Daily Papers

Medical Vision-Language Models (MVLMs) have achieved par excellence generalization in medical image analysis, yet their performance under noisy, corrupted conditions remains largely untested. Clinical imaging is inherently susceptible to acquisition artifacts and noise; however, existing evaluations predominantly assess generally clean datasets, overlooking robustness -- i.e., the model's ability to perform under real-world distortions. To address this gap, we first introduce MediMeta-C, a corruption benchmark that systematically applies several perturbations across multiple medical imaging datasets. Combined with MedMNIST-C, this establishes a comprehensive robustness evaluation framework for MVLMs. We further propose RobustMedCLIP, a visual encoder adaptation of a pretrained MVLM that incorporates few-shot tuning to enhance resilience against corruptions. Through extensive experiments, we benchmark 5 major MVLMs across 5 medical imaging modalities, revealing that existing models exhibit severe degradation under corruption and struggle with domain-modality tradeoffs. Our findings highlight the necessity of diverse training and robust adaptation strategies, demonstrating that efficient low-rank adaptation when paired with few-shot tuning, improves robustness while preserving generalization across modalities.

This short technical report demonstrates a simple technique that yields state of the art results in medical image-text matching tasks. We analyze the use of OpenAI's CLIP, a general image-text matching model, and observe that CLIP's limited textual input size has negative impact on downstream performance in the medical domain where encoding longer textual contexts is often required. We thus train and release ClipMD, which is trained with a simple sliding window technique to encode textual captions. ClipMD was tested on two medical image-text datasets and compared with other image-text matching models. The results show that ClipMD outperforms other models on both datasets by a large margin. We make our code and pretrained model publicly available.

Existing vision-text contrastive learning like CLIP aims to match the paired image and caption embeddings while pushing others apart, which improves representation transferability and supports zero-shot prediction. However, medical image-text datasets are orders of magnitude below the general images and captions from the internet. Moreover, previous methods encounter many false negatives, i.e., images and reports from separate patients probably carry the same semantics but are wrongly treated as negatives. In this paper, we decouple images and texts for multimodal contrastive learning thus scaling the usable training data in a combinatorial magnitude with low cost. We also propose to replace the InfoNCE loss with semantic matching loss based on medical knowledge to eliminate false negatives in contrastive learning. We prove that MedCLIP is a simple yet effective framework: it outperforms state-of-the-art methods on zero-shot prediction, supervised classification, and image-text retrieval. Surprisingly, we observe that with only 20K pre-training data, MedCLIP wins over the state-of-the-art method (using around 200K data). Our code is available at https://github.com/RyanWangZf/MedCLIP.

The integration of neural-network-based systems into clinical practice is limited by challenges related to domain generalization and robustness. The computer vision community established benchmarks such as ImageNet-C as a fundamental prerequisite to measure progress towards those challenges. Similar datasets are largely absent in the medical imaging community which lacks a comprehensive benchmark that spans across imaging modalities and applications. To address this gap, we create and open-source MedMNIST-C, a benchmark dataset based on the MedMNIST+ collection covering 12 datasets and 9 imaging modalities. We simulate task and modality-specific image corruptions of varying severity to comprehensively evaluate the robustness of established algorithms against real-world artifacts and distribution shifts. We further provide quantitative evidence that our simple-to-use artificial corruptions allow for highly performant, lightweight data augmentation to enhance model robustness. Unlike traditional, generic augmentation strategies, our approach leverages domain knowledge, exhibiting significantly higher robustness when compared to widely adopted methods. By introducing MedMNIST-C and open-sourcing the corresponding library allowing for targeted data augmentations, we contribute to the development of increasingly robust methods tailored to the challenges of medical imaging. The code is available at https://github.com/francescodisalvo05/medmnistc-api .

A pre-trained visual-language model, contrastive language-image pre-training (CLIP), successfully accomplishes various downstream tasks with text prompts, such as finding images or localizing regions within the image. Despite CLIP's strong multi-modal data capabilities, it remains limited in specialized environments, such as medical applications. For this purpose, many CLIP variants-i.e., BioMedCLIP, and MedCLIP-SAMv2-have emerged, but false positives related to normal regions persist. Thus, we aim to present a simple yet important goal of reducing false positives in medical anomaly detection. We introduce a Contrastive LAnguage Prompting (CLAP) method that leverages both positive and negative text prompts. This straightforward approach identifies potential lesion regions by visual attention to the positive prompts in the given image. To reduce false positives, we attenuate attention on normal regions using negative prompts. Extensive experiments with the BMAD dataset, including six biomedical benchmarks, demonstrate that CLAP method enhances anomaly detection performance. Our future plans include developing an automated fine prompting method for more practical usage.

The increasing interest in developing Artificial Intelligence applications in the medical domain, suffers from the lack of high-quality dataset, mainly due to privacy-related issues. Moreover, the recent rising of Multimodal Large Language Models (MLLM) leads to a need for multimodal medical datasets, where clinical reports and findings are attached to the corresponding CT or MR scans. This paper illustrates the entire workflow for building the data set MedPix 2.0. Starting from the well-known multimodal dataset MedPix\textregistered, mainly used by physicians, nurses and healthcare students for Continuing Medical Education purposes, a semi-automatic pipeline was developed to extract visual and textual data followed by a manual curing procedure where noisy samples were removed, thus creating a MongoDB database. Along with the dataset, we developed a GUI aimed at navigating efficiently the MongoDB instance, and obtaining the raw data that can be easily used for training and/or fine-tuning MLLMs. To enforce this point, we also propose a CLIP-based model trained on MedPix 2.0 for scan classification tasks.

Medical image classification in radiology faces significant challenges, particularly in generalizing to unseen pathologies. In contrast, CLIP offers a promising solution by leveraging multimodal learning to improve zero-shot classification performance. However, in the medical domain, lesions can be small and might not be well represented in the embedding space. Therefore, in this paper, we explore the potential of visual prompt engineering to enhance the capabilities of Vision Language Models (VLMs) in radiology. Leveraging BiomedCLIP, trained on extensive biomedical image-text pairs, we investigate the impact of embedding visual markers directly within radiological images to guide the model's attention to critical regions. Our evaluation on the JSRT dataset, focusing on lung nodule malignancy classification, demonstrates that incorporating visual prompts x2013 such as arrows, circles, and contours x2013 significantly improves classification metrics including AUROC, AUPRC, F1 score, and accuracy. Moreover, the study provides attention maps, showcasing enhanced model interpretability and focus on clinically relevant areas. These findings underscore the efficacy of visual prompt engineering as a straightforward yet powerful approach to advance VLM performance in medical image analysis.

Contrastive Language--Image Pre-training (CLIP) has shown remarkable success in learning with cross-modal supervision from extensive amounts of image--text pairs collected online. Thus far, the effectiveness of CLIP has been investigated primarily in general-domain multimodal problems. This work evaluates the effectiveness of CLIP for the task of Medical Visual Question Answering (MedVQA). To this end, we present PubMedCLIP, a fine-tuned version of CLIP for the medical domain based on PubMed articles. Our experiments are conducted on two MedVQA benchmark datasets and investigate two MedVQA methods, MEVF (Mixture of Enhanced Visual Features) and QCR (Question answering via Conditional Reasoning). For each of these, we assess the merits of visual representation learning using PubMedCLIP, the original CLIP, and state-of-the-art MAML (Model-Agnostic Meta-Learning) networks pre-trained only on visual data. We open source the code for our MedVQA pipeline and pre-training PubMedCLIP. CLIP and PubMedCLIP achieve improvements in comparison to MAML's visual encoder. PubMedCLIP achieves the best results with gains in the overall accuracy of up to 3%. Individual examples illustrate the strengths of PubMedCLIP in comparison to the previously widely used MAML networks. Visual representation learning with language supervision in PubMedCLIP leads to noticeable improvements for MedVQA. Our experiments reveal distributional differences in the two MedVQA benchmark datasets that have not been imparted in previous work and cause different back-end visual encoders in PubMedCLIP to exhibit different behavior on these datasets. Moreover, we witness fundamental performance differences of VQA in general versus medical domains.

Contrastive Language-Image Pre-training (CLIP) demonstrates strong potential in medical image analysis but requires substantial data and computational resources. Due to these restrictions, existing CLIP applications in medical imaging focus mainly on modalities like chest X-rays that have abundant image-report data available, leaving many other important modalities underexplored. Here, we propose one of the first adaptations of the full CLIP model to mammography, which presents significant challenges due to labeled data scarcity, high-resolution images with small regions of interest, and class-wise imbalance. We first develop a specialized supervision framework for mammography that leverages its multi-view nature. Furthermore, we design a symmetric local alignment module to better focus on detailed features in high-resolution images. Lastly, we incorporate a parameter-efficient fine-tuning approach for large language models pre-trained with medical knowledge to address data limitations. Our multi-view and multi-scale alignment (MaMA) method outperforms state-of-the-art baselines for three different tasks on two large real-world mammography datasets, EMBED and RSNA-Mammo, with only 52% model size compared with the largest baseline. The code is available at https://github.com/XYPB/MaMA

Pathology Foundation Models (FMs) hold great promise for healthcare. Before they can be used in clinical practice, it is essential to ensure they are robust to variations between medical centers. We measure whether pathology FMs focus on biological features like tissue and cancer type, or on the well known confounding medical center signatures introduced by staining procedure and other differences. We introduce the Robustness Index. This novel robustness metric reflects to what degree biological features dominate confounding features. Ten current publicly available pathology FMs are evaluated. We find that all current pathology foundation models evaluated represent the medical center to a strong degree. Significant differences in the robustness index are observed. Only one model so far has a robustness index greater than one, meaning biological features dominate confounding features, but only slightly. A quantitative approach to measure the influence of medical center differences on FM-based prediction performance is described. We analyze the impact of unrobustness on classification performance of downstream models, and find that cancer-type classification errors are not random, but specifically attributable to same-center confounders: images of other classes from the same medical center. We visualize FM embedding spaces, and find these are more strongly organized by medical centers than by biological factors. As a consequence, the medical center of origin is predicted more accurately than the tissue source and cancer type. The robustness index introduced here is provided with the aim of advancing progress towards clinical adoption of robust and reliable pathology FMs.

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.

Standard benchmarks for optical flow, scene flow, and stereo vision algorithms generally focus on model accuracy rather than robustness to image corruptions like noise or rain. Hence, the resilience of models to such real-world perturbations is largely unquantified. To address this, we present RobustSpring, a comprehensive dataset and benchmark for evaluating robustness to image corruptions for optical flow, scene flow, and stereo models. RobustSpring applies 20 different image corruptions, including noise, blur, color changes, quality degradations, and weather distortions, in a time-, stereo-, and depth-consistent manner to the high-resolution Spring dataset, creating a suite of 20,000 corrupted images that reflect challenging conditions. RobustSpring enables comparisons of model robustness via a new corruption robustness metric. Integration with the Spring benchmark enables public two-axis evaluations of both accuracy and robustness. We benchmark a curated selection of initial models, observing that accurate models are not necessarily robust and that robustness varies widely by corruption type. RobustSpring is a new computer vision benchmark that treats robustness as a first-class citizen to foster models that combine accuracy with resilience. It will be available at https://spring-benchmark.org.

Vision-Language Models (VLMs) trained via contrastive learning have achieved notable success in natural image tasks. However, their application in the medical domain remains limited due to the scarcity of openly accessible, large-scale medical image-text datasets. Existing medical VLMs either train on closed-source proprietary or relatively small open-source datasets that do not generalize well. Similarly, most models remain specific to a single or limited number of medical imaging domains, again restricting their applicability to other modalities. To address this gap, we introduce UniMed, a large-scale, open-source multi-modal medical dataset comprising over 5.3 million image-text pairs across six diverse imaging modalities: X-ray, CT, MRI, Ultrasound, Pathology, and Fundus. UniMed is developed using a data-collection framework that leverages Large Language Models (LLMs) to transform modality-specific classification datasets into image-text formats while incorporating existing image-text data from the medical domain, facilitating scalable VLM pretraining. Using UniMed, we trained UniMed-CLIP, a unified VLM for six modalities that significantly outperforms existing generalist VLMs and matches modality-specific medical VLMs, achieving notable gains in zero-shot evaluations. For instance, UniMed-CLIP improves over BiomedCLIP (trained on proprietary data) by an absolute gain of +12.61, averaged over 21 datasets, while using 3x less training data. To facilitate future research, we release UniMed dataset, training codes, and models at https://github.com/mbzuai-oryx/UniMed-CLIP.

Within the domain of medical analysis, extensive research has explored the potential of mutual learning between Masked Autoencoders(MAEs) and multimodal data. However, the impact of MAEs on intermodality remains a key challenge. We introduce MedFLIP, a Fast Language-Image Pre-training method for Medical analysis. We explore MAEs for zero-shot learning with crossed domains, which enhances the model's ability to learn from limited data, a common scenario in medical diagnostics. We verify that masking an image does not affect inter-modal learning. Furthermore, we propose the SVD loss to enhance the representation learning for characteristics of medical images, aiming to improve classification accuracy by leveraging the structural intricacies of such data. Our theory posits that masking encourages semantic preservation, robust feature extraction, regularization, domain adaptation, and invariance learning. Lastly, we validate using language will improve the zero-shot performance for the medical image analysis. MedFLIP's scaling of the masking process marks an advancement in the field, offering a pathway to rapid and precise medical image analysis without the traditional computational bottlenecks. Through experiments and validation, MedFLIP demonstrates efficient performance improvements, helps for future research and application in medical diagnostics.

We introduce eCLIP, an enhanced version of the CLIP model that integrates expert annotations in the form of radiologist eye-gaze heatmaps. It tackles key challenges in contrastive multi-modal medical imaging analysis, notably data scarcity and the "modality gap" -- a significant disparity between image and text embeddings that diminishes the quality of representations and hampers cross-modal interoperability. eCLIP integrates a heatmap processor and leverages mixup augmentation to efficiently utilize the scarce expert annotations, thus boosting the model's learning effectiveness. eCLIP is designed to be generally applicable to any variant of CLIP without requiring any modifications of the core architecture. Through detailed evaluations across several tasks, including zero-shot inference, linear probing, cross-modal retrieval, and Retrieval Augmented Generation (RAG) of radiology reports using a frozen Large Language Model, eCLIP showcases consistent improvements in embedding quality. The outcomes reveal enhanced alignment and uniformity, affirming eCLIP's capability to harness high-quality annotations for enriched multi-modal analysis in the medical imaging domain.

The burgeoning integration of 3D medical imaging into healthcare has led to a substantial increase in the workload of medical professionals. To assist clinicians in their diagnostic processes and alleviate their workload, the development of a robust system for retrieving similar case studies presents a viable solution. While the concept holds great promise, the field of 3D medical text-image retrieval is currently limited by the absence of robust evaluation benchmarks and curated datasets. To remedy this, our study presents a groundbreaking dataset, BIMCV-R (This dataset will be released upon acceptance.), which includes an extensive collection of 8,069 3D CT volumes, encompassing over 2 million slices, paired with their respective radiological reports. Expanding upon the foundational work of our dataset, we craft a retrieval strategy, MedFinder. This approach employs a dual-stream network architecture, harnessing the potential of large language models to advance the field of medical image retrieval beyond existing text-image retrieval solutions. It marks our preliminary step towards developing a system capable of facilitating text-to-image, image-to-text, and keyword-based retrieval tasks.

Purpose: Surgical video is an important data stream for gesture recognition. Thus, robust visual encoders for those data-streams is similarly important. Methods: Leveraging the Bridge-Prompt framework, we fine-tune a pre-trained vision-text model (CLIP) for gesture recognition in surgical videos. This can utilize extensive outside video data such as text, but also make use of label meta-data and weakly supervised contrastive losses. Results: Our experiments show that prompt-based video encoder outperforms standard encoders in surgical gesture recognition tasks. Notably, it displays strong performance in zero-shot scenarios, where gestures/tasks that were not provided during the encoder training phase are included in the prediction phase. Additionally, we measure the benefit of inclusion text descriptions in the feature extractor training schema. Conclusion: Bridge-Prompt and similar pre-trained+fine-tuned video encoder models present significant visual representation for surgical robotics, especially in gesture recognition tasks. Given the diverse range of surgical tasks (gestures), the ability of these models to zero-shot transfer without the need for any task (gesture) specific retraining makes them invaluable.

The lack of large and diverse training data on Computer-Aided Diagnosis (CAD) in breast cancer detection has been one of the concerns that impedes the adoption of the system. Recently, pre-training with large-scale image text datasets via Vision-Language models (VLM) (\eg CLIP) partially addresses the issue of robustness and data efficiency in computer vision (CV). This paper proposes Mammo-CLIP, the first VLM pre-trained on a substantial amount of screening mammogram-report pairs, addressing the challenges of dataset diversity and size. Our experiments on two public datasets demonstrate strong performance in classifying and localizing various mammographic attributes crucial for breast cancer detection, showcasing data efficiency and robustness similar to CLIP in CV. We also propose Mammo-FActOR, a novel feature attribution method, to provide spatial interpretation of representation with sentence-level granularity within mammography reports. Code is available publicly: https://github.com/batmanlab/Mammo-CLIP.

Contrastive Language-Image Pre-training (CLIP) models have shown significant potential, particularly in zero-shot classification across diverse distribution shifts. Building on existing evaluations of overall classification robustness, this work aims to provide a more comprehensive assessment of CLIP by introducing several new perspectives. First, we investigate their robustness to variations in specific visual factors. Second, we assess two critical safety objectives--confidence uncertainty and out-of-distribution detection--beyond mere classification accuracy. Third, we evaluate the finesse with which CLIP models bridge the image and text modalities. Fourth, we extend our examination to 3D awareness in CLIP models, moving beyond traditional 2D image understanding. Finally, we explore the interaction between vision and language encoders within modern large multimodal models (LMMs) that utilize CLIP as the visual backbone, focusing on how this interaction impacts classification robustness. In each aspect, we consider the impact of six factors on CLIP models: model architecture, training distribution, training set size, fine-tuning, contrastive loss, and test-time prompts. Our study uncovers several previously unknown insights into CLIP. For instance, the architecture of the visual encoder in CLIP plays a significant role in their robustness against 3D corruption. CLIP models tend to exhibit a bias towards shape when making predictions. Moreover, this bias tends to diminish after fine-tuning on ImageNet. Vision-language models like LLaVA, leveraging the CLIP vision encoder, could exhibit benefits in classification performance for challenging categories over CLIP alone. Our findings are poised to offer valuable guidance for enhancing the robustness and reliability of CLIP models.

