Few-shot learning in medical image classification presents a significant challenge due to the limited availability of annotated data and the complex nature of medical imagery. In this work, we propose Adaptive Vision-Language Fine-tuning with Hierarchical Contrastive Alignment (HiCA), a novel framework that leverages the capabilities of Large Vision-Language Models (LVLMs) for medical image analysis. HiCA introduces a two-stage fine-tuning strategy, combining domain-specific pretraining and hierarchical contrastive learning to align visual and textual representations at multiple levels. We evaluate our approach on two benchmark datasets, Chest X-ray and Breast Ultrasound, achieving state-of-the-art performance in both few-shot and zero-shot settings. Further analyses demonstrate the robustness, generalizability, and interpretability of our method, with substantial improvements in performance compared to existing baselines. Our work highlights the potential of hierarchical contrastive strategies in adapting LVLMs to the unique challenges of medical imaging tasks.
Feature extraction techniques are crucial in medical image classification; however, classical feature extractors in addition to traditional machine learning classifiers often exhibit significant limitations in providing sufficient discriminative information for complex image sets. While Convolutional Neural Networks (CNNs) and Vision Transformer (ViT) have shown promise in feature extraction, they are prone to overfitting due to the inherent characteristics of medical imaging data, including small sample sizes or high intra-class variance. In this work, the Medical Image Attention-based Feature Extractor (MIAFEx) is proposed, a novel method that employs a learnable refinement mechanism to enhance the classification token within the Transformer encoder architecture. This mechanism adjusts the token based on learned weights, improving the extraction of salient features and enhancing the model's adaptability to the challenges presented by medical imaging data. The MIAFEx output features quality is compared against classical feature extractors using traditional and hybrid classifiers. Also, the performance of these features is compared against modern CNN and ViT models in classification tasks, demonstrating its superiority in accuracy and robustness across multiple complex classification medical imaging datasets. This advantage is particularly pronounced in scenarios with limited training data, where traditional and modern models often struggle to generalize effectively. The source code of this proposal can be found at https://github.com/Oscar-RamosS/Medical-Image-Attention-based-Feature-Extractor-MIAFEx
With the popularity of foundational models, parameter efficient fine tuning has become the defacto approach to leverage pretrained models to perform downstream tasks. Taking inspiration from recent advances in large language models, Visual Prompt Tuning, and similar techniques, learn an additional prompt to efficiently finetune a pretrained vision foundational model. However, we observe that such prompting is insufficient for fine-grained visual classification tasks such as medical image classification, where there is large inter-class variance, and small intra-class variance. Hence, in this paper we propose to leverage advanced segmentation capabilities of Segment Anything Model 2 (SAM2) as a visual prompting cue to help visual encoder in the CLIP (Contrastive Language-Image Pretraining) by guiding the attention in CLIP visual encoder to relevant regions in the image. This helps the model to focus on highly discriminative regions, without getting distracted from visually similar background features, an essential requirement in a fewshot, finegrained classification setting. We evaluate our method on diverse medical datasets including X-rays, CT scans, and MRI images, and report an accuracy of (71%, 81%, 86%, 58%) from the proposed approach on (COVID, lung-disease, brain-tumor, breast-cancer) datasets against (66%, 70%, 68%, 29%) from a pretrained CLIP model after fewshot training. The proposed approach also allows to obtain interpretable explanation for the classification performance through the localization obtained using segmentation.
The AUTO-PCOS Classification Challenge seeks to advance the diagnostic capabilities of artificial intelligence (AI) in identifying Polycystic Ovary Syndrome (PCOS) through automated classification of healthy and unhealthy ultrasound frames. This report outlines our methodology for building a robust AI pipeline utilizing transfer learning with the InceptionV3 architecture to achieve high accuracy in binary classification. Preprocessing steps ensured the dataset was optimized for training, validation, and testing, while interpretability methods like LIME and saliency maps provided valuable insights into the model's decision-making. Our approach achieved an accuracy of 90.52%, with precision, recall, and F1-score metrics exceeding 90% on validation data, demonstrating its efficacy. The project underscores the transformative potential of AI in healthcare, particularly in addressing diagnostic challenges like PCOS. Key findings, challenges, and recommendations for future enhancements are discussed, highlighting the pathway for creating reliable, interpretable, and scalable AI-driven medical diagnostic tools.
