lung diseases remain a critical global health concern, and it's crucial to have accurate and quick ways to diagnose them. This work focuses on classifying different lung diseases into five groups: viral pneumonia, bacterial pneumonia, COVID, tuberculosis, and normal lungs. Employing advanced deep learning techniques, we explore a diverse range of models including CNN, hybrid models, ensembles, transformers, and Big Transfer. The research encompasses comprehensive methodologies such as hyperparameter tuning, stratified k-fold cross-validation, and transfer learning with fine-tuning.Remarkably, our findings reveal that the Xception model, fine-tuned through 5-fold cross-validation, achieves the highest accuracy of 96.21\%. This success shows that our methods work well in accurately identifying different lung diseases. The exploration of explainable artificial intelligence (XAI) methodologies further enhances our understanding of the decision-making processes employed by these models, contributing to increased trust in their clinical applications.

Chest X-rays (CXRs) are commonly utilized as a low-dose modality for lung screening. Nonetheless, the efficacy of CXRs is somewhat impeded, given that approximately 75% of the lung area overlaps with bone, which in turn hampers the detection and diagnosis of diseases. As a remedial measure, bone suppression techniques have been introduced. The current dual-energy subtraction imaging technique in the clinic requires costly equipment and subjects being exposed to high radiation. To circumvent these issues, deep learning-based image generation algorithms have been proposed. However, existing methods fall short in terms of producing high-quality images and capturing texture details, particularly with pulmonary vessels. To address these issues, this paper proposes a new bone suppression framework, termed BS-Diff, that comprises a conditional diffusion model equipped with a U-Net architecture and a simple enhancement module to incorporate an autoencoder. Our proposed network cannot only generate soft tissue images with a high bone suppression rate but also possesses the capability to capture fine image details. Additionally, we compiled the largest dataset since 2010, including data from 120 patients with high-definition, high-resolution paired CXRs and soft tissue images collected by our affiliated hospital. Extensive experiments, comparative analyses, ablation studies, and clinical evaluations indicate that the proposed BS-Diff outperforms several bone-suppression models across multiple metrics. Our code can be accessed at https://github.com/Benny0323/BS-Diff.

The development of successful artificial intelligence models for chest X-ray analysis relies on large, diverse datasets with high-quality annotations. While several databases of chest X-ray images have been released, most include disease diagnosis labels but lack detailed pixel-level anatomical segmentation labels. To address this gap, we introduce an extensive chest X-ray multi-center segmentation dataset with uniform and fine-grain anatomical annotations for images coming from six well-known publicly available databases: CANDID-PTX, ChestX-ray8, Chexpert, MIMIC-CXR-JPG, Padchest, and VinDr-CXR, resulting in 676,803 segmentation masks. Our methodology utilizes the HybridGNet model to ensure consistent and high-quality segmentations across all datasets. Rigorous validation, including expert physician evaluation and automatic quality control, was conducted to validate the resulting masks. Additionally, we provide individualized quality indices per mask and an overall quality estimation per dataset. This dataset serves as a valuable resource for the broader scientific community, streamlining the development and assessment of innovative methodologies in chest X-ray analysis. The CheXmask dataset is publicly available at: https://physionet.org/content/chexmask-cxr-segmentation-data/.

Spreading of COVID-19 virus has increased the efforts to provide testing kits. Not only the preparation of these kits had been hard, rare, and expensive but also using them is another issue. Results have shown that these kits take some crucial time to recognize the virus, in addition to the fact that they encounter with 30% loss. In this paper, we have studied the usage of x-ray pictures which are ubiquitous, for the classification of COVID-19 chest Xray images, by the existing convolutional neural networks (CNNs). We intend to train chest x-rays of infected and not infected ones with different CNNs architectures including VGG19, Densnet-121, and Xception. Training these architectures resulted in different accuracies which were much faster and more precise than usual ways of testing.

Uncertainty estimation is essential for the safe clinical deployment of medical image segmentation systems, enabling the identification of unreliable predictions and supporting human oversight. While prior work has largely focused on pixel-level uncertainty, landmark-based segmentation offers inherent topological guarantees yet remains underexplored from an uncertainty perspective. In this work, we study uncertainty estimation for anatomical landmark-based segmentation on chest X-rays. Inspired by hybrid neural network architectures that combine standard image convolutional encoders with graph-based generative decoders, and leveraging their variational latent space, we derive two complementary measures: (i) latent uncertainty, captured directly from the learned distribution parameters, and (ii) predictive uncertainty, obtained by generating multiple stochastic output predictions from latent samples. Through controlled corruption experiments we show that both uncertainty measures increase with perturbation severity, reflecting both global and local degradation. We demonstrate that these uncertainty signals can identify unreliable predictions by comparing with manual ground-truth, and support out-of-distribution detection on the CheXmask dataset. More importantly, we release CheXmask-U (huggingface.co/datasets/mcosarinsky/CheXmask-U), a large scale dataset of 657,566 chest X-ray landmark segmentations with per-node uncertainty estimates, enabling researchers to account for spatial variations in segmentation quality when using these anatomical masks. Our findings establish uncertainty estimation as a promising direction to enhance robustness and safe deployment of landmark-based anatomical segmentation methods in chest X-ray. A fully working interactive demo of the method is available at huggingface.co/spaces/matiasky/CheXmask-U and the source code at github.com/mcosarinsky/CheXmask-U.

Purpose: Recent advancements in large language models (LLMs) have expanded their capabilities in a multimodal fashion, potentially replicating the image interpretation of human radiologists. This study aimed to develop open-source multimodal large language model for interpreting chest X-ray images (CXR-LLaVA). We also examined the effect of prompt engineering and model parameters such as temperature and nucleus sampling. Materials and Methods: For training, we collected 659,287 publicly available CXRs: 417,336 CXRs had labels for certain radiographic abnormalities (dataset 1); 241,951 CXRs provided free-text radiology reports (dataset 2). After pre-training the Resnet50 as an image encoder, the contrastive language-image pre-training was used to align CXRs and corresponding radiographic abnormalities. Then, the Large Language Model Meta AI-2 was fine-tuned using dataset 2, which were refined using GPT-4, with generating various question answering scenarios. The code can be found at https://github.com/ECOFRI/CXR_LLaVA. Results: In the test set, we observed that the model's performance fluctuated based on its parameters. On average, it achieved F1 score of 0.34 for five pathologic findings (atelectasis, cardiomegaly, consolidation, edema, and pleural effusion), which was improved to 0.46 through prompt engineering. In the independent set, the model achieved an average F1 score of 0.30 for the same pathologic findings. Notably, for the pediatric chest radiograph dataset, which was unseen during training, the model differentiated abnormal radiographs with an F1 score ranging from 0.84 to 0.85. Conclusion: CXR-LLaVA demonstrates promising potential in CXR interpretation. Both prompt engineering and model parameter adjustments can play pivotal roles in interpreting CXRs.

Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis, primarily affecting the lungs. Early detection is crucial for improving treatment effectiveness and reducing transmission risk. Artificial intelligence (AI), particularly through image classification of chest X-rays, can assist in TB detection. However, class imbalance in TB chest X-ray datasets presents a challenge for accurate classification. In this paper, we propose a few-shot learning (FSL) approach using the Prototypical Network algorithm to address this issue. We compare the performance of ResNet-18, ResNet-50, and VGG16 in feature extraction from the TBX11K Chest X-ray dataset. Experimental results demonstrate classification accuracies of 98.93% for ResNet-18, 98.60% for ResNet-50, and 33.33% for VGG16. These findings indicate that the proposed method outperforms others in mitigating data imbalance, which is particularly beneficial for disease classification applications.

Lung diseases represent a significant global health challenge, with Chest X-Ray (CXR) being a key diagnostic tool due to their accessibility and affordability. Nonetheless, the detection of pulmonary lesions is often hindered by overlapping bone structures in CXR images, leading to potential misdiagnoses. To address this issue, we developed an end-to-end framework called BS-LDM, designed to effectively suppress bone in high-resolution CXR images. This framework is based on conditional latent diffusion models and incorporates a multi-level hybrid loss-constrained vector-quantized generative adversarial network which is crafted for perceptual compression, ensuring the preservation of details. To further enhance the framework's performance, we introduce offset noise and a temporal adaptive thresholding strategy. These additions help minimize discrepancies in generating low-frequency information, thereby improving the clarity of the generated soft tissue images. Additionally, we have compiled a high-quality bone suppression dataset named SZCH-X-Rays. This dataset includes 818 pairs of high-resolution CXR and dual-energy subtraction soft tissue images collected from a partner hospital. Moreover, we processed 241 data pairs from the JSRT dataset into negative images, which are more commonly used in clinical practice. Our comprehensive experimental and clinical evaluations reveal that BS-LDM excels in bone suppression, underscoring its significant clinical value.

Coronavirus disease 2019 (COVID-19) has been diagnosed automatically using Machine Learning algorithms over chest X-ray (CXR) images. However, most of the earlier studies used Deep Learning models over scarce datasets bearing the risk of overfitting. Additionally, previous studies have revealed the fact that deep networks are not reliable for classification since their decisions may originate from irrelevant areas on the CXRs. Therefore, in this study, we propose Operational Segmentation Network (OSegNet) that performs detection by segmenting COVID-19 pneumonia for a reliable diagnosis. To address the data scarcity encountered in training and especially in evaluation, this study extends the largest COVID-19 CXR dataset: QaTa-COV19 with 121,378 CXRs including 9258 COVID-19 samples with their corresponding ground-truth segmentation masks that are publicly shared with the research community. Consequently, OSegNet has achieved a detection performance with the highest accuracy of 99.65% among the state-of-the-art deep models with 98.09% precision.

The outbreak of COVID-19 has shocked the entire world with its fairly rapid spread and has challenged different sectors. One of the most effective ways to limit its spread is the early and accurate diagnosing infected patients. Medical imaging, such as X-ray and Computed Tomography (CT), combined with the potential of Artificial Intelligence (AI), plays an essential role in supporting medical personnel in the diagnosis process. Thus, in this article five different deep learning models (ResNet18, ResNet34, InceptionV3, InceptionResNetV2 and DenseNet161) and their ensemble, using majority voting have been used to classify COVID-19, pneumoni{\ae} and healthy subjects using chest X-ray images. Multilabel classification was performed to predict multiple pathologies for each patient, if present. Firstly, the interpretability of each of the networks was thoroughly studied using local interpretability methods - occlusion, saliency, input X gradient, guided backpropagation, integrated gradients, and DeepLIFT, and using a global technique - neuron activation profiles. The mean Micro-F1 score of the models for COVID-19 classifications ranges from 0.66 to 0.875, and is 0.89 for the ensemble of the network models. The qualitative results showed that the ResNets were the most interpretable models. This research demonstrates the importance of using interpretability methods to compare different models before making a decision regarding the best performing model.

The global outbreak of the Coronavirus 2019 (COVID-19) has overloaded worldwide healthcare systems. Computer-aided diagnosis for COVID-19 fast detection and patient triage is becoming critical. This paper proposes a novel self-knowledge distillation based self-supervised learning method for COVID-19 detection from chest X-ray images. Our method can use self-knowledge of images based on similarities of their visual features for self-supervised learning. Experimental results show that our method achieved an HM score of 0.988, an AUC of 0.999, and an accuracy of 0.957 on the largest open COVID-19 chest X-ray dataset.

Electronic Health Records (EHRs), which contain patients' medical histories in various multi-modal formats, often overlook the potential for joint reasoning across imaging and table modalities underexplored in current EHR Question Answering (QA) systems. In this paper, we introduce EHRXQA, a novel multi-modal question answering dataset combining structured EHRs and chest X-ray images. To develop our dataset, we first construct two uni-modal resources: 1) The MIMIC- CXR-VQA dataset, our newly created medical visual question answering (VQA) benchmark, specifically designed to augment the imaging modality in EHR QA, and 2) EHRSQL (MIMIC-IV), a refashioned version of a previously established table-based EHR QA dataset. By integrating these two uni-modal resources, we successfully construct a multi-modal EHR QA dataset that necessitates both uni-modal and cross-modal reasoning. To address the unique challenges of multi-modal questions within EHRs, we propose a NeuralSQL-based strategy equipped with an external VQA API. This pioneering endeavor enhances engagement with multi-modal EHR sources and we believe that our dataset can catalyze advances in real-world medical scenarios such as clinical decision-making and research. EHRXQA is available at https://github.com/baeseongsu/ehrxqa.

Deep neural networks have been extensively applied in the medical domain for various tasks, including image classification, segmentation, and landmark detection. However, their application is often hindered by data scarcity, both in terms of available annotations and images. This study introduces a novel application of denoising diffusion probabilistic models (DDPMs) to the landmark detection task, specifically addressing the challenge of limited annotated data in x-ray imaging. Our key innovation lies in leveraging DDPMs for self-supervised pre-training in landmark detection, a previously unexplored approach in this domain. This method enables accurate landmark detection with minimal annotated training data (as few as 50 images), surpassing both ImageNet supervised pre-training and traditional self-supervised techniques across three popular x-ray benchmark datasets. To our knowledge, this work represents the first application of diffusion models for self-supervised learning in landmark detection, which may offer a valuable pre-training approach in few-shot regimes, for mitigating data scarcity.

The field of Explainable Artificial Intelligence (XAI) aims to build explainable and interpretable machine learning (or deep learning) methods without sacrificing prediction performance. Convolutional Neural Networks (CNNs) have been successful in making predictions, especially in image classification. However, these famous deep learning models use tens of millions of parameters based on a large number of pre-trained filters which have been repurposed from previous data sets. We propose a novel Interaction-based Convolutional Neural Network (ICNN) that does not make assumptions about the relevance of local information. Instead, we use a model-free Influence Score (I-score) to directly extract the influential information from images to form important variable modules. We demonstrate that the proposed method produces state-of-the-art prediction performance of 99.8% on a real-world data set classifying COVID-19 Chest X-ray images without sacrificing the explanatory power of the model. This proposed design can efficiently screen COVID-19 patients before human diagnosis, and will be the benchmark for addressing future XAI problems in large-scale data sets.

In the field of eXplainable AI (XAI), robust "blackbox" algorithms such as Convolutional Neural Networks (CNNs) are known for making high prediction performance. However, the ability to explain and interpret these algorithms still require innovation in the understanding of influential and, more importantly, explainable features that directly or indirectly impact the performance of predictivity. A number of methods existing in literature focus on visualization techniques but the concepts of explainability and interpretability still require rigorous definition. In view of the above needs, this paper proposes an interaction-based methodology -- Influence Score (I-score) -- to screen out the noisy and non-informative variables in the images hence it nourishes an environment with explainable and interpretable features that are directly associated to feature predictivity. We apply the proposed method on a real world application in Pneumonia Chest X-ray Image data set and produced state-of-the-art results. We demonstrate how to apply the proposed approach for more general big data problems by improving the explainability and interpretability without sacrificing the prediction performance. The contribution of this paper opens a novel angle that moves the community closer to the future pipelines of XAI problems.