Multi-modal foundation models like OpenFlamingo, LLaVA, and GPT-4 are increasingly used for various real-world tasks. Prior work has shown that these models are highly vulnerable to adversarial attacks on the vision modality. These attacks can be leveraged to spread fake information or defraud users, and thus pose a significant risk, which makes the robustness of large multi-modal foundation models a pressing problem. The CLIP model, or one of its variants, is used as a frozen vision encoder in many vision-language models (VLMs), e.g. LLaVA and OpenFlamingo. We propose an unsupervised adversarial fine-tuning scheme to obtain a robust CLIP vision encoder, which yields robustness on all vision down-stream tasks (VLMs, zero-shot classification) that rely on CLIP. In particular, we show that stealth-attacks on users of VLMs by a malicious third party providing manipulated images are no longer possible once one replaces the original CLIP model with our robust one. No retraining or fine-tuning of the VLM is required. The code and robust models are available at https://github.com/chs20/RobustVLM

Large Vision-Language Models (LVLMs) have made significant strides in multimodal comprehension, thanks to extensive pre-training and fine-tuning on large-scale visual datasets. However, despite their robust textual safety mechanisms, they remain vulnerable to harmful visual inputs. Existing safeguards-typically relying on pre-filtering or fine-tuning-incur high costs and diminish overall utility. To address this critical vulnerability, we introduce SafeCLIP, a lightweight method that leverages LVLMs inherent multimodal alignment for zero-shot toxic image detection. By projecting CLIPs discarded CLS token into its text space and matching it with toxic descriptors, SafeCLIP detects harmful content without any architectural changes-adding minimal latency and enabling dynamic safety corrections during inference and fine-tuning.Experiments show that SafeCLIP achieves a 66.9% defense success rate with only 3.2% false positive rate and 7.2% overhead. In contrast, state-of-the-art methods achieve 52.9% success but have a 10.7% false positive rate and 210% overhead. Our work demonstrates that leveraging inherent multimodal alignment can yield efficient, low-cost LVLM safety. Code is available at anonymous.4open.science/r/safeclip-2C01.

Recently, multimodal contrastive learning (MMCL) approaches, such as CLIP, have achieved a remarkable success in learning representations that are robust against distribution shift and generalize to new domains. Despite the empirical success, the mechanism behind learning such generalizable representations is not understood. In this work, we rigorously analyze this problem and uncover two mechanisms behind MMCL's robustness: intra-class contrasting, which allows the model to learn features with a high variance, and inter-class feature sharing, where annotated details in one class help learning other classes better. Both mechanisms prevent spurious features that are over-represented in the training data to overshadow the generalizable core features. This yields superior zero-shot classification accuracy under distribution shift. Furthermore, we theoretically demonstrate the benefits of using rich captions on robustness and explore the effect of annotating different types of details in the captions. We validate our theoretical findings through experiments, including a well-designed synthetic experiment and an experiment involving training CLIP models on MSCOCO/Conceptual Captions and evaluating them on shifted ImageNets.

Recent advancements in mixed-modal generative models have enabled flexible integration of information across image-text content. These models have opened new avenues for developing unified biomedical assistants capable of analyzing biomedical images, answering complex questions about them, and predicting the impact of medical procedures on a patient's health. However, existing resources face challenges such as limited data availability, narrow domain coverage, and restricted sources (e.g., medical papers). To address these gaps, we present MedMax, the first large-scale multimodal biomedical instruction-tuning dataset for mixed-modal foundation models. With 1.47 million instances, MedMax encompasses a diverse range of tasks, including multimodal content generation (interleaved image-text data), biomedical image captioning and generation, visual chatting, and report understanding. These tasks span diverse medical domains such as radiology and histopathology. Subsequently, we fine-tune a mixed-modal foundation model on the MedMax dataset, achieving significant performance improvements: a 26% gain over the Chameleon model and an 18.3% improvement over GPT-4o across 12 downstream biomedical visual question-answering tasks. Additionally, we introduce a unified evaluation suite for biomedical tasks, providing a robust framework to guide the development of next-generation mixed-modal biomedical AI assistants.

Large-scale image-text pre-trained models enable zero-shot classification and provide consistent accuracy across various data distributions. Nonetheless, optimizing these models in downstream tasks typically requires fine-tuning, which reduces generalization to out-of-distribution (OOD) data and demands extensive computational resources. We introduce Robust Adapter (R-Adapter), a novel method for fine-tuning zero-shot models to downstream tasks while simultaneously addressing both these issues. Our method integrates lightweight modules into the pre-trained model and employs novel self-ensemble techniques to boost OOD robustness and reduce storage expenses substantially. Furthermore, we propose MPM-NCE loss designed for fine-tuning on vision-language downstream tasks. It ensures precise alignment of multiple image-text pairs and discriminative feature learning. By extending the benchmark for robust fine-tuning beyond classification to include diverse tasks such as cross-modal retrieval and open vocabulary segmentation, we demonstrate the broad applicability of R-Adapter. Our extensive experiments demonstrate that R-Adapter achieves state-of-the-art performance across a diverse set of tasks, tuning only 13% of the parameters of the CLIP encoders.

Pre-trained multi-modal models, such as CLIP, provide transferable embeddings and show promising results in diverse applications. However, the analysis of learned multi-modal embeddings is relatively unexplored, and the embedding transferability can be improved. In this work, we observe that CLIP holds separated embedding subspaces for two different modalities, and then we investigate it through the lens of uniformity-alignment to measure the quality of learned representation. Both theoretically and empirically, we show that CLIP retains poor uniformity and alignment even after fine-tuning. Such a lack of alignment and uniformity might restrict the transferability and robustness of embeddings. To this end, we devise a new fine-tuning method for robust representation equipping better alignment and uniformity. First, we propose a Geodesic Multi-Modal Mixup that mixes the embeddings of image and text to generate hard negative samples on the hypersphere. Then, we fine-tune the model on hard negatives as well as original negatives and positives with contrastive loss. Based on the theoretical analysis about hardness guarantee and limiting behavior, we justify the use of our method. Extensive experiments on retrieval, calibration, few- or zero-shot classification (under distribution shift), embedding arithmetic, and image captioning further show that our method provides transferable representations, enabling robust model adaptation on diverse tasks. Code: https://github.com/changdaeoh/multimodal-mixup

Recent advancements in vision-language models (VLMs), such as CLIP, have demonstrated substantial success in self-supervised representation learning for vision tasks. However, effectively adapting VLMs to downstream applications remains challenging, as their accuracy often depends on time-intensive and expertise-demanding prompt engineering, while full model fine-tuning is costly. This is particularly true for biomedical images, which, unlike natural images, typically suffer from limited annotated datasets, unintuitive image contrasts, and nuanced visual features. Recent prompt learning techniques, such as Context Optimization (CoOp) intend to tackle these issues, but still fall short in generalizability. Meanwhile, explorations in prompt learning for biomedical image analysis are still highly limited. In this work, we propose BiomedCoOp, a novel prompt learning framework that enables efficient adaptation of BiomedCLIP for accurate and highly generalizable few-shot biomedical image classification. Our approach achieves effective prompt context learning by leveraging semantic consistency with average prompt ensembles from Large Language Models (LLMs) and knowledge distillation with a statistics-based prompt selection strategy. We conducted comprehensive validation of our proposed framework on 11 medical datasets across 9 modalities and 10 organs against existing state-of-the-art methods, demonstrating significant improvements in both accuracy and generalizability. The code is publicly available at https://github.com/HealthX-Lab/BiomedCoOp.

The rapid development of multimodal large language models (MLLMs), such as GPT-4V, has led to significant advancements. However, these models still face challenges in medical multimodal capabilities due to limitations in the quantity and quality of medical vision-text data, stemming from data privacy concerns and high annotation costs. While pioneering approaches utilize PubMed's large-scale, de-identified medical image-text pairs to address these limitations, they still fall short due to inherent data noise. To tackle this, we refined medical image-text pairs from PubMed and employed MLLMs (GPT-4V) in an 'unblinded' capacity to denoise and reformat the data, resulting in the creation of the PubMedVision dataset with 1.3 million medical VQA samples. Our validation demonstrates that: (1) PubMedVision can significantly enhance the medical multimodal capabilities of current MLLMs, showing significant improvement in benchmarks including the MMMU Health & Medicine track; (2) manual checks by medical experts and empirical results validate the superior data quality of our dataset compared to other data construction methods. Using PubMedVision, we train a 34B medical MLLM HuatuoGPT-Vision, which shows superior performance in medical multimodal scenarios among open-source MLLMs.

Medical image analysis is essential to clinical diagnosis and treatment, which is increasingly supported by multi-modal large language models (MLLMs). However, previous research has primarily focused on 2D medical images, leaving 3D images under-explored, despite their richer spatial information. This paper aims to advance 3D medical image analysis with MLLMs. To this end, we present a large-scale 3D multi-modal medical dataset, M3D-Data, comprising 120K image-text pairs and 662K instruction-response pairs specifically tailored for various 3D medical tasks, such as image-text retrieval, report generation, visual question answering, positioning, and segmentation. Additionally, we propose M3D-LaMed, a versatile multi-modal large language model for 3D medical image analysis. Furthermore, we introduce a new 3D multi-modal medical benchmark, M3D-Bench, which facilitates automatic evaluation across eight tasks. Through comprehensive evaluation, our method proves to be a robust model for 3D medical image analysis, outperforming existing solutions. All code, data, and models are publicly available at: https://github.com/BAAI-DCAI/M3D.

The development of vision-language models (VLMs) is driven by large-scale and diverse multimodal datasets. However, progress toward generalist biomedical VLMs is limited by the lack of annotated, publicly accessible datasets across biology and medicine. Existing efforts are restricted to narrow domains, missing the full diversity of biomedical knowledge encoded in scientific literature. To address this gap, we introduce BIOMEDICA, a scalable, open-source framework to extract, annotate, and serialize the entirety of the PubMed Central Open Access subset into an easy-to-use, publicly accessible dataset.Our framework produces a comprehensive archive with over 24 million unique image-text pairs from over 6 million articles. Metadata and expert-guided annotations are also provided. We demonstrate the utility and accessibility of our resource by releasing BMCA-CLIP, a suite of CLIP-style models continuously pre-trained on the BIOMEDICA dataset via streaming, eliminating the need to download 27 TB of data locally.On average, our models achieve state-of-the-art performance across 40 tasks - spanning pathology, radiology, ophthalmology, dermatology, surgery, molecular biology, parasitology, and cell biology - excelling in zero-shot classification with a 6.56% average improvement (as high as 29.8% and 17.5% in dermatology and ophthalmology, respectively), and stronger image-text retrieval, all while using 10x less compute. To foster reproducibility and collaboration, we release our codebase and dataset for the broader research community.

Vision-language pre-training (VLP) models have shown significant advancements in the medical domain. Yet, most VLP models align raw reports to images at a very coarse level, without modeling fine-grained relationships between anatomical and pathological concepts outlined in reports and the corresponding semantic counterparts in images. To address this problem, we propose a Medical Dual-Stream Language-Image Pre-training (MeDSLIP) framework. Specifically, MeDSLIP establishes vision-language fine-grained alignments via disentangling visual and textual representations into anatomy-relevant and pathology-relevant streams. Moreover, a novel vision-language Prototypical Contr-astive Learning (ProtoCL) method is adopted in MeDSLIP to enhance the alignment within the anatomical and pathological streams. MeDSLIP further employs cross-stream Intra-image Contrastive Learning (ICL) to ensure the consistent coexistence of paired anatomical and pathological concepts within the same image. Such a cross-stream regularization encourages the model to exploit the synchrony between two streams for a more comprehensive representation learning. MeDSLIP is evaluated under zero-shot and supervised fine-tuning settings on three public datasets: NIH CXR14, RSNA Pneumonia, and SIIM-ACR Pneumothorax. Under these settings, MeDSLIP outperforms six leading CNN-based models on classification, grounding, and segmentation tasks.

Multi-modal semantic segmentation (MMSS) addresses the limitations of single-modality data by integrating complementary information across modalities. Despite notable progress, a significant gap persists between research and real-world deployment due to variability and uncertainty in multi-modal data quality. Robustness has thus become essential for practical MMSS applications. However, the absence of standardized benchmarks for evaluating robustness hinders further advancement. To address this, we first survey existing MMSS literature and categorize representative methods to provide a structured overview. We then introduce a robustness benchmark that evaluates MMSS models under three scenarios: Entire-Missing Modality (EMM), Random-Missing Modality (RMM), and Noisy Modality (NM). From a probabilistic standpoint, we model modality failure under two conditions: (1) all damaged combinations are equally probable; (2) each modality fails independently following a Bernoulli distribution. Based on these, we propose four metrics-mIoU^{Avg}_{EMM}, mIoU^{E}_{EMM}, mIoU^{Avg}_{RMM}, and mIoU^{E}_{RMM}-to assess model robustness under EMM and RMM. This work provides the first dedicated benchmark for MMSS robustness, offering new insights and tools to advance the field. Source code is available at https://github.com/Chenfei-Liao/Multi-Modal-Semantic-Segmentation-Robustness-Benchmark.

Despite the growing scale of medical Vision-Language datasets, the impact of dataset quality on model performance remains under-explored. We introduce Open-PMC, a high-quality medical dataset from PubMed Central, containing 2.2 million image-text pairs, enriched with image modality annotations, subfigures, and summarized in-text references. Notably, the in-text references provide richer medical context, extending beyond the abstract information typically found in captions. Through extensive experiments, we benchmark Open-PMC against larger datasets across retrieval and zero-shot classification tasks. Our results show that dataset quality-not just size-drives significant performance gains. We complement our benchmark with an in-depth analysis of feature representation. Our findings highlight the crucial role of data curation quality in advancing multimodal medical AI. We release Open-PMC, along with the trained models and our codebase.

Trustworthiness is essential for the precise and interpretable application of artificial intelligence (AI) in medical imaging. Traditionally, precision and interpretability have been addressed as separate tasks, namely medical image analysis and explainable AI, each developing its own models independently. In this study, for the first time, we investigate the development of a unified medical vision-language pre-training model that can achieve both accurate analysis and interpretable understanding of medical images across various modalities. To build the model, we construct MedConcept-23M, a large-scale dataset comprising 23 million medical image-text pairs extracted from 6.2 million scientific articles, enriched with concepts from the Unified Medical Language System (UMLS). Based on MedConcept-23M, we introduce ConceptCLIP, a medical AI model utilizing concept-enhanced contrastive language-image pre-training. The pre-training of ConceptCLIP involves two primary components: image-text alignment learning (IT-Align) and patch-concept alignment learning (PC-Align). This dual alignment strategy enhances the model's capability to associate specific image regions with relevant concepts, thereby improving both the precision of analysis and the interpretability of the AI system. We conducted extensive experiments on 5 diverse types of medical image analysis tasks, spanning 51 subtasks across 10 image modalities, with the broadest range of downstream tasks. The results demonstrate the effectiveness of the proposed vision-language pre-training model. Further explainability analysis across 6 modalities reveals that ConceptCLIP achieves superior performance, underscoring its robust ability to advance explainable AI in medical imaging. These findings highlight ConceptCLIP's capability in promoting trustworthy AI in the field of medicine.

Zero-shot medical detection can further improve detection performance without relying on annotated medical images even upon the fine-tuned model, showing great clinical value. Recent studies leverage grounded vision-language models (GLIP) to achieve this by using detailed disease descriptions as prompts for the target disease name during the inference phase. However, these methods typically treat prompts as equivalent context to the target name, making it difficult to assign specific disease knowledge based on visual information, leading to a coarse alignment between images and target descriptions. In this paper, we propose StructuralGLIP, which introduces an auxiliary branch to encode prompts into a latent knowledge bank layer-by-layer, enabling more context-aware and fine-grained alignment. Specifically, in each layer, we select highly similar features from both the image representation and the knowledge bank, forming structural representations that capture nuanced relationships between image patches and target descriptions. These features are then fused across modalities to further enhance detection performance. Extensive experiments demonstrate that StructuralGLIP achieves a +4.1\% AP improvement over prior state-of-the-art methods across seven zero-shot medical detection benchmarks, and consistently improves fine-tuned models by +3.2\% AP on endoscopy image datasets.

Contrastive pretraining of image-text foundation models, such as CLIP, demonstrated excellent zero-shot performance and improved robustness on a wide range of downstream tasks. However, these models utilize large transformer-based encoders with significant memory and latency overhead which pose challenges for deployment on mobile devices. In this work, we introduce MobileCLIP -- a new family of efficient image-text models optimized for runtime performance along with a novel and efficient training approach, namely multi-modal reinforced training. The proposed training approach leverages knowledge transfer from an image captioning model and an ensemble of strong CLIP encoders to improve the accuracy of efficient models. Our approach avoids train-time compute overhead by storing the additional knowledge in a reinforced dataset. MobileCLIP sets a new state-of-the-art latency-accuracy tradeoff for zero-shot classification and retrieval tasks on several datasets. Our MobileCLIP-S2 variant is 2.3times faster while more accurate compared to previous best CLIP model based on ViT-B/16. We further demonstrate the effectiveness of our multi-modal reinforced training by training a CLIP model based on ViT-B/16 image backbone and achieving +2.9% average performance improvement on 38 evaluation benchmarks compared to the previous best. Moreover, we show that the proposed approach achieves 10times-1000times improved learning efficiency when compared with non-reinforced CLIP training.