This study aims to explore the automatic classification method of pneumonia X-ray images based on VGG19 deep convolutional neural network, and evaluate its application effect in pneumonia diagnosis by comparing with classic models such as SVM, XGBoost, MLP, and ResNet50. The experimental results show that VGG19 performs well in multiple indicators such as accuracy (92%), AUC (0.95), F1 score (0.90) and recall rate (0.87), which is better than other comparison models, especially in image feature extraction and classification accuracy. Although ResNet50 performs well in some indicators, it is slightly inferior to VGG19 in recall rate and F1 score. Traditional machine learning models SVM and XGBoost are obviously limited in image classification tasks, especially in complex medical image analysis tasks, and their performance is relatively mediocre. The research results show that deep learning, especially convolutional neural networks, have significant advantages in medical image classification tasks, especially in pneumonia X-ray image analysis, and can provide efficient and accurate automatic diagnosis support. This research provides strong technical support for the early detection of pneumonia and the development of automated diagnosis systems and also lays the foundation for further promoting the application and development of automated medical image processing technology.
This paper explores and enhances the application of Transfer Learning (TL) for multilabel image classification in medical imaging, focusing on brain tumor class and diabetic retinopathy stage detection. The effectiveness of TL-using pre-trained models on the ImageNet dataset-varies due to domain-specific challenges. We evaluate five pre-trained models-MobileNet, Xception, InceptionV3, ResNet50, and DenseNet201-on two datasets: Brain Tumor MRI and APTOS 2019. Our results show that TL models excel in brain tumor classification, achieving near-optimal metrics. However, performance in diabetic retinopathy detection is hindered by class imbalance. To mitigate this, we integrate the Synthetic Minority Over-sampling Technique (SMOTE) with TL and traditional machine learning(ML) methods, which improves accuracy by 1.97%, recall (sensitivity) by 5.43%, and specificity by 0.72%. These findings underscore the need for combining TL with resampling techniques and ML methods to address data imbalance and enhance classification performance, offering a pathway to more accurate and reliable medical image analysis and improved patient outcomes with minimal extra computation powers.
Current transferability estimation methods designed for natural image datasets are often suboptimal in medical image classification. These methods primarily focus on estimating the suitability of pre-trained source model features for a target dataset, which can lead to unrealistic predictions, such as suggesting that the target dataset is the best source for itself. To address this, we propose a novel transferability metric that combines feature quality with gradients to evaluate both the suitability and adaptability of source model features for target tasks. We evaluate our approach in two new scenarios: source dataset transferability for medical image classification and cross-domain transferability. Our results show that our method outperforms existing transferability metrics in both settings. We also provide insight into the factors influencing transfer performance in medical image classification, as well as the dynamics of cross-domain transfer from natural to medical images. Additionally, we provide ground-truth transfer performance benchmarking results to encourage further research into transferability estimation for medical image classification. Our code and experiments are available at https://github.com/DovileDo/transferability-in-medical-imaging.
Geographic health disparities pose a pressing global challenge, particularly in underserved regions of low- and middle-income nations. Addressing this issue requires a collaborative approach to enhance healthcare quality, leveraging support from medically more developed areas. Federated learning emerges as a promising tool for this purpose. However, the scarcity of medical data and limited computation resources in underserved regions make collaborative training of powerful machine learning models challenging. Furthermore, there exists an asymmetrical reciprocity between underserved and developed regions. To overcome these challenges, we propose a novel cross-silo federated learning framework, named FedHelp, aimed at alleviating geographic health disparities and fortifying the diagnostic capabilities of underserved regions. Specifically, FedHelp leverages foundational model knowledge via one-time API access to guide the learning process of underserved small clients, addressing the challenge of insufficient data. Additionally, we introduce a novel asymmetric dual knowledge distillation module to manage the issue of asymmetric reciprocity, facilitating the exchange of necessary knowledge between developed large clients and underserved small clients. We validate the effectiveness and utility of FedHelp through extensive experiments on both medical image classification and segmentation tasks. The experimental results demonstrate significant performance improvement compared to state-of-the-art baselines, particularly benefiting clients in underserved regions.
