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This book constitutes the refereed joint proceedings of the 4th International Workshop on Deep Learning in Medical Image Analysis, DLMIA 2018, and the 8th International Workshop on Multimodal Learning for Clinical Decision Support, ML-CDS 2018, held in conjunction with the 21st International Conference on Medical Imaging and Computer-Assisted Intervention, MICCAI 2018, in Granada, Spain, in September 2018. The 39 full papers presented at DLMIA 2018 and the 4 full papers presented at ML-CDS 2018 were carefully reviewed and selected from 77 submissions to DLMIA and xx submissions to ML-CDS. The DLMIA papers focus on the design and use of deep learning methods in medical imaging. The ML-CDS papers discuss new techniques of multimodal mining/retrieval and their use in clinical decision support.