Medical imaging data contain sensitive patient information requiring strong privacy protection. Many analytical setups require data to be sent to a server for inference purposes. Homomorphic encryption (HE) provides a solution by allowing computations to be performed on encrypted data without revealing the original information. However, HE inference is computationally expensive, particularly for large images (e.g., chest X-rays). In this study, we propose an HE inference framework for medical images that uses VQGAN to compress images into latent representations, thereby significantly reducing the computational burden while preserving image quality. We approximate the activation functions with lower-degree polynomials to balance the accuracy and efficiency in compliance with HE requirements. We observed that a downsampling factor of eight for compression achieved an optimal balance between performance and computational cost. We further adapted the squeeze and excitation module, which is known to improve traditional CNNs, to enhance the HE framework. Our method was tested on two chest X-ray datasets for multi-label classification tasks using vanilla CNN backbones. Although HE inference remains relatively slow and introduces minor performance differences compared with unencrypted inference, our approach shows strong potential for practical use in medical images
While Multi-Task Learning (MTL) offers inherent advantages in complex domains such as medical imaging by enabling shared representation learning, effectively balancing task contributions remains a significant challenge. This paper addresses this critical issue by introducing DeepChest, a novel, computationally efficient and effective dynamic task-weighting framework specifically designed for multi-label chest X-ray (CXR) classification. Unlike existing heuristic or gradient-based methods that often incur substantial overhead, DeepChest leverages a performance-driven weighting mechanism based on effective analysis of task-specific loss trends. Given a network architecture (e.g., ResNet18), our model-agnostic approach adaptively adjusts task importance without requiring gradient access, thereby significantly reducing memory usage and achieving a threefold increase in training speed. It can be easily applied to improve various state-of-the-art methods. Extensive experiments on a large-scale CXR dataset demonstrate that DeepChest not only outperforms state-of-the-art MTL methods by 7% in overall accuracy but also yields substantial reductions in individual task losses, indicating improved generalization and effective mitigation of negative transfer. The efficiency and performance gains of DeepChest pave the way for more practical and robust deployment of deep learning in critical medical diagnostic applications. The code is publicly available at https://github.com/youssefkhalil320/DeepChest-MTL
Background: Lung disease is a significant health issue, particularly in children and elderly individuals. It often results from lung infections and is one of the leading causes of mortality in children. Globally, lung-related diseases claim many lives each year, making early and accurate diagnoses crucial. Radiographs are valuable tools for the diagnosis of such conditions. The most prevalent lung diseases, including pneumonia, asthma, allergies, chronic obstructive pulmonary disease (COPD), bronchitis, emphysema, and lung cancer, represent significant public health challenges. Early prediction of these conditions is critical, as it allows for the identification of risk factors and implementation of preventive measures to reduce the likelihood of disease onset Methods: In this study, we utilized a dataset comprising 3,475 chest X-ray images sourced from from Mendeley Data provided by Talukder, M. A. (2023) [14], categorized into three classes: normal, lung opacity, and pneumonia. We applied five pre-trained deep learning models, including CNN, ResNet50, DenseNet, CheXNet, and U-Net, as well as two transfer learning algorithms such as Vision Transformer (ViT) and Shifted Window (Swin) to classify these images. This approach aims to address diagnostic issues in lung abnormalities by reducing reliance on human intervention through automated classification systems. Our analysis was conducted in both binary and multiclass settings. Results: In the binary classification, we focused on distinguishing between normal and viral pneumonia cases, whereas in the multi-class classification, all three classes (normal, lung opacity, and viral pneumonia) were included. Our proposed methodology (ViT) achieved remarkable performance, with accuracy rates of 99% for binary classification and 95.25% for multiclass classification.
