Towards Interpretable, Sequential Multiple Instance Learning: An Application to Clinical Imaging

Xiaolong Luo, Hsin-Hsiao Scott Wang, Michael Lingzhi Li

Keywords: Multiple Instance Learning, Sequential Learning, Binary Classification, Medical Imaging, Uncertainty, Interpretability

TL;DR: The paper presents a framework for sequential, multiple instance learning in clinical imaging and proposes a bidirectional Transformer architecture to solve it.

Abstract: This work introduces the Sequential Multiple Instance Learning (SMIL) framework, addressing the challenge of interpreting sequential, variable-length sequences of medical images with a single diagnostic label. Diverging from traditional MIL approaches that treat image sequences as unordered sets, SMIL systematically integrates the sequential nature of clinical imaging. We develop a bidirectional Transformer architecture, BiSMIL, that optimizes for both early and final prediction accuracies through a novel training procedure to balance diagnostic accuracy with operational efficiency. We evaluate BiSMIL on three medical image datasets to demonstrate that it simultaneously achieves state-of-the-art final accuracy and superior performance in early prediction accuracy, requiring 30-50% fewer images for a similar level of performance compared to existing models. Additionally, we introduce SMILU, an interpretable uncertainty metric that outperforms traditional metrics in identifying challenging instances.

Primary Area: applications to computer vision, audio, language, and other modalities

Code Of Ethics: I acknowledge that I and all co-authors of this work have read and commit to adhering to the ICLR Code of Ethics.

Submission Guidelines: I certify that this submission complies with the submission instructions as described on https://iclr.cc/Conferences/2025/AuthorGuide.

Anonymous Url: I certify that there is no URL (e.g., github page) that could be used to find authors’ identity.

No Acknowledgement Section: I certify that there is no acknowledgement section in this submission for double blind review.

Submission Number: 8130