Pathology plays a critical role in diagnosing a wide range of diseases, yet existing approaches often rely heavily on task-specific models trained on extensive, well-labeled datasets. These methods face sustainability challenges due to the diversity of pathologies and the labor-intensive nature of data collection. To address these limitations, we highlight the need for universal multimodal embeddings that can support multiple downstream tasks. Previous approaches often involve fine-tuning CLIP-based models, which handle images and text separately, limiting their ability to capture complex multimodal relationships. Additionally, these models are evaluated across diverse datasets without a unified benchmark for assessing multimodal embeddings in pathology. To address these challenges, we propose MLLM4PUE, a novel framework that leverages Multimodal Large Language Models (MLLMs) to generate Pathology Universal Embeddings. The MLLM4PUE framework not only facilitates robust integration of images and text but also enhances understanding and fusion capabilities across various tasks. We further introduce the Pathology Multimodal Embedding Benchmark (PMEB), a comprehensive benchmark designed to assess the quality of pathology multimodal embeddings. PMEB comprises 15 original tasks drawn from 14 datasets, organized into three meta-tasks: retrieval, classification, and composed retrieval. Experimental results demonstrate the superiority of MLLM4PUE, illustrating MLLM-based models can effectively support a wide range of downstream tasks and unify the research direction for foundation models in pathology.

Security concerns related to Large Language Models (LLMs) have been extensively explored, yet the safety implications for Multimodal Large Language Models (MLLMs), particularly in medical contexts (MedMLLMs), remain insufficiently studied. This paper delves into the underexplored security vulnerabilities of MedMLLMs, especially when deployed in clinical environments where the accuracy and relevance of question-and-answer interactions are critically tested against complex medical challenges. By combining existing clinical medical data with atypical natural phenomena, we redefine two types of attacks: mismatched malicious attack (2M-attack) and optimized mismatched malicious attack (O2M-attack). Using our own constructed voluminous 3MAD dataset, which covers a wide range of medical image modalities and harmful medical scenarios, we conduct a comprehensive analysis and propose the MCM optimization method, which significantly enhances the attack success rate on MedMLLMs. Evaluations with this dataset and novel attack methods, including white-box attacks on LLaVA-Med and transfer attacks on four other state-of-the-art models, indicate that even MedMLLMs designed with enhanced security features are vulnerable to security breaches. Our work underscores the urgent need for a concerted effort to implement robust security measures and enhance the safety and efficacy of open-source MedMLLMs, particularly given the potential severity of jailbreak attacks and other malicious or clinically significant exploits in medical settings. For further research and replication, anonymous access to our code is available at https://github.com/dirtycomputer/O2M_attack. Warning: Medical large model jailbreaking may generate content that includes unverified diagnoses and treatment recommendations. Always consult professional medical advice.

The robustness of multimodal deep learning models to realistic changes in the input text is critical for their applicability to important tasks such as text-to-image retrieval and cross-modal entailment. To measure robustness, several existing approaches edit the text data, but do so without leveraging the cross-modal information present in multimodal data. Information from the visual modality, such as color, size, and shape, provide additional attributes that users can include in their inputs. Thus, we propose cross-modal attribute insertions as a realistic perturbation strategy for vision-and-language data that inserts visual attributes of the objects in the image into the corresponding text (e.g., "girl on a chair" to "little girl on a wooden chair"). Our proposed approach for cross-modal attribute insertions is modular, controllable, and task-agnostic. We find that augmenting input text using cross-modal insertions causes state-of-the-art approaches for text-to-image retrieval and cross-modal entailment to perform poorly, resulting in relative drops of 15% in MRR and 20% in F_1 score, respectively. Crowd-sourced annotations demonstrate that cross-modal insertions lead to higher quality augmentations for multimodal data than augmentations using text-only data, and are equivalent in quality to original examples. We release the code to encourage robustness evaluations of deep vision-and-language models: https://github.com/claws-lab/multimodal-robustness-xmai.

Artificial Intelligence (AI) has demonstrated significant potential in healthcare, particularly in disease diagnosis and treatment planning. Recent progress in Medical Large Vision-Language Models (Med-LVLMs) has opened up new possibilities for interactive diagnostic tools. However, these models often suffer from factual hallucination, which can lead to incorrect diagnoses. Fine-tuning and retrieval-augmented generation (RAG) have emerged as methods to address these issues. However, the amount of high-quality data and distribution shifts between training data and deployment data limit the application of fine-tuning methods. Although RAG is lightweight and effective, existing RAG-based approaches are not sufficiently general to different medical domains and can potentially cause misalignment issues, both between modalities and between the model and the ground truth. In this paper, we propose a versatile multimodal RAG system, MMed-RAG, designed to enhance the factuality of Med-LVLMs. Our approach introduces a domain-aware retrieval mechanism, an adaptive retrieved contexts selection method, and a provable RAG-based preference fine-tuning strategy. These innovations make the RAG process sufficiently general and reliable, significantly improving alignment when introducing retrieved contexts. Experimental results across five medical datasets (involving radiology, ophthalmology, pathology) on medical VQA and report generation demonstrate that MMed-RAG can achieve an average improvement of 43.8% in the factual accuracy of Med-LVLMs. Our data and code are available in https://github.com/richard-peng-xia/MMed-RAG.

Web-crawled datasets have enabled remarkable generalization capabilities in recent image-text models such as CLIP (Contrastive Language-Image pre-training) or Flamingo, but little is known about the dataset creation processes. In this work, we introduce a testbed of six publicly available data sources - YFCC, LAION, Conceptual Captions, WIT, RedCaps, Shutterstock - to investigate how pre-training distributions induce robustness in CLIP. We find that the performance of the pre-training data varies substantially across distribution shifts, with no single data source dominating. Moreover, we systematically study the interactions between these data sources and find that combining multiple sources does not necessarily yield better models, but rather dilutes the robustness of the best individual data source. We complement our empirical findings with theoretical insights from a simple setting, where combining the training data also results in diluted robustness. In addition, our theoretical model provides a candidate explanation for the success of the CLIP-based data filtering technique recently employed in the LAION dataset. Overall our results demonstrate that simply gathering a large amount of data from the web is not the most effective way to build a pre-training dataset for robust generalization, necessitating further study into dataset design. Code is available at https://github.com/mlfoundations/clip_quality_not_quantity.

Foundation models trained on large-scale dataset gain a recent surge in CV and NLP. In contrast, development in biomedical domain lags far behind due to data scarcity. To address this issue, we build and release PMC-OA, a biomedical dataset with 1.6M image-caption pairs collected from PubMedCentral's OpenAccess subset, which is 8 times larger than before. PMC-OA covers diverse modalities or diseases, with majority of the image-caption samples aligned at finer-grained level, i.e., subfigure and subcaption. While pretraining a CLIP-style model on PMC-OA, our model named PMC-CLIP achieves state-of-the-art results on various downstream tasks, including image-text retrieval on ROCO, MedMNIST image classification, Medical VQA, i.e. +8.1% R@10 on image-text retrieval, +3.9% accuracy on image classification.

Severe data imbalance naturally exists among web-scale vision-language datasets. Despite this, we find CLIP pre-trained thereupon exhibits notable robustness to the data imbalance compared to supervised learning, and demonstrates significant effectiveness in learning generalizable representations. With an aim to investigate the reasons behind this finding, we conduct controlled experiments to study various underlying factors, and reveal that CLIP's pretext task forms a dynamic classification problem wherein only a subset of classes is present in training. This isolates the bias from dominant classes and implicitly balances the learning signal. Furthermore, the robustness and discriminability of CLIP improve with more descriptive language supervision, larger data scale, and broader open-world concepts, which are inaccessible to supervised learning. Our study not only uncovers the mechanisms behind CLIP's generalizability beyond data imbalance but also provides transferable insights for the research community. The findings are validated in both supervised and self-supervised learning, enabling models trained on imbalanced data to achieve CLIP-level performance on diverse recognition tasks. Code and data are available at: https://github.com/CVMI-Lab/clip-beyond-tail.

Adversarial input attacks can cause a significant shift of CLIP embeddings. This can affect the downstream robustness of models incorporating CLIP in the pipeline, such as text-to-image generative models or large vision language models. While some efforts have been done towards making the CLIP image encoders robust, the robustness of text encoders remains unexplored. In this work, we cover this gap in the literature. We propose LEAF: an efficient adversarial finetuning method for the text domain, with the ability to scale to large CLIP models. Our models significantly improve the zero-shot adversarial accuracy in the text domain, while maintaining the vision performance provided by robust image encoders. When combined with text-to-image diffusion models, we can improve the generation quality under adversarial noise. When employing our robust CLIP encoders in multimodal retrieval tasks, we improve the recall under adversarial noise over standard CLIP models. Finally, we show that robust text encoders facilitate better reconstruction of input text from its embedding via direct optimization.

Zero-shot anomaly detection (ZSAD) requires detection models trained using auxiliary data to detect anomalies without any training sample in a target dataset. It is a crucial task when training data is not accessible due to various concerns, eg, data privacy, yet it is challenging since the models need to generalize to anomalies across different domains where the appearance of foreground objects, abnormal regions, and background features, such as defects/tumors on different products/organs, can vary significantly. Recently large pre-trained vision-language models (VLMs), such as CLIP, have demonstrated strong zero-shot recognition ability in various vision tasks, including anomaly detection. However, their ZSAD performance is weak since the VLMs focus more on modeling the class semantics of the foreground objects rather than the abnormality/normality in the images. In this paper we introduce a novel approach, namely AnomalyCLIP, to adapt CLIP for accurate ZSAD across different domains. The key insight of AnomalyCLIP is to learn object-agnostic text prompts that capture generic normality and abnormality in an image regardless of its foreground objects. This allows our model to focus on the abnormal image regions rather than the object semantics, enabling generalized normality and abnormality recognition on diverse types of objects. Large-scale experiments on 17 real-world anomaly detection datasets show that AnomalyCLIP achieves superior zero-shot performance of detecting and segmenting anomalies in datasets of highly diverse class semantics from various defect inspection and medical imaging domains. Code will be made available at https://github.com/zqhang/AnomalyCLIP.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

This paper introduces DeeCLIP, a novel framework for detecting AI-generated images using CLIP-ViT and fusion learning. Despite significant advancements in generative models capable of creating highly photorealistic images, existing detection methods often struggle to generalize across different models and are highly sensitive to minor perturbations. To address these challenges, DeeCLIP incorporates DeeFuser, a fusion module that combines high-level and low-level features, improving robustness against degradations such as compression and blurring. Additionally, we apply triplet loss to refine the embedding space, enhancing the model's ability to distinguish between real and synthetic content. To further enable lightweight adaptation while preserving pre-trained knowledge, we adopt parameter-efficient fine-tuning using low-rank adaptation (LoRA) within the CLIP-ViT backbone. This approach supports effective zero-shot learning without sacrificing generalization. Trained exclusively on 4-class ProGAN data, DeeCLIP achieves an average accuracy of 89.00% on 19 test subsets composed of generative adversarial network (GAN) and diffusion models. Despite having fewer trainable parameters, DeeCLIP outperforms existing methods, demonstrating superior robustness against various generative models and real-world distortions. The code is publicly available at https://github.com/Mamadou-Keita/DeeCLIP for research purposes.

With the advent of vision-language models (VLMs) that can perform in-context and prompt-based learning, how can we design prompting approaches that robustly generalize to distribution shift and can be used on novel classes outside the support set of the prompts? In this work, we first define two types of robustness to distribution shift on VLMs, namely, robustness on base classes (the classes included in the support set of prompts) and robustness on novel classes. Then, we study the robustness of existing in-context learning and prompt learning approaches, where we find that prompt learning performs robustly on test images from base classes, while it does not generalize well on images from novel classes. We propose robust prompt learning by integrating multiple-scale image features into the prompt, which improves both types of robustness. Comprehensive experiments are conducted to study the defined robustness on six benchmarks and show the effectiveness of our proposal.

The outstanding performance of Large Multimodal Models (LMMs) has made them widely applied in vision-related tasks. However, various corruptions in the real world mean that images will not be as ideal as in simulations, presenting significant challenges for the practical application of LMMs. To address this issue, we introduce R-Bench, a benchmark focused on the **Real-world Robustness of LMMs**. Specifically, we: (a) model the complete link from user capture to LMMs reception, comprising 33 corruption dimensions, including 7 steps according to the corruption sequence, and 7 groups based on low-level attributes; (b) collect reference/distorted image dataset before/after corruption, including 2,970 question-answer pairs with human labeling; (c) propose comprehensive evaluation for absolute/relative robustness and benchmark 20 mainstream LMMs. Results show that while LMMs can correctly handle the original reference images, their performance is not stable when faced with distorted images, and there is a significant gap in robustness compared to the human visual system. We hope that R-Bench will inspire improving the robustness of LMMs, **extending them from experimental simulations to the real-world application**. Check https://q-future.github.io/R-Bench for details.

In recent years, Multimodal Large Language Models (MLLM) have achieved notable advancements, demonstrating the feasibility of developing an intelligent biomedical assistant. However, current biomedical MLLMs predominantly focus on image-level understanding and restrict interactions to textual commands, thus limiting their capability boundaries and the flexibility of usage. In this paper, we introduce a novel end-to-end multimodal large language model for the biomedical domain, named MedPLIB, which possesses pixel-level understanding. Excitingly, it supports visual question answering (VQA), arbitrary pixel-level prompts (points, bounding boxes, and free-form shapes), and pixel-level grounding. We propose a novel Mixture-of-Experts (MoE) multi-stage training strategy, which divides MoE into separate training phases for a visual-language expert model and a pixel-grounding expert model, followed by fine-tuning using MoE. This strategy effectively coordinates multitask learning while maintaining the computational cost at inference equivalent to that of a single expert model. To advance the research of biomedical MLLMs, we introduce the Medical Complex Vision Question Answering Dataset (MeCoVQA), which comprises an array of 8 modalities for complex medical imaging question answering and image region understanding. Experimental results indicate that MedPLIB has achieved state-of-the-art outcomes across multiple medical visual language tasks. More importantly, in zero-shot evaluations for the pixel grounding task, MedPLIB leads the best small and large models by margins of 19.7 and 15.6 respectively on the mDice metric. The codes, data, and model checkpoints will be made publicly available at https://github.com/ShawnHuang497/MedPLIB.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Universal visual anomaly detection aims to identify anomalies from novel or unseen vision domains without additional fine-tuning, which is critical in open scenarios. Recent studies have demonstrated that pre-trained vision-language models like CLIP exhibit strong generalization with just zero or a few normal images. However, existing methods struggle with designing prompt templates, complex token interactions, or requiring additional fine-tuning, resulting in limited flexibility. In this work, we present a simple yet effective method called AdaptCLIP based on two key insights. First, adaptive visual and textual representations should be learned alternately rather than jointly. Second, comparative learning between query and normal image prompt should incorporate both contextual and aligned residual features, rather than relying solely on residual features. AdaptCLIP treats CLIP models as a foundational service, adding only three simple adapters, visual adapter, textual adapter, and prompt-query adapter, at its input or output ends. AdaptCLIP supports zero-/few-shot generalization across domains and possesses a training-free manner on target domains once trained on a base dataset. AdaptCLIP achieves state-of-the-art performance on 12 anomaly detection benchmarks from industrial and medical domains, significantly outperforming existing competitive methods. We will make the code and model of AdaptCLIP available at https://github.com/gaobb/AdaptCLIP.

Recent studies have shown that higher accuracy on ImageNet usually leads to better robustness against different corruptions. Therefore, in this paper, instead of following the traditional research paradigm that investigates new out-of-distribution corruptions or perturbations deep models may encounter, we conduct model debugging in in-distribution data to explore which object attributes a model may be sensitive to. To achieve this goal, we create a toolkit for object editing with controls of backgrounds, sizes, positions, and directions, and create a rigorous benchmark named ImageNet-E(diting) for evaluating the image classifier robustness in terms of object attributes. With our ImageNet-E, we evaluate the performance of current deep learning models, including both convolutional neural networks and vision transformers. We find that most models are quite sensitive to attribute changes. A small change in the background can lead to an average of 9.23\% drop on top-1 accuracy. We also evaluate some robust models including both adversarially trained models and other robust trained models and find that some models show worse robustness against attribute changes than vanilla models. Based on these findings, we discover ways to enhance attribute robustness with preprocessing, architecture designs, and training strategies. We hope this work can provide some insights to the community and open up a new avenue for research in robust computer vision. The code and dataset are available at https://github.com/alibaba/easyrobust.

Excellence in a wide variety of medical applications poses considerable challenges for AI, requiring advanced reasoning, access to up-to-date medical knowledge and understanding of complex multimodal data. Gemini models, with strong general capabilities in multimodal and long-context reasoning, offer exciting possibilities in medicine. Building on these core strengths of Gemini, we introduce Med-Gemini, a family of highly capable multimodal models that are specialized in medicine with the ability to seamlessly use web search, and that can be efficiently tailored to novel modalities using custom encoders. We evaluate Med-Gemini on 14 medical benchmarks, establishing new state-of-the-art (SoTA) performance on 10 of them, and surpass the GPT-4 model family on every benchmark where a direct comparison is viable, often by a wide margin. On the popular MedQA (USMLE) benchmark, our best-performing Med-Gemini model achieves SoTA performance of 91.1% accuracy, using a novel uncertainty-guided search strategy. On 7 multimodal benchmarks including NEJM Image Challenges and MMMU (health & medicine), Med-Gemini improves over GPT-4V by an average relative margin of 44.5%. We demonstrate the effectiveness of Med-Gemini's long-context capabilities through SoTA performance on a needle-in-a-haystack retrieval task from long de-identified health records and medical video question answering, surpassing prior bespoke methods using only in-context learning. Finally, Med-Gemini's performance suggests real-world utility by surpassing human experts on tasks such as medical text summarization, alongside demonstrations of promising potential for multimodal medical dialogue, medical research and education. Taken together, our results offer compelling evidence for Med-Gemini's potential, although further rigorous evaluation will be crucial before real-world deployment in this safety-critical domain.

