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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Deep Multimodal Learning for Medical Visual Question Answering1</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Lei Shi</string-name>
          <email>lshi@wpi.edu</email>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Feifan Liu</string-name>
          <email>feifan.liu@umassmed.edu</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Max P. Rosen</string-name>
          <email>max.rosen@umassmemorial.org</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>University of Massachusetts Medical School</institution>
          ,
          <addr-line>Worcester MA 01655</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Worcester Polytechnic Institute</institution>
          ,
          <addr-line>Worcester MA 01609</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>This paper describes the participation of the University of Massachusetts Medical School in the ImageCLEF 2019 Med-VQA task. The goal is to predict the answers given the medical images and the questions. The categories of the questions are provided for the training and validation datasets. We implemented long-short-term memory (LSTM) for question textual feature extraction and transfer learning followed by the co-attention mechanism for image feature extraction. Due to the provided category information, we implemented the SVM model the predict the question category which is used as another feature for our system. In addition, we applied the embedding based topic model (ETM) to generate question topic distribution as one more feature for our system. To efficiently integrate different types of features, we employed the multi-modal factorized high-order pooling (MFH). For the answer prediction, we developed a two-channel framework to handle different categories of questions through single-label classification and multi-label classification respectively. We submitted 3 valid runs, and the best system achieved the accuracy of 0.566 and the BLEU score of 0.593, ranking the 5th place among 17 participating groups.</p>
      </abstract>
      <kwd-group>
        <kwd>Visual Question Answering</kwd>
        <kwd>Transfer Learning</kwd>
        <kwd>ETM</kwd>
        <kwd>Multi-modal Fusion</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>Given an image and a natural language question about the image, visual question
answering (VQA) task is to provide an accurate natural language answer. This task
combines computer vision (CV) and natural language processing (NLP). One of the
challenges for VQA task is how to fuse different types of features. Various methods, like
LinearSum and Multi-modal Factorized Bilinear Pooling (MFB), have been designed
and practiced on the VQA task.</p>
      <p>A lot of studies of VQA task are in the general domain. With increasing
implementations of deep learning to support clinical decision making and improve patient
engagement, some studies begin to focus on the VQA task in the medical domain.
ImageCLEF 2019 [1] organized the inaugural edition of the Medical Domain Visual
Question Answering (Med-VQA) Task [2]. Given a medical image with a clinically relevant
question, the system is tasked with answering the question based on the visual image
content. The dataset of this year is different from the last year. The categories of the
questions are provided. For the questions in the first three categories, there are a limited
number of answer candidates. And the answers to the questions in the last category are
narrative.</p>
      <p>In this work, we introduced the question category information and the question topic
distribution as two additional information during the information fusion process. To
develop an integrated system that is able to handle all four categories of questions, we
developed two-channel structures for the answer prediction. One channel is to classify
the image-question pairs into the close set of answer candidates. The other channel is
to generate a narrative answer given an image-question pair.
2</p>
    </sec>
    <sec id="sec-2">
      <title>System description</title>
      <p>Our system consists of 6 components: transfer learning for image feature extraction,
LSTM for question textual feature extraction, other features (including question
category information and question topic distribution), co-attention mechanism, MFH for
feature fusion, and answer generation. Fig. 1 shows the architecture of our system.
A pre-trained biomedical word embedding (dimension of 200) is used as the embedding
layer. After the word embedding layer, a bidirectional LSTM network is used to extract
textual features of the question. During the training process, the embedding of the
“unknown” token is first initialized randomly and then learned. The textual features are
transformed to predict the attention weight of different grid locations, which generates
the attentional features of the question.
2.2</p>
      <sec id="sec-2-1">
        <title>Image Processing</title>
        <p>We applied transfer learning to extract image features. The pre-trained ResNet-152
model of ImageNet (excluding the last 2 layers, pooling layer and fully-connected
layer) is the image feature extractor. The parameters of the last 2 convolutional blocks
of ResNet-152 model are fine-tuned during the training process. Then we applied the
co-attention mechanism to generate the attentional features of the image.
2.3</p>
      </sec>
      <sec id="sec-2-2">
        <title>Question Topic Distribution</title>
        <p>ETM [3] is applied to generate several topics from the questions. 10 topics are
generated by applying ETM on the questions in the training dataset. Each question is assigned
a vector of topic distribution according to the frequencies of topics’ words appearing in
the question. The topic distribution is used as another input feature of the MFH.
According to the instruction of the 2019 Med-VQA, the questions are from 4 categories.
SVM is used to classify the category of the question. We applied TF-IDF based unigram
vectorization to extract textual features, and trained a support vector machines (SVM)
model using the questions from the training dataset. The accuracy of the SVM model
on validation dataset is 100%, which shows that the language used in different
categories of questions are relatively unique and less ambiguous. The category information of
the question is used as an additional input of the MFH.
