Medical image segmentation is crucial for clinical diagnosis, yet existing models are limited by their reliance on explicit human instructions and lack the active reasoning capabilities to understand complex clinical questions. While recent advancements in multimodal large language models (MLLMs) have improved medical question-answering (QA) tasks, most methods struggle to generate precise segmentation masks, limiting their application in automatic medical diagnosis. In this paper, we introduce medical image reasoning segmentation, a novel task that aims to generate segmentation masks based on complex and implicit medical instructions. To address this, we propose MedSeg-R, an end-to-end framework that leverages the reasoning abilities of MLLMs to interpret clinical questions while also capable of producing corresponding precise segmentation masks for medical images. It is built on two core components: 1) a global context understanding module that interprets images and comprehends complex medical instructions to generate multi-modal intermediate tokens, and 2) a pixel-level grounding module that decodes these tokens to produce precise segmentation masks and textual responses. Furthermore, we introduce MedSeg-QA, a large-scale dataset tailored for the medical image reasoning segmentation task. It includes over 10,000 image-mask pairs and multi-turn conversations, automatically annotated using large language models and refined through physician reviews. Experiments show MedSeg-R's superior performance across several benchmarks, achieving high segmentation accuracy and enabling interpretable textual analysis of medical images.
Medical dictation systems are essential tools in modern healthcare, enabling accurate and efficient conversion of speech into written medical documentation. The main objective of this paper is to create a domain-specific system for Greek medical speech transcriptions. The ultimate goal is to assist healthcare professionals by reducing the overload of manual documentation and improving workflow efficiency. Towards this goal, we develop a system that combines automatic speech recognition techniques with text correction model, allowing better handling of domain-specific terminology and linguistic variations in Greek. Our approach leverages both acoustic and textual modeling to create more realistic and reliable transcriptions. We focused on adapting existing language and speech technologies to the Greek medical context, addressing challenges such as complex medical terminology and linguistic inconsistencies. Through domain-specific fine-tuning, our system achieves more accurate and coherent transcriptions, contributing to the development of practical language technologies for the Greek healthcare sector.
Sourya Sengupta, Satrajit Chakrabarty, Keerthi Sravan Ravi
et al.
Foundation models like the Segment Anything Model (SAM) excel in zero-shot segmentation for natural images but struggle with medical image segmentation due to differences in texture, contrast, and noise. Annotating medical images is costly and requires domain expertise, limiting large-scale annotated data availability. To address this, we propose SynthFM, a synthetic data generation framework that mimics the complexities of medical images, enabling foundation models to adapt without real medical data. Using SAM's pretrained encoder and training the decoder from scratch on SynthFM's dataset, we evaluated our method on 11 anatomical structures across 9 datasets (CT, MRI, and Ultrasound). SynthFM outperformed zero-shot baselines like SAM and MedSAM, achieving superior results under different prompt settings and on out-of-distribution datasets.
Referring Medical Image Sequence Segmentation (Ref-MISS) is a novel and challenging task that aims to segment anatomical structures in medical image sequences (\emph{e.g.} endoscopy, ultrasound, CT, and MRI) based on natural language descriptions. This task holds significant clinical potential and offers a user-friendly advancement in medical imaging interpretation. Existing 2D and 3D segmentation models struggle to explicitly track objects of interest across medical image sequences, and lack support for nteractive, text-driven guidance. To address these limitations, we propose Text-Promptable Propagation (TPP), a model designed for referring medical image sequence segmentation. TPP captures the intrinsic relationships among sequential images along with their associated textual descriptions. Specifically, it enables the recognition of referred objects through cross-modal referring interaction, and maintains continuous tracking across the sequence via Transformer-based triple propagation, using text embeddings as queries. To support this task, we curate a large-scale benchmark, Ref-MISS-Bench, which covers 4 imaging modalities and 20 different organs and lesions. Experimental results on this benchmark demonstrate that TPP consistently outperforms state-of-the-art methods in both medical segmentation and referring video object segmentation.
Large Vision-Language Models (LVLMs) augmented with Retrieval-Augmented Generation (RAG) are increasingly employed in medical AI to enhance factual grounding through external clinical image-text retrieval. However, this reliance creates a significant attack surface. We propose MedThreatRAG, a novel multimodal poisoning framework that systematically probes vulnerabilities in medical RAG systems by injecting adversarial image-text pairs. A key innovation of our approach is the construction of a simulated semi-open attack environment, mimicking real-world medical systems that permit periodic knowledge base updates via user or pipeline contributions. Within this setting, we introduce and emphasize Cross-Modal Conflict Injection (CMCI), which embeds subtle semantic contradictions between medical images and their paired reports. These mismatches degrade retrieval and generation by disrupting cross-modal alignment while remaining sufficiently plausible to evade conventional filters. While basic textual and visual attacks are included for completeness, CMCI demonstrates the most severe degradation. Evaluations on IU-Xray and MIMIC-CXR QA tasks show that MedThreatRAG reduces answer F1 scores by up to 27.66% and lowers LLaVA-Med-1.5 F1 rates to as low as 51.36%. Our findings expose fundamental security gaps in clinical RAG systems and highlight the urgent need for threat-aware design and robust multimodal consistency checks. Finally, we conclude with a concise set of guidelines to inform the safe development of future multimodal medical RAG systems.