Purpose: Surgical workflow analysis is crucial for improving surgical efficiency and safety. However, previous studies rely heavily on large-scale annotated datasets, posing challenges in cost, scalability, and reliance on expert annotations. To address this, we propose Surg-FTDA (Few-shot Text-driven Adaptation), designed to handle various surgical workflow analysis tasks with minimal paired image-label data. Methods: Our approach has two key components. First, Few-shot selection-based modality alignment selects a small subset of images and aligns their embeddings with text embeddings from the downstream task, bridging the modality gap. Second, Text-driven adaptation leverages only text data to train a decoder, eliminating the need for paired image-text data. This decoder is then applied to aligned image embeddings, enabling image-related tasks without explicit image-text pairs. Results: We evaluate our approach to generative tasks (image captioning) and discriminative tasks (triplet recognition and phase recognition). Results show that Surg-FTDA outperforms baselines and generalizes well across downstream tasks. Conclusion: We propose a text-driven adaptation approach that mitigates the modality gap and handles multiple downstream tasks in surgical workflow analysis, with minimal reliance on large annotated datasets. The code and dataset will be released in https://github.com/CAMMA-public/Surg-FTDA

This paper introduces MedTrinity-25M, a comprehensive, large-scale multimodal dataset for medicine, covering over 25 million images across 10 modalities, with multigranular annotations for more than 65 diseases. These enriched annotations encompass both global textual information, such as disease/lesion type, modality, region-specific descriptions, and inter-regional relationships, as well as detailed local annotations for regions of interest (ROIs), including bounding boxes, segmentation masks. Unlike existing approach which is limited by the availability of image-text pairs, we have developed the first automated pipeline that scales up multimodal data by generating multigranular visual and texual annotations (in the form of image-ROI-description triplets) without the need for any paired text descriptions. Specifically, data from over 90 different sources have been collected, preprocessed, and grounded using domain-specific expert models to identify ROIs related to abnormal regions. We then build a comprehensive knowledge base and prompt multimodal large language models to perform retrieval-augmented generation with the identified ROIs as guidance, resulting in multigranular texual descriptions. Compared to existing datasets, MedTrinity-25M provides the most enriched annotations, supporting a comprehensive range of multimodal tasks such as captioning and report generation, as well as vision-centric tasks like classification and segmentation. Pretraining on MedTrinity-25M, our model achieves state-of-the-art performance on VQA-RAD and PathVQA, surpassing both multimodal large language models and other representative SoTA approaches. This dataset can also be utilized to support large-scale pre-training of multimodal medical AI models, contributing to the development of future foundation models in the medical domain.

We propose to study and promote the robustness of a model as per its performance through the interpolation of training data distributions. Specifically, (1) we augment the data by finding the worst-case Wasserstein barycenter on the geodesic connecting subpopulation distributions of different categories. (2) We regularize the model for smoother performance on the continuous geodesic path connecting subpopulation distributions. (3) Additionally, we provide a theoretical guarantee of robustness improvement and investigate how the geodesic location and the sample size contribute, respectively. Experimental validations of the proposed strategy on four datasets, including CIFAR-100 and ImageNet, establish the efficacy of our method, e.g., our method improves the baselines' certifiable robustness on CIFAR10 up to 7.7%, with 16.8% on empirical robustness on CIFAR-100. Our work provides a new perspective of model robustness through the lens of Wasserstein geodesic-based interpolation with a practical off-the-shelf strategy that can be combined with existing robust training methods.

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

Although deep learning (DL) has received much attention in accelerated magnetic resonance imaging (MRI), recent studies show that tiny input perturbations may lead to instabilities of DL-based MRI reconstruction models. However, the approaches of robustifying these models are underdeveloped. Compared to image classification, it could be much more challenging to achieve a robust MRI image reconstruction network considering its regression-based learning objective, limited amount of training data, and lack of efficient robustness metrics. To circumvent the above limitations, our work revisits the problem of DL-based image reconstruction through the lens of robust machine learning. We find a new instability source of MRI image reconstruction, i.e., the lack of reconstruction robustness against spatial transformations of an input, e.g., rotation and cutout. Inspired by this new robustness metric, we develop a robustness-aware image reconstruction method that can defend against both pixel-wise adversarial perturbations as well as spatial transformations. Extensive experiments are also conducted to demonstrate the effectiveness of our proposed approaches.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

In the era of modern healthcare, swiftly generating medical question summaries is crucial for informed and timely patient care. Despite the increasing complexity and volume of medical data, existing studies have focused solely on text-based summarization, neglecting the integration of visual information. Recognizing the untapped potential of combining textual queries with visual representations of medical conditions, we introduce the Multimodal Medical Question Summarization (MMQS) Dataset. This dataset, a major contribution to our work, pairs medical queries with visual aids, facilitating a richer and more nuanced understanding of patient needs. We also propose a framework, utilizing the power of Contrastive Language Image Pretraining(CLIP) and Large Language Models(LLMs), consisting of four modules that identify medical disorders, generate relevant context, filter medical concepts, and craft visually aware summaries. Our comprehensive framework harnesses the power of CLIP, a multimodal foundation model, and various general-purpose LLMs, comprising four main modules: the medical disorder identification module, the relevant context generation module, the context filtration module for distilling relevant medical concepts and knowledge, and finally, a general-purpose LLM to generate visually aware medical question summaries. Leveraging our MMQS dataset, we showcase how visual cues from images enhance the generation of medically nuanced summaries. This multimodal approach not only enhances the decision-making process in healthcare but also fosters a more nuanced understanding of patient queries, laying the groundwork for future research in personalized and responsive medical care

With the surge in available data from various modalities, there is a growing need to bridge the gap between different data types. In this work, we introduce a novel approach to learn cross-modal representations between image data and molecular representations for drug discovery. We propose EMM and IMM, two innovative loss functions built on top of CLIP that leverage weak supervision and cross sites replicates in High-Content Screening. Evaluating our model against known baseline on cross-modal retrieval, we show that our proposed approach allows to learn better representations and mitigate batch effect. In addition, we also present a preprocessing method for the JUMP-CP dataset that effectively reduce the required space from 85Tb to a mere usable 7Tb size, still retaining all perturbations and most of the information content.

The ability to automatically detect and track surgical instruments in endoscopic videos can enable transformational interventions. Assessing surgical performance and efficiency, identifying skilled tool use and choreography, and planning operational and logistical aspects of OR resources are just a few of the applications that could benefit. Unfortunately, obtaining the annotations needed to train machine learning models to identify and localize surgical tools is a difficult task. Annotating bounding boxes frame-by-frame is tedious and time-consuming, yet large amounts of data with a wide variety of surgical tools and surgeries must be captured for robust training. Moreover, ongoing annotator training is needed to stay up to date with surgical instrument innovation. In robotic-assisted surgery, however, potentially informative data like timestamps of instrument installation and removal can be programmatically harvested. The ability to rely on tool installation data alone would significantly reduce the workload to train robust tool-tracking models. With this motivation in mind we invited the surgical data science community to participate in the challenge, SurgToolLoc 2022. The goal was to leverage tool presence data as weak labels for machine learning models trained to detect tools and localize them in video frames with bounding boxes. We present the results of this challenge along with many of the team's efforts. We conclude by discussing these results in the broader context of machine learning and surgical data science. The training data used for this challenge consisting of 24,695 video clips with tool presence labels is also being released publicly and can be accessed at https://console.cloud.google.com/storage/browser/isi-surgtoolloc-2022.

Robust and accurate detection and segmentation of heterogenous tumors appearing in different anatomical organs with supervised methods require large-scale labeled datasets covering all possible types of diseases. Due to the unavailability of such rich datasets and the high cost of annotations, unsupervised anomaly detection (UAD) methods have been developed aiming to detect the pathologies as deviation from the normality by utilizing the unlabeled healthy image data. However, developed UAD models are often trained with an incomplete distribution of healthy anatomies and have difficulties in preserving anatomical constraints. This work intends to, first, propose a robust inpainting model to learn the details of healthy anatomies and reconstruct high-resolution images by preserving anatomical constraints. Second, we propose an autoinpainting pipeline to automatically detect tumors, replace their appearance with the learned healthy anatomies, and based on that segment the tumoral volumes in a purely unsupervised fashion. Three imaging datasets, including PET, CT, and PET-CT scans of lung tumors and head and neck tumors, are studied as benchmarks for evaluation. Experimental results demonstrate the significant superiority of the proposed method over a wide range of state-of-the-art UAD methods. Moreover, the unsupervised method we propose produces comparable results to a robust supervised segmentation method when applied to multimodal images.

Video-text retrieval plays an essential role in multi-modal research and has been widely used in many real-world web applications. The CLIP (Contrastive Language-Image Pre-training), an image-language pre-training model, has demonstrated the power of visual concepts learning from web collected image-text datasets. In this paper, we propose a CLIP4Clip model to transfer the knowledge of the CLIP model to video-language retrieval in an end-to-end manner. Several questions are investigated via empirical studies: 1) Whether image feature is enough for video-text retrieval? 2) How a post-pretraining on a large-scale video-text dataset based on the CLIP affect the performance? 3) What is the practical mechanism to model temporal dependency between video frames? And 4) The Hyper-parameters sensitivity of the model on video-text retrieval task. Extensive experimental results present that the CLIP4Clip model transferred from the CLIP can achieve SOTA results on various video-text retrieval datasets, including MSR-VTT, MSVC, LSMDC, ActivityNet, and DiDeMo. We release our code at https://github.com/ArrowLuo/CLIP4Clip.

Web-crawled datasets are pivotal to the success of pre-training vision-language models, exemplified by CLIP. However, web-crawled AltTexts can be noisy and potentially irrelevant to images, thereby undermining the crucial image-text alignment. Existing methods for rewriting captions using large language models (LLMs) have shown promise on small, curated datasets like CC3M and CC12M. Nevertheless, their efficacy on massive web-captured captions is constrained by the inherent noise and randomness in such data. In this study, we address this limitation by focusing on two key aspects: data quality and data variety. Unlike recent LLM rewriting techniques, we emphasize exploiting visual concepts and their integration into the captions to improve data quality. For data variety, we propose a novel mixed training scheme that optimally leverages AltTexts alongside newly generated Visual-enriched Captions (VeC). We use CLIP as one example and adapt the method for CLIP training on large-scale web-crawled datasets, named VeCLIP. We conduct a comprehensive evaluation of VeCLIP across small, medium, and large scales of raw data. Our results show significant advantages in image-text alignment and overall model performance, underscoring the effectiveness of VeCLIP in improving CLIP training. For example, VeCLIP achieves a remarkable over 20% improvement in COCO and Flickr30k retrieval tasks under the 12M setting. For data efficiency, we also achieve a notable over 3% improvement while using only 14% of the data employed in the vanilla CLIP and 11% in ALIGN.

Zero-shot anomaly detection (ZSAD) targets the identification of anomalies within images from arbitrary novel categories. This study introduces AdaCLIP for the ZSAD task, leveraging a pre-trained vision-language model (VLM), CLIP. AdaCLIP incorporates learnable prompts into CLIP and optimizes them through training on auxiliary annotated anomaly detection data. Two types of learnable prompts are proposed: static and dynamic. Static prompts are shared across all images, serving to preliminarily adapt CLIP for ZSAD. In contrast, dynamic prompts are generated for each test image, providing CLIP with dynamic adaptation capabilities. The combination of static and dynamic prompts is referred to as hybrid prompts, and yields enhanced ZSAD performance. Extensive experiments conducted across 14 real-world anomaly detection datasets from industrial and medical domains indicate that AdaCLIP outperforms other ZSAD methods and can generalize better to different categories and even domains. Finally, our analysis highlights the importance of diverse auxiliary data and optimized prompts for enhanced generalization capacity. Code is available at https://github.com/caoyunkang/AdaCLIP.

As deep learning models gain attraction in medical data, ensuring transparent and trustworthy decision-making is essential. In skin cancer diagnosis, while advancements in lesion detection and classification have improved accuracy, the black-box nature of these methods poses challenges in understanding their decision processes, leading to trust issues among physicians. This study leverages the CLIP (Contrastive Language-Image Pretraining) model, trained on different skin lesion datasets, to capture meaningful relationships between visual features and diagnostic criteria terms. To further enhance transparency, we propose a method called MedGrad E-CLIP, which builds on gradient-based E-CLIP by incorporating a weighted entropy mechanism designed for complex medical imaging like skin lesions. This approach highlights critical image regions linked to specific diagnostic descriptions. The developed integrated pipeline not only classifies skin lesions by matching corresponding descriptions but also adds an essential layer of explainability developed especially for medical data. By visually explaining how different features in an image relates to diagnostic criteria, this approach demonstrates the potential of advanced vision-language models in medical image analysis, ultimately improving transparency, robustness, and trust in AI-driven diagnostic systems.

Electronic health record (EHR) systems are used extensively throughout the healthcare domain. However, data interchangeability between EHR systems is limited due to the use of different coding standards across systems. Existing methods of mapping coding standards based on manual human experts mapping, dictionary mapping, symbolic NLP and classification are unscalable and cannot accommodate large scale EHR datasets. In this work, we present Text2Node, a cross-domain mapping system capable of mapping medical phrases to concepts in a large taxonomy (such as SNOMED CT). The system is designed to generalize from a limited set of training samples and map phrases to elements of the taxonomy that are not covered by training data. As a result, our system is scalable, robust to wording variants between coding systems and can output highly relevant concepts when no exact concept exists in the target taxonomy. Text2Node operates in three main stages: first, the lexicon is mapped to word embeddings; second, the taxonomy is vectorized using node embeddings; and finally, the mapping function is trained to connect the two embedding spaces. We compared multiple algorithms and architectures for each stage of the training, including GloVe and FastText word embeddings, CNN and Bi-LSTM mapping functions, and node2vec for node embeddings. We confirmed the robustness and generalisation properties of Text2Node by mapping ICD-9-CM Diagnosis phrases to SNOMED CT and by zero-shot training at comparable accuracy. This system is a novel methodological contribution to the task of normalizing and linking phrases to a taxonomy, advancing data interchangeability in healthcare. When applied, the system can use electronic health records to generate an embedding that incorporates taxonomical medical knowledge to improve clinical predictive models.

Large-scale vision-and-language models, such as CLIP, are typically trained on web-scale data, which can introduce inappropriate content and lead to the development of unsafe and biased behavior. This, in turn, hampers their applicability in sensitive and trustworthy contexts and could raise significant concerns in their adoption. Our research introduces a novel approach to enhancing the safety of vision-and-language models by diminishing their sensitivity to NSFW (not safe for work) inputs. In particular, our methodology seeks to sever "toxic" linguistic and visual concepts, unlearning the linkage between unsafe linguistic or visual items and unsafe regions of the embedding space. We show how this can be done by fine-tuning a CLIP model on synthetic data obtained from a large language model trained to convert between safe and unsafe sentences, and a text-to-image generator. We conduct extensive experiments on the resulting embedding space for cross-modal retrieval, text-to-image, and image-to-text generation, where we show that our model can be remarkably employed with pre-trained generative models. Our source code and trained models are available at: https://github.com/aimagelab/safe-clip.

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

Compound figures, which are multi-panel composites containing diverse subfigures, are ubiquitous in biomedical literature, yet large-scale subfigure extraction remains largely unaddressed. Prior work on subfigure extraction has been limited in both dataset size and generalizability, leaving a critical open question: How does high-fidelity image-text alignment via large-scale subfigure extraction impact representation learning in vision-language models? We address this gap by introducing a scalable subfigure extraction pipeline based on transformer-based object detection, trained on a synthetic corpus of 500,000 compound figures, and achieving state-of-the-art performance on both ImageCLEF 2016 and synthetic benchmarks. Using this pipeline, we release OPEN-PMC-18M, a large-scale high quality biomedical vision-language dataset comprising 18 million clinically relevant subfigure-caption pairs spanning radiology, microscopy, and visible light photography. We train and evaluate vision-language models on our curated datasets and show improved performance across retrieval, zero-shot classification, and robustness benchmarks, outperforming existing baselines. We release our dataset, models, and code to support reproducible benchmarks and further study into biomedical vision-language modeling and representation learning.

Given a robust model trained to be resilient to one or multiple types of distribution shifts (e.g., natural image corruptions), how is that "robustness" encoded in the model weights, and how easily can it be disentangled and/or "zero-shot" transferred to some other models? This paper empirically suggests a surprisingly simple answer: linearly - by straightforward model weight arithmetic! We start by drawing several key observations: (1)assuming that we train the same model architecture on both a clean dataset and its corrupted version, resultant weights mostly differ in shallow layers; (2)the weight difference after projection, which we call "Robust Weight Signature" (RWS), appears to be discriminative and indicative of different corruption types; (3)for the same corruption type, the RWSs obtained by one model architecture are highly consistent and transferable across different datasets. We propose a minimalistic model robustness "patching" framework that carries a model trained on clean data together with its pre-extracted RWSs. In this way, injecting certain robustness to the model is reduced to directly adding the corresponding RWS to its weight. We verify our proposed framework to be remarkably (1)lightweight. since RWSs concentrate on the shallowest few layers and we further show they can be painlessly quantized, storing an RWS is up to 13 x more compact than storing the full weight copy; (2)in-situ adjustable. RWSs can be appended as needed and later taken off to restore the intact clean model. We further demonstrate one can linearly re-scale the RWS to control the patched robustness strength; (3)composable. Multiple RWSs can be added simultaneously to patch more comprehensive robustness at once; and (4)transferable. Even when the clean model backbone is continually adapted or updated, RWSs remain as effective patches due to their outstanding cross-dataset transferability.