2.5</p>
      </sec>
      <sec id="sec-2-3">
        <title>Feature Fusion</title>
        <p>MFH [4] contains multiple dependent MFB blocks. The output from the expand stage
of the previous MFB block is fed into the next MFB block as additional input, and the
output from multiple MFB blocks are merged together as a final fused feature
representation.</p>
        <p>We applied a 2-block MFH model to fuse 4 types of features including image
attentional features, question attentional features, question topic distribution, and question
category, which is shown in Fig. 2.
2.6</p>
      </sec>
      <sec id="sec-2-4">
        <title>Answer Prediction</title>
        <p>According to the instruction of 2019 Med-VQA, for the questions of the first 3
categories, the corresponding answers are in a limited number of certain candidates. We
regarded this case as a single-label classification task. On the other hand, the questions
of “abnormality” category are the narrative type. This case is regarded as a multi-label
classification task. So, we built two-channel structures which are shown in Fig. 3. One
is for the single-label classification task and the other one is for the multi-label
classification task. For multi-label classification, each unique word in the answer sentence is
considered an answer label for the corresponding image-question pair. Based on the
distribution of all the answer labels, the narrative answer is generated using the
sampling method.</p>
        <p>Therefore, both a classification result and a distribution of words in the answer are
predicted through our system for each pair of image-question. If the classification result
is one of the certain candidates of the answers, the final answer is that candidate.
Otherwise, the final answer is a combination of words generated by the sampling method.</p>
        <p>
          The loss function of our system is an integration of two loss functions. We applied
the cross-entropy loss function for the single-label classification structure and
Kullback–Leibler divergence loss function for the multi-label classification structure. Given
an image-question pair, the loss L is calculated as follows:
 = (1 − ) ∗  +  ∗ 
(
          <xref ref-type="bibr" rid="ref1">1</xref>
          )
where A is 1 if the predicted category of the question is “Abnormality” otherwise 0.
3
        </p>
      </sec>
    </sec>
    <sec id="sec-3">
      <title>Experiments</title>
      <p>
        We experimented with 4 settings of the pre-trained ResNet-152 model on ImageNet:
(
        <xref ref-type="bibr" rid="ref1">1</xref>
        ) Res-2 is using the pre-trained ResNet-152 model excluding the last 2 layers (pooling
layer and fully-connected layer); (
        <xref ref-type="bibr" rid="ref2">2</xref>
        ) Res-3 is using the pre-trained ResNet-152 model
excluding the last 3 layers (last residual block, pooling layer and fully-connected layer);
(
        <xref ref-type="bibr" rid="ref3">3</xref>
        ) Res-2-tunable is using the pre-trained ResNet-152 model excluding the last 2 layers,
and the last residual block is fine-tuned during the training process of our system; (
        <xref ref-type="bibr" rid="ref4">4</xref>
        )
ETM-Res-2 is using the pre-trained ResNet-152 model excluding the last 2 layers. We
used the topics of the questions generated by the ETM model to label the corresponding
images and fine-tuned this ResNet-152 model.
      </p>
      <p>
        A pre-trained word-embedding (dimension of 200) on PubMed and the clinical notes
from MIMIC-III Clinical Database is used as the word embedding layer. We
experimented with 2 settings to handle “unknown” token in the questions: (
        <xref ref-type="bibr" rid="ref1">1</xref>
        ) Fixed-Unknown
is using a fixed 0 vector for “unknown” token; (
        <xref ref-type="bibr" rid="ref2">2</xref>
        ) Learned-Unknown is initializing a
random vector for “unknown” token and this vector is trained during the training
process of our system.
Table 1 shows the performance of different settings on the validation dataset. We can
see that ETM based transfer learning is not as helpful as shown in [5]. It is partially
because the questions in 2019 data are less diverse and the topic labels derived from
ETM are not distinctive enough to finetune the pre-trained ImageNet model during
image classification training. We also found that visual features from different layers of
Residual networks perform differently (Res-2 vs. Res-3 in Table 1), which suggests
that combining them together may help improve the system performance.
3.2
      </p>
      <sec id="sec-3-1">
        <title>Official Test Runs in ImageCLEF 2019</title>
        <p>We submitted 3 runs on the test dataset and the settings and results are shown in Table
1. The accuracy of our best system is 0.566 and the BLEU score is 0.593 on the test
dataset, ranking fifth place. The team ranking first place of this competition obtained
an accuracy of 0.624 and a BLEU score of 0.644.
We experimented with three different settings of deep learning structures for
MEDVQA task 2019, where we introduced two more types of features and we constructed
two-channel structures for answer prediction. Due to the limited time, we did not
implement Bidirectional Encoder Representations from Transformers (BERT) [6] which
will be explored in the future to extract question textual features.
5</p>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>Acknowledgments</title>
      <p>We gratefully acknowledge the support of NVIDIA Corporation with the donation of
the Titan Xp GPU used for this research.</p>
    </sec>
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