Aryaman Raina, Prateek Mishra, Harshit goyal
et al.
This study investigates the integration and impact of Large Language Models (LLMs), like ChatGPT, in India's healthcare sector. Our research employs a dual approach, engaging both general users and medical professionals through surveys and interviews respectively. Our findings reveal that healthcare professionals value ChatGPT in medical education and preliminary clinical settings, but exercise caution due to concerns about reliability, privacy, and the need for cross-verification with medical references. General users show a preference for AI interactions in healthcare, but concerns regarding accuracy and trust persist. The study underscores the need for these technologies to complement, not replace, human medical expertise, highlighting the importance of developing LLMs in collaboration with healthcare providers. This paper enhances the understanding of LLMs in healthcare, detailing current usage, user trust, and improvement areas. Our insights inform future research and development, underscoring the need for ethically compliant, user-focused LLM advancements that address healthcare-specific challenges.
Medical phrase grounding is crucial for identifying relevant regions in medical images based on phrase queries, facilitating accurate image analysis and diagnosis. However, current methods rely on manual extraction of key phrases from medical reports, reducing efficiency and increasing the workload for clinicians. Additionally, the lack of model confidence estimation limits clinical trust and usability. In this paper, we introduce a novel task called Medical Report Grounding (MRG), which aims to directly identify diagnostic phrases and their corresponding grounding boxes from medical reports in an end-to-end manner. To address this challenge, we propose uMedGround, a robust and reliable framework that leverages a multimodal large language model to predict diagnostic phrases by embedding a unique token, <BOX>, into the vocabulary to enhance detection capabilities. A vision encoder-decoder processes the embedded token and input image to generate grounding boxes. Critically, uMedGround incorporates an uncertainty-aware prediction model, significantly improving the robustness and reliability of grounding predictions. Experimental results demonstrate that uMedGround outperforms state-of-the-art medical phrase grounding methods and fine-tuned large visual-language models, validating its effectiveness and reliability. This study represents a pioneering exploration of the MRG task, marking the first-ever endeavor in this domain. Additionally, we demonstrate the applicability of uMedGround in medical visual question answering and class-based localization tasks, where it highlights visual evidence aligned with key diagnostic phrases, supporting clinicians in interpreting various types of textual inputs, including free-text reports, visual question answering queries, and class labels.
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.
Giovanni Pasqualino, Luca Guarnera, Alessandro Ortis
et al.
The progress in generative models, particularly Generative Adversarial Networks (GANs), opened new possibilities for image generation but raised concerns about potential malicious uses, especially in sensitive areas like medical imaging. This study introduces MITS-GAN, a novel approach to prevent tampering in medical images, with a specific focus on CT scans. The approach disrupts the output of the attacker's CT-GAN architecture by introducing finely tuned perturbations that are imperceptible to the human eye. Specifically, the proposed approach involves the introduction of appropriate Gaussian noise to the input as a protective measure against various attacks. Our method aims to enhance tamper resistance, comparing favorably to existing techniques. Experimental results on a CT scan demonstrate MITS-GAN's superior performance, emphasizing its ability to generate tamper-resistant images with negligible artifacts. As image tampering in medical domains poses life-threatening risks, our proactive approach contributes to the responsible and ethical use of generative models. This work provides a foundation for future research in countering cyber threats in medical imaging. Models and codes are publicly available on https://iplab.dmi.unict.it/MITS-GAN-2024/.
Medical report generation is the task of automatically writing radiology reports for chest X-ray images. Manually composing these reports is a time-consuming process that is also prone to human errors. Generating medical reports can therefore help reduce the burden on radiologists. In other words, we can promote greater clinical automation in the medical domain. In this work, we propose a new framework leveraging vision-enabled Large Language Models (LLM) for the task of medical report generation. We introduce a lightweight solution that achieves better or comparative performance as compared to previous solutions on the task of medical report generation. We conduct extensive experiments exploring different model sizes and enhancement approaches, such as prefix tuning to improve the text generation abilities of the LLMs. We evaluate our approach on a prominent large-scale radiology report dataset - MIMIC-CXR. Our results demonstrate the capability of our resource-efficient framework to generate patient-specific reports with strong medical contextual understanding and high precision.
Medical decisions directly impact individuals' health and well-being. Extracting decision spans from clinical notes plays a crucial role in understanding medical decision-making processes. In this paper, we develop a new dataset called "MedDec", which contains clinical notes of eleven different phenotypes (diseases) annotated by ten types of medical decisions. We introduce the task of medical decision extraction, aiming to jointly extract and classify different types of medical decisions within clinical notes. We provide a comprehensive analysis of the dataset, develop a span detection model as a baseline for this task, evaluate recent span detection approaches, and employ a few metrics to measure the complexity of data samples. Our findings shed light on the complexities inherent in clinical decision extraction and enable future work in this area of research. The dataset and code are available through https://github.com/CLU-UML/MedDec.
