Sturdy and environment friendly medical imaging with self-supervision – Google AI Weblog

Replace — 2023/06/09: This submit has been up to date as work described is now revealed in Nature Biomedical Engineering.

Regardless of current progress within the subject of medical synthetic intelligence (AI), most present fashions are slender, single-task methods that require massive portions of labeled knowledge to coach. Furthermore, these fashions can’t be simply reused in new scientific contexts as they typically require the gathering, de-identification and annotation of site-specific knowledge for each new deployment surroundings, which is each laborious and costly. This downside of data-efficient generalization (a mannequin’s means to generalize to new settings utilizing minimal new knowledge) continues to be a key translational problem for medical machine studying (ML) fashions and has in flip, prevented their broad uptake in actual world healthcare settings.

The emergence of basis fashions presents a major alternative to rethink growth of medical AI to make it extra performant, safer, and equitable. These fashions are educated utilizing knowledge at scale, typically by self-supervised studying. This course of leads to generalist fashions that may quickly be tailored to new duties and environments with much less want for supervised knowledge. With basis fashions, it might be attainable to securely and effectively deploy fashions throughout numerous scientific contexts and environments.

In “Sturdy and Environment friendly MEDical Imaging with Self-supervision” (REMEDIS), revealed in Nature Biomedical Engineering, we introduce a unified large-scale self-supervised studying framework for constructing basis medical imaging fashions. This technique combines massive scale supervised switch studying with self-supervised studying and requires minimal task-specific customization. REMEDIS exhibits vital enchancment in data-efficient generalization throughout medical imaging duties and modalities with a 3–100x discount in site-specific knowledge for adapting fashions to new scientific contexts and environments. Constructing on this, we’re excited to announce Medical AI Analysis Foundations (hosted by PhysioNet), an growth of the general public launch of chest X-ray Foundations in 2022. Medical AI Analysis Foundations is a set of open-source non-diagnostic fashions (beginning with REMEDIS fashions), APIs, and assets to assist researchers and builders speed up medical AI analysis.

Massive scale self-supervision for medical imaging

REMEDIS makes use of a mixture of pure (non-medical) photos and unlabeled medical photos to develop sturdy medical imaging basis fashions. Its pre-training technique consists of two steps. The primary includes supervised illustration studying on a large-scale dataset of labeled pure photos (pulled from Imagenet 21k or JFT) utilizing the Large Switch (BiT) methodology.

The second step includes intermediate self-supervised studying, which doesn’t require any labels and as an alternative, trains a mannequin to be taught medical knowledge representations independently of labels. The particular method used for pre-training and studying representations is SimCLR. The strategy works by maximizing settlement between in another way augmented views of the identical coaching instance through a contrastive loss in a hidden layer of a feed-forward neural community with multilayer perceptron (MLP) outputs. Nevertheless, REMEDIS is equally suitable with different contrastive self-supervised studying strategies. This coaching methodology is relevant for healthcare environments as many hospitals purchase uncooked knowledge (photos) as a routine observe. Whereas processes must be carried out to make this knowledge usable inside fashions (i.e., affected person consent previous to gathering the info, de-identification, and many others.), the expensive, time-consuming, and troublesome job of labeling that knowledge might be prevented utilizing REMEDIS.

REMEDIS leverages large-scale supervised studying utilizing pure photos and self-supervised studying utilizing unlabeled medical knowledge to create sturdy basis fashions for medical imaging.

Given ML mannequin parameter constraints, it can be crucial that our proposed method works when utilizing each small and huge mannequin structure sizes. To review this intimately, we thought-about two ResNet architectures with generally used depth and width multipliers, ResNet-50 (1×) and ResNet-152 (2×) because the spine encoder networks.

After pre-training, the mannequin was fine-tuned utilizing labeled task-specific medical knowledge and evaluated for in-distribution job efficiency. As well as, to judge the data-efficient generalization, the mannequin was additionally optionally fine-tuned utilizing small quantities of out-of-distribution (OOD) knowledge.

REMEDIS begins with representations initialized utilizing large-scale pure picture pretraining following the Large Switch (BiT) methodology. We then adapt the mannequin to the medical area utilizing intermediate contrastive self-supervised studying with out utilizing any labeled medical knowledge. Lastly, we fine-tune the mannequin to particular downstream medical imaging duties. We consider the ML mannequin each in an in-distribution (ID) setting and in an out-of-distribution (OOD) setting to determine the data-efficient generalization efficiency of the mannequin.