X-ray images play a vital role in the intraoperative processes due to their high resolution and fast imaging speed and greatly promote the subsequent segmentation, registration and reconstruction. However, over-dosed X-rays superimpose potential risks to human health to some extent. Data-driven algorithms from volume scans to X-ray images are restricted by the scarcity of paired X-ray and volume data. Existing methods are mainly realized by modelling the whole X-ray imaging procedure. In this study, we propose a learning-based approach termed CT2X-GAN to synthesize the X-ray images in an end-to-end manner using the content and style disentanglement from three different image domains. Our method decouples the anatomical structure information from CT scans and style information from unpaired real X-ray images/ digital reconstructed radiography (DRR) images via a series of decoupling encoders. Additionally, we introduce a novel consistency regularization term to improve the stylistic resemblance between synthesized X-ray images and real X-ray images. Meanwhile, we also impose a supervised process by computing the similarity of computed real DRR and synthesized DRR images. We further develop a pose attention module to fully strengthen the comprehensive information in the decoupled content code from CT scans, facilitating high-quality multi-view image synthesis in the lower 2D space. Extensive experiments were conducted on the publicly available CTSpine1K dataset and achieved 97.8350, 0.0842 and 3.0938 in terms of FID, KID and defined user-scored X-ray similarity, respectively. In comparison with 3D-aware methods (pi-GAN, EG3D), CT2X-GAN is superior in improving the synthesis quality and realistic to the real X-ray images.

Ensuring the quality and integrity of medical images is crucial for maintaining diagnostic accuracy in deep learning-based Computer-Aided Diagnosis and Computer-Aided Detection (CAD) systems. Covariate shifts are subtle variations in the data distribution caused by different imaging devices or settings and can severely degrade model performance, similar to the effects of adversarial attacks. Therefore, it is vital to have a lightweight and fast method to assess the quality of these images prior to using CAD models. AdverX-Ray addresses this need by serving as an image-quality assessment layer, designed to detect covariate shifts effectively. This Adversarial Variational Autoencoder prioritizes the discriminator's role, using the suboptimal outputs of the generator as negative samples to fine-tune the discriminator's ability to identify high-frequency artifacts. Images generated by adversarial networks often exhibit severe high-frequency artifacts, guiding the discriminator to focus excessively on these components. This makes the discriminator ideal for this approach. Trained on patches from X-ray images of specific machine models, AdverX-Ray can evaluate whether a scan matches the training distribution, or if a scan from the same machine is captured under different settings. Extensive comparisons with various OOD detection methods show that AdverX-Ray significantly outperforms existing techniques, achieving a 96.2% average AUROC using only 64 random patches from an X-ray. Its lightweight and fast architecture makes it suitable for real-time applications, enhancing the reliability of medical imaging systems. The code and pretrained models are publicly available.

Radiology plays a pivotal role in modern medicine due to its non-invasive diagnostic capabilities. However, the manual generation of unstructured medical reports is time consuming and prone to errors. It creates a significant bottleneck in clinical workflows. Despite advancements in AI-generated radiology reports, challenges remain in achieving detailed and accurate report generation. In this study we have evaluated different combinations of multimodal models that integrate Computer Vision and Natural Language Processing to generate comprehensive radiology reports. We employed a pretrained Vision Transformer (ViT-B16) and a SWIN Transformer as the image encoders. The BART and GPT-2 models serve as the textual decoders. We used Chest X-ray images and reports from the IU-Xray dataset to evaluate the usability of the SWIN Transformer-BART, SWIN Transformer-GPT-2, ViT-B16-BART and ViT-B16-GPT-2 models for report generation. We aimed at finding the best combination among the models. The SWIN-BART model performs as the best-performing model among the four models achieving remarkable results in almost all the evaluation metrics like ROUGE, BLEU and BERTScore.

Reading and interpreting chest X-ray images is one of the most radiologist's routines. However, it still can be challenging, even for the most experienced ones. Therefore, we proposed a multi-model deep learning-based automated chest X-ray report generator system designed to assist radiologists in their work. The basic idea of the proposed system is by utilizing multi binary-classification models for detecting multi abnormalities, with each model responsible for detecting one abnormality, in a single image. In this study, we limited the radiology abnormalities detection to only cardiomegaly, lung effusion, and consolidation. The system generates a radiology report by performing the following three steps: image pre-processing, utilizing deep learning models to detect abnormalities, and producing a report. The aim of the image pre-processing step is to standardize the input by scaling it to 128x128 pixels and slicing it into three segments, which covers the upper, lower, and middle parts of the lung. After pre-processing, each corresponding model classifies the image, resulting in a 0 (zero) for no abnormality detected and a 1 (one) for the presence of an abnormality. The prediction outputs of each model are then concatenated to form a 'result code'. The 'result code' is used to construct a report by selecting the appropriate pre-determined sentence for each detected abnormality in the report generation step. The proposed system is expected to reduce the workload of radiologists and increase the accuracy of chest X-ray diagnosis.

Tuberculosis (TB) is a chronic lung disease that occurs due to bacterial infection and is one of the top 10 leading causes of death. Accurate and early detection of TB is very important, otherwise, it could be life-threatening. In this work, we have detected TB reliably from the chest X-ray images using image pre-processing, data augmentation, image segmentation, and deep-learning classification techniques. Several public databases were used to create a database of 700 TB infected and 3500 normal chest X-ray images for this study. Nine different deep CNNs (ResNet18, ResNet50, ResNet101, ChexNet, InceptionV3, Vgg19, DenseNet201, SqueezeNet, and MobileNet), which were used for transfer learning from their pre-trained initial weights and trained, validated and tested for classifying TB and non-TB normal cases. Three different experiments were carried out in this work: segmentation of X-ray images using two different U-net models, classification using X-ray images, and segmented lung images. The accuracy, precision, sensitivity, F1-score, specificity in the detection of tuberculosis using X-ray images were 97.07 %, 97.34 %, 97.07 %, 97.14 % and 97.36 % respectively. However, segmented lungs for the classification outperformed than whole X-ray image-based classification and accuracy, precision, sensitivity, F1-score, specificity were 99.9 %, 99.91 %, 99.9 %, 99.9 %, and 99.52 % respectively. The paper also used a visualization technique to confirm that CNN learns dominantly from the segmented lung regions results in higher detection accuracy. The proposed method with state-of-the-art performance can be useful in the computer-aided faster diagnosis of tuberculosis.

Synthetic medical data offers a scalable solution for training robust models, but significant domain gaps limit its generalizability to real-world clinical settings. This paper addresses the challenge of cross-domain translation between synthetic and real X-ray images of the head, focusing on bridging discrepancies in attenuation behavior, noise characteristics, and soft tissue representation. We propose MedShift, a unified class-conditional generative model based on Flow Matching and Schrodinger Bridges, which enables high-fidelity, unpaired image translation across multiple domains. Unlike prior approaches that require domain-specific training or rely on paired data, MedShift learns a shared domain-agnostic latent space and supports seamless translation between any pair of domains seen during training. We introduce X-DigiSkull, a new dataset comprising aligned synthetic and real skull X-rays under varying radiation doses, to benchmark domain translation models. Experimental results demonstrate that, despite its smaller model size compared to diffusion-based approaches, MedShift offers strong performance and remains flexible at inference time, as it can be tuned to prioritize either perceptual fidelity or structural consistency, making it a scalable and generalizable solution for domain adaptation in medical imaging. The code and dataset are available at https://caetas.github.io/medshift.html

X-ray imaging is a rapid and cost-effective tool for visualizing internal human anatomy. While multi-view X-ray imaging provides complementary information that enhances diagnosis, intervention, and education, acquiring images from multiple angles increases radiation exposure and complicates clinical workflows. To address these challenges, we propose a novel view-conditioned diffusion model for synthesizing multi-view X-ray images from a single view. Unlike prior methods, which are limited in angular range, resolution, and image quality, our approach leverages the Diffusion Transformer to preserve fine details and employs a weak-to-strong training strategy for stable high-resolution image generation. Experimental results demonstrate that our method generates higher-resolution outputs with improved control over viewing angles. This capability has significant implications not only for clinical applications but also for medical education and data extension, enabling the creation of diverse, high-quality datasets for training and analysis. Our code is available at https://github.com/xiechun298/SV-DRR.

This paper investigates the use of deep learning approaches to estimate the femur caput-collum-diaphyseal (CCD) angle from X-ray images. The CCD angle is an important measurement in the diagnosis of hip problems, and correct prediction can help in the planning of surgical procedures. Manual measurement of this angle, on the other hand, can be time-intensive and vulnerable to inter-observer variability. In this paper, we present a deep-learning algorithm that can reliably estimate the femur CCD angle from X-ray images. To train and test the performance of our model, we employed an X-ray image dataset with associated femur CCD angle measurements. Furthermore, we built a prototype to display the resulting predictions and to allow the user to interact with the predictions. As this is happening in a sterile setting during surgery, we expanded our interface to the possibility of being used only by voice commands. Our results show that our deep learning model predicts the femur CCD angle on X-ray images with great accuracy, with a mean absolute error of 4.3 degrees on the left femur and 4.9 degrees on the right femur on the test dataset. Our results suggest that deep learning has the potential to give a more efficient and accurate technique for predicting the femur CCD angle, which might have substantial therapeutic implications for the diagnosis and management of hip problems.

Language promptable X-ray image segmentation would enable greater flexibility for human-in-the-loop workflows in diagnostic and interventional precision medicine. Prior efforts have contributed task-specific models capable of solving problems within a narrow scope, but expanding to broader use requires additional data, annotations, and training time. Recently, language-aligned foundation models (LFMs) -- machine learning models trained on large amounts of highly variable image and text data thus enabling broad applicability -- have emerged as promising tools for automated image analysis. Existing foundation models for medical image analysis focus on scenarios and modalities where large, richly annotated datasets are available. However, the X-ray imaging modality features highly variable image appearance and applications, from diagnostic chest X-rays to interventional fluoroscopy, with varying availability of data. To pave the way toward an LFM for comprehensive and language-aligned analysis of arbitrary medical X-ray images, we introduce FluoroSAM, a language-promptable variant of the Segment Anything Model, trained from scratch on 3M synthetic X-ray images from a wide variety of human anatomies, imaging geometries, and viewing angles. These include pseudo-ground truth masks for 128 organ types and 464 tools with associated text descriptions. FluoroSAM is capable of segmenting myriad anatomical structures and tools based on natural language prompts, thanks to the novel incorporation of vector quantization (VQ) of text embeddings in the training process. We demonstrate FluoroSAM's performance quantitatively on real X-ray images and showcase on several applications how FluoroSAM is a key enabler for rich human-machine interaction in the X-ray image acquisition and analysis context. Code is available at https://github.com/arcadelab/fluorosam.

The automated generation of imaging reports proves invaluable in alleviating the workload of radiologists. A clinically applicable reports generation algorithm should demonstrate its effectiveness in producing reports that accurately describe radiology findings and attend to patient-specific indications. In this paper, we introduce a novel method, Structural Entities extraction and patient indications Incorporation (SEI) for chest X-ray report generation. Specifically, we employ a structural entities extraction (SEE) approach to eliminate presentation-style vocabulary in reports and improve the quality of factual entity sequences. This reduces the noise in the following cross-modal alignment module by aligning X-ray images with factual entity sequences in reports, thereby enhancing the precision of cross-modal alignment and further aiding the model in gradient-free retrieval of similar historical cases. Subsequently, we propose a cross-modal fusion network to integrate information from X-ray images, similar historical cases, and patient-specific indications. This process allows the text decoder to attend to discriminative features of X-ray images, assimilate historical diagnostic information from similar cases, and understand the examination intention of patients. This, in turn, assists in triggering the text decoder to produce high-quality reports. Experiments conducted on MIMIC-CXR validate the superiority of SEI over state-of-the-art approaches on both natural language generation and clinical efficacy metrics.

Automatic security inspection using computer vision technology is a challenging task in real-world scenarios due to various factors, including intra-class variance, class imbalance, and occlusion. Most of the previous methods rarely solve the cases that the prohibited items are deliberately hidden in messy objects due to the lack of large-scale datasets, restricted their applications in real-world scenarios. Towards real-world prohibited item detection, we collect a large-scale dataset, named as PIDray, which covers various cases in real-world scenarios for prohibited item detection, especially for deliberately hidden items. With an intensive amount of effort, our dataset contains 12 categories of prohibited items in 47,677 X-ray images with high-quality annotated segmentation masks and bounding boxes. To the best of our knowledge, it is the largest prohibited items detection dataset to date. Meanwhile, we design the selective dense attention network (SDANet) to construct a strong baseline, which consists of the dense attention module and the dependency refinement module. The dense attention module formed by the spatial and channel-wise dense attentions, is designed to learn the discriminative features to boost the performance. The dependency refinement module is used to exploit the dependencies of multi-scale features. Extensive experiments conducted on the collected PIDray dataset demonstrate that the proposed method performs favorably against the state-of-the-art methods, especially for detecting the deliberately hidden items.

The chest X-ray is one of the most commonly accessible radiological examinations for screening and diagnosis of many lung diseases. A tremendous number of X-ray imaging studies accompanied by radiological reports are accumulated and stored in many modern hospitals' Picture Archiving and Communication Systems (PACS). On the other side, it is still an open question how this type of hospital-size knowledge database containing invaluable imaging informatics (i.e., loosely labeled) can be used to facilitate the data-hungry deep learning paradigms in building truly large-scale high precision computer-aided diagnosis (CAD) systems. In this paper, we present a new chest X-ray database, namely "ChestX-ray8", which comprises 108,948 frontal-view X-ray images of 32,717 unique patients with the text-mined eight disease image labels (where each image can have multi-labels), from the associated radiological reports using natural language processing. Importantly, we demonstrate that these commonly occurring thoracic diseases can be detected and even spatially-located via a unified weakly-supervised multi-label image classification and disease localization framework, which is validated using our proposed dataset. Although the initial quantitative results are promising as reported, deep convolutional neural network based "reading chest X-rays" (i.e., recognizing and locating the common disease patterns trained with only image-level labels) remains a strenuous task for fully-automated high precision CAD systems. Data download link: https://nihcc.app.box.com/v/ChestXray-NIHCC

The conversion from 2D X-ray to 3D shape holds significant potential for improving diagnostic efficiency and safety. However, existing reconstruction methods often rely on hand-crafted features, manual intervention, and prior knowledge, resulting in unstable shape errors and additional processing costs. In this paper, we introduce Swin-X2S, an end-to-end deep learning method for directly reconstructing 3D segmentation and labeling from 2D biplanar orthogonal X-ray images. Swin-X2S employs an encoder-decoder architecture: the encoder leverages 2D Swin Transformer for X-ray information extraction, while the decoder employs 3D convolution with cross-attention to integrate structural features from orthogonal views. A dimension-expanding module is introduced to bridge the encoder and decoder, ensuring a smooth conversion from 2D pixels to 3D voxels. We evaluate proposed method through extensive qualitative and quantitative experiments across nine publicly available datasets covering four anatomies (femur, hip, spine, and rib), with a total of 54 categories. Significant improvements over previous methods have been observed not only in the segmentation and labeling metrics but also in the clinically relevant parameters that are of primary concern in practical applications, which demonstrates the promise of Swin-X2S to provide an effective option for anatomical shape reconstruction in clinical scenarios. Code implementation is available at: https://github.com/liukuan5625/Swin-X2S.

