With the rapid advancement of deep learning, particularly in the field of medical image analysis, an increasing number of Vision-Language Models (VLMs) are being widely applied to solve complex health and biomedical challenges. However, existing research has primarily focused on specific tasks or single modalities, which limits their applicability and generalization across diverse medical scenarios. To address this challenge, we propose UMIT, a unified multi-modal, multi-task VLM designed specifically for medical imaging tasks. UMIT is able to solve various tasks, including visual question answering, disease detection, and medical report generation. In addition, it is applicable to multiple imaging modalities (e.g., X-ray, CT and PET), covering a wide range of applications from basic diagnostics to complex lesion analysis. Moreover, UMIT supports both English and Chinese, expanding its applicability globally and ensuring accessibility to healthcare services in different linguistic contexts. To enhance the model's adaptability and task-handling capability, we design a unique two-stage training strategy and fine-tune UMIT with designed instruction templates. Through extensive empirical evaluation, UMIT outperforms previous methods in five tasks across multiple datasets. The performance of UMIT indicates that it can significantly enhance diagnostic accuracy and workflow efficiency, thus providing effective solutions for medical imaging applications.
Automatic medical report generation supports clinical diagnosis, reduces the workload of radiologists, and holds the promise of improving diagnosis consistency. However, existing evaluation metrics primarily assess the accuracy of key medical information coverage in generated reports compared to human-written reports, while overlooking crucial details such as the location and certainty of reported abnormalities. These limitations hinder the comprehensive assessment of the reliability of generated reports and pose risks in their selection for clinical use. Therefore, we propose a Granular Explainable Multi-Agent Score (GEMA-Score) in this paper, which conducts both objective quantification and subjective evaluation through a large language model-based multi-agent workflow. Our GEMA-Score parses structured reports and employs NER-F1 calculations through interactive exchanges of information among agents to assess disease diagnosis, location, severity, and uncertainty. Additionally, an LLM-based scoring agent evaluates completeness, readability, and clinical terminology while providing explanatory feedback. Extensive experiments validate that GEMA-Score achieves the highest correlation with human expert evaluations on a public dataset, demonstrating its effectiveness in clinical scoring (Kendall coefficient = 0.70 for Rexval dataset and Kendall coefficient = 0.54 for RadEvalX dataset). The anonymous project demo is available at: https://github.com/Zhenxuan-Zhang/GEMA_score.
X-ray image based medical report generation achieves significant progress in recent years with the help of the large language model, however, these models have not fully exploited the effective information in visual image regions, resulting in reports that are linguistically sound but insufficient in describing key diseases. In this paper, we propose a novel associative memory-enhanced X-ray report generation model that effectively mimics the process of professional doctors writing medical reports. It considers both the mining of global and local visual information and associates historical report information to better complete the writing of the current report. Specifically, given an X-ray image, we first utilize a classification model along with its activation maps to accomplish the mining of visual regions highly associated with diseases and the learning of disease query tokens. Then, we employ a visual Hopfield network to establish memory associations for disease-related tokens, and a report Hopfield network to retrieve report memory information. This process facilitates the generation of high-quality reports based on a large language model and achieves state-of-the-art performance on multiple benchmark datasets, including the IU X-ray, MIMIC-CXR, and Chexpert Plus. The source code of this work is released on \url{https://github.com/Event-AHU/Medical_Image_Analysis}.
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.
X-ray image-based medical report generation (MRG) is a pivotal area in artificial intelligence which can significantly reduce diagnostic burdens and patient wait times. Despite significant progress, we believe that the task has reached a bottleneck due to the limited benchmark datasets and the existing large models' insufficient capability enhancements in this specialized domain. Specifically, the recently released CheXpert Plus dataset lacks comparative evaluation algorithms and their results, providing only the dataset itself. This situation makes the training, evaluation, and comparison of subsequent algorithms challenging. Thus, we conduct a comprehensive benchmarking of existing mainstream X-ray report generation models and large language models (LLMs), on the CheXpert Plus dataset. We believe that the proposed benchmark can provide a solid comparative basis for subsequent algorithms and serve as a guide for researchers to quickly grasp the state-of-the-art models in this field. More importantly, we propose a large model for the X-ray image report generation using a multi-stage pre-training strategy, including self-supervised autoregressive generation and Xray-report contrastive learning, and supervised fine-tuning. Extensive experimental results indicate that the autoregressive pre-training based on Mamba effectively encodes X-ray images, and the image-text contrastive pre-training further aligns the feature spaces, achieving better experimental results. Source code can be found on \url{https://github.com/Event-AHU/Medical_Image_Analysis}.
