The increasing availability of biomedical data from large biobanks, electronic health records, medical imaging, wearable and ambient biosensors, and the lower cost of genome and microbiome sequencing have set the stage for the development of multimodal artificial intelligence solutions that capture the complexity of human health and disease. In this Review, we outline the key applications enabled, along with the technical and analytical challenges. We explore opportunities in personalized medicine, digital clinical trials, remote monitoring and care, pandemic surveillance, digital twin technology and virtual health assistants. Further, we survey the data, modeling and privacy challenges that must be overcome to realize the full potential of multimodal artificial intelligence in health. 

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Multimodal biomedical AI

Graph Neural Networks (GNNs) have gained momentum in graph representation learning and boosted the state of the art in a variety of areas, such as data mining (\emph{e.g.,} social network analysis and recommender systems), computer vision (\emph{e.g.,} object detection and point cloud learning), and natural language processing (\emph{e.g.,} relation extraction and sequence learning), to name a few. With the emergence of Transformers in natural language processing and computer vision, graph Transformers embed a graph structure into the Transformer architecture to overcome the limitations of local neighborhood aggregation while avoiding strict structural inductive biases. In this paper, we present a comprehensive review of GNNs and graph Transformers in computer vision from a task-oriented perspective. Specifically, we divide their applications in computer vision into five categories according to the modality of input data, \emph{i.e.,} 2D natural images, videos, 3D data, vision + language, and medical images. In each category, we further divide the applications according to a set of vision tasks. Such a task-oriented taxonomy allows us to examine how each task is tackled by different GNN-based approaches and how well these approaches perform. Based on the necessary preliminaries, we provide the definitions and challenges of the tasks, in-depth coverage of the representative approaches, as well as discussions regarding insights, limitations, and future directions.

A Survey on Graph Neural Networks and Graph Transformers in Computer Vision: A Task-Oriented Perspective

Learning medical visual representations directly from paired radiology reports has become an emerging topic in representation learning. However, existing medical image-text joint learning methods are limited by instance or local supervision analysis, ignoring disease-level semantic correspondences. In this paper, we present a novel Multi-Granularity Cross-modal Alignment (MGCA) framework for generalized medical visual representation learning by harnessing the naturally exhibited semantic correspondences between medical image and radiology reports at three different levels, i.e., pathological region-level, instance-level, and disease-level. Specifically, we first incorporate the instance-wise alignment module by maximizing the agreement between image-report pairs. Further, for token-wise alignment, we introduce a bidirectional cross-attention strategy to explicitly learn the matching between fine-grained visual tokens and text tokens, followed by contrastive learning to align them. More important, to leverage the high-level inter-subject relationship semantic (e.g., disease) correspondences, we design a novel cross-modal disease-level alignment paradigm to enforce the cross-modal cluster assignment consistency. Extensive experimental results on seven downstream medical image datasets covering image classification, object detection, and semantic segmentation tasks demonstrate the stable and superior performance of our framework.

Multi-Granularity Cross-modal Alignment for Generalized Medical Visual Representation Learning

The application of AI to medical image interpretation tasks has largely been limited to the identification of a handful of individual pathologies. In contrast, the generation of complete narrative radiology reports more closely matches how radiologists communicate diagnostic information in clinical workflows. Recent progress in artificial intelligence (AI) on vision-language tasks has enabled the possibility of generating high-quality radiology reports from medical images. Automated metrics to evaluate the quality of generated reports attempt to capture overlap in the language or clinical entities between a machine-generated report and a radiologist-generated report. In this study, we quantitatively examine the correlation between automated metrics and the scoring of reports by radiologists. We analyze failure modes of the metrics, namely the types of information the metrics do not capture, to understand when to choose particular metrics and how to interpret metric scores. We propose a composite metric, called RadCliQ, that we find is able to rank the quality of reports similarly to radiologists and better than existing metrics. Lastly, we measure the performance of state-of-the-art report generation approaches using the investigated metrics. We expect that our work can guide both the evaluation and the development of report generation systems that can generate reports from medical images approaching the level of radiologists.

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Evaluating Progress in Automatic Chest X-Ray Radiology Report Generation

The increasing popularity of attention mechanisms in deep learning algorithms for computer vision and natural language processing made these models attractive to other research domains. In healthcare, there is a strong need for tools that may improve the routines of the clinicians and the patients. Naturally, the use of attention-based algorithms for medical applications occurred smoothly. However, being healthcare a domain that depends on high-stake decisions, the scientific community must ponder if these high-performing algorithms fit the needs of medical applications. With this motto, this paper extensively reviews the use of attention mechanisms in machine learning methods (including Transformers) for several medical applications based on the types of tasks that may integrate several works pipelines of the medical domain. This work distinguishes itself from its predecessors by proposing a critical analysis of the claims and potentialities of attention mechanisms presented in the literature through an experimental case study on medical image classification with three different use cases. These experiments focus on the integrating process of attention mechanisms into established deep learning architectures, the analysis of their predictive power, and a visual assessment of their saliency maps generated by post-hoc explanation methods. This paper concludes with a critical analysis of the claims and potentialities presented in the literature about attention mechanisms and proposes future research lines in medical applications that may benefit from these frameworks.

A Survey on Attention Mechanisms for Medical Applications: are we Moving Toward Better Algorithms?

Pre-training lays the foundation for recent successes in radiograph analysis supported by deep learning. It learns transferable image representations by conducting large-scale fully-supervised or self-supervised learning on a source domain. However, supervised pre-training requires a complex and labor intensive two-stage human-assisted annotation process while self-supervised learning cannot compete with the supervised paradigm. To tackle these issues, we propose a cross-supervised methodology named REviewing FreE-text Reports for Supervision (REFERS), which acquires free supervision signals from original radiology reports accompanying the radiographs. The proposed approach employs a vision transformer and is designed to learn joint representations from multiple views within every patient study. REFERS outperforms its transfer learning and self-supervised learning counterparts on 4 well-known X-ray datasets under extremely limited supervision. Moreover, REFERS even surpasses methods based on a source domain of radiographs with human-assisted structured labels. Thus REFERS has the potential to replace canonical pre-training methodologies.

https://medrxiv.org/content/10.1101/2021.11.02.21265838v1.full.pdf

Ruibang Luo

Papers

Generalized Radiograph Representation Learning via Cross-supervision between Images and Free-text Radiology Reports.

Generalized Radiograph Representation Learning via Cross-supervision between Images and Free-text Radiology Reports