With the emergence of large-scale vision language models (VLM), it is now possible to produce realistic-looking radiology reports for chest X-ray images. However, their clinical translation has been hampered by the factual errors and hallucinations in the produced descriptions during inference. In this paper, we present a novel phrase-grounded fact-checking model (FC model) that detects errors in findings and their indicated locations in automatically generated chest radiology reports. Specifically, we simulate the errors in reports through a large synthetic dataset derived by perturbing findings and their locations in ground truth reports to form real and fake findings-location pairs with images. A new multi-label cross-modal contrastive regression network is then trained on this dataset. We present results demonstrating the robustness of our method in terms of accuracy of finding veracity prediction and localization on multiple X-ray datasets. We also show its effectiveness for error detection in reports of SOTA report generators on multiple datasets achieving a concordance correlation coefficient of 0.997 with ground truth-based verification, thus pointing to its utility during clinical inference in radiology workflows.

Anatomical segmentation is a fundamental task in medical image computing, generally tackled with fully convolutional neural networks which produce dense segmentation masks. These models are often trained with loss functions such as cross-entropy or Dice, which assume pixels to be independent of each other, thus ignoring topological errors and anatomical inconsistencies. We address this limitation by moving from pixel-level to graph representations, which allow to naturally incorporate anatomical constraints by construction. To this end, we introduce HybridGNet, an encoder-decoder neural architecture that leverages standard convolutions for image feature encoding and graph convolutional neural networks (GCNNs) to decode plausible representations of anatomical structures. We also propose a novel image-to-graph skip connection layer which allows localized features to flow from standard convolutional blocks to GCNN blocks, and show that it improves segmentation accuracy. The proposed architecture is extensively evaluated in a variety of domain shift and image occlusion scenarios, and audited considering different types of demographic domain shift. Our comprehensive experimental setup compares HybridGNet with other landmark and pixel-based models for anatomical segmentation in chest x-ray images, and shows that it produces anatomically plausible results in challenging scenarios where other models tend to fail.

Osteoporosis is a widespread and chronic metabolic bone disease that often remains undiagnosed and untreated due to limited access to bone mineral density (BMD) tests like Dual-energy X-ray absorptiometry (DXA). In response to this challenge, current advancements are pivoting towards detecting osteoporosis by examining alternative indicators from peripheral bone areas, with the goal of increasing screening rates without added expenses or time. In this paper, we present a method to predict osteoporosis using hand and wrist X-ray images, which are both widely accessible and affordable, though their link to DXA-based data is not thoroughly explored. Initially, our method segments the ulnar, radius, and metacarpal bones using a foundational model for image segmentation. Then, we use a self-supervised learning approach to extract meaningful representations without the need for explicit labels, and move on to classify osteoporosis in a supervised manner. Our method is evaluated on a dataset with 192 individuals, cross-referencing their verified osteoporosis conditions against the standard DXA test. With a notable classification score (AUC=0.83), our model represents a pioneering effort in leveraging vision-based techniques for osteoporosis identification from the peripheral skeleton sites.

The applicability of current lesion segmentation models for chest X-rays (CXRs) has been limited both by a small number of target labels and the reliance on long, detailed expert-level text inputs, creating a barrier to practical use. To address these limitations, we introduce a new paradigm: instruction-guided lesion segmentation (ILS), which is designed to segment diverse lesion types based on simple, user-friendly instructions. Under this paradigm, we construct MIMIC-ILS, the first large-scale instruction-answer dataset for CXR lesion segmentation, using our fully automated multimodal pipeline that generates annotations from chest X-ray images and their corresponding reports. MIMIC-ILS contains 1.1M instruction-answer pairs derived from 192K images and 91K unique segmentation masks, covering seven major lesion types. To empirically demonstrate its utility, we introduce ROSALIA, a vision-language model fine-tuned on MIMIC-ILS. ROSALIA can segment diverse lesions and provide textual explanations in response to user instructions. The model achieves high segmentation and textual accuracy in our newly proposed task, highlighting the effectiveness of our pipeline and the value of MIMIC-ILS as a foundational resource for pixel-level CXR lesion grounding.

We develop an algorithm that can detect pneumonia from chest X-rays at a level exceeding practicing radiologists. Our algorithm, CheXNet, is a 121-layer convolutional neural network trained on ChestX-ray14, currently the largest publicly available chest X-ray dataset, containing over 100,000 frontal-view X-ray images with 14 diseases. Four practicing academic radiologists annotate a test set, on which we compare the performance of CheXNet to that of radiologists. We find that CheXNet exceeds average radiologist performance on the F1 metric. We extend CheXNet to detect all 14 diseases in ChestX-ray14 and achieve state of the art results on all 14 diseases.

Medical report generation from X-ray images is a challenging task, particularly in an unpaired setting where paired image-report data is unavailable for training. To address this challenge, we propose a novel model that leverages the available information in two distinct datasets, one comprising reports and the other consisting of images. The core idea of our model revolves around the notion that combining auto-encoding report generation with multi-modal (report-image) alignment can offer a solution. However, the challenge persists regarding how to achieve this alignment when pair correspondence is absent. Our proposed solution involves the use of auxiliary tasks, particularly contrastive learning and classification, to position related images and reports in close proximity to each other. This approach differs from previous methods that rely on pre-processing steps, such as using external information stored in a knowledge graph. Our model, named MedRAT, surpasses previous state-of-the-art methods, demonstrating the feasibility of generating comprehensive medical reports without the need for paired data or external tools.

Methods. We utilized the combined five SRG/eROSITA All-Sky Survey data (eRASS:5) to perform X-ray imaging and spectral analyses of the Centaurus cluster in various directions to large radii. Surface brightness (SB) profiles out to 2R_{200} were constructed. We acquired gas temperature, metallicity, and normalization per area profiles out to R_{200}. We compared our results with previous Centaurus studies, cluster outskirts measurements, and simulations. Comprehensive sky background analysis was done across the FoV, in particular, to assess the variation of the eROSITA Bubble emission that partially contaminates the field. Results. The processed X-ray images show the known sloshing-induced structures in the core. The core (rleq11~kpc) is better described with a 2T model than a 1T model. Here, we measured lower T from the cooler component (~1.0 keV) and higher Z (sim!1.6Z_odot), signifying an iron bias. In the intermediate radial range, we observed prominent SB and normalization per area excesses in the eastern sector (Cen 45 location), reaching out to R_{500}. Temperature enhancements near the location of Cen 45 imply that the gas is shock-heated due to the interaction with Cen 30, the significant excess behind Cen 45 center might be the tail/ram-pressure-stripped gas. We found good agreement between the outskirt temperatures with the profile from simulations and fit from Suzaku outskirts measurements. We detected significant SB emission to the sky background level out to R_{200} with a 3.5sigma and followed by 2.9sigma at 1.1R_{200}. The metallicity at R_{500}-R_{200} is low but within the ranges of other outskirts studies. Conclusions. We present the first measurement of ICM morphology and properties of Centaurus cluster sampling the whole azimuth beyond 30', increasing the probed volume by a factor of almost 30.

Digitally reconstructed radiographs (DRRs) are simulated 2D X-ray images generated from 3D CT volumes, widely used in preoperative settings but limited in intraoperative applications due to computational bottlenecks, especially for accurate but heavy physics-based Monte Carlo methods. While analytical DRR renderers offer greater efficiency, they overlook anisotropic X-ray image formation phenomena, such as Compton scattering. We present a novel approach that marries realistic physics-inspired X-ray simulation with efficient, differentiable DRR generation using 3D Gaussian splatting (3DGS). Our direction-disentangled 3DGS (DDGS) method separates the radiosity contribution into isotropic and direction-dependent components, approximating complex anisotropic interactions without intricate runtime simulations. Additionally, we adapt the 3DGS initialization to account for tomography data properties, enhancing accuracy and efficiency. Our method outperforms state-of-the-art techniques in image accuracy. Furthermore, our DDGS shows promise for intraoperative applications and inverse problems such as pose registration, delivering superior registration accuracy and runtime performance compared to analytical DRR methods.

The increasing complexity of Artificial Intelligence models poses challenges to interpretability, particularly in the healthcare sector. This study investigates the impact of deep learning model complexity and Explainable AI (XAI) efficacy, utilizing four ResNet architectures (ResNet-18, 34, 50, 101). Through methodical experimentation on 4,369 lung X-ray images of COVID-19-infected and healthy patients, the research evaluates models' classification performance and the relevance of corresponding XAI explanations with respect to the ground-truth disease masks. Results indicate that the increase in model complexity is associated with a decrease in classification accuracy and AUC-ROC scores (ResNet-18: 98.4%, 0.997; ResNet-101: 95.9%, 0.988). Notably, in eleven out of twelve statistical tests performed, no statistically significant differences occurred between XAI quantitative metrics - Relevance Rank Accuracy and the proposed Positive Attribution Ratio - across trained models. These results suggest that increased model complexity does not consistently lead to higher performance or relevance of explanations for models' decision-making processes.

Medical imaging analysis plays a critical role in the diagnosis and treatment of various medical conditions. This paper focuses on chest X-ray images and their corresponding radiological reports. It presents a new model that learns a joint X-ray image & report representation. The model is based on a novel alignment scheme between the visual data and the text, which takes into account both local and global information. Furthermore, the model integrates domain-specific information of two types -- lateral images and the consistent visual structure of chest images. Our representation is shown to benefit three types of retrieval tasks: text-image retrieval, class-based retrieval, and phrase-grounding.

Automated structured radiology report generation (SRRG) from chest X-ray images offers significant potential to reduce workload of radiologists by generating reports in structured formats that ensure clarity, consistency, and adherence to clinical reporting standards. While radiologists effectively utilize available clinical contexts in their diagnostic reasoning, existing SRRG systems overlook these essential elements. This fundamental gap leads to critical problems including temporal hallucinations when referencing non-existent clinical contexts. To address these limitations, we propose contextualized SRRG (C-SRRG) that comprehensively incorporates rich clinical context for SRRG. We curate C-SRRG dataset by integrating comprehensive clinical context encompassing 1) multi-view X-ray images, 2) clinical indication, 3) imaging techniques, and 4) prior studies with corresponding comparisons based on patient histories. Through extensive benchmarking with state-of-the-art multimodal large language models, we demonstrate that incorporating clinical context with the proposed C-SRRG significantly improves report generation quality. We publicly release dataset, code, and checkpoints to facilitate future research for clinically-aligned automated RRG at https://github.com/vuno/contextualized-srrg.

Generating accurate and clinically meaningful radiology reports from chest X-ray images remains a significant challenge in medical AI. While recent vision-language models achieve strong results in general radiology report generation, they often fail to adequately describe rare but clinically important pathologies like fractures. This work addresses this gap by developing specialized models for fracture pathology detection and description. We train fracture-specific vision-language models with encoders from MAIRA-2 and CheXagent, demonstrating significant improvements over general-purpose models in generating accurate fracture descriptions. Analysis of model outputs by fracture type, location, and age reveals distinct strengths and limitations of current vision-language model architectures. We publicly release our best-performing fracture-reporting model, facilitating future research in accurate reporting of rare pathologies.

The pandemic resulted in vast repositories of unstructured data, including radiology reports, due to increased medical examinations. Previous research on automated diagnosis of COVID-19 primarily focuses on X-ray images, despite their lower precision compared to computed tomography (CT) scans. In this work, we leverage unstructured data from a hospital and harness the fine-grained details offered by CT scans to perform zero-shot multi-label classification based on contrastive visual language learning. In collaboration with human experts, we investigate the effectiveness of multiple zero-shot models that aid radiologists in detecting pulmonary embolisms and identifying intricate lung details like ground glass opacities and consolidations. Our empirical analysis provides an overview of the possible solutions to target such fine-grained tasks, so far overlooked in the medical multimodal pretraining literature. Our investigation promises future advancements in the medical image analysis community by addressing some challenges associated with unstructured data and fine-grained multi-label classification.

This paper presents a comprehensive evaluation of GPT-4V's capabilities across diverse medical imaging tasks, including Radiology Report Generation, Medical Visual Question Answering (VQA), and Visual Grounding. While prior efforts have explored GPT-4V's performance in medical image analysis, to the best of our knowledge, our study represents the first quantitative evaluation on publicly available benchmarks. Our findings highlight GPT-4V's potential in generating descriptive reports for chest X-ray images, particularly when guided by well-structured prompts. Meanwhile, its performance on the MIMIC-CXR dataset benchmark reveals areas for improvement in certain evaluation metrics, such as CIDEr. In the domain of Medical VQA, GPT-4V demonstrates proficiency in distinguishing between question types but falls short of the VQA-RAD benchmark in terms of accuracy. Furthermore, our analysis finds the limitations of conventional evaluation metrics like the BLEU scores, advocating for the development of more semantically robust assessment methods. In the field of Visual Grounding, GPT-4V exhibits preliminary promise in recognizing bounding boxes, but its precision is lacking, especially in identifying specific medical organs and signs. Our evaluation underscores the significant potential of GPT-4V in the medical imaging domain, while also emphasizing the need for targeted refinements to fully unlock its capabilities.

This paper addresses the challenge of localization of anatomical landmarks in knee X-ray images at different stages of osteoarthritis (OA). Landmark localization can be viewed as regression problem, where the landmark position is directly predicted by using the region of interest or even full-size images leading to large memory footprint, especially in case of high resolution medical images. In this work, we propose an efficient deep neural networks framework with an hourglass architecture utilizing a soft-argmax layer to directly predict normalized coordinates of the landmark points. We provide an extensive evaluation of different regularization techniques and various loss functions to understand their influence on the localization performance. Furthermore, we introduce the concept of transfer learning from low-budget annotations, and experimentally demonstrate that such approach is improving the accuracy of landmark localization. Compared to the prior methods, we validate our model on two datasets that are independent from the train data and assess the performance of the method for different stages of OA severity. The proposed approach demonstrates better generalization performance compared to the current state-of-the-art.