Knee Osteoarthritis (KOA) is a degenerative musculoskeletal joint disorder that significantly impacts middle-aged and elderly individuals. Although X-rays and MRIs are clinically used to identify such disorders, combining these imaging modalities is challenging due to the distinct nature of the data, as MRI volume provides detailed views of cartilage and soft tissues, while X-rays offer a global perspective of bone anatomy and positioning in single scan. In this context, the proposed work aims to address two key challenges: (1) how to automatically select the most informative slices from large and dis-organized MRI volume in a clinically relevant way and (2) how to effectively capture the discriminative multimodal interactions between X-ray and MRI modalities. In order to solve these issues, the Context-Guided Slice Selection and Prioritization (CG-SSP) module and Xray-MRI Cross-Attention (XMRCA) module are proposed. The CG-SSP module focuses on rejecting non-efficient slices and prioritizing the efficient slices in a multi-stage approach, first by segmenting the Femoral Cartilage (FC) then extracting the sequential patches of FC located in each MRI slice followed by assigning the attention weight to each of these slices based on learned structural complexity, while the XMRCA module focuses on learning the global interactions between X-ray and MRI feature space in a computationally efficient manner. Overall, the proposed model achieved an accuracy improvement of 2.66% over the state-of-the-art in unimodal and multimodal baselines on the OAI dataset. The proposed model identifies key diagnostic slices from MRI and can provide valuable insights into interactions between X-ray and MRI data for radiological KOA diagnosis in an end-to-end manner. Code will be made available at: https://github.com/adaydar/MedCAM-OsteoCls
The integration of artificial intelligence in medical imaging has shown tremendous potential, yet the relationship between pre-trained knowledge and performance in cross-modality learning remains unclear. This study investigates how explicitly injecting medical knowledge into the learning process affects the performance of cross-modality classification, focusing on Chest X-ray (CXR) images. We introduce a novel Set Theory-based knowledge injection framework that generates captions for CXR images with controllable knowledge granularity. Using this framework, we fine-tune CLIP model on captions with varying levels of medical information. We evaluate the model's performance through zero-shot classification on the CheXpert dataset, a benchmark for CXR classification. Our results demonstrate that injecting fine-grained medical knowledge substantially improves classification accuracy, achieving 72.5\% compared to 49.9\% when using human-generated captions. This highlights the crucial role of domain-specific knowledge in medical cross-modality learning. Furthermore, we explore the influence of knowledge density and the use of domain-specific Large Language Models (LLMs) for caption generation, finding that denser knowledge and specialized LLMs contribute to enhanced performance. This research advances medical image analysis by demonstrating the effectiveness of knowledge injection for improving automated CXR classification, paving the way for more accurate and reliable diagnostic tools.
Compared with standard learning, adversarially robust learning is widely recognized to demand significantly more training examples. Recent works propose the use of self-supervised adversarial training (SSAT) with external or synthetically generated unlabeled data to enhance model robustness. However, SSAT requires a substantial amount of extra unlabeled data, significantly increasing memory usage and model training times. To address these challenges, we propose novel methods to strategically select a small subset of unlabeled data essential for SSAT and robustness improvement. Our selection prioritizes data points near the model's decision boundary based on latent clustering-based techniques, efficiently identifying a critical subset of unlabeled data with a higher concentration of boundary-adjacent points. While focusing on near-boundary data, our methods are designed to maintain a balanced ratio between boundary and non-boundary data points to avoid overfitting. Our experiments on image benchmarks show that integrating our selection strategies into self-supervised adversarial training can largely reduce memory and computational requirements while achieving high model robustness. In particular, our latent clustering-based selection method with k-means is the most effective, achieving nearly identical test-time robust accuracies with 5 to 10 times less external or generated unlabeled data when applied to image benchmarks. Additionally, we validate the generalizability of our approach across various application scenarios, including a real-world medical dataset for COVID-19 chest X-ray classification.
Internet of Things (IoT) based healthcare systems offer significant potential for improving the delivery of healthcare services in humanitarian engineering, providing essential healthcare services to millions of underserved people in remote areas worldwide. However, these areas have poor network infrastructure, making communications difficult for traditional IoT. This paper presents a real-time chest X-ray classification system for hospitals in remote areas using FastDDS real-time middleware, offering reliable real-time communication. We fine-tuned a ResNet50 neural network to an accuracy of 88.61%, a precision of 88.76%, and a recall of 88.49\%. Our system results mark an average throughput of 3.2 KB/s and an average latency of 65 ms. The proposed system demonstrates how middleware-based systems can assist doctors in remote locations.
Recent advancements in medical image analysis have predominantly relied on Convolutional Neural Networks (CNNs), achieving impressive performance in chest X-ray classification tasks, such as the 92% AUC reported by AutoThorax-Net and the 88% AUC achieved by ChexNet in classifcation tasks. However, in the medical field, even small improvements in accuracy can have significant clinical implications. This study explores the application of Vision Transformers (ViT), a state-of-the-art architecture in machine learning, to chest X-ray analysis, aiming to push the boundaries of diagnostic accuracy. I present a comparative analysis of two ViT-based approaches: one utilizing full chest X-ray images and another focusing on segmented lung regions. Experiments demonstrate that both methods surpass the performance of traditional CNN-based models, with the full-image ViT achieving up to 97.83% accuracy and the lung-segmented ViT reaching 96.58% accuracy in classifcation of diseases on three label and AUC of 94.54% when label numbers are increased to eight. Notably, the full-image approach showed superior performance across all metrics, including precision, recall, F1 score, and AUC-ROC. These findings suggest that Vision Transformers can effectively capture relevant features from chest X-rays without the need for explicit lung segmentation, potentially simplifying the preprocessing pipeline while maintaining high accuracy. This research contributes to the growing body of evidence supporting the efficacy of transformer-based architectures in medical image analysis and highlights their potential to enhance diagnostic precision in clinical settings.
