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Jan 12

FetalCLIP: A Visual-Language Foundation Model for Fetal Ultrasound Image Analysis

Foundation models are becoming increasingly effective in the medical domain, offering pre-trained models on large datasets that can be readily adapted for downstream tasks. Despite progress, fetal ultrasound images remain a challenging domain for foundation models due to their inherent complexity, often requiring substantial additional training and facing limitations due to the scarcity of paired multimodal data. To overcome these challenges, here we introduce FetalCLIP, a vision-language foundation model capable of generating universal representation of fetal ultrasound images. FetalCLIP was pre-trained using a multimodal learning approach on a diverse dataset of 210,035 fetal ultrasound images paired with text. This represents the largest paired dataset of its kind used for foundation model development to date. This unique training approach allows FetalCLIP to effectively learn the intricate anatomical features present in fetal ultrasound images, resulting in robust representations that can be used for a variety of downstream applications. In extensive benchmarking across a range of key fetal ultrasound applications, including classification, gestational age estimation, congenital heart defect (CHD) detection, and fetal structure segmentation, FetalCLIP outperformed all baselines while demonstrating remarkable generalizability and strong performance even with limited labeled data. We plan to release the FetalCLIP model publicly for the benefit of the broader scientific community.

  • 11 authors
·
Feb 20, 2025

Epistemic-aware Vision-Language Foundation Model for Fetal Ultrasound Interpretation

Recent medical vision-language models have shown promise on tasks such as VQA, report generation, and anomaly detection. However, most are adapted to structured adult imaging and underperform in fetal ultrasound, which poses challenges of multi-view image reasoning, numerous diseases, and image diversity. To bridge this gap, we introduce FetalMind, a medical AI system tailored to fetal ultrasound for both report generation and diagnosis. Guided by clinical workflow, we propose Salient Epistemic Disentanglement (SED), which injects an expert-curated bipartite graph into the model to decouple view-disease associations and to steer preference selection along clinically faithful steps via reinforcement learning. This design mitigates variability across diseases and heterogeneity across views, reducing learning bottlenecks while aligning the model's inference with obstetric practice. To train FetalMind at scale, we curate FetalSigma-1M dataset, the first large-scale fetal ultrasound report corpus, comprising 20K reports from twelve medical centers, addressing the scarcity of domain data. Extensive experiments show that FetalMind outperforms open- and closed-source baselines across all gestational stages, achieving +14% average gains and +61.2% higher accuracy on critical conditions while remaining efficient, stable, and scalable. Project Page: https://hexiao0275.github.io/FetalMind.

  • 10 authors
·
Oct 14, 2025

Artificial Intelligence-derived Vascular Age from Photoplethysmography: A Novel Digital Biomarker for Cardiovascular Health

With the increasing availability of wearable devices, photoplethysmography (PPG) has emerged as a promising non-invasive tool for monitoring human hemodynamics. We propose a deep learning framework to estimate vascular age (AI-vascular age) from PPG signals, incorporating a distribution-aware loss to address biases caused by imbalanced data. The model was developed using data from the UK Biobank (UKB), with 98,672 participants in the development cohort and 113,559 participants (144,683 data pairs) for clinical evaluation. After adjusting for key confounders, individuals with a vascular age gap (AI-vascular age minus calendar age) exceeding 9 years had a significantly higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) (HR = 2.37, p < 0.005) and secondary outcomes, including diabetes (HR = 2.69, p < 0.005), hypertension (HR = 2.88, p < 0.005), coronary heart disease (HR = 2.20, p < 0.005), heart failure (HR = 2.15, p < 0.005), myocardial infarction (HR = 2.51, p < 0.005), stroke (HR = 2.55, p < 0.005), and all-cause mortality (HR = 2.51, p < 0.005). Conversely, participants with a vascular age gap below -9 years exhibited a significantly lower incidence of these outcomes. We further evaluated the longitudinal applicability of AI-vascular age using serial PPG data from the UKB, demonstrating its value in risk stratification by leveraging AI-vascular age at two distinct time points to predict future MACCE incidence. External validation was performed on a MIMIC-III-derived cohort (n = 2,343), where each one-year increase in vascular age gap was significantly associated with elevated in-hospital mortality risk (OR = 1.02, p < 0.005). In conclusion, our study establishes AI-vascular age as a novel, non-invasive digital biomarker for cardiovascular health assessment.