We introduce a radiology-focused visual language model designed to generate radiology reports from chest X-rays. Building on previous findings that large language models (LLMs) can acquire multimodal capabilities when aligned with pretrained vision encoders, we demonstrate similar potential with chest X-ray images. This integration enhances the ability of model to understand and describe chest X-ray images. Our model combines an image encoder with a fine-tuned LLM based on the Vicuna-7B architecture, enabling it to generate different sections of a radiology report with notable accuracy. The training process involves a two-stage approach: (i) initial alignment of chest X-ray features with the LLM (ii) followed by fine-tuning for radiology report generation.

A deep understanding of the physical world is a central goal for embodied AI and realistic simulation. While current models excel at capturing an object's surface geometry and appearance, they largely neglect its internal physical properties. This omission is critical, as properties like volumetric density are fundamental for predicting an object's center of mass, stability, and interaction dynamics in applications ranging from robotic manipulation to physical simulation. The primary bottleneck has been the absence of large-scale, real-world data. To bridge this gap, we introduce XDen-1K, the first large-scale, multi-modal dataset designed for real-world physical property estimation, with a particular focus on volumetric density. The core of this dataset consists of 1,000 real-world objects across 148 categories, for which we provide comprehensive multi-modal data, including a high-resolution 3D geometric model with part-level annotations and a corresponding set of real-world biplanar X-ray scans. Building upon this data, we introduce a novel optimization framework that recovers a high-fidelity volumetric density field of each object from its sparse X-ray views. To demonstrate its practical value, we add X-ray images as a conditioning signal to an existing segmentation network and perform volumetric segmentation. Furthermore, we conduct experiments on downstream robotics tasks. The results show that leveraging the dataset can effectively improve the accuracy of center-of-mass estimation and the success rate of robotic manipulation. We believe XDen-1K will serve as a foundational resource and a challenging new benchmark, catalyzing future research in physically grounded visual inference and embodied AI.

Power batteries are essential components in electric vehicles, where internal structural defects can pose serious safety risks. We conduct a comprehensive study on a new task, power battery detection (PBD), which aims to localize the dense endpoints of cathode and anode plates from industrial X-ray images for quality inspection. Manual inspection is inefficient and error-prone, while traditional vision algorithms struggle with densely packed plates, low contrast, scale variation, and imaging artifacts. To address this issue and drive more attention into this meaningful task, we present PBD5K, the first large-scale benchmark for this task, consisting of 5,000 X-ray images from nine battery types with fine-grained annotations and eight types of real-world visual interference. To support scalable and consistent labeling, we develop an intelligent annotation pipeline that combines image filtering, model-assisted pre-labeling, cross-verification, and layered quality evaluation. We formulate PBD as a point-level segmentation problem and propose MDCNeXt, a model designed to extract and integrate multi-dimensional structure clues including point, line, and count information from the plate itself. To improve discrimination between plates and suppress visual interference, MDCNeXt incorporates two state space modules. The first is a prompt-filtered module that learns contrastive relationships guided by task-specific prompts. The second is a density-aware reordering module that refines segmentation in regions with high plate density. In addition, we propose a distance-adaptive mask generation strategy to provide robust supervision under varying spatial distributions of anode and cathode positions. The source code and datasets will be publicly available at https://github.com/Xiaoqi-Zhao-DLUT/X-ray-PBD{PBD5K}.

In this work we address the problem of landmark-based segmentation for anatomical structures. We propose HybridGNet, an encoder-decoder neural architecture which combines standard convolutions for image feature encoding, with graph convolutional neural networks to decode plausible representations of anatomical structures. We benchmark the proposed architecture considering other standard landmark and pixel-based models for anatomical segmentation in chest x-ray images, and found that HybridGNet is more robust to image occlusions. We also show that it can be used to construct landmark-based segmentations from pixel level annotations. Our experimental results suggest that HybridGNet produces accurate and anatomically plausible landmark-based segmentations, by naturally incorporating shape constraints within the decoding process via spectral convolutions.

Coronavirus disease (COVID-19) is a pandemic disease, which has already caused thousands of causalities and infected several millions of people worldwide. Any technological tool enabling rapid screening of the COVID-19 infection with high accuracy can be crucially helpful to healthcare professionals. The main clinical tool currently in use for the diagnosis of COVID-19 is the Reverse transcription polymerase chain reaction (RT-PCR), which is expensive, less-sensitive and requires specialized medical personnel. X-ray imaging is an easily accessible tool that can be an excellent alternative in the COVID-19 diagnosis. This research was taken to investigate the utility of artificial intelligence (AI) in the rapid and accurate detection of COVID-19 from chest X-ray images. The aim of this paper is to propose a robust technique for automatic detection of COVID-19 pneumonia from digital chest X-ray images applying pre-trained deep-learning algorithms while maximizing the detection accuracy. A public database was created by the authors combining several public databases and also by collecting images from recently published articles. The database contains a mixture of 423 COVID-19, 1485 viral pneumonia, and 1579 normal chest X-ray images. Transfer learning technique was used with the help of image augmentation to train and validate several pre-trained deep Convolutional Neural Networks (CNNs). The networks were trained to classify two different schemes: i) normal and COVID-19 pneumonia; ii) normal, viral and COVID-19 pneumonia with and without image augmentation. The classification accuracy, precision, sensitivity, and specificity for both the schemes were 99.7%, 99.7%, 99.7% and 99.55% and 97.9%, 97.95%, 97.9%, and 98.8%, respectively.

Medical visual question answering (VQA) aims to answer clinically relevant questions regarding input medical images. This technique has the potential to improve the efficiency of medical professionals while relieving the burden on the public health system, particularly in resource-poor countries. Existing medical VQA methods tend to encode medical images and learn the correspondence between visual features and questions without exploiting the spatial, semantic, or medical knowledge behind them. This is partially because of the small size of the current medical VQA dataset, which often includes simple questions. Therefore, we first collected a comprehensive and large-scale medical VQA dataset, focusing on chest X-ray images. The questions involved detailed relationships, such as disease names, locations, levels, and types in our dataset. Based on this dataset, we also propose a novel baseline method by constructing three different relationship graphs: spatial relationship, semantic relationship, and implicit relationship graphs on the image regions, questions, and semantic labels. The answer and graph reasoning paths are learned for different questions.

Instance level detection and segmentation of thoracic diseases or abnormalities are crucial for automatic diagnosis in chest X-ray images. Leveraging on constant structure and disease relations extracted from domain knowledge, we propose a structure-aware relation network (SAR-Net) extending Mask R-CNN. The SAR-Net consists of three relation modules: 1. the anatomical structure relation module encoding spatial relations between diseases and anatomical parts. 2. the contextual relation module aggregating clues based on query-key pair of disease RoI and lung fields. 3. the disease relation module propagating co-occurrence and causal relations into disease proposals. Towards making a practical system, we also provide ChestX-Det, a chest X-Ray dataset with instance-level annotations (boxes and masks). ChestX-Det is a subset of the public dataset NIH ChestX-ray14. It contains ~3500 images of 13 common disease categories labeled by three board-certified radiologists. We evaluate our SAR-Net on it and another dataset DR-Private. Experimental results show that it can enhance the strong baseline of Mask R-CNN with significant improvements. The ChestX-Det is released at https://github.com/Deepwise-AILab/ChestX-Det-Dataset.

In this paper, we introduce DRR-RATE, a large-scale synthetic chest X-ray dataset derived from the recently released CT-RATE dataset. DRR-RATE comprises of 50,188 frontal Digitally Reconstructed Radiographs (DRRs) from 21,304 unique patients. Each image is paired with a corresponding radiology text report and binary labels for 18 pathology classes. Given the controllable nature of DRR generation, it facilitates the inclusion of lateral view images and images from any desired viewing position. This opens up avenues for research into new and novel multimodal applications involving paired CT, X-ray images from various views, text, and binary labels. We demonstrate the applicability of DRR-RATE alongside existing large-scale chest X-ray resources, notably the CheXpert dataset and CheXnet model. Experiments demonstrate that CheXnet, when trained and tested on the DRR-RATE dataset, achieves sufficient to high AUC scores for the six common pathologies cited in common literature: Atelectasis, Cardiomegaly, Consolidation, Lung Lesion, Lung Opacity, and Pleural Effusion. Additionally, CheXnet trained on the CheXpert dataset can accurately identify several pathologies, even when operating out of distribution. This confirms that the generated DRR images effectively capture the essential pathology features from CT images. The dataset and labels are publicly accessible at https://huggingface.co/datasets/farrell236/DRR-RATE.

This work describes the development and real-world deployment of a deep learning-based AI system for evaluating canine and feline radiographs across a broad range of findings and abnormalities. We describe a new semi-supervised learning approach that combines NLP-derived labels with self-supervised training leveraging more than 2.5 million x-ray images. Finally we describe the clinical deployment of the model including system architecture, real-time performance evaluation and data drift detection.

Adolescent idiopathic scoliosis (AIS) is a lifetime disease that arises in children. Accurate estimation of Cobb angles of the scoliosis is essential for clinicians to make diagnosis and treatment decisions. The Cobb angles are measured according to the vertebrae landmarks. Existing regression-based methods for the vertebra landmark detection typically suffer from large dense mapping parameters and inaccurate landmark localization. The segmentation-based methods tend to predict connected or corrupted vertebra masks. In this paper, we propose a novel vertebra-focused landmark detection method. Our model first localizes the vertebra centers, based on which it then traces the four corner landmarks of the vertebra through the learned corner offset. In this way, our method is able to keep the order of the landmarks. The comparison results demonstrate the merits of our method in both Cobb angle measurement and landmark detection on low-contrast and ambiguous X-ray images. Code is available at: https://github.com/yijingru/Vertebra-Landmark-Detection.

Despite that deep learning has achieved state-of-the-art performance for medical image segmentation, its success relies on a large set of manually annotated images for training that are expensive to acquire. In this paper, we propose an annotation-efficient learning framework for segmentation tasks that avoids annotations of training images, where we use an improved Cycle-Consistent Generative Adversarial Network (GAN) to learn from a set of unpaired medical images and auxiliary masks obtained either from a shape model or public datasets. We first use the GAN to generate pseudo labels for our training images under the implicit high-level shape constraint represented by a Variational Auto-encoder (VAE)-based discriminator with the help of the auxiliary masks, and build a Discriminator-guided Generator Channel Calibration (DGCC) module which employs our discriminator's feedback to calibrate the generator for better pseudo labels. To learn from the pseudo labels that are noisy, we further introduce a noise-robust iterative learning method using noise-weighted Dice loss. We validated our framework with two situations: objects with a simple shape model like optic disc in fundus images and fetal head in ultrasound images, and complex structures like lung in X-Ray images and liver in CT images. Experimental results demonstrated that 1) Our VAE-based discriminator and DGCC module help to obtain high-quality pseudo labels. 2) Our proposed noise-robust learning method can effectively overcome the effect of noisy pseudo labels. 3) The segmentation performance of our method without using annotations of training images is close or even comparable to that of learning from human annotations.

Critical retained foreign objects (RFOs), including surgical instruments like sponges and needles, pose serious patient safety risks and carry significant financial and legal implications for healthcare institutions. Detecting critical RFOs using artificial intelligence remains challenging due to their rarity and the limited availability of chest X-ray datasets that specifically feature critical RFOs cases. Existing datasets only contain non-critical RFOs, like necklace or zipper, further limiting their utility for developing clinically impactful detection algorithms. To address these limitations, we introduce "Hopkins RFOs Bench", the first and largest dataset of its kind, containing 144 chest X-ray images of critical RFO cases collected over 18 years from the Johns Hopkins Health System. Using this dataset, we benchmark several state-of-the-art object detection models, highlighting the need for enhanced detection methodologies for critical RFO cases. Recognizing data scarcity challenges, we further explore image synthetic methods to bridge this gap. We evaluate two advanced synthetic image methods, DeepDRR-RFO, a physics-based method, and RoentGen-RFO, a diffusion-based method, for creating realistic radiographs featuring critical RFOs. Our comprehensive analysis identifies the strengths and limitations of each synthetic method, providing insights into effectively utilizing synthetic data to enhance model training. The Hopkins RFOs Bench and our findings significantly advance the development of reliable, generalizable AI-driven solutions for detecting critical RFOs in clinical chest X-rays.

Radiographs are used as the most important imaging tool for identifying spine anomalies in clinical practice. The evaluation of spinal bone lesions, however, is a challenging task for radiologists. This work aims at developing and evaluating a deep learning-based framework, named VinDr-SpineXR, for the classification and localization of abnormalities from spine X-rays. First, we build a large dataset, comprising 10,468 spine X-ray images from 5,000 studies, each of which is manually annotated by an experienced radiologist with bounding boxes around abnormal findings in 13 categories. Using this dataset, we then train a deep learning classifier to determine whether a spine scan is abnormal and a detector to localize 7 crucial findings amongst the total 13. The VinDr-SpineXR is evaluated on a test set of 2,078 images from 1,000 studies, which is kept separate from the training set. It demonstrates an area under the receiver operating characteristic curve (AUROC) of 88.61% (95% CI 87.19%, 90.02%) for the image-level classification task and a mean average precision ([email protected]) of 33.56% for the lesion-level localization task. These results serve as a proof of concept and set a baseline for future research in this direction. To encourage advances, the dataset, codes, and trained deep learning models are made publicly available.

Deep AUC Maximization (DAM) is a new paradigm for learning a deep neural network by maximizing the AUC score of the model on a dataset. Most previous works of AUC maximization focus on the perspective of optimization by designing efficient stochastic algorithms, and studies on generalization performance of large-scale DAM on difficult tasks are missing. In this work, we aim to make DAM more practical for interesting real-world applications (e.g., medical image classification). First, we propose a new margin-based min-max surrogate loss function for the AUC score (named as AUC min-max-margin loss or simply AUC margin loss for short). It is more robust than the commonly used AUC square loss, while enjoying the same advantage in terms of large-scale stochastic optimization. Second, we conduct extensive empirical studies of our DAM method on four difficult medical image classification tasks, namely (i) classification of chest x-ray images for identifying many threatening diseases, (ii) classification of images of skin lesions for identifying melanoma, (iii) classification of mammogram for breast cancer screening, and (iv) classification of microscopic images for identifying tumor tissue. Our studies demonstrate that the proposed DAM method improves the performance of optimizing cross-entropy loss by a large margin, and also achieves better performance than optimizing the existing AUC square loss on these medical image classification tasks. Specifically, our DAM method has achieved the 1st place on Stanford CheXpert competition on Aug. 31, 2020. To the best of our knowledge, this is the first work that makes DAM succeed on large-scale medical image datasets. We also conduct extensive ablation studies to demonstrate the advantages of the new AUC margin loss over the AUC square loss on benchmark datasets. The proposed method is implemented in our open-sourced library LibAUC (www.libauc.org).