In this paper we introduce RE-tune, a novel approach for fine-tuning pre-trained Multimodal Biomedical Vision-Language models (VLMs) in Incremental Learning scenarios for multi-label chest disease diagnosis. RE-tune freezes the backbones and only trains simple adaptors on top of the Image and Text encoders of the VLM. By engineering positive and negative text prompts for diseases, we leverage the ability of Large Language Models to steer the training trajectory. We evaluate RE-tune in three realistic incremental learning scenarios: class-incremental, label-incremental, and data-incremental. Our results demonstrate that Biomedical VLMs are natural continual learners and prevent catastrophic forgetting. RE-tune not only achieves accurate multi-label classification results, but also prioritizes patient privacy and it distinguishes itself through exceptional computational efficiency, rendering it highly suitable for broad adoption in real-world healthcare settings.
Federated Learning (FL) is a rising approach towards collaborative and privacy-preserving machine learning where large-scale medical datasets remain localized to each client. However, the issue of data heterogeneity among clients often compels local models to diverge, leading to suboptimal global models. To mitigate the impact of data heterogeneity on FL performance, we start with analyzing how FL training influence FL performance by decomposing the global loss into three terms: local loss, distribution shift loss and aggregation loss. Remarkably, our loss decomposition reveals that existing local training-based FL methods attempt to reduce the distribution shift loss, while the global aggregation-based FL methods propose better aggregation strategies to reduce the aggregation loss. Nevertheless, a comprehensive joint effort to minimize all three terms is currently limited in the literature, leading to subpar performance when dealing with data heterogeneity challenges. To fill this gap, we propose a novel FL method based on global loss decomposition, called FedLD, to jointly reduce these three loss terms. Our FedLD involves a margin control regularization in local training to reduce the distribution shift loss, and a principal gradient-based server aggregation strategy to reduce the aggregation loss. Notably, under different levels of data heterogeneity, our strategies achieve better and more robust performance on retinal and chest X-ray classification compared to other FL algorithms. Our code is available at https://github.com/Zeng-Shuang/FedLD.
Objectives: This study aims to assess the impact of domain shift on chest X-ray classification accuracy and to analyze the influence of ground truth label quality and demographic factors such as age group, sex, and study year. Materials and Methods: We used a DenseNet121 model pretrained MIMIC-CXR dataset for deep learning-based multilabel classification using ground truth labels from radiology reports extracted using the CheXpert and CheXbert Labeler. We compared the performance of the 14 chest X-ray labels on the MIMIC-CXR and Veterans Healthcare Administration chest X-ray dataset (VA-CXR). The VA-CXR dataset comprises over 259k chest X-ray images spanning between the years 2010 and 2022. Results: The validation of ground truth and the assessment of multi-label classification performance across various NLP extraction tools revealed that the VA-CXR dataset exhibited lower disagreement rates than the MIMIC-CXR datasets. Additionally, there were notable differences in AUC scores between models utilizing CheXpert and CheXbert. When evaluating multi-label classification performance across different datasets, minimal domain shift was observed in unseen datasets, except for the label "Enlarged Cardiomediastinum." The study year's subgroup analyses exhibited the most significant variations in multi-label classification model performance. These findings underscore the importance of considering domain shifts in chest X-ray classification tasks, particularly concerning study years. Conclusion: Our study reveals the significant impact of domain shift and demographic factors on chest X-ray classification, emphasizing the need for improved transfer learning and equitable model development. Addressing these challenges is crucial for advancing medical imaging and enhancing patient care.
Continual Learning (CL) is crucial for enabling networks to dynamically adapt as they learn new tasks sequentially, accommodating new data and classes without catastrophic forgetting. Diverging from conventional perspectives on CL, our paper introduces a new perspective wherein forgetting could actually benefit the sequential learning paradigm. Specifically, we present BiasPruner, a CL framework that intentionally forgets spurious correlations in the training data that could lead to shortcut learning. Utilizing a new bias score that measures the contribution of each unit in the network to learning spurious features, BiasPruner prunes those units with the highest bias scores to form a debiased subnetwork preserved for a given task. As BiasPruner learns a new task, it constructs a new debiased subnetwork, potentially incorporating units from previous subnetworks, which improves adaptation and performance on the new task. During inference, BiasPruner employs a simple task-agnostic approach to select the best debiased subnetwork for predictions. We conduct experiments on three medical datasets for skin lesion classification and chest X-Ray classification and demonstrate that BiasPruner consistently outperforms SOTA CL methods in terms of classification performance and fairness. Our code is available here.