The success of Multimodal Large Language Models (MLLMs) in the medical auxiliary field shows great potential, allowing patients to engage in conversations using physiological signal data. However, general MLLMs perform poorly in cardiac disease diagnosis, particularly in the integration of ECG data analysis and medical report generation, mainly due to the complexity of ECG data analysis and the gap between text and ECG signal modalities. To address these issues, we propose ECG-Chat, a multitask MLLMs focused on ECG medical report generation, providing multimodal conversational capabilities based on cardiology knowledge. We propose a contrastive learning approach that integrates ECG waveform data with text reports, aligning ECG features with reports in a fine-grained manner. This method also results in an ECG encoder that excels in zero-shot report retrieval tasks. Additionally, expanding existing datasets, we constructed a 19k ECG diagnosis dataset and a 25k multi-turn dialogue dataset for training and fine-tuning ECG-Chat, which provides professional diagnostic and conversational capabilities. Furthermore, ECG-Chat can generate comprehensive ECG analysis reports through an automated LaTeX generation pipeline. We established a benchmark for the ECG report generation task and tested our model on multiple baselines. ECG-Chat achieved the best performance in classification, retrieval, and medical report generation tasks. Our code is available at https://github.com/YubaoZhao/ECG-Chat.
Inspired by the tremendous success of Large Language Models (LLMs), existing X-ray medical report generation methods attempt to leverage large models to achieve better performance. They usually adopt a Transformer to extract the visual features of a given X-ray image, and then, feed them into the LLM for text generation. How to extract more effective information for the LLMs to help them improve final results is an urgent problem that needs to be solved. Additionally, the use of visual Transformer models also brings high computational complexity. To address these issues, this paper proposes a novel context-guided efficient X-ray medical report generation framework. Specifically, we introduce the Mamba as the vision backbone with linear complexity, and the performance obtained is comparable to that of the strong Transformer model. More importantly, we perform context retrieval from the training set for samples within each mini-batch during the training phase, utilizing both positively and negatively related samples to enhance feature representation and discriminative learning. Subsequently, we feed the vision tokens, context information, and prompt statements to invoke the LLM for generating high-quality medical reports. Extensive experiments on three X-ray report generation datasets (i.e., IU-Xray, MIMIC-CXR, CheXpert Plus) fully validated the effectiveness of our proposed model. The source code of this work will be released on \url{https://github.com/Event-AHU/Medical_Image_Analysis}.
Recent advancements in artificial intelligence (AI) have precipitated significant breakthroughs in healthcare, particularly in refining diagnostic procedures. However, previous studies have often been constrained to limited functionalities. This study introduces MiniGPT-Med, a vision-language model derived from large-scale language models and tailored for medical applications. MiniGPT-Med demonstrates remarkable versatility across various imaging modalities, including X-rays, CT scans, and MRIs, enhancing its utility. The model is capable of performing tasks such as medical report generation, visual question answering (VQA), and disease identification within medical imagery. Its integrated processing of both image and textual clinical data markedly improves diagnostic accuracy. Our empirical assessments confirm MiniGPT-Med's superior performance in disease grounding, medical report generation, and VQA benchmarks, representing a significant step towards reducing the gap in assisting radiology practice. Furthermore, it achieves state-of-the-art performance on medical report generation, higher than the previous best model by 19\% accuracy. MiniGPT-Med promises to become a general interface for radiology diagnoses, enhancing diagnostic efficiency across a wide range of medical imaging applications.