Large-scale Vision-Language Models (LVLMs) have significantly advanced with text-aligned vision inputs. They have made remarkable progress in computer vision tasks by aligning text modality with vision inputs. There are also endeavors to incorporate multi-vision sensors beyond RGB, including thermal, depth, and medical X-ray images. However, we observe that current LVLMs view images taken from multi-vision sensors as if they were in the same RGB domain without considering the physical characteristics of multi-vision sensors. They fail to convey the fundamental multi-vision sensor information from the dataset and the corresponding contextual knowledge properly. Consequently, alignment between the information from the actual physical environment and the text is not achieved correctly, making it difficult to answer complex sensor-related questions that consider the physical environment. In this paper, we aim to establish a multi-vision Sensor Perception And Reasoning benchmarK called SPARK that can reduce the fundamental multi-vision sensor information gap between images and multi-vision sensors. We generated 6,248 vision-language test samples automatically to investigate multi-vision sensory perception and multi-vision sensory reasoning on physical sensor knowledge proficiency across different formats, covering different types of sensor-related questions. We utilized these samples to assess ten leading LVLMs. The results showed that most models displayed deficiencies in multi-vision sensory reasoning to varying extents. Codes and data are available at https://github.com/top-yun/SPARK

Radiology report generation (RRG) aims to automatically generate free-text descriptions from clinical radiographs, e.g., chest X-Ray images. RRG plays an essential role in promoting clinical automation and presents significant help to provide practical assistance for inexperienced doctors and alleviate radiologists' workloads. Therefore, consider these meaningful potentials, research on RRG is experiencing explosive growth in the past half-decade, especially with the rapid development of deep learning approaches. Existing studies perform RRG from the perspective of enhancing different modalities, provide insights on optimizing the report generation process with elaborated features from both visual and textual information, and further facilitate RRG with the cross-modal interactions among them. In this paper, we present a comprehensive review of deep learning-based RRG from various perspectives. Specifically, we firstly cover pivotal RRG approaches based on the task-specific features of radiographs, reports, and the cross-modal relations between them, and then illustrate the benchmark datasets conventionally used for this task with evaluation metrics, subsequently analyze the performance of different approaches and finally offer our summary on the challenges and the trends in future directions. Overall, the goal of this paper is to serve as a tool for understanding existing literature and inspiring potential valuable research in the field of RRG.

Supervised dictionary learning (SDL) is a classical machine learning method that simultaneously seeks feature extraction and classification tasks, which are not necessarily a priori aligned objectives. The goal of SDL is to learn a class-discriminative dictionary, which is a set of latent feature vectors that can well-explain both the features as well as labels of observed data. In this paper, we provide a systematic study of SDL, including the theory, algorithm, and applications of SDL. First, we provide a novel framework that `lifts' SDL as a convex problem in a combined factor space and propose a low-rank projected gradient descent algorithm that converges exponentially to the global minimizer of the objective. We also formulate generative models of SDL and provide global estimation guarantees of the true parameters depending on the hyperparameter regime. Second, viewed as a nonconvex constrained optimization problem, we provided an efficient block coordinate descent algorithm for SDL that is guaranteed to find an varepsilon-stationary point of the objective in O(varepsilon^{-1}(log varepsilon^{-1})^{2}) iterations. For the corresponding generative model, we establish a novel non-asymptotic local consistency result for constrained and regularized maximum likelihood estimation problems, which may be of independent interest. Third, we apply SDL for imbalanced document classification by supervised topic modeling and also for pneumonia detection from chest X-ray images. We also provide simulation studies to demonstrate that SDL becomes more effective when there is a discrepancy between the best reconstructive and the best discriminative dictionaries.

Given the ubiquity of deep neural networks, it is important that these models do not reveal information about sensitive data that they have been trained on. In model inversion attacks, a malicious user attempts to recover the private dataset used to train a supervised neural network. A successful model inversion attack should generate realistic and diverse samples that accurately describe each of the classes in the private dataset. In this work, we provide a probabilistic interpretation of model inversion attacks, and formulate a variational objective that accounts for both diversity and accuracy. In order to optimize this variational objective, we choose a variational family defined in the code space of a deep generative model, trained on a public auxiliary dataset that shares some structural similarity with the target dataset. Empirically, our method substantially improves performance in terms of target attack accuracy, sample realism, and diversity on datasets of faces and chest X-ray images.

Scientific researchers frequently use the in situ synchrotron high-energy powder X-ray diffraction (XRD) technique to examine the crystallographic structures of materials in functional devices such as rechargeable battery materials. We propose a method for identifying artifacts in experimental XRD images. The proposed method uses deep learning convolutional neural network architectures, such as tunable U-Nets to identify the artifacts. In particular, the predicted artifacts are evaluated against the corresponding ground truth (manually implemented) using the overall true positive rate or recall. The result demonstrates that the U-Nets can consistently produce great recall performance at 92.4% on the test dataset, which is not included in the training, with a 34% reduction in average false positives in comparison to the conventional method. The U-Nets also reduce the time required to identify and separate artifacts by more than 50%. Furthermore, the exclusion of the artifacts shows major changes in the integrated 1D XRD pattern, enhancing further analysis of the post-processing XRD data.

Accurate segmentation of coronary arteries remains a significant challenge in clinical practice, hindering the ability to effectively diagnose and manage coronary artery disease. The lack of large, annotated datasets for model training exacerbates this issue, limiting the development of automated tools that could assist radiologists. To address this, we introduce CM-UNet, which leverages self-supervised pre-training on unannotated datasets and transfer learning on limited annotated data, enabling accurate disease detection while minimizing the need for extensive manual annotations. Fine-tuning CM-UNet with only 18 annotated images instead of 500 resulted in a 15.2% decrease in Dice score, compared to a 46.5% drop in baseline models without pre-training. This demonstrates that self-supervised learning can enhance segmentation performance and reduce dependence on large datasets. This is one of the first studies to highlight the importance of self-supervised learning in improving coronary artery segmentation from X-ray angiography, with potential implications for advancing diagnostic accuracy in clinical practice. By enhancing segmentation accuracy in X-ray angiography images, the proposed approach aims to improve clinical workflows, reduce radiologists' workload, and accelerate disease detection, ultimately contributing to better patient outcomes. The source code is publicly available at https://github.com/CamilleChallier/Contrastive-Masked-UNet.

Training prohibited item detection models requires a large amount of X-ray security images, but collecting and annotating these images is time-consuming and laborious. To address data insufficiency, X-ray security image synthesis methods composite images to scale up datasets. However, previous methods primarily follow a two-stage pipeline, where they implement labor-intensive foreground extraction in the first stage and then composite images in the second stage. Such a pipeline introduces inevitable extra labor cost and is not efficient. In this paper, we propose a one-stage X-ray security image synthesis pipeline (Xsyn) based on text-to-image generation, which incorporates two effective strategies to improve the usability of synthetic images. The Cross-Attention Refinement (CAR) strategy leverages the cross-attention map from the diffusion model to refine the bounding box annotation. The Background Occlusion Modeling (BOM) strategy explicitly models background occlusion in the latent space to enhance imaging complexity. To the best of our knowledge, compared with previous methods, Xsyn is the first to achieve high-quality X-ray security image synthesis without extra labor cost. Experiments demonstrate that our method outperforms all previous methods with 1.2% mAP improvement, and the synthetic images generated by our method are beneficial to improve prohibited item detection performance across various X-ray security datasets and detectors. Code is available at https://github.com/pILLOW-1/Xsyn/.

Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists' workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT's hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.

Despite the progress in automatic detection of radiologic findings from chest X-ray (CXR) images in recent years, a quantitative evaluation of the explainability of these models is hampered by the lack of locally labeled datasets for different findings. With the exception of a few expert-labeled small-scale datasets for specific findings, such as pneumonia and pneumothorax, most of the CXR deep learning models to date are trained on global "weak" labels extracted from text reports, or trained via a joint image and unstructured text learning strategy. Inspired by the Visual Genome effort in the computer vision community, we constructed the first Chest ImaGenome dataset with a scene graph data structure to describe 242,072 images. Local annotations are automatically produced using a joint rule-based natural language processing (NLP) and atlas-based bounding box detection pipeline. Through a radiologist constructed CXR ontology, the annotations for each CXR are connected as an anatomy-centered scene graph, useful for image-level reasoning and multimodal fusion applications. Overall, we provide: i) 1,256 combinations of relation annotations between 29 CXR anatomical locations (objects with bounding box coordinates) and their attributes, structured as a scene graph per image, ii) over 670,000 localized comparison relations (for improved, worsened, or no change) between the anatomical locations across sequential exams, as well as ii) a manually annotated gold standard scene graph dataset from 500 unique patients.

Machine learning models in health care are often deployed in settings where it is important to protect patient privacy. In such settings, methods for differentially private (DP) learning provide a general-purpose approach to learn models with privacy guarantees. Modern methods for DP learning ensure privacy through mechanisms that censor information judged as too unique. The resulting privacy-preserving models, therefore, neglect information from the tails of a data distribution, resulting in a loss of accuracy that can disproportionately affect small groups. In this paper, we study the effects of DP learning in health care. We use state-of-the-art methods for DP learning to train privacy-preserving models in clinical prediction tasks, including x-ray classification of images and mortality prediction in time series data. We use these models to perform a comprehensive empirical investigation of the tradeoffs between privacy, utility, robustness to dataset shift, and fairness. Our results highlight lesser-known limitations of methods for DP learning in health care, models that exhibit steep tradeoffs between privacy and utility, and models whose predictions are disproportionately influenced by large demographic groups in the training data. We discuss the costs and benefits of differentially private learning in health care.

The study of jet-inflated X-ray cavities provides a powerful insight into the energetics of hot galactic atmospheres and radio-mechanical AGN feedback. By estimating the volumes of X-ray cavities, the total energy and thus also the corresponding mechanical jet power required for their inflation can be derived. Properly estimating their total extent is, however, non-trivial, prone to biases, nearly impossible for poor-quality data, and so far has been done manually by scientists. We present a novel and automated machine-learning pipeline called Cavity Detection Tool (CADET), developed to detect and estimate the sizes of X-ray cavities from raw Chandra images. The pipeline consists of a convolutional neural network trained for producing pixel-wise cavity predictions and a DBSCAN clustering algorithm, which decomposes the predictions into individual cavities. The convolutional network was trained using mock observations of early-type galaxies simulated to resemble real noisy Chandra-like images. The network's performance has been tested on simulated data obtaining an average cavity volume error of 14 % at an 89 % true-positive rate. For simulated images without any X-ray cavities inserted, we obtain a 5 % false-positive rate. When applied to real Chandra images, the pipeline recovered 91 out of 100 previously known X-ray cavities in nearby early-type galaxies and all 14 cavities in chosen galaxy clusters. Besides that, the CADET pipeline discovered 8 new cavity pairs in atmospheres of early-type galaxies and galaxy clusters (IC4765, NGC533, NGC2300, NGC3091, NGC4073, NGC4125, NGC4472, NGC5129) and a number of potential cavity candidates.

Automated diagnosis prediction from medical images is a valuable resource to support clinical decision-making. However, such systems usually need to be trained on large amounts of annotated data, which often is scarce in the medical domain. Zero-shot methods address this challenge by allowing a flexible adaption to new settings with different clinical findings without relying on labeled data. Further, to integrate automated diagnosis in the clinical workflow, methods should be transparent and explainable, increasing medical professionals' trust and facilitating correctness verification. In this work, we introduce Xplainer, a novel framework for explainable zero-shot diagnosis in the clinical setting. Xplainer adapts the classification-by-description approach of contrastive vision-language models to the multi-label medical diagnosis task. Specifically, instead of directly predicting a diagnosis, we prompt the model to classify the existence of descriptive observations, which a radiologist would look for on an X-Ray scan, and use the descriptor probabilities to estimate the likelihood of a diagnosis. Our model is explainable by design, as the final diagnosis prediction is directly based on the prediction of the underlying descriptors. We evaluate Xplainer on two chest X-ray datasets, CheXpert and ChestX-ray14, and demonstrate its effectiveness in improving the performance and explainability of zero-shot diagnosis. Our results suggest that Xplainer provides a more detailed understanding of the decision-making process and can be a valuable tool for clinical diagnosis.

We present a pipeline for generating defurnished replicas of indoor spaces represented as textured meshes and corresponding multi-view panoramic images. To achieve this, we first segment and remove furniture from the mesh representation, extend planes, and fill holes, obtaining a simplified defurnished mesh (SDM). This SDM acts as an ``X-ray'' of the scene's underlying structure, guiding the defurnishing process. We extract Canny edges from depth and normal images rendered from the SDM. We then use these as a guide to remove the furniture from panorama images via ControlNet inpainting. This control signal ensures the availability of global geometric information that may be hidden from a particular panoramic view by the furniture being removed. The inpainted panoramas are used to texture the mesh. We show that our approach produces higher quality assets than methods that rely on neural radiance fields, which tend to produce blurry low-resolution images, or RGB-D inpainting, which is highly susceptible to hallucinations.

We present a labeled large-scale, high resolution chest x-ray dataset for the automated exploration of medical images along with their associated reports. This dataset includes more than 160,000 images obtained from 67,000 patients that were interpreted and reported by radiologists at Hospital San Juan Hospital (Spain) from 2009 to 2017, covering six different position views and additional information on image acquisition and patient demography. The reports were labeled with 174 different radiographic findings, 19 differential diagnoses and 104 anatomic locations organized as a hierarchical taxonomy and mapped onto standard Unified Medical Language System (UMLS) terminology. Of these reports, 27% were manually annotated by trained physicians and the remaining set was labeled using a supervised method based on a recurrent neural network with attention mechanisms. The labels generated were then validated in an independent test set achieving a 0.93 Micro-F1 score. To the best of our knowledge, this is one of the largest public chest x-ray database suitable for training supervised models concerning radiographs, and the first to contain radiographic reports in Spanish. The PadChest dataset can be downloaded from http://bimcv.cipf.es/bimcv-projects/padchest/.

Deep neural networks excel in radiological image classification but frequently suffer from poor interpretability, limiting clinical acceptance. We present MedicalPatchNet, an inherently self-explainable architecture for chest X-ray classification that transparently attributes decisions to distinct image regions. MedicalPatchNet splits images into non-overlapping patches, independently classifies each patch, and aggregates predictions, enabling intuitive visualization of each patch's diagnostic contribution without post-hoc techniques. Trained on the CheXpert dataset (223,414 images), MedicalPatchNet matches the classification performance (AUROC 0.907 vs. 0.908) of EfficientNet-B0, while substantially improving interpretability: MedicalPatchNet demonstrates substantially improved interpretability with higher pathology localization accuracy (mean hit-rate 0.485 vs. 0.376 with Grad-CAM) on the CheXlocalize dataset. By providing explicit, reliable explanations accessible even to non-AI experts, MedicalPatchNet mitigates risks associated with shortcut learning, thus improving clinical trust. Our model is publicly available with reproducible training and inference scripts and contributes to safer, explainable AI-assisted diagnostics across medical imaging domains. We make the code publicly available: https://github.com/TruhnLab/MedicalPatchNet

Open-vocabulary object detection (OvOD) is set to revolutionize security screening by enabling systems to recognize any item in X-ray scans. However, developing effective OvOD models for X-ray imaging presents unique challenges due to data scarcity and the modality gap that prevents direct adoption of RGB-based solutions. To overcome these limitations, we propose RAXO, a training-free framework that repurposes off-the-shelf RGB OvOD detectors for robust X-ray detection. RAXO builds high-quality X-ray class descriptors using a dual-source retrieval strategy. It gathers relevant RGB images from the web and enriches them via a novel X-ray material transfer mechanism, eliminating the need for labeled databases. These visual descriptors replace text-based classification in OvOD, leveraging intra-modal feature distances for robust detection. Extensive experiments demonstrate that RAXO consistently improves OvOD performance, providing an average mAP increase of up to 17.0 points over base detectors. To further support research in this emerging field, we also introduce DET-COMPASS, a new benchmark featuring bounding box annotations for over 300 object categories, enabling large-scale evaluation of OvOD in X-ray. Code and dataset available at: https://github.com/PAGF188/RAXO.