This research addresses the challenges of diagnosing chest X-rays (CXRs) at low resolutions, a common limitation in resource-constrained healthcare settings. High-resolution CXR imaging is crucial for identifying small but critical anomalies, such as nodules or opacities. However, when images are downsized for processing in Computer-Aided Diagnosis (CAD) systems, vital spatial details and receptive fields are lost, hampering diagnosis accuracy. To address this, this paper presents the Multilevel Collaborative Attention Knowledge (MLCAK) method. This approach leverages the self-attention mechanism of Vision Transformers (ViT) to transfer critical diagnostic knowledge from high-resolution images to enhance the diagnostic efficacy of low-resolution CXRs. MLCAK incorporates local pathological findings to boost model explainability, enabling more accurate global predictions in a multi-task framework tailored for low-resolution CXR analysis. Our research, utilizing the Vindr CXR dataset, shows a considerable enhancement in the ability to diagnose diseases from low-resolution images (e.g. 28 x 28), suggesting a critical transition from the traditional reliance on high-resolution imaging (e.g. 224 x 224).
Quantum machine learning (QML) has the potential for improving the multi-label classification of rare, albeit critical, diseases in large-scale chest x-ray (CXR) datasets due to theoretical quantum advantages over classical machine learning (CML) in sample efficiency and generalizability. While prior literature has explored QML with CXRs, it has focused on binary classification tasks with small datasets due to limited access to quantum hardware and computationally expensive simulations. To that end, we implemented a Jax-based framework that enables the simulation of medium-sized qubit architectures with significant improvements in wall-clock time over current software offerings. We evaluated the performance of our Jax-based framework in terms of efficiency and performance for hybrid quantum transfer learning for long-tailed classification across 8, 14, and 19 disease labels using large-scale CXR datasets. The Jax-based framework resulted in up to a 58% and 95% speed-up compared to PyTorch and TensorFlow implementations, respectively. However, compared to CML, QML demonstrated slower convergence and an average AUROC of 0.70, 0.73, and 0.74 for the classification of 8, 14, and 19 CXR disease labels. In comparison, the CML models had an average AUROC of 0.77, 0.78, and 0.80 respectively. In conclusion, our work presents an accessible implementation of hybrid quantum transfer learning for long-tailed CXR classification with a computationally efficient Jax-based framework.
There has been significant progress in implementing deep learning models in disease diagnosis using chest X- rays. Despite these advancements, inherent biases in these models can lead to disparities in prediction accuracy across protected groups. In this study, we propose a framework to achieve accurate diagnostic outcomes and ensure fairness across intersectional groups in high-dimensional chest X- ray multi-label classification. Transcending traditional protected attributes, we consider complex interactions within social determinants, enabling a more granular benchmark and evaluation of fairness. We present a simple and robust method that involves retraining the last classification layer of pre-trained models using a balanced dataset across groups. Additionally, we account for fairness constraints and integrate class-balanced fine-tuning for multi-label settings. The evaluation of our method on the MIMIC-CXR dataset demonstrates that our framework achieves an optimal tradeoff between accuracy and fairness compared to baseline methods.
Image classifiers for domain-specific tasks like Synthetic Aperture Radar Automatic Target Recognition (SAR ATR) and chest X-ray classification often rely on convolutional neural networks (CNNs). These networks, while powerful, experience high latency due to the number of operations they perform, which can be problematic in real-time applications. Many image classification models are designed to work with both RGB and grayscale datasets, but classifiers that operate solely on grayscale images are less common. Grayscale image classification has critical applications in fields such as medical imaging and SAR ATR. In response, we present a novel grayscale image classification approach using a vectorized view of images. By leveraging the lightweight nature of Multi-Layer Perceptrons (MLPs), we treat images as vectors, simplifying the problem to grayscale image classification. Our approach incorporates a single graph convolutional layer in a batch-wise manner, enhancing accuracy and reducing performance variance. Additionally, we develop a customized accelerator on FPGA for our model, incorporating several optimizations to improve performance. Experimental results on benchmark grayscale image datasets demonstrate the effectiveness of our approach, achieving significantly lower latency (up to $16\times$ less on MSTAR) and competitive or superior performance compared to state-of-the-art models for SAR ATR and medical image classification.