Recent advancements in prompt-based medical image segmentation have enabled clinicians to identify tumors using simple input like bounding boxes or text prompts. However, existing methods face challenges when doctors need to interact through natural language or when position reasoning is required - understanding spatial relationships between anatomical structures and pathologies. We present PRS-Med, a framework that integrates vision-language models with segmentation capabilities to generate both accurate segmentation masks and corresponding spatial reasoning outputs. Additionally, we introduce the MMRS dataset (Multimodal Medical in Positional Reasoning Segmentation), which provides diverse, spatially-grounded question-answer pairs to address the lack of position reasoning data in medical imaging. PRS-Med demonstrates superior performance across six imaging modalities (CT, MRI, X-ray, ultrasound, endoscopy, RGB), significantly outperforming state-of-the-art methods in both segmentation accuracy and position reasoning. Our approach enables intuitive doctor-system interaction through natural language, facilitating more efficient diagnoses. Our dataset pipeline, model, and codebase will be released to foster further research in spatially-aware multimodal reasoning for medical applications.

Contrastive Language-Image Pre-training (CLIP) has become a foundation model and has been applied to various vision and multimodal tasks. However, recent works indicate that CLIP falls short in distinguishing detailed differences in images and shows suboptimal performance on dense-prediction and vision-centric multimodal tasks. Therefore, this work focuses on improving existing CLIP models, aiming to capture as many visual details in images as possible. We find that a specific type of generative models, unCLIP, provides a suitable framework for achieving our goal. Specifically, unCLIP trains an image generator conditioned on the CLIP image embedding. In other words, it inverts the CLIP image encoder. Compared to discriminative models like CLIP, generative models are better at capturing image details because they are trained to learn the data distribution of images. Additionally, the conditional input space of unCLIP aligns with CLIP's original image-text embedding space. Therefore, we propose to invert unCLIP (dubbed un^2CLIP) to improve the CLIP model. In this way, the improved image encoder can gain unCLIP's visual detail capturing ability while preserving its alignment with the original text encoder simultaneously. We evaluate our improved CLIP across various tasks to which CLIP has been applied, including the challenging MMVP-VLM benchmark, the dense-prediction open-vocabulary segmentation task, and multimodal large language model tasks. Experiments show that un^2CLIP significantly improves the original CLIP and previous CLIP improvement methods. Code and models will be available at https://github.com/LiYinqi/un2CLIP.

We present Distill CLIP (DCLIP), a fine-tuned variant of the CLIP model that enhances multimodal image-text retrieval while preserving the original model's strong zero-shot classification capabilities. CLIP models are typically constrained by fixed image resolutions and limited context, which can hinder their effectiveness in retrieval tasks that require fine-grained cross-modal understanding. DCLIP addresses these challenges through a meta teacher-student distillation framework, where a cross-modal transformer teacher is fine-tuned to produce enriched embeddings via bidirectional cross-attention between YOLO-extracted image regions and corresponding textual spans. These semantically and spatially aligned global representations guide the training of a lightweight student model using a hybrid loss that combines contrastive learning and cosine similarity objectives. Despite being trained on only ~67,500 samples curated from MSCOCO, Flickr30k, and Conceptual Captions-just a fraction of CLIP's original dataset-DCLIP significantly improves image-text retrieval metrics (Recall@K, MAP), while retaining approximately 94% of CLIP's zero-shot classification performance. These results demonstrate that DCLIP effectively mitigates the trade-off between task specialization and generalization, offering a resource-efficient, domain-adaptive, and detail-sensitive solution for advanced vision-language tasks. Code available at https://anonymous.4open.science/r/DCLIP-B772/README.md.

Text-to-image person re-identification (TIReID) is a compelling topic in the cross-modal community, which aims to retrieve the target person based on a textual query. Although numerous TIReID methods have been proposed and achieved promising performance, they implicitly assume the training image-text pairs are correctly aligned, which is not always the case in real-world scenarios. In practice, the image-text pairs inevitably exist under-correlated or even false-correlated, a.k.a noisy correspondence (NC), due to the low quality of the images and annotation errors. To address this problem, we propose a novel Robust Dual Embedding method (RDE) that can learn robust visual-semantic associations even with NC. Specifically, RDE consists of two main components: 1) A Confident Consensus Division (CCD) module that leverages the dual-grained decisions of dual embedding modules to obtain a consensus set of clean training data, which enables the model to learn correct and reliable visual-semantic associations. 2) A Triplet-Alignment Loss (TAL) relaxes the conventional triplet-ranking loss with hardest negatives, which tends to rapidly overfit NC, to a log-exponential upper bound over all negatives, thus preventing the model from overemphasizing false image-text pairs. We conduct extensive experiments on three public benchmarks, namely CUHK-PEDES, ICFG-PEDES, and RSTPReID, to evaluate the performance and robustness of our RDE. Our method achieves state-of-the-art results both with and without synthetic noisy correspondences on all three datasets.

Biomedical image analysis is fundamental for biomedical discovery in cell biology, pathology, radiology, and many other biomedical domains. Holistic image analysis comprises interdependent subtasks such as segmentation, detection, and recognition of relevant objects. Here, we propose BiomedParse, a biomedical foundation model for imaging parsing that can jointly conduct segmentation, detection, and recognition for 82 object types across 9 imaging modalities. Through joint learning, we can improve accuracy for individual tasks and enable novel applications such as segmenting all relevant objects in an image through a text prompt, rather than requiring users to laboriously specify the bounding box for each object. We leveraged readily available natural-language labels or descriptions accompanying those datasets and use GPT-4 to harmonize the noisy, unstructured text information with established biomedical object ontologies. We created a large dataset comprising over six million triples of image, segmentation mask, and textual description. On image segmentation, we showed that BiomedParse is broadly applicable, outperforming state-of-the-art methods on 102,855 test image-mask-label triples across 9 imaging modalities (everything). On object detection, which aims to locate a specific object of interest, BiomedParse again attained state-of-the-art performance, especially on objects with irregular shapes (everywhere). On object recognition, which aims to identify all objects in a given image along with their semantic types, we showed that BiomedParse can simultaneously segment and label all biomedical objects in an image (all at once). In summary, BiomedParse is an all-in-one tool for biomedical image analysis by jointly solving segmentation, detection, and recognition for all major biomedical image modalities, paving the path for efficient and accurate image-based biomedical discovery.

Deep learning methods for unsupervised registration often rely on objectives that assume a uniform noise level across the spatial domain (e.g. mean-squared error loss), but noise distributions are often heteroscedastic and input-dependent in real-world medical images. Thus, this assumption often leads to degradation in registration performance, mainly due to the undesired influence of noise-induced outliers. To mitigate this, we propose a framework for heteroscedastic image uncertainty estimation that can adaptively reduce the influence of regions with high uncertainty during unsupervised registration. The framework consists of a collaborative training strategy for the displacement and variance estimators, and a novel image fidelity weighting scheme utilizing signal-to-noise ratios. Our approach prevents the model from being driven away by spurious gradients caused by the simplified homoscedastic assumption, leading to more accurate displacement estimation. To illustrate its versatility and effectiveness, we tested our framework on two representative registration architectures across three medical image datasets. Our method consistently outperforms baselines and produces sensible uncertainty estimates. The code is publicly available at https://voldemort108x.github.io/hetero_uncertainty/.

We show that the basic classification framework alone can be used to tackle some of the most challenging tasks in image synthesis. In contrast to other state-of-the-art approaches, the toolkit we develop is rather minimal: it uses a single, off-the-shelf classifier for all these tasks. The crux of our approach is that we train this classifier to be adversarially robust. It turns out that adversarial robustness is precisely what we need to directly manipulate salient features of the input. Overall, our findings demonstrate the utility of robustness in the broader machine learning context. Code and models for our experiments can be found at https://git.io/robust-apps.

In this paper, we introduce Medical SAM 2 (MedSAM-2), an advanced segmentation model that utilizes the SAM 2 framework to address both 2D and 3D medical image segmentation tasks. By adopting the philosophy of taking medical images as videos, MedSAM-2 not only applies to 3D medical images but also unlocks new One-prompt Segmentation capability. That allows users to provide a prompt for just one or a specific image targeting an object, after which the model can autonomously segment the same type of object in all subsequent images, regardless of temporal relationships between the images. We evaluated MedSAM-2 across a variety of medical imaging modalities, including abdominal organs, optic discs, brain tumors, thyroid nodules, and skin lesions, comparing it against state-of-the-art models in both traditional and interactive segmentation settings. Our findings show that MedSAM-2 not only surpasses existing models in performance but also exhibits superior generalization across a range of medical image segmentation tasks. Our code will be released at: https://github.com/MedicineToken/Medical-SAM2

Deep neural networks that achieve remarkable performance in image classification have previously been shown to be easily fooled by tiny transformations such as a one pixel translation of the input image. In order to address this problem, two approaches have been proposed in recent years. The first approach suggests using huge datasets together with data augmentation in the hope that a highly varied training set will teach the network to learn to be invariant. The second approach suggests using architectural modifications based on sampling theory to deal explicitly with image translations. In this paper, we show that these approaches still fall short in robustly handling 'natural' image translations that simulate a subtle change in camera orientation. Our findings reveal that a mere one-pixel translation can result in a significant change in the predicted image representation for approximately 40% of the test images in state-of-the-art models (e.g. open-CLIP trained on LAION-2B or DINO-v2) , while models that are explicitly constructed to be robust to cyclic translations can still be fooled with 1 pixel realistic (non-cyclic) translations 11% of the time. We present Robust Inference by Crop Selection: a simple method that can be proven to achieve any desired level of consistency, although with a modest tradeoff with the model's accuracy. Importantly, we demonstrate how employing this method reduces the ability to fool state-of-the-art models with a 1 pixel translation to less than 5% while suffering from only a 1% drop in classification accuracy. Additionally, we show that our method can be easy adjusted to deal with circular shifts as well. In such case we achieve 100% robustness to integer shifts with state-of-the-art accuracy, and with no need for any further training.

Medical image segmentation involves partitioning medical images into meaningful regions, with a focus on identifying anatomical structures and lesions. It has broad applications in healthcare, and deep learning methods have enabled significant advancements in automating this process. Recently, the introduction of the Segmentation Anything Model (SAM), the first foundation model for segmentation task, has prompted researchers to adapt it for the medical domain to improve performance across various tasks. However, SAM's large model size and high GPU requirements hinder its scalability and development in the medical domain. In this work, we propose MCP-MedSAM, a powerful and lightweight medical SAM model designed to be trainable on a single A100 GPU with 40GB of memory within one day while delivering superior segmentation performance. Recognizing the significant internal differences between modalities and the need for direct segmentation target information within bounding boxes, we introduce two kinds of prompts: the modality prompt and the content prompt. After passing through the prompt encoder, their embedding representations can further improve the segmentation performance by incorporating more relevant information without adding significant training overhead. Additionally, we adopt an effective modality-based data sampling strategy to address data imbalance between modalities, ensuring more balanced performance across all modalities. Our method was trained and evaluated using a large-scale challenge dataset, compared to top-ranking methods on the challenge leaderboard, MCP-MedSAM achieved superior performance while requiring only one day of training on a single GPU. The code is publicly available at blue{https://github.com/dong845/MCP-MedSAM}.}

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

Medical image and video segmentation is a critical task for precision medicine, which has witnessed considerable progress in developing task or modality-specific and generalist models for 2D images. However, there have been limited studies on building general-purpose models for 3D images and videos with comprehensive user studies. Here, we present MedSAM2, a promptable segmentation foundation model for 3D image and video segmentation. The model is developed by fine-tuning the Segment Anything Model 2 on a large medical dataset with over 455,000 3D image-mask pairs and 76,000 frames, outperforming previous models across a wide range of organs, lesions, and imaging modalities. Furthermore, we implement a human-in-the-loop pipeline to facilitate the creation of large-scale datasets resulting in, to the best of our knowledge, the most extensive user study to date, involving the annotation of 5,000 CT lesions, 3,984 liver MRI lesions, and 251,550 echocardiogram video frames, demonstrating that MedSAM2 can reduce manual costs by more than 85%. MedSAM2 is also integrated into widely used platforms with user-friendly interfaces for local and cloud deployment, making it a practical tool for supporting efficient, scalable, and high-quality segmentation in both research and healthcare environments.

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.

In the healthcare domain, summarizing medical questions posed by patients is critical for improving doctor-patient interactions and medical decision-making. Although medical data has grown in complexity and quantity, the current body of research in this domain has primarily concentrated on text-based methods, overlooking the integration of visual cues. Also prior works in the area of medical question summarisation have been limited to the English language. This work introduces the task of multimodal medical question summarization for codemixed input in a low-resource setting. To address this gap, we introduce the Multimodal Medical Codemixed Question Summarization MMCQS dataset, which combines Hindi-English codemixed medical queries with visual aids. This integration enriches the representation of a patient's medical condition, providing a more comprehensive perspective. We also propose a framework named MedSumm that leverages the power of LLMs and VLMs for this task. By utilizing our MMCQS dataset, we demonstrate the value of integrating visual information from images to improve the creation of medically detailed summaries. This multimodal strategy not only improves healthcare decision-making but also promotes a deeper comprehension of patient queries, paving the way for future exploration in personalized and responsive medical care. Our dataset, code, and pre-trained models will be made publicly available.

Understanding the workflow of surgical procedures in complex operating rooms requires a deep understanding of the interactions between clinicians and their environment. Surgical activity recognition (SAR) is a key computer vision task that detects activities or phases from multi-view camera recordings. Existing SAR models often fail to account for fine-grained clinician movements and multi-view knowledge, or they require calibrated multi-view camera setups and advanced point-cloud processing to obtain better results. In this work, we propose a novel calibration-free multi-view multi-modal pretraining framework called Multiview Pretraining for Video-Pose Surgical Activity Recognition PreViPS, which aligns 2D pose and vision embeddings across camera views. Our model follows CLIP-style dual-encoder architecture: one encoder processes visual features, while the other encodes human pose embeddings. To handle the continuous 2D human pose coordinates, we introduce a tokenized discrete representation to convert the continuous 2D pose coordinates into discrete pose embeddings, thereby enabling efficient integration within the dual-encoder framework. To bridge the gap between these two modalities, we propose several pretraining objectives using cross- and in-modality geometric constraints within the embedding space and incorporating masked pose token prediction strategy to enhance representation learning. Extensive experiments and ablation studies demonstrate improvements over the strong baselines, while data-efficiency experiments on two distinct operating room datasets further highlight the effectiveness of our approach. We highlight the benefits of our approach for surgical activity recognition in both multi-view and single-view settings, showcasing its practical applicability in complex surgical environments. Code will be made available at: https://github.com/CAMMA-public/PreViPS.

Several medical Multimodal Large Languange Models (MLLMs) have been developed to address tasks involving visual images with textual instructions across various medical modalities, achieving impressive results. Most current medical generalist models are region-agnostic, treating the entire image as a holistic representation. However, they struggle to identify which specific regions they are focusing on when generating a sentence. To mimic the behavior of doctors, who typically begin by reviewing the entire image before concentrating on specific regions for a thorough evaluation, we aim to enhance the capability of medical MLLMs in understanding anatomical regions within entire medical scans. To achieve it, we first formulate Region-Centric tasks and construct a large-scale dataset, MedRegInstruct, to incorporate regional information into training. Combining our collected dataset with other medical multimodal corpora for training, we propose a Region-Aware medical MLLM, MedRegA, which is the first bilingual generalist medical AI system to simultaneously handle image-level and region-level medical vision-language tasks across a broad range of modalities. Our MedRegA not only enables three region-centric tasks, but also achieves the best performance for visual question answering, report generation and medical image classification over 8 modalities, showcasing significant versatility. Experiments demonstrate that our model can not only accomplish powerful performance across various medical vision-language tasks in bilingual settings, but also recognize and detect structures in multimodal medical scans, boosting the interpretability and user interactivity of medical MLLMs. Our project page is https://medrega.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.

Research connecting text and images has recently seen several breakthroughs, with models like CLIP, DALL-E 2, and Stable Diffusion. However, the connection between text and other visual modalities, such as lidar data, has received less attention, prohibited by the lack of text-lidar datasets. In this work, we propose LidarCLIP, a mapping from automotive point clouds to a pre-existing CLIP embedding space. Using image-lidar pairs, we supervise a point cloud encoder with the image CLIP embeddings, effectively relating text and lidar data with the image domain as an intermediary. We show the effectiveness of LidarCLIP by demonstrating that lidar-based retrieval is generally on par with image-based retrieval, but with complementary strengths and weaknesses. By combining image and lidar features, we improve upon both single-modality methods and enable a targeted search for challenging detection scenarios under adverse sensor conditions. We also explore zero-shot classification and show that LidarCLIP outperforms existing attempts to use CLIP for point clouds by a large margin. Finally, we leverage our compatibility with CLIP to explore a range of applications, such as point cloud captioning and lidar-to-image generation, without any additional training. Code and pre-trained models are available at https://github.com/atonderski/lidarclip.

Understanding the relationship between figures and text is key to scientific document understanding. Medical figures in particular are quite complex, often consisting of several subfigures (75% of figures in our dataset), with detailed text describing their content. Previous work studying figures in scientific papers focused on classifying figure content rather than understanding how images relate to the text. To address challenges in figure retrieval and figure-to-text alignment, we introduce MedICaT, a dataset of medical images in context. MedICaT consists of 217K images from 131K open access biomedical papers, and includes captions, inline references for 74% of figures, and manually annotated subfigures and subcaptions for a subset of figures. Using MedICaT, we introduce the task of subfigure to subcaption alignment in compound figures and demonstrate the utility of inline references in image-text matching. Our data and code can be accessed at https://github.com/allenai/medicat.

Addressing the retrieval of unsafe content from vision-language models such as CLIP is an important step towards real-world integration. Current efforts have relied on unlearning techniques that try to erase the model's knowledge of unsafe concepts. While effective in reducing unwanted outputs, unlearning limits the model's capacity to discern between safe and unsafe content. In this work, we introduce a novel approach that shifts from unlearning to an awareness paradigm by leveraging the inherent hierarchical properties of the hyperbolic space. We propose to encode safe and unsafe content as an entailment hierarchy, where both are placed in different regions of hyperbolic space. Our HySAC, Hyperbolic Safety-Aware CLIP, employs entailment loss functions to model the hierarchical and asymmetrical relations between safe and unsafe image-text pairs. This modelling, ineffective in standard vision-language models due to their reliance on Euclidean embeddings, endows the model with awareness of unsafe content, enabling it to serve as both a multimodal unsafe classifier and a flexible content retriever, with the option to dynamically redirect unsafe queries toward safer alternatives or retain the original output. Extensive experiments show that our approach not only enhances safety recognition but also establishes a more adaptable and interpretable framework for content moderation in vision-language models. Our source code is available at https://github.com/aimagelab/HySAC.