In this paper we propose a novel image representation called face X-ray for detecting forgery in face images. The face X-ray of an input face image is a greyscale image that reveals whether the input image can be decomposed into the blending of two images from different sources. It does so by showing the blending boundary for a forged image and the absence of blending for a real image. We observe that most existing face manipulation methods share a common step: blending the altered face into an existing background image. For this reason, face X-ray provides an effective way for detecting forgery generated by most existing face manipulation algorithms. Face X-ray is general in the sense that it only assumes the existence of a blending step and does not rely on any knowledge of the artifacts associated with a specific face manipulation technique. Indeed, the algorithm for computing face X-ray can be trained without fake images generated by any of the state-of-the-art face manipulation methods. Extensive experiments show that face X-ray remains effective when applied to forgery generated by unseen face manipulation techniques, while most existing face forgery detection or deepfake detection algorithms experience a significant performance drop.

Our approach, which we call Embeddings for Language/Image-aligned X-Rays, or ELIXR, leverages a language-aligned image encoder combined or grafted onto a fixed LLM, PaLM 2, to perform a broad range of tasks. We train this lightweight adapter architecture using images paired with corresponding free-text radiology reports from the MIMIC-CXR dataset. ELIXR achieved state-of-the-art performance on zero-shot chest X-ray (CXR) classification (mean AUC of 0.850 across 13 findings), data-efficient CXR classification (mean AUCs of 0.893 and 0.898 across five findings (atelectasis, cardiomegaly, consolidation, pleural effusion, and pulmonary edema) for 1% (~2,200 images) and 10% (~22,000 images) training data), and semantic search (0.76 normalized discounted cumulative gain (NDCG) across nineteen queries, including perfect retrieval on twelve of them). Compared to existing data-efficient methods including supervised contrastive learning (SupCon), ELIXR required two orders of magnitude less data to reach similar performance. ELIXR also showed promise on CXR vision-language tasks, demonstrating overall accuracies of 58.7% and 62.5% on visual question answering and report quality assurance tasks, respectively. These results suggest that ELIXR is a robust and versatile approach to CXR AI.

Multimodal models trained on large natural image-text pair datasets have exhibited astounding abilities in generating high-quality images. Medical imaging data is fundamentally different to natural images, and the language used to succinctly capture relevant details in medical data uses a different, narrow but semantically rich, domain-specific vocabulary. Not surprisingly, multi-modal models trained on natural image-text pairs do not tend to generalize well to the medical domain. Developing generative imaging models faithfully representing medical concepts while providing compositional diversity could mitigate the existing paucity of high-quality, annotated medical imaging datasets. In this work, we develop a strategy to overcome the large natural-medical distributional shift by adapting a pre-trained latent diffusion model on a corpus of publicly available chest x-rays (CXR) and their corresponding radiology (text) reports. We investigate the model's ability to generate high-fidelity, diverse synthetic CXR conditioned on text prompts. We assess the model outputs quantitatively using image quality metrics, and evaluate image quality and text-image alignment by human domain experts. We present evidence that the resulting model (RoentGen) is able to create visually convincing, diverse synthetic CXR images, and that the output can be controlled to a new extent by using free-form text prompts including radiology-specific language. Fine-tuning this model on a fixed training set and using it as a data augmentation method, we measure a 5% improvement of a classifier trained jointly on synthetic and real images, and a 3% improvement when trained on a larger but purely synthetic training set. Finally, we observe that this fine-tuning distills in-domain knowledge in the text-encoder and can improve its representation capabilities of certain diseases like pneumothorax by 25%.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Since the release of the original CheXpert paper five years ago, CheXpert has become one of the most widely used and cited clinical AI datasets. The emergence of vision language models has sparked an increase in demands for sharing reports linked to CheXpert images, along with a growing interest among AI fairness researchers in obtaining demographic data. To address this, CheXpert Plus serves as a new collection of radiology data sources, made publicly available to enhance the scaling, performance, robustness, and fairness of models for all subsequent machine learning tasks in the field of radiology. CheXpert Plus is the largest text dataset publicly released in radiology, with a total of 36 million text tokens, including 13 million impression tokens. To the best of our knowledge, it represents the largest text de-identification effort in radiology, with almost 1 million PHI spans anonymized. It is only the second time that a large-scale English paired dataset has been released in radiology, thereby enabling, for the first time, cross-institution training at scale. All reports are paired with high-quality images in DICOM format, along with numerous image and patient metadata covering various clinical and socio-economic groups, as well as many pathology labels and RadGraph annotations. We hope this dataset will boost research for AI models that can further assist radiologists and help improve medical care. Data is available at the following URL: https://stanfordaimi.azurewebsites.net/datasets/5158c524-d3ab-4e02-96e9-6ee9efc110a1 Models are available at the following URL: https://github.com/Stanford-AIMI/chexpert-plus

The integration of artificial intelligence in image-guided interventions holds transformative potential, promising to extract 3D geometric and quantitative information from conventional 2D imaging modalities during complex procedures. Achieving this requires the rapid and precise alignment of 2D intraoperative images (e.g., X-ray) with 3D preoperative volumes (e.g., CT, MRI). However, current 2D/3D registration methods fail across the broad spectrum of procedures dependent on X-ray guidance: traditional optimization techniques require custom parameter tuning for each subject, whereas neural networks trained on small datasets do not generalize to new patients or require labor-intensive manual annotations, increasing clinical burden and precluding application to new anatomical targets. To address these challenges, we present xvr, a fully automated framework for training patient-specific neural networks for 2D/3D registration. xvr uses physics-based simulation to generate abundant high-quality training data from a patient's own preoperative volumetric imaging, thereby overcoming the inherently limited ability of supervised models to generalize to new patients and procedures. Furthermore, xvr requires only 5 minutes of training per patient, making it suitable for emergency interventions as well as planned procedures. We perform the largest evaluation of a 2D/3D registration algorithm on real X-ray data to date and find that xvr robustly generalizes across a diverse dataset comprising multiple anatomical structures, imaging modalities, and hospitals. Across surgical tasks, xvr achieves submillimeter-accurate registration at intraoperative speeds, improving upon existing methods by an order of magnitude. xvr is released as open-source software freely available at https://github.com/eigenvivek/xvr.

Recent advances in large vision-language models (LVLMs) have demonstrated strong performance on general-purpose medical tasks. However, their effectiveness in specialized domains such as dentistry remains underexplored. In particular, panoramic X-rays, a widely used imaging modality in oral radiology, pose interpretative challenges due to dense anatomical structures and subtle pathological cues, which are not captured by existing medical benchmarks or instruction datasets. To this end, we introduce MMOral, the first large-scale multimodal instruction dataset and benchmark tailored for panoramic X-ray interpretation. MMOral consists of 20,563 annotated images paired with 1.3 million instruction-following instances across diverse task types, including attribute extraction, report generation, visual question answering, and image-grounded dialogue. In addition, we present MMOral-Bench, a comprehensive evaluation suite covering five key diagnostic dimensions in dentistry. We evaluate 64 LVLMs on MMOral-Bench and find that even the best-performing model, i.e., GPT-4o, only achieves 41.45% accuracy, revealing significant limitations of current models in this domain. To promote the progress of this specific domain, we also propose OralGPT, which conducts supervised fine-tuning (SFT) upon Qwen2.5-VL-7B with our meticulously curated MMOral instruction dataset. Remarkably, a single epoch of SFT yields substantial performance enhancements for LVLMs, e.g., OralGPT demonstrates a 24.73% improvement. Both MMOral and OralGPT hold significant potential as a critical foundation for intelligent dentistry and enable more clinically impactful multimodal AI systems in the dental field. The dataset, model, benchmark, and evaluation suite are available at https://github.com/isbrycee/OralGPT.

Radiologists rely on eye movements to navigate and interpret medical images. A trained radiologist possesses knowledge about the potential diseases that may be present in the images and, when searching, follows a mental checklist to locate them using their gaze. This is a key observation, yet existing models fail to capture the underlying intent behind each fixation. In this paper, we introduce a deep learning-based approach, RadGazeIntent, designed to model this behavior: having an intention to find something and actively searching for it. Our transformer-based architecture processes both the temporal and spatial dimensions of gaze data, transforming fine-grained fixation features into coarse, meaningful representations of diagnostic intent to interpret radiologists' goals. To capture the nuances of radiologists' varied intention-driven behaviors, we process existing medical eye-tracking datasets to create three intention-labeled subsets: RadSeq (Systematic Sequential Search), RadExplore (Uncertainty-driven Exploration), and RadHybrid (Hybrid Pattern). Experimental results demonstrate RadGazeIntent's ability to predict which findings radiologists are examining at specific moments, outperforming baseline methods across all intention-labeled datasets.

Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing CheXinstruct - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present CheXagent - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce CheXbench - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at https://stanford-aimi.github.io/chexagent.html.

Medical Visual Question Answering (Med-VQA) combines computer vision and natural language processing to automatically answer clinical inquiries about medical images. However, current Med-VQA datasets exhibit two significant limitations: (1) they often lack visual and textual explanations for answers, hindering comprehension for patients and junior doctors; (2) they typically offer a narrow range of question formats, inadequately reflecting the diverse requirements in practical 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 question types, open-ended, closed-ended, single-choice, and multiple-choice, to better reflect practical needs. With 151,025 images and 1,605,575 questions, GEMeX is the currently largest chest X-ray VQA dataset. Evaluation of 12 representative large vision language models (LVLMs) on GEMeX reveals suboptimal performance, underscoring the dataset's complexity. Meanwhile, we propose a strong model by fine-tuning an existing LVLM on the GEMeX training set. The substantial performance improvement showcases the dataset's effectiveness. The benchmark is available at https://www.med-vqa.com/GEMeX.

We investigate the stellar shape and size-mass relationship of X-ray selected Active Galactic Nuclei (AGN) host galaxies using the high-angular resolution and deep sensitivity in the near-infrared of the COSMOS-Web JWST survey field. We present the rest-frame 1-mu m size, stellar mass, Sersic index, axis-ratio, Gini-M_{20} parameters of 690 moderate luminosity AGNs between redshift 0-3 and with stellar mass log M_ssim 10.75. We find that AGN host galaxies have an effective radius of 1-5 kpc, which is between star-forming (SFG) and quiescent galaxies (QGs) of the same stellar mass. AGN hosts have similar size-mass trends as SFG and QGs, being smaller at higher redshift for the same stellar mass. The slope of the size-mass relationship of AGN host galaxies is steeper than that of star-forming galaxies. Their rest-frame 1mu m stellar morphology indicates a significant spheroidal component. We observed a low merger fraction (6%) in our sample as well as substructures similar to disks, bars, and spiral arms in the residual images, which are in tension with evolutionary pathways that require major mergers. However, it may also be due to the different timescales between mergers and AGN activity.

This study investigates the integration of diverse patient data sources into multimodal language models for automated chest X-ray (CXR) report generation. Traditionally, CXR report generation relies solely on CXR images and limited radiology data, overlooking valuable information from patient health records, particularly from emergency departments. Utilising the MIMIC-CXR and MIMIC-IV-ED datasets, we incorporate detailed patient information such as aperiodic vital signs, medications, and clinical history to enhance diagnostic accuracy. We introduce a novel approach to transform these heterogeneous data sources into embeddings that prompt a multimodal language model, significantly enhancing the diagnostic accuracy of generated radiology reports. Our comprehensive evaluation demonstrates the benefits of using a broader set of patient data, underscoring the potential for enhanced diagnostic capabilities and better patient outcomes through the integration of multimodal data in CXR report generation.

Large vision-language models (LVLMs) have shown great promise in medical applications, particularly in visual question answering (MedVQA) and diagnosis from medical images. However, existing datasets and models often fail to consider critical aspects of medical diagnostics, such as the integration of historical records and the analysis of disease progression over time. In this paper, we introduce MMXU (Multimodal and MultiX-ray Understanding), a novel dataset for MedVQA that focuses on identifying changes in specific regions between two patient visits. Unlike previous datasets that primarily address single-image questions, MMXU enables multi-image questions, incorporating both current and historical patient data. We demonstrate the limitations of current LVLMs in identifying disease progression on MMXU-test, even those that perform well on traditional benchmarks. To address this, we propose a MedRecord-Augmented Generation (MAG) approach, incorporating both global and regional historical records. Our experiments show that integrating historical records significantly enhances diagnostic accuracy by at least 20\%, bridging the gap between current LVLMs and human expert performance. Additionally, we fine-tune models with MAG on MMXU-dev, which demonstrates notable improvements. We hope this work could illuminate the avenue of advancing the use of LVLMs in medical diagnostics by emphasizing the importance of historical context in interpreting medical images. Our dataset is released at https://github.com/linjiemu/MMXU{https://github.com/linjiemu/MMXU}.

Automated radiology report generation offers an effective solution to alleviate radiologists' workload. However, most existing methods focus primarily on single or fixed-view images to model current disease conditions, which limits diagnostic accuracy and overlooks disease progression. Although some approaches utilize longitudinal data to track disease progression, they still rely on single images to analyze current visits. To address these issues, we propose enhanced contrastive learning with Multi-view Longitudinal data to facilitate chest X-ray Report Generation, named MLRG. Specifically, we introduce a multi-view longitudinal contrastive learning method that integrates spatial information from current multi-view images and temporal information from longitudinal data. This method also utilizes the inherent spatiotemporal information of radiology reports to supervise the pre-training of visual and textual representations. Subsequently, we present a tokenized absence encoding technique to flexibly handle missing patient-specific prior knowledge, allowing the model to produce more accurate radiology reports based on available prior knowledge. Extensive experiments on MIMIC-CXR, MIMIC-ABN, and Two-view CXR datasets demonstrate that our MLRG outperforms recent state-of-the-art methods, achieving a 2.3% BLEU-4 improvement on MIMIC-CXR, a 5.5% F1 score improvement on MIMIC-ABN, and a 2.7% F1 RadGraph improvement on Two-view CXR.