Analysis and outcomes

To judge the REMEDIS mannequin’s efficiency, we simulate practical situations utilizing retrospective de-identified knowledge throughout a broad vary of medical imaging duties and modalities, together with dermatology, retinal imaging, chest X-ray interpretation, pathology and mammography. We additional introduce the notion of data-efficient generalization, capturing the mannequin’s means to generalize to new deployment distributions with a considerably diminished want for knowledgeable annotated knowledge from the brand new scientific setting. In-distribution efficiency is measured as (1) enchancment in zero-shot generalization to OOD settings (assessing efficiency in an OOD analysis set, with zero entry to coaching knowledge from the OOD dataset) and (2) vital discount within the want for annotated knowledge from the OOD settings to achieve efficiency equal to scientific consultants (or threshold demonstrating scientific utility). REMEDIS displays considerably improved in-distribution efficiency with as much as 11.5% relative enchancment in diagnostic accuracy over a strongly supervised baseline.

Extra importantly, our technique results in data-efficient generalization of medical imaging fashions, matching sturdy supervised baselines leading to a 3–100x discount within the want for retraining knowledge. Whereas SimCLR is the first self-supervised studying method used within the examine, we additionally present that REMEDIS is suitable with different approaches, reminiscent of MoCo-V2, RELIC and Barlow Twins. Moreover, the method works throughout mannequin structure sizes.

REMEDIS outperformed the supervised baseline pre-trained on JFT-300M for numerous medical duties and demonstrated improved data-efficient generalization, lowering knowledge wants by 3–100x for adapting fashions to new scientific settings. This might doubtlessly translate to vital discount in clinician hours saved annotating knowledge and price of creating strong medical imaging methods.
REMEDIS is suitable with MoCo-V2, RELIC and Barlow Twins as alternate self-supervised studying methods. All of the REMEDIS variants result in data-efficient generalization enhancements over the sturdy supervised baseline for dermatology situation classification (T1), diabetic macular edema classification (T2), and chest X-ray situation classification (T3). The grey shaded space signifies the efficiency of the sturdy supervised baseline pre-trained on JFT.

Medical AI Analysis Foundations

Constructing on REMEDIS, we’re excited to announce Medical AI Analysis Foundations, an growth of the general public launch of chest X-ray Foundations in 2022. Medical AI Analysis Foundations is a repository of open-source medical basis fashions hosted by PhysioNet. This expands the earlier API-based method to additionally embody non-diagnostic fashions, to assist researchers and builders speed up their medical AI analysis. We imagine that REMEDIS and the discharge of the Medical AI Analysis Foundations are a step towards constructing medical fashions that may generalize throughout healthcare settings and duties.

We’re seeding Medical AI Analysis Foundations with REMEDIS fashions for chest X-ray and pathology (with associated code). Whereas the prevailing chest X-ray Basis method focuses on offering frozen embeddings for application-specific tremendous tuning from a mannequin educated on a number of massive personal datasets, the REMEDIS fashions (educated on public datasets) allow customers to fine-tune end-to-end for his or her software, and to run on native units. We suggest customers take a look at completely different approaches based mostly on their distinctive wants for his or her desired software. We anticipate so as to add extra fashions and assets for coaching medical basis fashions reminiscent of datasets and benchmarks sooner or later. We additionally welcome the medical AI analysis group to contribute to this.


These outcomes counsel that REMEDIS has the potential to considerably speed up the event of ML methods for medical imaging, which might protect their sturdy efficiency when deployed in a wide range of altering contexts. We imagine this is a vital step ahead for medical imaging AI to ship a broad influence. Past the experimental outcomes offered, the method and insights described right here have been built-in into a number of of Google’s medical imaging analysis initiatives, reminiscent of dermatology, mammography and radiology amongst others. We’re utilizing the same self-supervised studying method with our non-imaging basis mannequin efforts, reminiscent of Med-PaLM and Med-PaLM 2.

With REMEDIS, we demonstrated the potential of basis fashions for medical imaging functions. Such fashions maintain thrilling potentialities in medical functions with the chance of multimodal illustration studying. The observe of medication is inherently multimodal and incorporates info from photos, digital well being information, sensors, wearables, genomics and extra. We imagine ML methods that leverage these knowledge at scale utilizing self-supervised studying with cautious consideration of privateness, security, equity and ethics will assist lay the groundwork for the subsequent technology of studying well being methods that scale world-class healthcare to everybody.


This work concerned in depth collaborative efforts from a multidisciplinary crew of researchers, software program engineers, clinicians, and cross-functional contributors throughout Google Well being AI and Google Mind. Specifically, we wish to thank our first co-author Jan Freyberg and our lead senior authors of those initiatives, Vivek Natarajan, Alan Karthikesalingam, Mohammad Norouzi and Neil Houlsby for his or her invaluable contributions and help. We additionally thank Lauren Winer, Sami Lachgar, Yun Liu and Karan Singhal for his or her suggestions on this submit and Tom Small for help in creating the visuals. Lastly, we additionally thank the PhysioNet crew for his or her help on internet hosting Medical AI Analysis Foundations. Customers with questions can attain out to medical-ai-research-foundations at

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