Recent advancements in deep learning have shown transformative potential in medical imaging, yet concerns about fairness persist due to performance disparities across demographic subgroups. Existing methods aim to address these biases by mitigating sensitive attributes in image data; however, these attributes often carry clinically relevant information, and their removal can compromise model performance-a highly undesirable outcome. To address this challenge, we propose Fair Re-fusion After Disentanglement (FairREAD), a novel, simple, and efficient framework that mitigates unfairness by re-integrating sensitive demographic attributes into fair image representations. FairREAD employs orthogonality constraints and adversarial training to disentangle demographic information while using a controlled re-fusion mechanism to preserve clinically relevant details. Additionally, subgroup-specific threshold adjustments ensure equitable performance across demographic groups. Comprehensive evaluations on a large-scale clinical X-ray dataset demonstrate that FairREAD significantly reduces unfairness metrics while maintaining diagnostic accuracy, establishing a new benchmark for fairness and performance in medical image classification.
Deep learning has advanced medical image classification, but interpretability challenges hinder its clinical adoption. This study enhances interpretability in Chest X-ray (CXR) classification by using concept bottleneck models (CBMs) and a multi-agent Retrieval-Augmented Generation (RAG) system for report generation. By modeling relationships between visual features and clinical concepts, we create interpretable concept vectors that guide a multi-agent RAG system to generate radiology reports, enhancing clinical relevance, explainability, and transparency. Evaluation of the generated reports using an LLM-as-a-judge confirmed the interpretability and clinical utility of our model's outputs. On the COVID-QU dataset, our model achieved 81% classification accuracy and demonstrated robust report generation performance, with five key metrics ranging between 84% and 90%. This interpretable multi-agent framework bridges the gap between high-performance AI and the explainability required for reliable AI-driven CXR analysis in clinical settings. Our code is available at https://github.com/tifat58/IRR-with-CBM-RAG.git.
The development of accurate medical image classification models is often constrained by privacy concerns and data scarcity for certain conditions, leading to small and imbalanced datasets. To address these limitations, this study explores the use of generative models, such as Denoising Diffusion Probabilistic Models (DDPM) and Progressive Growing Generative Adversarial Networks (PGGANs), for dataset augmentation. The research introduces a framework to assess the impact of synthetic images generated by DDPM and PGGANs on the performance of four models: a custom CNN, Untrained VGG16, Pretrained VGG16, and Pretrained ResNet50. Experiments were conducted using Random Sampling and Greedy K Sampling to create small, imbalanced datasets. The synthetic images were evaluated using Frechet Inception Distance (FID) and compared to original datasets through classification metrics. The results show that DDPM consistently generated more realistic images with lower FID scores and significantly outperformed PGGANs in improving classification metrics across all models and datasets. Incorporating DDPM-generated images into the original datasets increased accuracy by up to 6%, enhancing model robustness and stability, particularly in imbalanced scenarios. Random Sampling demonstrated superior stability, while Greedy K Sampling offered diversity at the cost of higher FID scores. This study highlights the efficacy of DDPM in augmenting small, imbalanced medical image datasets, improving model performance by balancing the dataset and expanding its size.
Developing artificial intelligence (AI) and machine learning (ML) models for medical imaging typically involves extensive training and testing on large datasets, consuming significant computational time, energy, and resources. There is a need for more efficient methods that can achieve comparable or superior diagnostic performance without the associated resource burden. We investigated the feasibility of replacing conventional training procedures with an embedding-based approach that leverages concise and semantically meaningful representations of medical images. Using pre-trained foundational models-specifically, convolutional neural networks (CNN) like ResNet and multimodal models like Contrastive Language-Image Pre-training (CLIP)-we generated image embeddings for multi-class classification tasks. Simple linear classifiers were then applied to these embeddings. The approach was evaluated across diverse medical imaging modalities, including retinal images, mammography, dermatoscopic images, and chest radiographs. Performance was compared to benchmark models trained and tested using traditional methods. The embedding-based models surpassed the benchmark area under the receiver operating characteristic curve (AUC-ROC) scores by up to 87 percentage in multi-class classification tasks across the various medical imaging modalities. Notably, CLIP embedding models achieved the highest AUC-ROC scores, demonstrating superior classification performance while significantly reducing computational demands. Our study indicates that leveraging embeddings from pre-trained foundational models can effectively replace conventional, resource-intensive training and testing procedures in medical image analysis. This embedding-based approach offers a more efficient alternative for image segmentation, classification, and prediction, potentially accelerating AI technology integration into clinical practice.