This large scale study focuses on quantifying what X-rays diagnostic prediction tasks generalize well across multiple different datasets. We present evidence that the issue of generalization is not due to a shift in the images but instead a shift in the labels. We study the cross-domain performance, agreement between models, and model representations. We find interesting discrepancies between performance and agreement where models which both achieve good performance disagree in their predictions as well as models which agree yet achieve poor performance. We also test for concept similarity by regularizing a network to group tasks across multiple datasets together and observe variation across the tasks. All code is made available online and data is publicly available: https://github.com/mlmed/torchxrayvision

Synthetic medical data generation has opened up new possibilities in the healthcare domain, offering a powerful tool for simulating clinical scenarios, enhancing diagnostic and treatment quality, gaining granular medical knowledge, and accelerating the development of unbiased algorithms. In this context, we present a novel approach called ViewXGen, designed to overcome the limitations of existing methods that rely on general domain pipelines using only radiology reports to generate frontal-view chest X-rays. Our approach takes into consideration the diverse view positions found in the dataset, enabling the generation of chest X-rays with specific views, which marks a significant advancement in the field. To achieve this, we introduce a set of specially designed tokens for each view position, tailoring the generation process to the user's preferences. Furthermore, we leverage multi-view chest X-rays as input, incorporating valuable information from different views within the same study. This integration rectifies potential errors and contributes to faithfully capturing abnormal findings in chest X-ray generation. To validate the effectiveness of our approach, we conducted statistical analyses, evaluating its performance in a clinical efficacy metric on the MIMIC-CXR dataset. Also, human evaluation demonstrates the remarkable capabilities of ViewXGen, particularly in producing realistic view-specific X-rays that closely resemble the original images.

The limited availability of labeled chest X-ray datasets is a significant bottleneck in the development of medical imaging methods. Self-supervised learning (SSL) can mitigate this problem by training models on unlabeled data. Furthermore, self-supervised pretraining has yielded promising results in visual recognition of natural images but has not been given much consideration in medical image analysis. In this work, we propose a self-supervised method, DINO-CXR, which is a novel adaptation of a self-supervised method, DINO, based on a vision transformer for chest X-ray classification. A comparative analysis is performed to show the effectiveness of the proposed method for both pneumonia and COVID-19 detection. Through a quantitative analysis, it is also shown that the proposed method outperforms state-of-the-art methods in terms of accuracy and achieves comparable results in terms of AUC and F-1 score while requiring significantly less labeled data.

The global ramifications of the COVID-19 pandemic remain significant, exerting persistent pressure on nations even three years after its initial outbreak. Deep learning models have shown promise in improving COVID-19 diagnostics but require diverse and larger-scale datasets to improve performance. In this paper, we introduce COVIDx CXR-4, an expanded multi-institutional open-source benchmark dataset for chest X-ray image-based computer-aided COVID-19 diagnostics. COVIDx CXR-4 expands significantly on the previous COVIDx CXR-3 dataset by increasing the total patient cohort size by greater than 2.66 times, resulting in 84,818 images from 45,342 patients across multiple institutions. We provide extensive analysis on the diversity of the patient demographic, imaging metadata, and disease distributions to highlight potential dataset biases. To the best of the authors' knowledge, COVIDx CXR-4 is the largest and most diverse open-source COVID-19 CXR dataset and is made publicly available as part of an open initiative to advance research to aid clinicians against the COVID-19 disease.

The rapid evolution of artificial intelligence, especially in large language models (LLMs), has significantly impacted various domains, including healthcare. In chest X-ray (CXR) analysis, previous studies have employed LLMs, but with limitations: either underutilizing the multi-tasking capabilities of LLMs or lacking clinical accuracy. This paper presents M4CXR, a multi-modal LLM designed to enhance CXR interpretation. The model is trained on a visual instruction-following dataset that integrates various task-specific datasets in a conversational format. As a result, the model supports multiple tasks such as medical report generation (MRG), visual grounding, and visual question answering (VQA). M4CXR achieves state-of-the-art clinical accuracy in MRG by employing a chain-of-thought prompting strategy, in which it identifies findings in CXR images and subsequently generates corresponding reports. The model is adaptable to various MRG scenarios depending on the available inputs, such as single-image, multi-image, and multi-study contexts. In addition to MRG, M4CXR performs visual grounding at a level comparable to specialized models and also demonstrates outstanding performance in VQA. Both quantitative and qualitative assessments reveal M4CXR's versatility in MRG, visual grounding, and VQA, while consistently maintaining clinical accuracy.

Recent advances in 3D X-ray Computed Tomographic (CT) sensors have stimulated research efforts to unveil the extremely complex micro-scale processes that control the activity of soil microorganisms. Voxel-based description (up to hundreds millions voxels) of the pore space can be extracted, from grey level 3D CT scanner images, by means of simple image processing tools. Classical methods for numerical simulation of biological dynamics using mesh of voxels, such as Lattice Boltzmann Model (LBM), are too much time consuming. Thus, the use of more compact and reliable geometrical representations of pore space can drastically decrease the computational cost of the simulations. Several recent works propose basic analytic volume primitives (e.g. spheres, generalized cylinders, ellipsoids) to define a piece-wise approximation of pore space for numerical simulation of draining, diffusion and microbial decomposition. Such approaches work well but the drawback is that it generates approximation errors. In the present work, we study another alternative where pore space is described by means of geometrically relevant connected subsets of voxels (regions) computed from the curvilinear skeleton. Indeed, many works use the curvilinear skeleton (3D medial axis) for analyzing and partitioning 3D shapes within various domains (medicine, material sciences, petroleum engineering, etc.) but only a few ones in soil sciences. Within the context of soil sciences, most studies dealing with 3D medial axis focus on the determination of pore throats. Here, we segment pore space using curvilinear skeleton in order to achieve numerical simulation of microbial decomposition (including diffusion processes). We validate simulation outputs by comparison with other methods using different pore space geometrical representations (balls, voxels).

Pre-training lays the foundation for recent successes in radiograph analysis supported by deep learning. It learns transferable image representations by conducting large-scale fully-supervised or self-supervised learning on a source domain. However, supervised pre-training requires a complex and labor intensive two-stage human-assisted annotation process while self-supervised learning cannot compete with the supervised paradigm. To tackle these issues, we propose a cross-supervised methodology named REviewing FreE-text Reports for Supervision (REFERS), which acquires free supervision signals from original radiology reports accompanying the radiographs. The proposed approach employs a vision transformer and is designed to learn joint representations from multiple views within every patient study. REFERS outperforms its transfer learning and self-supervised learning counterparts on 4 well-known X-ray datasets under extremely limited supervision. Moreover, REFERS even surpasses methods based on a source domain of radiographs with human-assisted structured labels. Thus REFERS has the potential to replace canonical pre-training methodologies.

Unsupervised anomaly detection (UAD) aims to find anomalous images by optimising a detector using a training set that contains only normal images. UAD approaches can be based on reconstruction methods, self-supervised approaches, and Imagenet pre-trained models. Reconstruction methods, which detect anomalies from image reconstruction errors, are advantageous because they do not rely on the design of problem-specific pretext tasks needed by self-supervised approaches, and on the unreliable translation of models pre-trained from non-medical datasets. However, reconstruction methods may fail because they can have low reconstruction errors even for anomalous images. In this paper, we introduce a new reconstruction-based UAD approach that addresses this low-reconstruction error issue for anomalous images. Our UAD approach, the memory-augmented multi-level cross-attentional masked autoencoder (MemMC-MAE), is a transformer-based approach, consisting of a novel memory-augmented self-attention operator for the encoder and a new multi-level cross-attention operator for the decoder. MemMCMAE masks large parts of the input image during its reconstruction, reducing the risk that it will produce low reconstruction errors because anomalies are likely to be masked and cannot be reconstructed. However, when the anomaly is not masked, then the normal patterns stored in the encoder's memory combined with the decoder's multi-level cross attention will constrain the accurate reconstruction of the anomaly. We show that our method achieves SOTA anomaly detection and localisation on colonoscopy, pneumonia, and covid-19 chest x-ray datasets.

Segment Anything Model (SAM) has gained significant attention because of its ability to segment a variety of objects in images given a prompt. The recently developed SAM 2 has extended this ability to video inputs. This opens an opportunity to apply SAM to 3D images, one of the fundamental tasks in the medical imaging field. In this paper, we provide an extensive evaluation of SAM 2's ability to segment both 2D and 3D medical images. We collect 18 medical imaging datasets, including common 3D modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) as well as 2D modalities such as X-ray and ultrasound. We consider two evaluation pipelines of SAM 2: (1) multi-frame 3D segmentation, where prompts are provided to one or multiple slice(s) selected from the volume, and (2) single-frame 2D segmentation, where prompts are provided to each slice. The former is only applicable to 3D modalities, while the latter applies to both 2D and 3D modalities. We learn that SAM 2 exhibits similar performance as SAM under single-frame 2D segmentation, and has variable performance under multi-frame 3D segmentation depending on the choices of slices to annotate, the direction of the propagation, the predictions utilized during the propagation, etc.

Influenced by the complexity of volumetric imaging, there is a shortage of established datasets useful for benchmarking volumetric deep-learning models. As a consequence, new and existing models are not easily comparable, limiting the development of architectures optimized specifically for volumetric data. To counteract this trend, we introduce MozzaVID - a large, clean, and versatile volumetric classification dataset. Our dataset contains X-ray computed tomography (CT) images of mozzarella microstructure and enables the classification of 25 cheese types and 149 cheese samples. We provide data in three different resolutions, resulting in three dataset instances containing from 591 to 37,824 images. While being general-purpose, the dataset also facilitates investigating mozzarella structure properties. The structure of food directly affects its functional properties and thus its consumption experience. Understanding food structure helps tune the production and mimicking it enables sustainable alternatives to animal-derived food products. The complex and disordered nature of food structures brings a unique challenge, where a choice of appropriate imaging method, scale, and sample size is not trivial. With this dataset we aim to address these complexities, contributing to more robust structural analysis models. The dataset can be downloaded from: https://archive.compute.dtu.dk/files/public/projects/MozzaVID/.

To evaluate the variability of multi-phase flow properties of porous media at the pore scale, it is necessary to acquire a number of representative samples of the void-solid structure. While modern x-ray computer tomography has made it possible to extract three-dimensional images of the pore space, assessment of the variability in the inherent material properties is often experimentally not feasible. We present a novel method to reconstruct the solid-void structure of porous media by applying a generative neural network that allows an implicit description of the probability distribution represented by three-dimensional image datasets. We show, by using an adversarial learning approach for neural networks, that this method of unsupervised learning is able to generate representative samples of porous media that honor their statistics. We successfully compare measures of pore morphology, such as the Euler characteristic, two-point statistics and directional single-phase permeability of synthetic realizations with the calculated properties of a bead pack, Berea sandstone, and Ketton limestone. Results show that GANs can be used to reconstruct high-resolution three-dimensional images of porous media at different scales that are representative of the morphology of the images used to train the neural network. The fully convolutional nature of the trained neural network allows the generation of large samples while maintaining computational efficiency. Compared to classical stochastic methods of image reconstruction, the implicit representation of the learned data distribution can be stored and reused to generate multiple realizations of the pore structure very rapidly.

Contrastive pretraining on parallel image-text data has attained great success in vision-language processing (VLP), as exemplified by CLIP and related methods. However, prior explorations tend to focus on general domains in the web. Biomedical images and text are rather different, but publicly available datasets are small and skew toward chest X-ray, thus severely limiting progress. In this paper, we conducted by far the largest study on biomedical VLP, using 15 million figure-caption pairs extracted from biomedical research articles in PubMed Central. Our dataset (PMC-15M) is two orders of magnitude larger than existing biomedical image-text datasets such as MIMIC-CXR, and spans a diverse range of biomedical images. The standard CLIP method is suboptimal for the biomedical domain. We propose BiomedCLIP with domain-specific adaptations tailored to biomedical VLP. We conducted extensive experiments and ablation studies on standard biomedical imaging tasks from retrieval to classification to visual question-answering (VQA). BiomedCLIP established new state of the art in a wide range of standard datasets, substantially outperformed prior VLP approaches. Surprisingly, BiomedCLIP even outperformed radiology-specific state-of-the-art models such as BioViL on radiology-specific tasks such as RSNA pneumonia detection, thus highlighting the utility in large-scale pretraining across all biomedical image types. We will release our models at https://aka.ms/biomedclip to facilitate future research in biomedical VLP.

We present 4KAgent, a unified agentic super-resolution generalist system designed to universally upscale any image to 4K resolution (and even higher, if applied iteratively). Our system can transform images from extremely low resolutions with severe degradations, for example, highly distorted inputs at 256x256, into crystal-clear, photorealistic 4K outputs. 4KAgent comprises three core components: (1) Profiling, a module that customizes the 4KAgent pipeline based on bespoke use cases; (2) A Perception Agent, which leverages vision-language models alongside image quality assessment experts to analyze the input image and make a tailored restoration plan; and (3) A Restoration Agent, which executes the plan, following a recursive execution-reflection paradigm, guided by a quality-driven mixture-of-expert policy to select the optimal output for each step. Additionally, 4KAgent embeds a specialized face restoration pipeline, significantly enhancing facial details in portrait and selfie photos. We rigorously evaluate our 4KAgent across 11 distinct task categories encompassing a total of 26 diverse benchmarks, setting new state-of-the-art on a broad spectrum of imaging domains. Our evaluations cover natural images, portrait photos, AI-generated content, satellite imagery, fluorescence microscopy, and medical imaging like fundoscopy, ultrasound, and X-ray, demonstrating superior performance in terms of both perceptual (e.g., NIQE, MUSIQ) and fidelity (e.g., PSNR) metrics. By establishing a novel agentic paradigm for low-level vision tasks, we aim to catalyze broader interest and innovation within vision-centric autonomous agents across diverse research communities. We will release all the code, models, and results at: https://4kagent.github.io.

In this work, we present MedImageInsight, an open-source medical imaging embedding model. MedImageInsight is trained on medical images with associated text and labels across a diverse collection of domains, including X-Ray, CT, MRI, dermoscopy, OCT, fundus photography, ultrasound, histopathology, and mammography. Rigorous evaluations demonstrate MedImageInsight's ability to achieve state-of-the-art (SOTA) or human expert level performance across classification, image-image search, and fine-tuning tasks. Specifically, on public datasets, MedImageInsight achieves SOTA in CT 3D medical image retrieval, as well as SOTA in disease classification and search for chest X-ray, dermatology, and OCT imaging. Furthermore, MedImageInsight achieves human expert performance in bone age estimation (on both public and partner data), as well as AUC above 0.9 in most other domains. When paired with a text decoder, MedImageInsight achieves near SOTA level single image report findings generation with less than 10\% the parameters of other models. Compared to fine-tuning GPT-4o with only MIMIC-CXR data for the same task, MedImageInsight outperforms in clinical metrics, but underperforms on lexical metrics where GPT-4o sets a new SOTA. Importantly for regulatory purposes, MedImageInsight can generate ROC curves, adjust sensitivity and specificity based on clinical need, and provide evidence-based decision support through image-image search (which can also enable retrieval augmented generation). In an independent clinical evaluation of image-image search in chest X-ray, MedImageInsight outperformed every other publicly available foundation model evaluated by large margins (over 6 points AUC), and significantly outperformed other models in terms of AI fairness (across age and gender). We hope releasing MedImageInsight will help enhance collective progress in medical imaging AI research and development.

