Aligning Synthetic Medical Images with Clinical Knowledge using Human Feedback

Generative models capable of precisely capturing nuanced clinical features in medical images hold great promise for facilitating clinical data sharing, enhancing rare disease datasets, and efficiently synthesizing (annotated) medical images at scale. Despite their potential, assessing the quality of synthetic medical images remains a challenge. While modern generative models can synthesize visually-realistic medical images, the clinical plausibility of these images may be called into question. Domain-agnostic scores, such as FID score, precision, and recall, cannot incorporate clinical knowledge and are, therefore, not suitable for assessing clinical sensibility. Additionally, there are numerous unpredictable ways in which generative models may fail to synthesize clinically plausible images, making it challenging to anticipate potential failures and design automated scores for their detection. To address these challenges, this paper introduces a pathologist-in-the-loop framework for generating clinically-plausible synthetic medical images. Our framework comprises three steps: (1) pretraining a conditional diffusion model to generate medical images conditioned on a clinical concept, (2) expert pathologist evaluation of the generated images to assess whether they satisfy clinical desiderata, and (3) training a reward model that predicts human feedback on new samples, which we use to incorporate expert knowledge into the finetuning objective of the diffusion model. Our results show that human feedback significantly improves the quality of synthetic images in terms of fidelity, diversity, utility in downstream applications, and plausibility as evaluated by experts. We also demonstrate that human feedback can teach the model new clinical concepts not annotated in the original training data. Our results demonstrate the value of incorporating human feedback in clinical applications where generative models may struggle to capture extensive domain knowledge from raw data alone.