Transformers are now ubiquitous for sequence modeling tasks, but their extension to multi-dimensional data remains a challenge due to the quadratic cost of the attention mechanism. In this paper, we propose Higher-Order Transformers (HOT), a novel architecture designed to efficiently process data with more than two axes, i.e. higher-order tensors. To address the computational challenges associated with high-order tensor attention, we introduce a novel Kronecker factorized attention mechanism that reduces the attention cost to quadratic in each axis' dimension, rather than quadratic in the total size of the input tensor. To further enhance efficiency, HOT leverages kernelized attention, reducing the complexity to linear. This strategy maintains the model's expressiveness while enabling scalable attention computation. We validate the effectiveness of HOT on two high-dimensional tasks, including multivariate time series forecasting, and 3D medical image classification. Experimental results demonstrate that HOT achieves competitive performance while significantly improving computational efficiency, showcasing its potential for tackling a wide range of complex, multi-dimensional data.
Deep neural networks have demonstrated remarkable performance in various vision tasks, but their success heavily depends on the quality of the training data. Noisy labels are a critical issue in medical datasets and can significantly degrade model performance. Previous clean sample selection methods have not utilized the well pre-trained features of vision foundation models (VFMs) and assumed that training begins from scratch. In this paper, we propose CUFIT, a curriculum fine-tuning paradigm of VFMs for medical image classification under label noise. Our method is motivated by the fact that linear probing of VFMs is relatively unaffected by noisy samples, as it does not update the feature extractor of the VFM, thus robustly classifying the training samples. Subsequently, curriculum fine-tuning of two adapters is conducted, starting with clean sample selection from the linear probing phase. Our experimental results demonstrate that CUFIT outperforms previous methods across various medical image benchmarks. Specifically, our method surpasses previous baselines by 5.0%, 2.1%, 4.6%, and 5.8% at a 40% noise rate on the HAM10000, APTOS-2019, BloodMnist, and OrgancMnist datasets, respectively. Furthermore, we provide extensive analyses to demonstrate the impact of our method on noisy label detection. For instance, our method shows higher label precision and recall compared to previous approaches. Our work highlights the potential of leveraging VFMs in medical image classification under challenging conditions of noisy labels.
With increasing concerns over privacy in healthcare, especially for sensitive medical data, this research introduces a federated learning framework that combines local differential privacy and secure aggregation using Secure Multi-Party Computation for medical image classification. Further, we propose DPResNet, a modified ResNet architecture optimized for differential privacy. Leveraging the BloodMNIST benchmark dataset, we simulate a realistic data-sharing environment across different hospitals, addressing the distinct privacy challenges posed by federated healthcare data. Experimental results indicate that our privacy-preserving federated model achieves accuracy levels close to non-private models, surpassing traditional approaches while maintaining strict data confidentiality. By enhancing the privacy, efficiency, and reliability of healthcare data management, our approach offers substantial benefits to patients, healthcare providers, and the broader healthcare ecosystem.
Given sufficient data from multiple edge devices, federated learning (FL) enables training a shared model without transmitting private data to a central server. However, FL is generally vulnerable to Byzantine attacks from compromised edge devices, which can significantly degrade the model performance. In this paper, we propose a intuitive plugin that can be integrated into existing FL techniques to achieve Byzantine-Resilience. Key idea is to generate virtual data samples and evaluate model consistency scores across local updates to effectively filter out compromised edge devices. By utilizing this scoring mechanism before the aggregation phase, the proposed plugin enables existing FL techniques to become robust against Byzantine attacks while maintaining their original benefits. Numerical results on medical image classification task validate that plugging the proposed approach into representative FL algorithms, effectively achieves Byzantine resilience. Furthermore, the proposed plugin maintains the original convergence properties of the base FL algorithms when no Byzantine attacks are present.
Semi-supervised learning (SSL) is a popular solution to alleviate the high annotation cost in medical image classification. As a main branch of SSL, consistency regularization engages in imposing consensus between the predictions of a single sample from different views, termed as Absolute Location consistency (AL-c). However, only AL-c may be insufficient. Just like when diagnosing a case in practice, besides the case itself, the doctor usually refers to certain related trustworthy cases to make more reliable decisions.Therefore, we argue that solely relying on AL-c may ignore the relative differences across samples, which we interpret as relative locations, and only exploit limited information from one perspective. To address this issue, we propose a Sample Consistency Mean Teacher (SCMT) which not only incorporates AL c but also additionally enforces consistency between the samples' relative similarities to its related samples, called Relative Location consistency (RL c). AL c and RL c conduct consistency regularization from two different perspectives, jointly extracting more diverse semantic information for classification. On the other hand, due to the highly similar structures in medical images, the sample distribution could be overly dense in feature space, making their relative locations susceptible to noise. To tackle this problem, we further develop a Sample Scatter Mean Teacher (SSMT) by utilizing contrastive learning to sparsify the sample distribution and obtain robust and effective relative locations. Extensive experiments on different datasets demonstrate the superiority of our method.