Multi-modal large language models (MLLMs) have been given free rein to explore exciting medical applications with a primary focus on radiology report generation. Nevertheless, the preliminary success in 2D radiology captioning is incompetent to reflect the real-world diagnostic challenge in the volumetric 3D anatomy. To mitigate three crucial limitation aspects in the existing literature, including (1) data complexity, (2) model capacity, and (3) evaluation metric fidelity, we collected an 18,885 text-scan pairs 3D-BrainCT dataset and applied clinical visual instruction tuning (CVIT) to train BrainGPT models to generate radiology-adherent 3D brain CT reports. Statistically, our BrainGPT scored BLEU-1 = 44.35, BLEU-4 = 20.38, METEOR = 30.13, ROUGE-L = 47.6, and CIDEr-R = 211.77 during internal testing and demonstrated an accuracy of 0.91 in captioning midline shifts on the external validation CQ500 dataset. By further inspecting the captioned report, we reported that the traditional metrics appeared to measure only the surface text similarity and failed to gauge the information density of the diagnostic purpose. To close this gap, we proposed a novel Feature-Oriented Radiology Task Evaluation (FORTE) to estimate the report's clinical relevance (lesion feature and landmarks). Notably, the BrainGPT model scored an average FORTE F1-score of 0.71 (degree=0.661; landmark=0.706; feature=0.693; impression=0.779). To demonstrate that BrainGPT models possess objective readiness to generate human-like radiology reports, we conducted a Turing test that enrolled 11 physician evaluators, and around 74% of the BrainGPT-generated captions were indistinguishable from those written by humans. Our work embodies a holistic framework that showcased the first-hand experience of curating a 3D brain CT dataset, fine-tuning anatomy-sensible language models, and proposing robust radiology evaluation metrics.
The automated generation of imaging reports proves invaluable in alleviating the workload of radiologists. A clinically applicable reports generation algorithm should demonstrate its effectiveness in producing reports that accurately describe radiology findings and attend to patient-specific indications. In this paper, we introduce a novel method, \textbf{S}tructural \textbf{E}ntities extraction and patient indications \textbf{I}ncorporation (SEI) for chest X-ray report generation. Specifically, we employ a structural entities extraction (SEE) approach to eliminate presentation-style vocabulary in reports and improve the quality of factual entity sequences. This reduces the noise in the following cross-modal alignment module by aligning X-ray images with factual entity sequences in reports, thereby enhancing the precision of cross-modal alignment and further aiding the model in gradient-free retrieval of similar historical cases. Subsequently, we propose a cross-modal fusion network to integrate information from X-ray images, similar historical cases, and patient-specific indications. This process allows the text decoder to attend to discriminative features of X-ray images, assimilate historical diagnostic information from similar cases, and understand the examination intention of patients. This, in turn, assists in triggering the text decoder to produce high-quality reports. Experiments conducted on MIMIC-CXR validate the superiority of SEI over state-of-the-art approaches on both natural language generation and clinical efficacy metrics.
A radiology report comprises presentation-style vocabulary, which ensures clarity and organization, and factual vocabulary, which provides accurate and objective descriptions based on observable findings. While manually writing these reports is time-consuming and labor-intensive, automatic report generation offers a promising alternative. A critical step in this process is to align radiographs with their corresponding reports. However, existing methods often rely on complete reports for alignment, overlooking the impact of presentation-style vocabulary. To address this issue, we propose FSE, a two-stage Factual Serialization Enhancement method. In Stage 1, we introduce factuality-guided contrastive learning for visual representation by maximizing the semantic correspondence between radiographs and corresponding factual descriptions. In Stage 2, we present evidence-driven report generation that enhances diagnostic accuracy by integrating insights from similar historical cases structured as factual serialization. Experiments on MIMIC-CXR and IU X-ray datasets across specific and general scenarios demonstrate that FSE outperforms state-of-the-art approaches in both natural language generation and clinical efficacy metrics. Ablation studies further emphasize the positive effects of factual serialization in Stage 1 and Stage 2. The code is available at https://github.com/mk-runner/FSE.