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}.

Purpose: To introduce a deep learning model capable of multi-organ segmentation in MRI scans, offering a solution to the current limitations in MRI analysis due to challenges in resolution, standardized intensity values, and variability in sequences. Materials and Methods: he model was trained on 1,200 manually annotated MRI scans from the UK Biobank, 221 in-house MRI scans and 1228 CT scans, leveraging cross-modality transfer learning from CT segmentation models. A human-in-the-loop annotation workflow was employed to efficiently create high-quality segmentations. The model's performance was evaluated on NAKO and the AMOS22 dataset containing 600 and 60 MRI examinations. Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD) was used to assess segmentation accuracy. The model will be open sourced. Results: The model showcased high accuracy in segmenting well-defined organs, achieving Dice Similarity Coefficient (DSC) scores of 0.97 for the right and left lungs, and 0.95 for the heart. It also demonstrated robustness in organs like the liver (DSC: 0.96) and kidneys (DSC: 0.95 left, 0.95 right), which present more variability. However, segmentation of smaller and complex structures such as the portal and splenic veins (DSC: 0.54) and adrenal glands (DSC: 0.65 left, 0.61 right) revealed the need for further model optimization. Conclusion: The proposed model is a robust, tool for accurate segmentation of 40 anatomical structures in MRI and CT images. By leveraging cross-modality learning and interactive annotation, the model achieves strong performance and generalizability across diverse datasets, making it a valuable resource for researchers and clinicians. It is open source and can be downloaded from https://github.com/hhaentze/MRSegmentator.

Multimodal learning is defined as learning over multiple heterogeneous input modalities such as video, audio, and text. In this work, we are concerned with understanding how models behave as the type of modalities differ between training and deployment, a situation that naturally arises in many applications of multimodal learning to hardware platforms. We present a multimodal robustness framework to provide a systematic analysis of common multimodal representation learning methods. Further, we identify robustness short-comings of these approaches and propose two intervention techniques leading to 1.5times-4times robustness improvements on three datasets, AudioSet, Kinetics-400 and ImageNet-Captions. Finally, we demonstrate that these interventions better utilize additional modalities, if present, to achieve competitive results of 44.2 mAP on AudioSet 20K.

Text-guided image editing has seen rapid progress in natural image domains, but its adaptation to medical imaging remains limited and lacks standardized evaluation. Clinically, such editing holds promise for simulating surgical outcomes, creating personalized teaching materials, and enhancing patient communication. To bridge this gap, we introduce MedEBench, a comprehensive benchmark for evaluating text-guided medical image editing. It consists of 1,182 clinically sourced image-prompt triplets spanning 70 tasks across 13 anatomical regions. MedEBench offers three key contributions: (1) a clinically relevant evaluation framework covering Editing Accuracy, Contextual Preservation, and Visual Quality, supported by detailed descriptions of expected change and ROI (Region of Interest) masks; (2) a systematic comparison of seven state-of-the-art models, revealing common failure patterns; and (3) a failure analysis protocol based on attention grounding, using IoU between attention maps and ROIs to identify mislocalization. MedEBench provides a solid foundation for developing and evaluating reliable, clinically meaningful medical image editing systems.

Semantic segmentation methods have advanced significantly. Still, their robustness to real-world perturbations and object types not seen during training remains a challenge, particularly in safety-critical applications. We propose a novel approach to improve the robustness of semantic segmentation techniques by leveraging the synergy between label-to-image generators and image-to-label segmentation models. Specifically, we design Robusta, a novel robust conditional generative adversarial network to generate realistic and plausible perturbed images that can be used to train reliable segmentation models. We conduct in-depth studies of the proposed generative model, assess the performance and robustness of the downstream segmentation network, and demonstrate that our approach can significantly enhance the robustness in the face of real-world perturbations, distribution shifts, and out-of-distribution samples. Our results suggest that this approach could be valuable in safety-critical applications, where the reliability of perception modules such as semantic segmentation is of utmost importance and comes with a limited computational budget in inference. We release our code at https://github.com/ENSTA-U2IS/robusta.

The emergence of large multimodal models has unlocked remarkable potential in AI, particularly in pathology. However, the lack of specialized, high-quality benchmark impeded their development and precise evaluation. To address this, we introduce PathMMU, the largest and highest-quality expert-validated pathology benchmark for LMMs. It comprises 33,573 multimodal multi-choice questions and 21,599 images from various sources, and an explanation for the correct answer accompanies each question. The construction of PathMMU capitalizes on the robust capabilities of GPT-4V, utilizing approximately 30,000 gathered image-caption pairs to generate Q\&As. Significantly, to maximize PathMMU's authority, we invite six pathologists to scrutinize each question under strict standards in PathMMU's validation and test sets, while simultaneously setting an expert-level performance benchmark for PathMMU. We conduct extensive evaluations, including zero-shot assessments of 14 open-sourced and three closed-sourced LMMs and their robustness to image corruption. We also fine-tune representative LMMs to assess their adaptability to PathMMU. The empirical findings indicate that advanced LMMs struggle with the challenging PathMMU benchmark, with the top-performing LMM, GPT-4V, achieving only a 51.7\% zero-shot performance, significantly lower than the 71.4\% demonstrated by human pathologists. After fine-tuning, even open-sourced LMMs can surpass GPT-4V with a performance of over 60\%, but still fall short of the expertise shown by pathologists. We hope that the PathMMU will offer valuable insights and foster the development of more specialized, next-generation LLMs for pathology.

Large-scale multi-modal deep learning models have revolutionized domains such as healthcare, highlighting the importance of computational power. However, in resource-constrained regions like Low and Middle-Income Countries (LMICs), limited access to GPUs and data poses significant challenges, often leaving CPUs as the sole resource. To address this, we advocate for leveraging vector embeddings to enable flexible and efficient computational methodologies, democratizing multimodal deep learning across diverse contexts. Our paper investigates the efficiency and effectiveness of using vector embeddings from single-modal foundation models and multi-modal Vision-Language Models (VLMs) for multimodal deep learning in low-resource environments, particularly in healthcare. Additionally, we propose a simple yet effective inference-time method to enhance performance by aligning image-text embeddings. Comparing these approaches with traditional methods, we assess their impact on computational efficiency and model performance using metrics like accuracy, F1-score, inference time, training time, and memory usage across three medical modalities: BRSET (ophthalmology), HAM10000 (dermatology), and SatelliteBench (public health). Our findings show that embeddings reduce computational demands without compromising model performance. Furthermore, our alignment method improves performance in medical tasks. This research promotes sustainable AI practices by optimizing resources in constrained environments, highlighting the potential of embedding-based approaches for efficient multimodal learning. Vector embeddings democratize multimodal deep learning in LMICs, particularly in healthcare, enhancing AI adaptability in varied use cases.

Zero-shot models like CLIP are often fine-tuned on a target dataset to improve its accuracy further, but this can compromise out-of-distribution (OOD) robustness. Robust Fine-Tuning (RFT )~wortsman2021robust, which interpolates between the zero-shot and fine-tuned models, has been proposed to address this issue. However, understanding when RFT actually improves OOD error remains limited. In this work, we empirically investigate the robustness of RFT in CLIP models, with a focus on the sharpness of the CLIP model during interpolation. First, we demonstrate that while sharpness may not serve as a reliable indicator for predicting the generalization of modern architectures like CLIP on OOD data, this challenges the conventional belief in the generalization benefits of flat minima in foundation models. However, by examining the role of the straggler layer phenomenon, we show that, unlike overall sharpness, the layer-wise sharpness of straggler layers can reliably capture the generalization performance of interpolated CLIP models on OOD data. Our extensive experiments reveal that layer-wise sharpness correlates with generalization in OOD accuracy for RFT. Furthermore, we demonstrate that by inducing sparsity in the straggler layers, we can mitigate the failure mode phenomenon in RFT. To the best of our knowledge, this is the first work to study the role of sharpness in the success of interpolation in the weight space of CLIP foundation models. Our code is available at https://github.com/alirezaabdollahpour/CLIP_Mode_Connectivity.

A recent trend in deep learning algorithms has been towards training large scale models, having high parameter count and trained on big dataset. However, robustness of such large scale models towards real-world settings is still a less-explored topic. In this work, we first benchmark the performance of these models under different perturbations and datasets thereby representing real-world shifts, and highlight their degrading performance under these shifts. We then discuss on how complete model fine-tuning based existing robustification schemes might not be a scalable option given very large scale networks and can also lead them to forget some of the desired characterstics. Finally, we propose a simple and cost-effective method to solve this problem, inspired by knowledge transfer literature. It involves robustifying smaller models, at a lower computation cost, and then use them as teachers to tune a fraction of these large scale networks, reducing the overall computational overhead. We evaluate our proposed method under various vision perturbations including ImageNet-C,R,S,A datasets and also for transfer learning, zero-shot evaluation setups on different datasets. Benchmark results show that our method is able to induce robustness to these large scale models efficiently, requiring significantly lower time and also preserves the transfer learning, zero-shot properties of the original model which none of the existing methods are able to achieve.

Contrastive learning methods, such as CLIP, leverage naturally paired data-for example, images and their corresponding text captions-to learn general representations that transfer efficiently to downstream tasks. While such approaches are generally applied to two modalities, domains such as robotics, healthcare, and video need to support many types of data at once. We show that the pairwise application of CLIP fails to capture joint information between modalities, thereby limiting the quality of the learned representations. To address this issue, we present Symile, a simple contrastive learning approach that captures higher-order information between any number of modalities. Symile provides a flexible, architecture-agnostic objective for learning modality-specific representations. To develop Symile's objective, we derive a lower bound on total correlation, and show that Symile representations for any set of modalities form a sufficient statistic for predicting the remaining modalities. Symile outperforms pairwise CLIP, even with modalities missing in the data, on cross-modal classification and retrieval across several experiments including on an original multilingual dataset of 33M image, text and audio samples and a clinical dataset of chest X-rays, electrocardiograms, and laboratory measurements. All datasets and code used in this work are publicly available at https://github.com/rajesh-lab/symile.

General-purpose foundation models have become increasingly important in the field of artificial intelligence. While self-supervised learning (SSL) and Masked Image Modeling (MIM) have led to promising results in building such foundation models for remote sensing, these models primarily learn low-level features, require annotated data for fine-tuning, and not applicable for retrieval and zero-shot applications due to the lack of language understanding. In response to these limitations, we propose RemoteCLIP, the first vision-language foundation model for remote sensing that aims to learn robust visual features with rich semantics, as well as aligned text embeddings for seamless downstream application. To address the scarcity of pre-training data, we leverage data scaling, converting heterogeneous annotations based on Box-to-Caption (B2C) and Mask-to-Box (M2B) conversion, and further incorporating UAV imagery, resulting a 12xlarger pretraining dataset. RemoteCLIP can be applied to a variety of downstream tasks, including zero-shot image classification, linear probing, k-NN classification, few-shot classification, image-text retrieval, and object counting. Evaluations on 16 datasets, including a newly introduced RemoteCount benchmark to test the object counting ability, show that RemoteCLIP consistently outperforms baseline foundation models across different model scales. Impressively, RemoteCLIP outperform previous SoTA by 9.14% mean recall on RSICD dataset and by 8.92% on RSICD dataset. For zero-shot classification, our RemoteCLIP outperform CLIP baseline by up to 6.39% average accuracy on 12 downstream datasets.

We present an approach to estimating camera rotation in crowded, real-world scenes from handheld monocular video. While camera rotation estimation is a well-studied problem, no previous methods exhibit both high accuracy and acceptable speed in this setting. Because the setting is not addressed well by other datasets, we provide a new dataset and benchmark, with high-accuracy, rigorously verified ground truth, on 17 video sequences. Methods developed for wide baseline stereo (e.g., 5-point methods) perform poorly on monocular video. On the other hand, methods used in autonomous driving (e.g., SLAM) leverage specific sensor setups, specific motion models, or local optimization strategies (lagging batch processing) and do not generalize well to handheld video. Finally, for dynamic scenes, commonly used robustification techniques like RANSAC require large numbers of iterations, and become prohibitively slow. We introduce a novel generalization of the Hough transform on SO(3) to efficiently and robustly find the camera rotation most compatible with optical flow. Among comparably fast methods, ours reduces error by almost 50\% over the next best, and is more accurate than any method, irrespective of speed. This represents a strong new performance point for crowded scenes, an important setting for computer vision. The code and the dataset are available at https://fabiendelattre.com/robust-rotation-estimation.

Biomedical data is inherently multimodal, consisting of electronic health records, medical imaging, digital pathology, genome sequencing, wearable sensors, and more. The application of artificial intelligence tools to these multifaceted sensing technologies has the potential to revolutionize the prognosis, diagnosis, and management of human health and disease. However, current approaches to biomedical AI typically only train and evaluate with one or a small set of medical modalities and tasks. This limitation hampers the development of comprehensive tools that can leverage the rich interconnected information across many heterogeneous biomedical sensors. To address this challenge, we present MultiMed, a benchmark designed to evaluate and enable large-scale learning across a wide spectrum of medical modalities and tasks. MultiMed consists of 2.56 million samples across ten medical modalities such as medical reports, pathology, genomics, and protein data, and is structured into eleven challenging tasks, including disease prognosis, protein structure prediction, and medical question answering. Using MultiMed, we conduct comprehensive experiments benchmarking state-of-the-art unimodal, multimodal, and multitask models. Our analysis highlights the advantages of training large-scale medical models across many related modalities and tasks. Moreover, MultiMed enables studies of generalization across related medical concepts, robustness to real-world noisy data and distribution shifts, and novel modality combinations to improve prediction performance. MultiMed will be publicly available and regularly updated and welcomes inputs from the community.

Vision-language models such as CLIP learn a generic text-image embedding from large-scale training data. A vision-language model can be adapted to a new classification task through few-shot prompt tuning. We find that such a prompt tuning process is highly robust to label noises. This intrigues us to study the key reasons contributing to the robustness of the prompt tuning paradigm. We conducted extensive experiments to explore this property and find the key factors are: 1) the fixed classname tokens provide a strong regularization to the optimization of the model, reducing gradients induced by the noisy samples; 2) the powerful pre-trained image-text embedding that is learned from diverse and generic web data provides strong prior knowledge for image classification. Further, we demonstrate that noisy zero-shot predictions from CLIP can be used to tune its own prompt, significantly enhancing prediction accuracy in the unsupervised setting. The code is available at https://github.com/CEWu/PTNL.

As advances in large language models (LLMs) and multimodal techniques continue to mature, the development of general-purpose multimodal large language models (MLLMs) has surged, offering significant applications in interpreting natural images. However, the field of pathology has largely remained untapped, particularly in gathering high-quality data and designing comprehensive model frameworks. To bridge the gap in pathology MLLMs, we present PathAsst, a multimodal generative foundation AI assistant to revolutionize diagnostic and predictive analytics in pathology. The development of PathAsst involves three pivotal steps: data acquisition, CLIP model adaptation, and the training of PathAsst's multimodal generative capabilities. Firstly, we collect over 207K high-quality pathology image-text pairs from authoritative sources. Leveraging the advanced power of ChatGPT, we generate over 180K instruction-following samples. Furthermore, we devise additional instruction-following data specifically tailored for invoking eight pathology-specific sub-models we prepared, allowing the PathAsst to effectively collaborate with these models, enhancing its diagnostic ability. Secondly, by leveraging the collected data, we construct PathCLIP, a pathology-dedicated CLIP, to enhance PathAsst's capabilities in interpreting pathology images. Finally, we integrate PathCLIP with the Vicuna-13b and utilize pathology-specific instruction-tuning data to enhance the multimodal generation capacity of PathAsst and bolster its synergistic interactions with sub-models. The experimental results of PathAsst show the potential of harnessing AI-powered generative foundation model to improve pathology diagnosis and treatment processes.

Knowing the features of a complex system that are highly relevant to a particular target variable is of fundamental interest in many areas of science. Existing approaches are often limited to linear settings, sometimes lack guarantees, and in most cases, do not scale to the problem at hand, in particular to images. We propose DRCFS, a doubly robust feature selection method for identifying the causal features even in nonlinear and high dimensional settings. We provide theoretical guarantees, illustrate necessary conditions for our assumptions, and perform extensive experiments across a wide range of simulated and semi-synthetic datasets. DRCFS significantly outperforms existing state-of-the-art methods, selecting robust features even in challenging highly non-linear and high-dimensional problems.

Recently a number of studies demonstrated impressive performance on diverse vision-language multi-modal tasks such as image captioning and visual question answering by extending the BERT architecture with multi-modal pre-training objectives. In this work we explore a broad set of multi-modal representation learning tasks in the medical domain, specifically using radiology images and the unstructured report. We propose Medical Vision Language Learner (MedViLL), which adopts a BERT-based architecture combined with a novel multi-modal attention masking scheme to maximize generalization performance for both vision-language understanding tasks (diagnosis classification, medical image-report retrieval, medical visual question answering) and vision-language generation task (radiology report generation). By statistically and rigorously evaluating the proposed model on four downstream tasks with three radiographic image-report datasets (MIMIC-CXR, Open-I, and VQA-RAD), we empirically demonstrate the superior downstream task performance of MedViLL against various baselines, including task-specific architectures. The source code is publicly available at: https://github.com/SuperSupermoon/MedViLL

Contrastive Language-Image Pre-training (CLIP) is an approach that has advanced research and applications in computer vision, fueling modern recognition systems and generative models. We believe that the main ingredient to the success of CLIP is its data and not the model architecture or pre-training objective. However, CLIP only provides very limited information about its data and how it has been collected, leading to works that aim to reproduce CLIP's data by filtering with its model parameters. In this work, we intend to reveal CLIP's data curation approach and in our pursuit of making it open to the community introduce Metadata-Curated Language-Image Pre-training (MetaCLIP). MetaCLIP takes a raw data pool and metadata (derived from CLIP's concepts) and yields a balanced subset over the metadata distribution. Our experimental study rigorously isolates the model and training settings, concentrating solely on data. MetaCLIP applied to CommonCrawl with 400M image-text data pairs outperforms CLIP's data on multiple standard benchmarks. In zero-shot ImageNet classification, MetaCLIP achieves 70.8% accuracy, surpassing CLIP's 68.3% on ViT-B models. Scaling to 1B data, while maintaining the same training budget, attains 72.4%. Our observations hold across various model sizes, exemplified by ViT-H achieving 80.5%, without any bells-and-whistles. Curation code and training data distribution on metadata is made available at https://github.com/facebookresearch/MetaCLIP.