Knee Osteoarthritis (KOA) is a highly prevalent chronic musculoskeletal condition with no currently available treatment. The manifestation of KOA is heterogeneous and prediction of its progression is challenging. Current literature suggests that the use of multi-modal data and advanced modeling methods, such as the ones based on Deep Learning, has promise in tackling this challenge. To date, however, the evidence on the efficacy of this approach is limited. In this study, we leveraged recent advances in Deep Learning and, using a Transformer approach, developed a unified framework for the multi-modal fusion of knee imaging data. Subsequently, we analyzed its performance across a range of scenarios by investigating multiple progression horizons -- from short-term to long-term. We report our findings using a large cohort (n=2421-3967) derived from the Osteoarthritis Initiative dataset. We show that structural knee MRI allows identifying radiographic KOA progressors on par with multi-modal fusion approaches, achieving an area under the ROC curve (ROC AUC) of 0.70-0.76 and Average Precision (AP) of 0.15-0.54 in 2-8 year horizons. Progression within 1 year was better predicted with a multi-modal method using X-ray, structural, and compositional MR images -- ROC AUC of 0.76(0.04), AP of 0.13(0.04) -- or via clinical data. Our follow-up analysis generally shows that prediction from the imaging data is more accurate for post-traumatic subjects, and we further investigate which subject subgroups may benefit the most. The present study provides novel insights into multi-modal imaging of KOA and brings a unified data-driven framework for studying its progression in an end-to-end manner, providing new tools for the design of more efficient clinical trials. The source code of our framework and the pre-trained models are made publicly available.

Obtaining large pre-trained models that can be fine-tuned to new tasks with limited annotated samples has remained an open challenge for medical imaging data. While pre-trained deep networks on ImageNet and vision-language foundation models trained on web-scale data are prevailing approaches, their effectiveness on medical tasks is limited due to the significant domain shift between natural and medical images. To bridge this gap, we introduce LVM-Med, the first family of deep networks trained on large-scale medical datasets. We have collected approximately 1.3 million medical images from 55 publicly available datasets, covering a large number of organs and modalities such as CT, MRI, X-ray, and Ultrasound. We benchmark several state-of-the-art self-supervised algorithms on this dataset and propose a novel self-supervised contrastive learning algorithm using a graph-matching formulation. The proposed approach makes three contributions: (i) it integrates prior pair-wise image similarity metrics based on local and global information; (ii) it captures the structural constraints of feature embeddings through a loss function constructed via a combinatorial graph-matching objective; and (iii) it can be trained efficiently end-to-end using modern gradient-estimation techniques for black-box solvers. We thoroughly evaluate the proposed LVM-Med on 15 downstream medical tasks ranging from segmentation and classification to object detection, and both for the in and out-of-distribution settings. LVM-Med empirically outperforms a number of state-of-the-art supervised, self-supervised, and foundation models. For challenging tasks such as Brain Tumor Classification or Diabetic Retinopathy Grading, LVM-Med improves previous vision-language models trained on 1 billion masks by 6-7% while using only a ResNet-50.

Biomedical imaging datasets are often small and biased, meaning that real-world performance of predictive models can be substantially lower than expected from internal testing. This work proposes using generative image editing to simulate dataset shifts and diagnose failure modes of biomedical vision models; this can be used in advance of deployment to assess readiness, potentially reducing cost and patient harm. Existing editing methods can produce undesirable changes, with spurious correlations learned due to the co-occurrence of disease and treatment interventions, limiting practical applicability. To address this, we train a text-to-image diffusion model on multiple chest X-ray datasets and introduce a new editing method RadEdit that uses multiple masks, if present, to constrain changes and ensure consistency in the edited images. We consider three types of dataset shifts: acquisition shift, manifestation shift, and population shift, and demonstrate that our approach can diagnose failures and quantify model robustness without additional data collection, complementing more qualitative tools for explainable AI.

Recent advances in generative AI have brought incredible breakthroughs in several areas, including medical imaging. These generative models have tremendous potential not only to help safely share medical data via synthetic datasets but also to perform an array of diverse applications, such as anomaly detection, image-to-image translation, denoising, and MRI reconstruction. However, due to the complexity of these models, their implementation and reproducibility can be difficult. This complexity can hinder progress, act as a use barrier, and dissuade the comparison of new methods with existing works. In this study, we present MONAI Generative Models, a freely available open-source platform that allows researchers and developers to easily train, evaluate, and deploy generative models and related applications. Our platform reproduces state-of-art studies in a standardised way involving different architectures (such as diffusion models, autoregressive transformers, and GANs), and provides pre-trained models for the community. We have implemented these models in a generalisable fashion, illustrating that their results can be extended to 2D or 3D scenarios, including medical images with different modalities (like CT, MRI, and X-Ray data) and from different anatomical areas. Finally, we adopt a modular and extensible approach, ensuring long-term maintainability and the extension of current applications for future features.

Radiography imaging protocols focus on particular body regions, therefore producing images of great similarity and yielding recurrent anatomical structures across patients. To exploit this structured information, we propose the use of Space-aware Memory Queues for In-painting and Detecting anomalies from radiography images (abbreviated as SQUID). We show that SQUID can taxonomize the ingrained anatomical structures into recurrent patterns; and in the inference, it can identify anomalies (unseen/modified patterns) in the image. SQUID surpasses 13 state-of-the-art methods in unsupervised anomaly detection by at least 5 points on two chest X-ray benchmark datasets measured by the Area Under the Curve (AUC). Additionally, we have created a new dataset (DigitAnatomy), which synthesizes the spatial correlation and consistent shape in chest anatomy. We hope DigitAnatomy can prompt the development, evaluation, and interpretability of anomaly detection methods.

We present a large-scale synthetic dataset for novel view synthesis consisting of ~300k images rendered from nearly 2000 complex scenes using high-quality ray tracing at high resolution (1600 x 1600 pixels). The dataset is orders of magnitude larger than existing synthetic datasets for novel view synthesis, thus providing a large unified benchmark for both training and evaluation. Using 4 distinct sources of high-quality 3D meshes, the scenes of our dataset exhibit challenging variations in camera views, lighting, shape, materials, and textures. Because our dataset is too large for existing methods to process, we propose Sparse Voxel Light Field (SVLF), an efficient voxel-based light field approach for novel view synthesis that achieves comparable performance to NeRF on synthetic data, while being an order of magnitude faster to train and two orders of magnitude faster to render. SVLF achieves this speed by relying on a sparse voxel octree, careful voxel sampling (requiring only a handful of queries per ray), and reduced network structure; as well as ground truth depth maps at training time. Our dataset is generated by NViSII, a Python-based ray tracing renderer, which is designed to be simple for non-experts to use and share, flexible and powerful through its use of scripting, and able to create high-quality and physically-based rendered images. Experiments with a subset of our dataset allow us to compare standard methods like NeRF and mip-NeRF for single-scene modeling, and pixelNeRF for category-level modeling, pointing toward the need for future improvements in this area.

Automated multi-label chest X-rays (CXR) image classification has achieved substantial progress in clinical diagnosis via utilizing sophisticated deep learning approaches. However, most deep models have high computational demands, which makes them less feasible for compact devices with low computational requirements. To overcome this problem, we propose a knowledge distillation (KD) strategy to create the compact deep learning model for the real-time multi-label CXR image classification. We study different alternatives of CNNs and Transforms as the teacher to distill the knowledge to a smaller student. Then, we employed explainable artificial intelligence (XAI) to provide the visual explanation for the model decision improved by the KD. Our results on three benchmark CXR datasets show that our KD strategy provides the improved performance on the compact student model, thus being the feasible choice for many limited hardware platforms. For instance, when using DenseNet161 as the teacher network, EEEA-Net-C2 achieved an AUC of 83.7%, 87.1%, and 88.7% on the ChestX-ray14, CheXpert, and PadChest datasets, respectively, with fewer parameters of 4.7 million and computational cost of 0.3 billion FLOPS.

Radiology report generation (RRG) has attracted significant attention due to its potential to reduce the workload of radiologists. Current RRG approaches are still unsatisfactory against clinical standards. This paper introduces a novel RRG method, LM-RRG, that integrates large models (LMs) with clinical quality reinforcement learning to generate accurate and comprehensive chest X-ray radiology reports. Our method first designs a large language model driven feature extractor to analyze and interpret different regions of the chest X-ray image, emphasizing specific regions with medical significance. Next, based on the large model's decoder, we develop a multimodal report generator that leverages multimodal prompts from visual features and textual instruction to produce the radiology report in an auto-regressive way. Finally, to better reflect the clinical significant and insignificant errors that radiologists would normally assign in the report, we introduce a novel clinical quality reinforcement learning strategy. It utilizes the radiology report clinical quality (RadCliQ) metric as a reward function in the learning process. Extensive experiments on the MIMIC-CXR and IU-Xray datasets demonstrate the superiority of our method over the state of the art.

This paper proposes a new two-step procedure for sparse-view tomographic image reconstruction. It is called RISING, since it combines an early-stopped Rapid Iterative Solver with a subsequent Iteration Network-based Gaining step. So far, regularized iterative methods have widely been used for X-ray computed tomography image reconstruction from low-sampled data, since they converge to a sparse solution in a suitable domain, as upheld by the Compressed Sensing theory. Unfortunately, their use is practically limited by their high computational cost which imposes to perform only a few iterations in the available time for clinical exams. Data-driven methods, using neural networks to post-process a coarse and noisy image obtained from geometrical algorithms, have been recently studied and appreciated for both their computational speed and accurate reconstructions. However, there is no evidence, neither theoretically nor numerically, that neural networks based algorithms solve the mathematical inverse problem modeling the tomographic reconstruction process. In our two-step approach, the first phase executes very few iterations of a regularized model-based algorithm whereas the second step completes the missing iterations by means of a neural network. The resulting hybrid deep-variational framework preserves the convergence properties of the iterative method and, at the same time, it exploits the computational speed and flexibility of a data-driven approach. Experiments performed on a simulated and a real data set confirm the numerical and visual accuracy of the reconstructed RISING images in short computational times.

Extraction of relevant pathological terms from radiology reports is important for correct image label generation and disease population studies. In this letter, we compare the performance of some known application program interface (APIs) for the task of thoracic abnormality extraction from radiology reports. We explored several medical domain specific annotation tools like Medical Text Indexer(MTI) with Non-MEDLINE and Mesh On Demand(MOD) options and generic Natural Language Understanding (NLU) API provided by the IBM cloud. Our results show that although MTI and MOD are intended for extracting medical terms, their performance is worst compared to generic extraction API like IBM NLU. Finally, we trained a DNN-based Named Entity Recognition (NER) model to extract the key concept words from radiology reports. Our model outperforms the medical specific and generic API performance by a large margin. Our results demonstrate the inadequacy of generic APIs for pathology extraction task and establish the importance of domain specific model training for improved results. We hope that these results motivate the research community to release larger de-identified radiology reports corpus for building high accuracy machine learning models for the important task of pathology extraction.

Generative models, particularly text-to-image (T2I) diffusion models, play a crucial role in medical image analysis. However, these models are prone to training data memorization, posing significant risks to patient privacy. Synthetic chest X-ray generation is one of the most common applications in medical image analysis with the MIMIC-CXR dataset serving as the primary data repository for this task. This study adopts a data-driven approach and presents the first systematic attempt to identify prompts and text tokens in MIMIC-CXR that contribute the most to training data memorization. Our analysis reveals an unexpected finding: prompts containing traces of de-identification procedures are among the most memorized, with de-identification markers contributing the most. Furthermore, we also find existing inference-time memorization mitigation strategies are ineffective and fail to sufficiently reduce the model's reliance on memorized text tokens highlighting a broader issue in T2I synthesis with MIMIC-CXR. On this front, we propose actionable strategies to enhance privacy and improve the reliability of generative models in medical imaging. Finally, our results provide a foundation for future work on developing and benchmarking memorization mitigation techniques for synthetic chest X-ray generation using the MIMIC-CXR dataset.

Chest X-ray (CXR) is the most frequently ordered imaging test, supporting diverse clinical tasks from thoracic disease detection to postoperative monitoring. However, task-specific classification models are limited in scope, require costly labeled data, and lack generalizability to out-of-distribution datasets. To address these challenges, we introduce CheXFound, a self-supervised vision foundation model that learns robust CXR representations and generalizes effectively across a wide range of downstream tasks. We pretrain CheXFound on a curated CXR-1M dataset, comprising over one million unique CXRs from publicly available sources. We propose a Global and Local Representations Integration (GLoRI) module for downstream adaptations, by incorporating disease-specific local features with global image features for enhanced performance in multilabel classification. Our experimental results show that CheXFound outperforms state-of-the-art models in classifying 40 disease findings across different prevalence levels on the CXR-LT 24 dataset and exhibits superior label efficiency on downstream tasks with limited training data. Additionally, CheXFound achieved significant improvements on new tasks with out-of-distribution datasets, including opportunistic cardiovascular disease risk estimation and mortality prediction. These results highlight CheXFound's strong generalization capabilities, enabling diverse adaptations with improved label efficiency. The project source code is publicly available at https://github.com/RPIDIAL/CheXFound.

Radiology report generation requires advanced medical image analysis, effective temporal reasoning, and accurate text generation. Although recent innovations, particularly multimodal large language models (MLLMs), have shown improved performance, their supervised fine-tuning (SFT) objective is not explicitly aligned with clinical efficacy. In this work, we introduce EditGRPO, a mixed-policy reinforcement learning (RL) algorithm designed specifically to optimize the generation through clinically motivated rewards. EditGRPO integrates on-policy exploration with off-policy guidance by injecting sentence-level detailed corrections during training rollouts. This mixed-policy approach addresses the exploration dilemma and sampling efficiency issues typically encountered in RL. Applied to a Qwen2.5-VL-3B MLLM initialized with supervised fine-tuning (SFT), EditGRPO outperforms both SFT and vanilla GRPO baselines, achieving an average improvement of 3.4% in CheXbert, GREEN, Radgraph, and RATEScore metrics across four major chest X-ray report generation datasets. Notably, EditGRPO also demonstrates superior out-of-domain generalization, with an average performance gain of 5.9% on unseen datasets.