Generalist foundation models (GFMs) are renowned for their exceptional capability and flexibility in effectively generalizing across diverse tasks and modalities. In the field of medicine, while GFMs exhibit superior generalizability based on their extensive intrinsic knowledge as well as proficiency in instruction following and in-context learning, specialist models excel in precision due to their domain knowledge. In this work, for the first time, we explore the synergy between the GFM and specialist models, to enable precise medical image analysis on a broader scope. Specifically, we propose a cooperative framework, Generalist-Specialist Collaboration (GSCo), which consists of two stages, namely the construction of GFM and specialists, and collaborative inference on downstream tasks. In the construction stage, we develop MedDr, the largest open-source GFM tailored for medicine, showcasing exceptional instruction-following and in-context learning capabilities. Meanwhile, a series of lightweight specialists are crafted for downstream tasks with low computational cost. In the collaborative inference stage, we introduce two cooperative mechanisms, Mixture-of-Expert Diagnosis and Retrieval-Augmented Diagnosis, to harvest the generalist's in-context learning abilities alongside the specialists' domain expertise. For a comprehensive evaluation, we curate a large-scale benchmark featuring 28 datasets and about 250,000 images. Extensive results demonstrate that MedDr consistently outperforms state-of-the-art GFMs on downstream datasets. Furthermore, GSCo exceeds both GFMs and specialists across all out-of-domain disease diagnosis datasets. These findings indicate a significant paradigm shift in the application of GFMs, transitioning from separate models for specific tasks to a collaborative approach between GFMs and specialists, thereby advancing the frontiers of generalizable AI in medicine.
Histopathology serves as the gold standard in cancer diagnosis, with clinical reports being vital in interpreting and understanding this process, guiding cancer treatment and patient care. The automation of histopathology report generation with deep learning stands to significantly enhance clinical efficiency and lessen the labor-intensive, time-consuming burden on pathologists in report writing. In pursuit of this advancement, we introduce HistGen, a multiple instance learning-empowered framework for histopathology report generation together with the first benchmark dataset for evaluation. Inspired by diagnostic and report-writing workflows, HistGen features two delicately designed modules, aiming to boost report generation by aligning whole slide images (WSIs) and diagnostic reports from local and global granularity. To achieve this, a local-global hierarchical encoder is developed for efficient visual feature aggregation from a region-to-slide perspective. Meanwhile, a cross-modal context module is proposed to explicitly facilitate alignment and interaction between distinct modalities, effectively bridging the gap between the extensive visual sequences of WSIs and corresponding highly summarized reports. Experimental results on WSI report generation show the proposed model outperforms state-of-the-art (SOTA) models by a large margin. Moreover, the results of fine-tuning our model on cancer subtyping and survival analysis tasks further demonstrate superior performance compared to SOTA methods, showcasing strong transfer learning capability. Dataset, model weights, and source code are available in https://github.com/dddavid4real/HistGen.
Medical vision-language models (VLMs) combine computer vision (CV) and natural language processing (NLP) to analyze visual and textual medical data. Our paper reviews recent advancements in developing VLMs specialized for healthcare, focusing on models designed for medical report generation and visual question answering (VQA). We provide background on NLP and CV, explaining how techniques from both fields are integrated into VLMs to enable learning from multimodal data. Key areas we address include the exploration of medical vision-language datasets, in-depth analyses of architectures and pre-training strategies employed in recent noteworthy medical VLMs, and comprehensive discussion on evaluation metrics for assessing VLMs' performance in medical report generation and VQA. We also highlight current challenges and propose future directions, including enhancing clinical validity and addressing patient privacy concerns. Overall, our review summarizes recent progress in developing VLMs to harness multimodal medical data for improved healthcare applications.
Previous research on radiology report generation has made significant progress in terms of increasing the clinical accuracy of generated reports. In this paper, we emphasize another crucial quality that it should possess, i.e., inter-report consistency, which refers to the capability of generating consistent reports for semantically equivalent radiographs. This quality is even of greater significance than the overall report accuracy in terms of ensuring the system's credibility, as a system prone to providing conflicting results would severely erode users' trust. Regrettably, existing approaches struggle to maintain inter-report consistency, exhibiting biases towards common patterns and susceptibility to lesion variants. To address this issue, we propose ICON, which improves the inter-report consistency of radiology report generation. Aiming to enhance the system's ability to capture similarities in semantically equivalent lesions, our approach first involves extracting lesions from input images and examining their characteristics. Then, we introduce a lesion-aware mixup technique to ensure that the representations of the semantically equivalent lesions align with the same attributes, achieved through a linear combination during the training phase. Extensive experiments on three publicly available chest X-ray datasets verify the effectiveness of our approach, both in terms of improving the consistency and accuracy of the generated reports.