The COVID19 pandemic has had a detrimental impact on the health and welfare of the worlds population. An important strategy in the fight against COVID19 is the effective screening of infected patients, with one of the primary screening methods involving radiological imaging with the use of chest Xrays. This is why this study introduces a customized convolutional neural network (CCNN) for medical image classification. This study used a dataset of 6432 images named Chest Xray (COVID19 and Pneumonia), and images were preprocessed using techniques, including resizing, normalizing, and augmentation, to improve model training and performance. The proposed CCNN was compared with a convolutional neural network (CNN) and other models that used the same dataset. This research found that the Convolutional Neural Network (CCNN) achieved 95.62% validation accuracy and 0.1270 validation loss. This outperformed earlier models and studies using the same dataset. This result indicates that our models learn effectively from training data and adapt efficiently to new, unseen data. In essence, the current CCNN model achieves better medical image classification performance, which is why this CCNN model efficiently classifies medical images. Future research may extend the models application to other medical imaging datasets and develop realtime offline medical image classification websites or apps.
Deep learning has excelled in medical image classification, but its clinical application is limited by poor interpretability. Capsule networks, known for encoding hierarchical relationships and spatial features, show potential in addressing this issue. Nevertheless, traditional capsule networks often underperform due to their shallow structures, and deeper variants lack hierarchical architectures, thereby compromising interpretability. This paper introduces a novel capsule network, ParseCaps, which utilizes the sparse axial attention routing and parse convolutional capsule layer to form a parse-tree-like structure, enhancing both depth and interpretability. Firstly, sparse axial attention routing optimizes connections between child and parent capsules, as well as emphasizes the weight distribution across instantiation parameters of parent capsules. Secondly, the parse convolutional capsule layer generates capsule predictions aligning with the parse tree. Finally, based on the loss design that is effective whether concept ground truth exists or not, ParseCaps advances interpretability by associating each dimension of the global capsule with a comprehensible concept, thereby facilitating clinician trust and understanding of the model's classification results. Experimental results on CE-MRI, PH$^2$, and Derm7pt datasets show that ParseCaps not only outperforms other capsule network variants in classification accuracy, redundancy reduction and robustness, but also provides interpretable explanations, regardless of the availability of concept labels.
Video capsule endoscopy has transformed gastrointestinal endoscopy (GIE) diagnostics by offering a non-invasive method for capturing detailed images of the gastrointestinal tract, enabling early disease detection. However, its potential is limited by the sheer volume of images generated during the imaging procedure, which can take anywhere from 6-8 hours and often produce up to 1 million images, necessitating automated analysis. Additionally, the variability of these images, combined with the need for expert annotations and the scarcity of large, high-quality labeled datasets, constrains the effectiveness of current medical image analysis models. To address this, we introduce a novel large GIE dataset, called EndoExtend24, created by merging ten existing public and private datasets, ensuring patient integrity across splits. EndoExtend24 includes over 226,000 labeled images, as well as dynamic class mappings, which allow unified training across datasets with differing labeling granularity, supporting up to 123 distinct pathological findings. Further, we propose to leverage domain adaptive pre-training of foundation models trained with self-supervision on generic image data, to adapt them to the task of GIE medical image diagnosis. Specifically, the EVA-02 model, which is based on the ViT architecture and trained on ImageNet-22k with masked image modeling (using EVA-CLIP as a MIM teacher), is pre-trained on the EndoExtend24 dataset to achieve domain adaptation, and finally trained on the Capsule Endoscopy 2024 Challenge dataset. Our model demonstrates robust performance, securing third place in the Capsule Endoscopy 2024 Challenge. We achieved a macro AUC of 0.762 and a balanced accuracy of 37.1% on the test set. These results emphasize the effectiveness of our domain-adaptive pre-training approach and the enriched EndoExtend24 dataset in advancing gastrointestinal endoscopy diagnostics.