Harsha Nori, Nicholas King, Scott Mayer McKinney
et al.
Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.
Inbar Fried, Janine Hoelscher, Jason A. Akulian
et al.
Anatomical models of a medical robot's environment can significantly help guide design and development of a new robotic system. These models can be used for benchmarking motion planning algorithms, evaluating controllers, optimizing mechanical design choices, simulating procedures, and even as resources for data generation. Currently, the time-consuming task of generating these environments is repeatedly performed by individual research groups and rarely shared broadly. This not only leads to redundant efforts, but also makes it challenging to compare systems and algorithms accurately. In this work, we present a collection of clinically-relevant anatomical environments for medical robots operating in the lungs. Since anatomical deformation is a fundamental challenge for medical robots operating in the lungs, we describe a way to model respiratory deformation in these environments using patient-derived data. We share the environments and deformation data publicly by adding them to the Medical Robotics Anatomical Dataset (Med-RAD), our public dataset of anatomical environments for medical robots.
Medical professionals frequently work in a data constrained setting to provide insights across a unique demographic. A few medical observations, for instance, informs the diagnosis and treatment of a patient. This suggests a unique setting for meta-learning, a method to learn models quickly on new tasks, to provide insights unattainable by other methods. We investigate the use of meta-learning and robustness techniques on a broad corpus of benchmark text and medical data. To do this, we developed new data pipelines, combined language models with meta-learning approaches, and extended existing meta-learning algorithms to minimize worst case loss. We find that meta-learning on text is a suitable framework for text-based data, providing better data efficiency and comparable performance to few-shot language models and can be successfully applied to medical note data. Furthermore, meta-learning models coupled with DRO can improve worst case loss across disease codes.
Machine learning techniques used in computer-aided medical image analysis usually suffer from the domain shift problem caused by different distributions between source/reference data and target data. As a promising solution, domain adaptation has attracted considerable attention in recent years. The aim of this paper is to survey the recent advances of domain adaptation methods in medical image analysis. We first present the motivation of introducing domain adaptation techniques to tackle domain heterogeneity issues for medical image analysis. Then we provide a review of recent domain adaptation models in various medical image analysis tasks. We categorize the existing methods into shallow and deep models, and each of them is further divided into supervised, semi-supervised and unsupervised methods. We also provide a brief summary of the benchmark medical image datasets that support current domain adaptation research. This survey will enable researchers to gain a better understanding of the current status, challenges.
Computer-aided medical image analysis plays a significant role in assisting medical practitioners for expert clinical diagnosis and deciding the optimal treatment plan. At present, convolutional neural networks (CNN) are the preferred choice for medical image analysis. In addition, with the rapid advancements in three-dimensional (3D) imaging systems and the availability of excellent hardware and software support to process large volumes of data, 3D deep learning methods are gaining popularity in medical image analysis. Here, we present an extensive review of the recently evolved 3D deep learning methods in medical image segmentation. Furthermore, the research gaps and future directions in 3D medical image segmentation are discussed.
Lihao Liu, Angelica I Aviles-Rivero, Carola-Bibiane Schönlieb
Medical image segmentation is a relevant task as it serves as the first step for several diagnosis processes, thus it is indispensable in clinical usage. Whilst major success has been reported using supervised techniques, they assume a large and well-representative labelled set. This is a strong assumption in the medical domain where annotations are expensive, time-consuming, and inherent to human bias. To address this problem, unsupervised techniques have been proposed in the literature yet it is still an open problem due to the difficulty of learning any transformation pattern. In this work, we present a novel optimisation model framed into a new CNN-based contrastive registration architecture for unsupervised medical image segmentation. The core of our approach is to exploit image-level registration and feature-level from a contrastive learning mechanism, to perform registration-based segmentation. Firstly, we propose an architecture to capture the image-to-image transformation pattern via registration for unsupervised medical image segmentation. Secondly, we embed a contrastive learning mechanism into the registration architecture to enhance the discriminating capacity of the network in the feature-level. We show that our proposed technique mitigates the major drawbacks of existing unsupervised techniques. We demonstrate, through numerical and visual experiments, that our technique substantially outperforms the current state-of-the-art unsupervised segmentation methods on two major medical image datasets.
Behavior trees (BTs) emerged from video game development as a graphical language for modeling intelligent agent behavior. BTs have several properties which are attractive for modeling medical procedures including human-readability, authoring tools, and composability. This paper will illustrate construction of BTs for exemplary medical procedures. We are pleased to acknowledge support from National Science Foundation grant #IIS-1637444 and collaborations on that project with Johns Hopkins University and Worcester Polytechnic Institute.