Multimodal large language models (MLLMs) represent an evolutionary expansion in the capabilities of traditional large language models, enabling them to tackle challenges that surpass the scope of purely text-based applications. It leverages the knowledge previously encoded within these language models, thereby enhancing their applicability and functionality in the reign of multimodal contexts. Recent works investigate the adaptation of MLLMs as a universal solution to address medical multi-modal problems as a generative task. In this paper, we propose a parameter efficient framework for fine-tuning MLLMs, specifically validated on medical visual question answering (Med-VQA) and medical report generation (MRG) tasks, using public benchmark datasets. We also introduce an evaluation metric using the 5-point Likert scale and its weighted average value to measure the quality of the generated reports for MRG tasks, where the scale ratings are labelled by both humans manually and the GPT-4 model. We further assess the consistency of performance metrics across traditional measures, GPT-4, and human ratings for both VQA and MRG tasks. The results indicate that semantic similarity assessments using GPT-4 align closely with human annotators and provide greater stability, yet they reveal a discrepancy when compared to conventional lexical similarity measurements. This questions the reliability of lexical similarity metrics for evaluating the performance of generative models in Med-VQA and report generation tasks. Besides, our fine-tuned model significantly outperforms GPT-4v. This indicates that without additional fine-tuning, multi-modal models like GPT-4v do not perform effectively on medical imaging tasks. The code will be available here: https://github.com/jinlHe/PeFoMed.
Medical report generation demands automatic creation of coherent and precise descriptions for medical images. However, the scarcity of labelled medical image-report pairs poses formidable challenges in developing large-scale neural networks capable of harnessing the potential of artificial intelligence, exemplified by large language models. This study builds upon the state-of-the-art vision-language pre-training and fine-tuning approach, BLIP-2, to customize general large-scale foundation models. Integrating adapter tuning and a medical knowledge enhancement loss, our model significantly improves accuracy and coherence. Validation on the dataset of ImageCLEFmedical 2023 demonstrates our model's prowess, achieving the best-averaged results against several state-of-the-art methods. Significant improvements in ROUGE and CIDEr underscore our method's efficacy, highlighting promising outcomes for the rapid medical-domain adaptation of the vision-language foundation models in addressing challenges posed by data scarcity.
The goal of automatic report generation is to generate a clinically accurate and coherent phrase from a single given X-ray image, which could alleviate the workload of traditional radiology reporting. However, in a real-world scenario, radiologists frequently face the challenge of producing extensive reports derived from numerous medical images, thereby medical report generation from multi-image perspective is needed. In this paper, we propose the Complex Organ Mask Guided (termed as COMG) report generation model, which incorporates masks from multiple organs (e.g., bones, lungs, heart, and mediastinum), to provide more detailed information and guide the model's attention to these crucial body regions. Specifically, we leverage prior knowledge of the disease corresponding to each organ in the fusion process to enhance the disease identification phase during the report generation process. Additionally, cosine similarity loss is introduced as target function to ensure the convergence of cross-modal consistency and facilitate model optimization.Experimental results on two public datasets show that COMG achieves a 11.4% and 9.7% improvement in terms of BLEU@4 scores over the SOTA model KiUT on IU-Xray and MIMIC, respectively. The code is publicly available at https://github.com/GaryGuTC/COMG_model.
Automating radiology report generation can significantly alleviate radiologists' workloads. Previous research has primarily focused on realizing highly concise observations while neglecting the precise attributes that determine the severity of diseases (e.g., small pleural effusion). Since incorrect attributes will lead to imprecise radiology reports, strengthening the generation process with precise attribute modeling becomes necessary. Additionally, the temporal information contained in the historical records, which is crucial in evaluating a patient's current condition (e.g., heart size is unchanged), has also been largely disregarded. To address these issues, we propose RECAP, which generates precise and accurate radiology reports via dynamic disease progression reasoning. Specifically, RECAP first predicts the observations and progressions (i.e., spatiotemporal information) given two consecutive radiographs. It then combines the historical records, spatiotemporal information, and radiographs for report generation, where a disease progression graph and dynamic progression reasoning mechanism are devised to accurately select the attributes of each observation and progression. Extensive experiments on two publicly available datasets demonstrate the effectiveness of our model.
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 disease identification. 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. The code is available at https://github.com/jhb86253817/PromptMRG.