We introduce a novel framework for incorporating human expertise into algorithmic predictions. Our approach leverages human judgment to distinguish inputs which are algorithmically indistinguishable, or "look the same" to predictive algorithms. We argue that this framing clarifies the problem of human-AI collaboration in prediction tasks, as experts often form judgments by drawing on information which is not encoded in an algorithm's training data. Algorithmic indistinguishability yields a natural test for assessing whether experts incorporate this kind of "side information", and further provides a simple but principled method for selectively incorporating human feedback into algorithmic predictions. We show that this method provably improves the performance of any feasible algorithmic predictor and precisely quantify this improvement. We find empirically that although algorithms often outperform their human counterparts on average, human judgment can improve algorithmic predictions on specific instances (which can be identified ex-ante). In an X-ray classification task, we find that this subset constitutes nearly $30\%$ of the patient population. Our approach provides a natural way of uncovering this heterogeneity and thus enabling effective human-AI collaboration.
Medical image datasets are essential for training models used in computer-aided diagnosis, treatment planning, and medical research. However, some challenges are associated with these datasets, including variability in data distribution, data scarcity, and transfer learning issues when using models pre-trained from generic images. This work studies the effect of these challenges at the intra- and inter-domain level in few-shot learning scenarios with severe data imbalance. For this, we propose a methodology based on Siamese neural networks in which a series of techniques are integrated to mitigate the effects of data scarcity and distribution imbalance. Specifically, different initialization and data augmentation methods are analyzed, and four adaptations to Siamese networks of solutions to deal with imbalanced data are introduced, including data balancing and weighted loss, both separately and combined, and with a different balance of pairing ratios. Moreover, we also assess the inference process considering four classifiers, namely Histogram, $k$NN, SVM, and Random Forest. Evaluation is performed on three chest X-ray datasets with annotated cases of both positive and negative COVID-19 diagnoses. The accuracy of each technique proposed for the Siamese architecture is analyzed separately and their results are compared to those obtained using equivalent methods on a state-of-the-art CNN. We conclude that the introduced techniques offer promising improvements over the baseline in almost all cases, and that the selection of the technique may vary depending on the amount of data available and the level of imbalance.
Vision-Language Pre-training (VLP) that utilizes the multi-modal information to promote the training efficiency and effectiveness, has achieved great success in vision recognition of natural domains and shown promise in medical imaging diagnosis for the Chest X-Rays (CXRs). However, current works mainly pay attention to the exploration on single dataset of CXRs, which locks the potential of this powerful paradigm on larger hybrid of multi-source CXRs datasets. We identify that although blending samples from the diverse sources offers the advantages to improve the model generalization, it is still challenging to maintain the consistent superiority for the task of each source due to the existing heterogeneity among sources. To handle this dilemma, we design a Conquer-and-Divide pre-training framework, termed as UniChest, aiming to make full use of the collaboration benefit of multiple sources of CXRs while reducing the negative influence of the source heterogeneity. Specially, the ``Conquer" stage in UniChest encourages the model to sufficiently capture multi-source common patterns, and the ``Divide" stage helps squeeze personalized patterns into different small experts (query networks). We conduct thorough experiments on many benchmarks, e.g., ChestX-ray14, CheXpert, Vindr-CXR, Shenzhen, Open-I and SIIM-ACR Pneumothorax, verifying the effectiveness of UniChest over a range of baselines, and release our codes and pre-training models at https://github.com/Elfenreigen/UniChest.
Chest X-rays are widely used to diagnose thoracic diseases, but the lack of detailed information about these abnormalities makes it challenging to develop accurate automated diagnosis systems, which is crucial for early detection and effective treatment. To address this challenge, we employed deep learning techniques to identify patterns in chest X-rays that correspond to different diseases. We conducted experiments on the "ChestX-ray14" dataset using various pre-trained CNNs, transformers, hybrid(CNN+Transformer) models and classical models. The best individual model was the CoAtNet, which achieved an area under the receiver operating characteristic curve (AUROC) of 84.2%. By combining the predictions of all trained models using a weighted average ensemble where the weight of each model was determined using differential evolution, we further improved the AUROC to 85.4%, outperforming other state-of-the-art methods in this field. Our findings demonstrate the potential of deep learning techniques, particularly ensemble deep learning, for improving the accuracy of automatic diagnosis of thoracic diseases from chest X-rays. Code available at:https://github.com/syednabilashraf/SynthEnsemble