Surgical scene segmentation is critical in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, referring surgical segmentation is emerging, given its advantage of providing surgeons with an interactive experience to segment the target object. However, existing methods are limited by low efficiency and short-term tracking, hindering their applicability in complex real-world surgical scenarios. In this paper, we introduce ReSurgSAM2, a two-stage surgical referring segmentation framework that leverages Segment Anything Model 2 to perform text-referred target detection, followed by tracking with reliable initial frame identification and diversity-driven long-term memory. For the detection stage, we propose a cross-modal spatial-temporal Mamba to generate precise detection and segmentation results. Based on these results, our credible initial frame selection strategy identifies the reliable frame for the subsequent tracking. Upon selecting the initial frame, our method transitions to the tracking stage, where it incorporates a diversity-driven memory mechanism that maintains a credible and diverse memory bank, ensuring consistent long-term tracking. Extensive experiments demonstrate that ReSurgSAM2 achieves substantial improvements in accuracy and efficiency compared to existing methods, operating in real-time at 61.2 FPS. Our code and datasets will be available at https://github.com/jinlab-imvr/ReSurgSAM2.

Foundation models in computational pathology promise to unlock the development of new clinical decision support systems and models for precision medicine. However, there is a mismatch between most clinical analysis, which is defined at the level of one or more whole slide images, and foundation models to date, which process the thousands of image tiles contained in a whole slide image separately. The requirement to train a network to aggregate information across a large number of tiles in multiple whole slide images limits these models' impact. In this work, we present a slide-level foundation model for H&E-stained histopathology, PRISM, that builds on Virchow tile embeddings and leverages clinical report text for pre-training. Using the tile embeddings, PRISM produces slide-level embeddings with the ability to generate clinical reports, resulting in several modes of use. Using text prompts, PRISM achieves zero-shot cancer detection and sub-typing performance approaching and surpassing that of a supervised aggregator model. Using the slide embeddings with linear classifiers, PRISM surpasses supervised aggregator models. Furthermore, we demonstrate that fine-tuning of the PRISM slide encoder yields label-efficient training for biomarker prediction, a task that typically suffers from low availability of training data; an aggregator initialized with PRISM and trained on as little as 10% of the training data can outperform a supervised baseline that uses all of the data.

Multi-modal information retrieval (MMIR) is a rapidly evolving field, where significant progress, particularly in image-text pairing, has been made through advanced representation learning and cross-modality alignment research. However, current benchmarks for evaluating MMIR performance in image-text pairing within the scientific domain show a notable gap, where chart and table images described in scholarly language usually do not play a significant role. To bridge this gap, we develop a specialised scientific MMIR (SciMMIR) benchmark by leveraging open-access paper collections to extract data relevant to the scientific domain. This benchmark comprises 530K meticulously curated image-text pairs, extracted from figures and tables with detailed captions in scientific documents. We further annotate the image-text pairs with two-level subset-subcategory hierarchy annotations to facilitate a more comprehensive evaluation of the baselines. We conducted zero-shot and fine-tuning evaluations on prominent multi-modal image-captioning and visual language models, such as CLIP and BLIP. Our analysis offers critical insights for MMIR in the scientific domain, including the impact of pre-training and fine-tuning settings and the influence of the visual and textual encoders. All our data and checkpoints are publicly available at https://github.com/Wusiwei0410/SciMMIR.

The popular CLIP model displays impressive zero-shot capabilities thanks to its seamless interaction with arbitrary text prompts. However, its lack of spatial awareness makes it unsuitable for dense computer vision tasks, e.g., semantic segmentation, without an additional fine-tuning step that often uses annotations and can potentially suppress its original open-vocabulary properties. Meanwhile, self-supervised representation methods have demonstrated good localization properties without human-made annotations nor explicit supervision. In this work, we take the best of both worlds and propose a zero-shot open-vocabulary semantic segmentation method, which does not require any annotations. We propose to locally improve dense MaskCLIP features, computed with a simple modification of CLIP's last pooling layer, by integrating localization priors extracted from self-supervised features. By doing so, we greatly improve the performance of MaskCLIP and produce smooth outputs. Moreover, we show that the used self-supervised feature properties can directly be learnt from CLIP features therefore allowing us to obtain the best results with a single pass through CLIP model. Our method CLIP-DINOiser needs only a single forward pass of CLIP and two light convolutional layers at inference, no extra supervision nor extra memory and reaches state-of-the-art results on challenging and fine-grained benchmarks such as COCO, Pascal Context, Cityscapes and ADE20k. The code to reproduce our results is available at https://github.com/wysoczanska/clip_dinoiser.

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.

Segment anything model (SAM) has revolutionized natural image segmentation, but its performance on medical images is limited. This work presents MedSAM, the first attempt at extending the success of SAM to medical images, with the goal of creating a universal tool for the segmentation of various medical targets. Specifically, we first curate a large-scale medical image dataset, encompassing over 200,000 masks across 11 different modalities. Then, we develop a simple fine-tuning method to adapt SAM to general medical image segmentation. Comprehensive experiments on 21 3D segmentation tasks and 9 2D segmentation tasks demonstrate that MedSAM outperforms the default SAM model with an average Dice Similarity Coefficient (DSC) of 22.5% and 17.6% on 3D and 2D segmentation tasks, respectively. The code and trained model are publicly available at https://github.com/bowang-lab/MedSAM.

The COVID-19 pandemic has underscored the need for low-cost, scalable approaches to measuring contactless vital signs, either during initial triage at a healthcare facility or virtual telemedicine visits. Remote photoplethysmography (rPPG) can accurately estimate heart rate (HR) when applied to close-up videos of healthy volunteers in well-lit laboratory settings. However, results from such highly optimized laboratory studies may not be readily translated to healthcare settings. One significant barrier to the practical application of rPPG in health care is the accurate localization of the region of interest (ROI). Clinical or telemedicine visits may involve sub-optimal lighting, movement artifacts, variable camera angle, and subject distance. This paper presents an rPPG ROI selection method based on 3D facial landmarks and patient head yaw angle. We then demonstrate the robustness of this ROI selection method when coupled to the Plane-Orthogonal-to-Skin (POS) rPPG method when applied to videos of patients presenting to an Emergency Department for respiratory complaints. Our results demonstrate the effectiveness of our proposed approach in improving the accuracy and robustness of rPPG in a challenging clinical environment.

Machine learning systems often experience a distribution shift between training and testing. In this paper, we introduce a simple variational objective whose optima are exactly the set of all representations on which risk minimizers are guaranteed to be robust to any distribution shift that preserves the Bayes predictor, e.g., covariate shifts. Our objective has two components. First, a representation must remain discriminative for the task, i.e., some predictor must be able to simultaneously minimize the source and target risk. Second, the representation's marginal support needs to be the same across source and target. We make this practical by designing self-supervised objectives that only use unlabelled data and augmentations to train robust representations. Our objectives give insights into the robustness of CLIP, and further improve CLIP's representations to achieve SOTA results on DomainBed.

Recent advances in vision language models (VLMs) have enabled broad progress in the general medical field. However, pathology still remains a more challenging subdomain, with current pathology specific VLMs exhibiting limitations in both diagnostic accuracy and reasoning plausibility. Such shortcomings are largely attributable to the nature of current pathology datasets, which are primarily composed of image description pairs that lack the depth and structured diagnostic paradigms employed by real world pathologists. In this study, we leverage pathology textbooks and real world pathology experts to construct high-quality, reasoning-oriented datasets. Building on this, we introduce Patho-R1, a multimodal RL-based pathology Reasoner, trained through a three-stage pipeline: (1) continued pretraining on 3.5 million image-text pairs for knowledge infusion; (2) supervised fine-tuning on 500k high-quality Chain-of-Thought samples for reasoning incentivizing; (3) reinforcement learning using Group Relative Policy Optimization and Decoupled Clip and Dynamic sAmpling Policy Optimization strategies for multimodal reasoning quality refinement. To further assess the alignment quality of our dataset, we propose PathoCLIP, trained on the same figure-caption corpus used for continued pretraining. Comprehensive experimental results demonstrate that both PathoCLIP and Patho-R1 achieve robust performance across a wide range of pathology-related tasks, including zero-shot classification, cross-modal retrieval, Visual Question Answering, and Multiple Choice Question. Our project is available at the Patho-R1 repository: https://github.com/Wenchuan-Zhang/Patho-R1.

The remarkable success of deep learning in recent years has prompted applications in medical image classification and diagnosis tasks. While classification models have demonstrated robustness in classifying simpler datasets like MNIST or natural images such as ImageNet, this resilience is not consistently observed in complex medical image datasets where data is more scarce and lacks diversity. Moreover, previous findings on natural image datasets have indicated a potential trade-off between data likelihood and classification accuracy. In this study, we explore the use of score-based generative models as classifiers for medical images, specifically mammographic images. Our findings suggest that our proposed generative classifier model not only achieves superior classification results on CBIS-DDSM, INbreast and Vin-Dr Mammo datasets, but also introduces a novel approach to image classification in a broader context. Our code is publicly available at https://github.com/sushmitasarker/sgc_for_medical_image_classification

This paper introduces BiMediX2, a bilingual (Arabic-English) Bio-Medical EXpert Large Multimodal Model (LMM) with a unified architecture that integrates text and visual modalities, enabling advanced image understanding and medical applications. BiMediX2 leverages the Llama3.1 architecture and integrates text and visual capabilities to facilitate seamless interactions in both English and Arabic, supporting text-based inputs and multi-turn conversations involving medical images. The model is trained on an extensive bilingual healthcare dataset consisting of 1.6M samples of diverse medical interactions for both text and image modalities, mixed in Arabic and English. We also propose the first bilingual GPT-4o based medical LMM benchmark named BiMed-MBench. BiMediX2 is benchmarked on both text-based and image-based tasks, achieving state-of-the-art performance across several medical benchmarks. It outperforms recent state-of-the-art models in medical LLM evaluation benchmarks. Our model also sets a new benchmark in multimodal medical evaluations with over 9% improvement in English and over 20% in Arabic evaluations. Additionally, it surpasses GPT-4 by around 9% in UPHILL factual accuracy evaluations and excels in various medical Visual Question Answering, Report Generation, and Report Summarization tasks. The project page including source code and the trained model, is available at https://github.com/mbzuai-oryx/BiMediX2.

LLMs have become increasingly capable at accomplishing a range of specialized-tasks and can be utilized to expand equitable access to medical knowledge. Most medical LLMs have involved extensive fine-tuning, leveraging specialized medical data and significant, thus costly, amounts of computational power. Many of the top performing LLMs are proprietary and their access is limited to very few research groups. However, open-source (OS) models represent a key area of growth for medical LLMs due to significant improvements in performance and an inherent ability to provide the transparency and compliance required in healthcare. We present OpenMedLM, a prompting platform which delivers state-of-the-art (SOTA) performance for OS LLMs on medical benchmarks. We evaluated a range of OS foundation LLMs (7B-70B) on four medical benchmarks (MedQA, MedMCQA, PubMedQA, MMLU medical-subset). We employed a series of prompting strategies, including zero-shot, few-shot, chain-of-thought (random selection and kNN selection), and ensemble/self-consistency voting. We found that OpenMedLM delivers OS SOTA results on three common medical LLM benchmarks, surpassing the previous best performing OS models that leveraged computationally costly extensive fine-tuning. The model delivers a 72.6% accuracy on the MedQA benchmark, outperforming the previous SOTA by 2.4%, and achieves 81.7% accuracy on the MMLU medical-subset, establishing itself as the first OS LLM to surpass 80% accuracy on this benchmark. Our results highlight medical-specific emergent properties in OS LLMs which have not yet been documented to date elsewhere, and showcase the benefits of further leveraging prompt engineering to improve the performance of accessible LLMs for medical applications.

Interstitial lung diseases (ILD) present diagnostic challenges due to their varied manifestations and overlapping imaging features. To address this, we propose a machine learning approach that utilizes CLIP, a multimodal (image and text) self-supervised model, for ILD classification. We extensively integrate zero-shot CLIP throughout our workflow, starting from the initial extraction of image patches from volumetric CT scans and proceeding to ILD classification using "patch montages". Furthermore, we investigate how domain adaptive pretraining (DAPT) CLIP with task-specific images (CT "patch montages" extracted with ILD-specific prompts for CLIP) and/or text (lung-specific sections of radiology reports) affects downstream ILD classification performance. By leveraging CLIP-extracted "patch montages" and DAPT, we achieve strong zero-shot ILD classification results, including an AUROC of 0.893, without the need for any labeled training data. This work highlights the versatility and potential of multimodal models like CLIP for medical image classification tasks where labeled data is scarce.

Precision medicine, such as patient-adaptive treatments assisted by medical image analysis, poses new challenges for segmentation algorithms in adapting to new patients, due to the large variability across different patients and the limited availability of annotated data for each patient. In this work, we propose a data-efficient segmentation algorithm, namely Part-aware Prompted Segment Anything Model (P^2SAM). Without any model fine-tuning, P^2SAM enables seamless adaptation to any new patients relying only on one-shot patient-specific data. We introduce a novel part-aware prompt mechanism to select multiple-point prompts based on the part-level features of the one-shot data, which can be extensively integrated into different promptable segmentation models, such as SAM and SAM 2. Moreover, to determine the optimal number of parts for each specific case, we propose a distribution-guided retrieval approach that further enhances the robustness of the part-aware prompt mechanism. P^2SAM improves the performance by +8.0% and +2.0% mean Dice score for two different patient-adaptive segmentation applications, respectively. In addition, P^2SAM also exhibits impressive generalizability in other adaptive segmentation tasks in the natural image domain, e.g., +6.4% mIoU within personalized object segmentation task. The code is available at: https://github.com/Zch0414/p2sam

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

3D pose estimation is an invaluable task in computer vision with various practical applications. Especially, 3D pose estimation for multi-person from a monocular video (3DMPPE) is particularly challenging and is still largely uncharted, far from applying to in-the-wild scenarios yet. We pose three unresolved issues with the existing methods: lack of robustness on unseen views during training, vulnerability to occlusion, and severe jittering in the output. As a remedy, we propose POTR-3D, the first realization of a sequence-to-sequence 2D-to-3D lifting model for 3DMPPE, powered by a novel geometry-aware data augmentation strategy, capable of generating unbounded data with a variety of views while caring about the ground plane and occlusions. Through extensive experiments, we verify that the proposed model and data augmentation robustly generalizes to diverse unseen views, robustly recovers the poses against heavy occlusions, and reliably generates more natural and smoother outputs. The effectiveness of our approach is verified not only by achieving the state-of-the-art performance on public benchmarks, but also by qualitative results on more challenging in-the-wild videos. Demo videos are available at https://www.youtube.com/@potr3d.

Visual anomaly classification and segmentation are vital for automating industrial quality inspection. The focus of prior research in the field has been on training custom models for each quality inspection task, which requires task-specific images and annotation. In this paper we move away from this regime, addressing zero-shot and few-normal-shot anomaly classification and segmentation. Recently CLIP, a vision-language model, has shown revolutionary generality with competitive zero-/few-shot performance in comparison to full-supervision. But CLIP falls short on anomaly classification and segmentation tasks. Hence, we propose window-based CLIP (WinCLIP) with (1) a compositional ensemble on state words and prompt templates and (2) efficient extraction and aggregation of window/patch/image-level features aligned with text. We also propose its few-normal-shot extension WinCLIP+, which uses complementary information from normal images. In MVTec-AD (and VisA), without further tuning, WinCLIP achieves 91.8%/85.1% (78.1%/79.6%) AUROC in zero-shot anomaly classification and segmentation while WinCLIP+ does 93.1%/95.2% (83.8%/96.4%) in 1-normal-shot, surpassing state-of-the-art by large margins.

Randomized Smoothing (RS) has been proven a promising method for endowing an arbitrary image classifier with certified robustness. However, the substantial uncertainty inherent in the high-dimensional isotropic Gaussian noise imposes the curse of dimensionality on RS. Specifically, the upper bound of {ell_2} certified robustness radius provided by RS exhibits a diminishing trend with the expansion of the input dimension d, proportionally decreasing at a rate of 1/d. This paper explores the feasibility of providing {ell_2} certified robustness for high-dimensional input through the utilization of dual smoothing in the lower-dimensional space. The proposed Dual Randomized Smoothing (DRS) down-samples the input image into two sub-images and smooths the two sub-images in lower dimensions. Theoretically, we prove that DRS guarantees a tight {ell_2} certified robustness radius for the original input and reveal that DRS attains a superior upper bound on the {ell_2} robustness radius, which decreases proportionally at a rate of (1/sqrt m + 1/sqrt n ) with m+n=d. Extensive experiments demonstrate the generalizability and effectiveness of DRS, which exhibits a notable capability to integrate with established methodologies, yielding substantial improvements in both accuracy and {ell_2} certified robustness baselines of RS on the CIFAR-10 and ImageNet datasets. Code is available at https://github.com/xiasong0501/DRS.