  • 5 authors
·
Feb 18, 2025

SynthBA: Reliable Brain Age Estimation Across Multiple MRI Sequences and Resolutions

Brain age is a critical measure that reflects the biological ageing process of the brain. The gap between brain age and chronological age, referred to as brain PAD (Predicted Age Difference), has been utilized to investigate neurodegenerative conditions. Brain age can be predicted using MRIs and machine learning techniques. However, existing methods are often sensitive to acquisition-related variabilities, such as differences in acquisition protocols, scanners, MRI sequences, and resolutions, significantly limiting their application in highly heterogeneous clinical settings. In this study, we introduce Synthetic Brain Age (SynthBA), a robust deep-learning model designed for predicting brain age. SynthBA utilizes an advanced domain randomization technique, ensuring effective operation across a wide array of acquisition-related variabilities. To assess the effectiveness and robustness of SynthBA, we evaluate its predictive capabilities on internal and external datasets, encompassing various MRI sequences and resolutions, and compare it with state-of-the-art techniques. Additionally, we calculate the brain PAD in a large cohort of subjects with Alzheimer's Disease (AD), demonstrating a significant correlation with AD-related measures of cognitive dysfunction. SynthBA holds the potential to facilitate the broader adoption of brain age prediction in clinical settings, where re-training or fine-tuning is often unfeasible. The SynthBA source code and pre-trained models are publicly available at https://github.com/LemuelPuglisi/SynthBA.

  • 6 authors
·
Jun 1, 2024

Efficient Feature Extraction Using Light-Weight CNN Attention-Based Deep Learning Architectures for Ultrasound Fetal Plane Classification

Ultrasound fetal imaging is beneficial to support prenatal development because it is affordable and non-intrusive. Nevertheless, fetal plane classification (FPC) remains challenging and time-consuming for obstetricians since it depends on nuanced clinical aspects, which increases the difficulty in identifying relevant features of the fetal anatomy. Thus, to assist with its accurate feature extraction, a lightweight artificial intelligence architecture leveraging convolutional neural networks and attention mechanisms is proposed to classify the largest benchmark ultrasound dataset. The approach fine-tunes from lightweight EfficientNet feature extraction backbones pre-trained on the ImageNet1k. to classify key fetal planes such as the brain, femur, thorax, cervix, and abdomen. Our methodology incorporates the attention mechanism to refine features and 3-layer perceptrons for classification, achieving superior performance with the highest Top-1 accuracy of 96.25%, Top-2 accuracy of 99.80% and F1-Score of 0.9576. Importantly, the model has 40x fewer trainable parameters than existing benchmark ensemble or transformer pipelines, facilitating easy deployment on edge devices to help clinical practitioners with real-time FPC. The findings are also interpreted using GradCAM to carry out clinical correlation to aid doctors with diagnostics and improve treatment plans for expectant mothers.

  • 4 authors
·
Oct 22, 2024

Site-Level Fine-Tuning with Progressive Layer Freezing: Towards Robust Prediction of Bronchopulmonary Dysplasia from Day-1 Chest Radiographs in Extremely Preterm Infants

Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting 35% of extremely low birth weight infants. Defined by oxygen dependence at 36 weeks postmenstrual age, it causes lifelong respiratory complications. However, preventive interventions carry severe risks, including neurodevelopmental impairment, ventilator-induced lung injury, and systemic complications. Therefore, early BPD prognosis and prediction of BPD outcome is crucial to avoid unnecessary toxicity in low risk infants. Admission radiographs of extremely preterm infants are routinely acquired within 24h of life and could serve as a non-invasive prognostic tool. In this work, we developed and investigated a deep learning approach using chest X-rays from 163 extremely low-birth-weight infants (leq32 weeks gestation, 401-999g) obtained within 24 hours of birth. We fine-tuned a ResNet-50 pretrained specifically on adult chest radiographs, employing progressive layer freezing with discriminative learning rates to prevent overfitting and evaluated a CutMix augmentation and linear probing. For moderate/severe BPD outcome prediction, our best performing model with progressive freezing, linear probing and CutMix achieved an AUROC of 0.78 pm 0.10, balanced accuracy of 0.69 pm 0.10, and an F1-score of 0.67 pm 0.11. In-domain pre-training significantly outperformed ImageNet initialization (p = 0.031) which confirms domain-specific pretraining to be important for BPD outcome prediction. Routine IRDS grades showed limited prognostic value (AUROC 0.57 pm 0.11), confirming the need of learned markers. Our approach demonstrates that domain-specific pretraining enables accurate BPD prediction from routine day-1 radiographs. Through progressive freezing and linear probing, the method remains computationally feasible for site-level implementation and future federated learning deployments.

  • 16 authors
·
Jul 16, 2025

FP-Age: Leveraging Face Parsing Attention for Facial Age Estimation in the Wild

Image-based age estimation aims to predict a person's age from facial images. It is used in a variety of real-world applications. Although end-to-end deep models have achieved impressive results for age estimation on benchmark datasets, their performance in-the-wild still leaves much room for improvement due to the challenges caused by large variations in head pose, facial expressions, and occlusions. To address this issue, we propose a simple yet effective method to explicitly incorporate facial semantics into age estimation, so that the model would learn to correctly focus on the most informative facial components from unaligned facial images regardless of head pose and non-rigid deformation. To this end, we design a face parsing-based network to learn semantic information at different scales and a novel face parsing attention module to leverage these semantic features for age estimation. To evaluate our method on in-the-wild data, we also introduce a new challenging large-scale benchmark called IMDB-Clean. This dataset is created by semi-automatically cleaning the noisy IMDB-WIKI dataset using a constrained clustering method. Through comprehensive experiment on IMDB-Clean and other benchmark datasets, under both intra-dataset and cross-dataset evaluation protocols, we show that our method consistently outperforms all existing age estimation methods and achieves a new state-of-the-art performance. To the best of our knowledge, our work presents the first attempt of leveraging face parsing attention to achieve semantic-aware age estimation, which may be inspiring to other high level facial analysis tasks. Code and data are available on https://github.com/ibug-group/fpage.

  • 4 authors
·
Jun 21, 2021

MedImageInsight: An Open-Source Embedding Model for General Domain Medical Imaging

In this work, we present MedImageInsight, an open-source medical imaging embedding model. MedImageInsight is trained on medical images with associated text and labels across a diverse collection of domains, including X-Ray, CT, MRI, dermoscopy, OCT, fundus photography, ultrasound, histopathology, and mammography. Rigorous evaluations demonstrate MedImageInsight's ability to achieve state-of-the-art (SOTA) or human expert level performance across classification, image-image search, and fine-tuning tasks. Specifically, on public datasets, MedImageInsight achieves SOTA in CT 3D medical image retrieval, as well as SOTA in disease classification and search for chest X-ray, dermatology, and OCT imaging. Furthermore, MedImageInsight achieves human expert performance in bone age estimation (on both public and partner data), as well as AUC above 0.9 in most other domains. When paired with a text decoder, MedImageInsight achieves near SOTA level single image report findings generation with less than 10\% the parameters of other models. Compared to fine-tuning GPT-4o with only MIMIC-CXR data for the same task, MedImageInsight outperforms in clinical metrics, but underperforms on lexical metrics where GPT-4o sets a new SOTA. Importantly for regulatory purposes, MedImageInsight can generate ROC curves, adjust sensitivity and specificity based on clinical need, and provide evidence-based decision support through image-image search (which can also enable retrieval augmented generation). In an independent clinical evaluation of image-image search in chest X-ray, MedImageInsight outperformed every other publicly available foundation model evaluated by large margins (over 6 points AUC), and significantly outperformed other models in terms of AI fairness (across age and gender). We hope releasing MedImageInsight will help enhance collective progress in medical imaging AI research and development.