A major challenge in computational research in 3D medical imaging is the lack of comprehensive datasets. Addressing this issue, our study introduces CT-RATE, the first 3D medical imaging dataset that pairs images with textual reports. CT-RATE consists of 25,692 non-contrast chest CT volumes, expanded to 50,188 through various reconstructions, from 21,304 unique patients, along with corresponding radiology text reports. Leveraging CT-RATE, we developed CT-CLIP, a CT-focused contrastive language-image pre-training framework. As a versatile, self-supervised model, CT-CLIP is designed for broad application and does not require task-specific training. Remarkably, CT-CLIP outperforms state-of-the-art, fully supervised methods in multi-abnormality detection across all key metrics, thus eliminating the need for manual annotation. We also demonstrate its utility in case retrieval, whether using imagery or textual queries, thereby advancing knowledge dissemination. The open-source release of CT-RATE and CT-CLIP marks a significant advancement in medical AI, enhancing 3D imaging analysis and fostering innovation in healthcare.

Contrastive Language--Image Pre-training (CLIP) has manifested remarkable improvements in zero-shot classification and cross-modal vision-language tasks. Yet, from a geometrical point of view, the CLIP embedding space has been found to have a pronounced modality gap. This gap renders the embedding space overly sparse and disconnected, with different modalities being densely distributed in distinct subregions of the hypersphere. In this work, we aim at answering two main questions: 1. Does sharing the parameter space between the multi-modal encoders reduce the modality gap? 2. Can the gap be mitigated by pushing apart the uni-modal embeddings via intra-modality separation? We design AlignCLIP, in order to answer these questions and show that answers to both questions are positive. Through extensive experiments, we show that AlignCLIP achieves noticeable enhancements in the cross-modal alignment of the embeddings, and thereby, reduces the modality gap, while maintaining the performance across several downstream evaluations, such as zero-shot image classification, zero-shot multi-modal retrieval and zero-shot semantic text similarity.

The emerging trend of advancing generalist artificial intelligence, such as GPTv4 and Gemini, has reshaped the landscape of research (academia and industry) in machine learning and many other research areas. However, domain-specific applications of such foundation models (e.g., in medicine) remain untouched or often at their very early stages. It will require an individual set of transfer learning and model adaptation techniques by further expanding and injecting these models with domain knowledge and data. The development of such technologies could be largely accelerated if the bundle of data, algorithms, and pre-trained foundation models were gathered together and open-sourced in an organized manner. In this work, we present OpenMEDLab, an open-source platform for multi-modality foundation models. It encapsulates not only solutions of pioneering attempts in prompting and fine-tuning large language and vision models for frontline clinical and bioinformatic applications but also building domain-specific foundation models with large-scale multi-modal medical data. Importantly, it opens access to a group of pre-trained foundation models for various medical image modalities, clinical text, protein engineering, etc. Inspiring and competitive results are also demonstrated for each collected approach and model in a variety of benchmarks for downstream tasks. We welcome researchers in the field of medical artificial intelligence to continuously contribute cutting-edge methods and models to OpenMEDLab, which can be accessed via https://github.com/openmedlab.

The Segment Anything Model 2 (SAM 2) is the latest generation foundation model for image and video segmentation. Trained on the expansive Segment Anything Video (SA-V) dataset, which comprises 35.5 million masks across 50.9K videos, SAM 2 advances its predecessor's capabilities by supporting zero-shot segmentation through various prompts (e.g., points, boxes, and masks). Its robust zero-shot performance and efficient memory usage make SAM 2 particularly appealing for surgical tool segmentation in videos, especially given the scarcity of labeled data and the diversity of surgical procedures. In this study, we evaluate the zero-shot video segmentation performance of the SAM 2 model across different types of surgeries, including endoscopy and microscopy. We also assess its performance on videos featuring single and multiple tools of varying lengths to demonstrate SAM 2's applicability and effectiveness in the surgical domain. We found that: 1) SAM 2 demonstrates a strong capability for segmenting various surgical videos; 2) When new tools enter the scene, additional prompts are necessary to maintain segmentation accuracy; and 3) Specific challenges inherent to surgical videos can impact the robustness of SAM 2.

Vision-language models (VLMs) have advanced reasoning in natural scenes, but their role in medical imaging remains underexplored. Medical reasoning tasks demand robust image analysis and well-justified answers, posing challenges due to the complexity of medical images. Transparency and trustworthiness are essential for clinical adoption and regulatory compliance. We introduce Med-R1, a framework exploring reinforcement learning (RL) to enhance VLMs' generalizability and trustworthiness in medical reasoning. Leveraging the DeepSeek strategy, we employ Group Relative Policy Optimization (GRPO) to guide reasoning paths via reward signals. Unlike supervised fine-tuning (SFT), which often overfits and lacks generalization, RL fosters robust and diverse reasoning. Med-R1 is evaluated across eight medical imaging modalities: CT, MRI, Ultrasound, Dermoscopy, Fundus Photography, Optical Coherence Tomography (OCT), Microscopy, and X-ray Imaging. Compared to its base model, Qwen2-VL-2B, Med-R1 achieves a 29.94% accuracy improvement and outperforms Qwen2-VL-72B, which has 36 times more parameters. Testing across five question types-modality recognition, anatomy identification, disease diagnosis, lesion grading, and biological attribute analysis Med-R1 demonstrates superior generalization, exceeding Qwen2-VL-2B by 32.06% and surpassing Qwen2-VL-72B in question-type generalization. These findings show that RL improves medical reasoning and enables parameter-efficient models to outperform significantly larger ones. With interpretable reasoning outputs, Med-R1 represents a promising step toward generalizable, trustworthy, and clinically viable medical VLMs.

Deep learning algorithms have shown promising results in visual question answering (VQA) tasks, but a more careful look reveals that they often do not understand the rich signal they are being fed with. To understand and better measure the generalization capabilities of VQA systems, we look at their robustness to counterfactually augmented data. Our proposed augmentations are designed to make a focused intervention on a specific property of the question such that the answer changes. Using these augmentations, we propose a new robustness measure, Robustness to Augmented Data (RAD), which measures the consistency of model predictions between original and augmented examples. Through extensive experimentation, we show that RAD, unlike classical accuracy measures, can quantify when state-of-the-art systems are not robust to counterfactuals. We find substantial failure cases which reveal that current VQA systems are still brittle. Finally, we connect between robustness and generalization, demonstrating the predictive power of RAD for performance on unseen augmentations.

Medical Visual Language Models have shown great potential in various healthcare applications, including medical image captioning and diagnostic assistance. However, most existing models rely on text-based instructions, limiting their usability in real-world clinical environments especially in scenarios such as surgery, text-based interaction is often impractical for physicians. In addition, current medical image analysis models typically lack comprehensive reasoning behind their predictions, which reduces their reliability for clinical decision-making. Given that medical diagnosis errors can have life-changing consequences, there is a critical need for interpretable and rational medical assistance. To address these challenges, we introduce an end-to-end speech-driven medical VLM, SilVar-Med, a multimodal medical image assistant that integrates speech interaction with VLMs, pioneering the task of voice-based communication for medical image analysis. In addition, we focus on the interpretation of the reasoning behind each prediction of medical abnormalities with a proposed reasoning dataset. Through extensive experiments, we demonstrate a proof-of-concept study for reasoning-driven medical image interpretation with end-to-end speech interaction. We believe this work will advance the field of medical AI by fostering more transparent, interactive, and clinically viable diagnostic support systems. Our code and dataset are publicly available at SiVar-Med.

Medical image segmentation has immense clinical applicability but remains a challenge despite advancements in deep learning. The Segment Anything Model (SAM) exhibits potential in this field, yet the requirement for expertise intervention and the domain gap between natural and medical images poses significant obstacles. This paper introduces a novel training-free evidential prompt generation method named EviPrompt to overcome these issues. The proposed method, built on the inherent similarities within medical images, requires only a single reference image-annotation pair, making it a training-free solution that significantly reduces the need for extensive labeling and computational resources. First, to automatically generate prompts for SAM in medical images, we introduce an evidential method based on uncertainty estimation without the interaction of clinical experts. Then, we incorporate the human prior into the prompts, which is vital for alleviating the domain gap between natural and medical images and enhancing the applicability and usefulness of SAM in medical scenarios. EviPrompt represents an efficient and robust approach to medical image segmentation, with evaluations across a broad range of tasks and modalities confirming its efficacy.

In this work, we address the challenge of developing automatic evaluation metrics for image captioning, with a particular focus on robustness against hallucinations. Existing metrics are often inadequate for handling hallucinations, primarily due to their limited ability to compare candidate captions with multifaceted reference captions. To address this shortcoming, we propose DENEB, a novel supervised automatic evaluation metric specifically robust against hallucinations. DENEB incorporates the Sim-Vec Transformer, a mechanism that processes multiple references simultaneously, thereby efficiently capturing the similarity between an image, a candidate caption, and reference captions. To train DENEB, we construct the diverse and balanced Nebula dataset comprising 32,978 images, paired with human judgments provided by 805 annotators. We demonstrated that DENEB achieves state-of-the-art performance among existing LLM-free metrics on the FOIL, Composite, Flickr8K-Expert, Flickr8K-CF, Nebula, and PASCAL-50S datasets, validating its effectiveness and robustness against hallucinations.

In this study, we aim to initiate the development of Radiology Foundation Model, termed as RadFM.We consider the construction of foundational models from the perspectives of data, model design, and evaluation thoroughly. Our contribution can be concluded as follows: (i), we construct a large-scale Medical Multi-modal Dataset, MedMD, consisting of 16M 2D and 3D medical scans. To the best of our knowledge, this is the first multi-modal dataset containing 3D medical scans. (ii), We propose an architecture that enables visually conditioned generative pre-training, allowing for the integration of text input interleaved with 2D or 3D medical scans to generate response for diverse radiologic tasks. The model was initially pre-trained on MedMD and subsequently domain-specific fine-tuned on RadMD, a radiologic cleaned version of MedMD, containing 3M radiologic visual-language pairs. (iii), we propose a new evaluation benchmark that comprises five tasks, aiming to comprehensively assess the capability of foundation models in handling practical clinical problems. Our experimental results confirm that RadFM significantly outperforms existing multi-modal foundation models. The codes, data, and model checkpoint will all be made publicly available to promote further research and development in the field.

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%.

Multi-modal models have shown a promising capability to effectively integrate information from various sources, yet meanwhile, they are found vulnerable to pervasive perturbations, such as uni-modal attacks and missing conditions. To counter these perturbations, robust multi-modal representations are highly expected, which are positioned well away from the discriminative multi-modal decision boundary. In this paper, different from conventional empirical studies, we focus on a commonly used joint multi-modal framework and theoretically discover that larger uni-modal representation margins and more reliable integration for modalities are essential components for achieving higher robustness. This discovery can further explain the limitation of multi-modal robustness and the phenomenon that multi-modal models are often vulnerable to attacks on the specific modality. Moreover, our analysis reveals how the widespread issue, that the model has different preferences for modalities, limits the multi-modal robustness by influencing the essential components and could lead to attacks on the specific modality highly effective. Inspired by our theoretical finding, we introduce a training procedure called Certifiable Robust Multi-modal Training (CRMT), which can alleviate this influence from modality preference and explicitly regulate essential components to significantly improve robustness in a certifiable manner. Our method demonstrates substantial improvements in performance and robustness compared with existing methods. Furthermore, our training procedure can be easily extended to enhance other robust training strategies, highlighting its credibility and flexibility.

We introduce a robust, real-time, high-resolution human video matting method that achieves new state-of-the-art performance. Our method is much lighter than previous approaches and can process 4K at 76 FPS and HD at 104 FPS on an Nvidia GTX 1080Ti GPU. Unlike most existing methods that perform video matting frame-by-frame as independent images, our method uses a recurrent architecture to exploit temporal information in videos and achieves significant improvements in temporal coherence and matting quality. Furthermore, we propose a novel training strategy that enforces our network on both matting and segmentation objectives. This significantly improves our model's robustness. Our method does not require any auxiliary inputs such as a trimap or a pre-captured background image, so it can be widely applied to existing human matting applications.

Recent accelerations in multi-modal applications have been made possible with the plethora of image and text data available online. However, the scarcity of analogous data in the medical field, specifically in histopathology, has halted comparable progress. To enable similar representation learning for histopathology, we turn to YouTube, an untapped resource of videos, offering 1,087 hours of valuable educational histopathology videos from expert clinicians. From YouTube, we curate Quilt: a large-scale vision-language dataset consisting of 768,826 image and text pairs. Quilt was automatically curated using a mixture of models, including large language models, handcrafted algorithms, human knowledge databases, and automatic speech recognition. In comparison, the most comprehensive datasets curated for histopathology amass only around 200K samples. We combine Quilt with datasets from other sources, including Twitter, research papers, and the internet in general, to create an even larger dataset: Quilt-1M, with 1M paired image-text samples, marking it as the largest vision-language histopathology dataset to date. We demonstrate the value of Quilt-1M by fine-tuning a pre-trained CLIP model. Our model outperforms state-of-the-art models on both zero-shot and linear probing tasks for classifying new histopathology images across 13 diverse patch-level datasets of 8 different sub-pathologies and cross-modal retrieval tasks.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

Deep learning methods have shown outstanding classification accuracy in medical imaging problems, which is largely attributed to the availability of large-scale datasets manually annotated with clean labels. However, given the high cost of such manual annotation, new medical imaging classification problems may need to rely on machine-generated noisy labels extracted from radiology reports. Indeed, many Chest X-ray (CXR) classifiers have already been modelled from datasets with noisy labels, but their training procedure is in general not robust to noisy-label samples, leading to sub-optimal models. Furthermore, CXR datasets are mostly multi-label, so current noisy-label learning methods designed for multi-class problems cannot be easily adapted. In this paper, we propose a new method designed for the noisy multi-label CXR learning, which detects and smoothly re-labels samples from the dataset, which is then used to train common multi-label classifiers. The proposed method optimises a bag of multi-label descriptors (BoMD) to promote their similarity with the semantic descriptors produced by BERT models from the multi-label image annotation. Our experiments on diverse noisy multi-label training sets and clean testing sets show that our model has state-of-the-art accuracy and robustness in many CXR multi-label classification benchmarks.

Spurious correlations that degrade model generalization or lead the model to be right for the wrong reasons are one of the main robustness concerns for real-world deployments. However, mitigating these correlations during pre-training for large-scale models can be costly and impractical, particularly for those without access to high-performance computing resources. This paper proposes a novel approach to address spurious correlations during fine-tuning for a given domain of interest. With a focus on multi-modal models (e.g., CLIP), the proposed method leverages different modalities in these models to detect and explicitly set apart spurious attributes from the affected class, achieved through a multi-modal contrastive loss function that expresses spurious relationships through language. Our experimental results and in-depth visualizations on CLIP show that such an intervention can effectively i) improve the model's accuracy when spurious attributes are not present, and ii) directs the model's activation maps towards the actual class rather than the spurious attribute when present. In particular, on the Waterbirds dataset, our algorithm achieved a worst-group accuracy 23% higher than ERM on CLIP with a ResNet-50 backbone, and 32% higher on CLIP with a ViT backbone, while maintaining the same average accuracy as ERM.

Cervical disc herniation (CDH) is a prevalent musculoskeletal disorder that significantly impacts health and requires labor-intensive analysis from experts. Despite advancements in automated detection of medical imaging, two significant challenges hinder the real-world application of these methods. First, the computational complexity and resource demands present a significant gap for real-time application. Second, noise in MRI reduces the effectiveness of existing methods by distorting feature extraction. To address these challenges, we propose three key contributions: Firstly, we introduced MedDet, which leverages the multi-teacher single-student knowledge distillation for model compression and efficiency, meanwhile integrating generative adversarial training to enhance performance. Additionally, we customize the second-order nmODE to improve the model's resistance to noise in MRI. Lastly, we conducted comprehensive experiments on the CDH-1848 dataset, achieving up to a 5% improvement in mAP compared to previous methods. Our approach also delivers over 5 times faster inference speed, with approximately 67.8% reduction in parameters and 36.9% reduction in FLOPs compared to the teacher model. These advancements significantly enhance the performance and efficiency of automated CDH detection, demonstrating promising potential for future application in clinical practice. See project website https://steve-zeyu-zhang.github.io/MedDet

Models leveraging both visual and textual data such as Contrastive Language-Image Pre-training (CLIP), are the backbone of many recent advances in artificial intelligence. In this work, we show that despite their versatility, such models are vulnerable to what we refer to as fooling master images. Fooling master images are capable of maximizing the confidence score of a CLIP model for a significant number of widely varying prompts, while being either unrecognizable or unrelated to the attacked prompts for humans. The existence of such images is problematic as it could be used by bad actors to maliciously interfere with CLIP-trained image retrieval models in production with comparably small effort as a single image can attack many different prompts. We demonstrate how fooling master images for CLIP (CLIPMasterPrints) can be mined using stochastic gradient descent, projected gradient descent, or blackbox optimization. Contrary to many common adversarial attacks, the blackbox optimization approach allows us to mine CLIPMasterPrints even when the weights of the model are not accessible. We investigate the properties of the mined images, and find that images trained on a small number of image captions generalize to a much larger number of semantically related captions. We evaluate possible mitigation strategies, where we increase the robustness of the model and introduce an approach to automatically detect CLIPMasterPrints to sanitize the input of vulnerable models. Finally, we find that vulnerability to CLIPMasterPrints is related to a modality gap in contrastive pre-trained multi-modal networks. Code available at https://github.com/matfrei/CLIPMasterPrints.

We present AstroCLIP, a strategy to facilitate the construction of astronomical foundation models that bridge the gap between diverse observational modalities. We demonstrate that a cross-modal contrastive learning approach between images and optical spectra of galaxies yields highly informative embeddings of both modalities. In particular, we apply our method on multi-band images and optical spectra from the Dark Energy Spectroscopic Instrument (DESI), and show that: (1) these embeddings are well-aligned between modalities and can be used for accurate cross-modal searches, and (2) these embeddings encode valuable physical information about the galaxies -- in particular redshift and stellar mass -- that can be used to achieve competitive zero- and few- shot predictions without further finetuning. Additionally, in the process of developing our approach, we also construct a novel, transformer-based model and pretraining approach for processing galaxy spectra.