  • 31 authors
·
Oct 9, 2024

PRISM Lite: A lightweight model for interactive 3D placenta segmentation in ultrasound

Placenta volume measured from 3D ultrasound (3DUS) images is an important tool for tracking the growth trajectory and is associated with pregnancy outcomes. Manual segmentation is the gold standard, but it is time-consuming and subjective. Although fully automated deep learning algorithms perform well, they do not always yield high-quality results for each case. Interactive segmentation models could address this issue. However, there is limited work on interactive segmentation models for the placenta. Despite their segmentation accuracy, these methods may not be feasible for clinical use as they require relatively large computational power which may be especially prohibitive in low-resource environments, or on mobile devices. In this paper, we propose a lightweight interactive segmentation model aiming for clinical use to interactively segment the placenta from 3DUS images in real-time. The proposed model adopts the segmentation from our fully automated model for initialization and is designed in a human-in-the-loop manner to achieve iterative improvements. The Dice score and normalized surface Dice are used as evaluation metrics. The results show that our model can achieve superior performance in segmentation compared to state-of-the-art models while using significantly fewer parameters. Additionally, the proposed model is much faster for inference and robust to poor initial masks. The code is available at https://github.com/MedICL-VU/PRISM-placenta.

  • 9 authors
·
Aug 9, 2024

Beyond Binary Gender Labels: Revealing Gender Biases in LLMs through Gender-Neutral Name Predictions

Name-based gender prediction has traditionally categorized individuals as either female or male based on their names, using a binary classification system. That binary approach can be problematic in the cases of gender-neutral names that do not align with any one gender, among other reasons. Relying solely on binary gender categories without recognizing gender-neutral names can reduce the inclusiveness of gender prediction tasks. We introduce an additional gender category, i.e., "neutral", to study and address potential gender biases in Large Language Models (LLMs). We evaluate the performance of several foundational and large language models in predicting gender based on first names only. Additionally, we investigate the impact of adding birth years to enhance the accuracy of gender prediction, accounting for shifting associations between names and genders over time. Our findings indicate that most LLMs identify male and female names with high accuracy (over 80%) but struggle with gender-neutral names (under 40%), and the accuracy of gender prediction is higher for English-based first names than non-English names. The experimental results show that incorporating the birth year does not improve the overall accuracy of gender prediction, especially for names with evolving gender associations. We recommend using caution when applying LLMs for gender identification in downstream tasks, particularly when dealing with non-binary gender labels.

  • 7 authors
·
Jul 7, 2024

TimelyGPT: Extrapolatable Transformer Pre-training for Long-term Time-Series Forecasting in Healthcare

Large-scale pre-trained models (PTMs) such as BERT and GPT have recently achieved great success in Natural Language Processing and Computer Vision domains. However, the development of PTMs on healthcare time-series data is lagging behind.This underscores the limitations of the existing transformer-based architectures, particularly their scalability to handle large-scale time series and ability to capture long-term temporal dependencies. In this study, we present Timely Generative Pre-trained Transformer (TimelyGPT). TimelyGPT employs an extrapolatable position (xPos) embedding to encode trend and periodic patterns into time-series representations. It also integrates recurrent attention and temporal convolution modules to effectively capture global-local temporal dependencies. We evaluated TimelyGPT on two large-scale healthcare time series datasets corresponding to continuous biosignals and irregularly-sampled time series, respectively. Our experiments show that during pre-training, TimelyGPT excels in learning time-series representations from continuously monitored biosignals and irregularly-sampled time series data commonly observed in longitudinal electronic health records (EHRs). In forecasting continuous biosignals, TimelyGPT achieves accurate extrapolation up to 6,000 timesteps of body temperature during the sleep stage transition, given a short look-up window (i.e., prompt) containing only 2,000 timesteps. For irregularly-sampled time series, TimelyGPT with a proposed time-specific inference demonstrates high top recall scores in predicting future diagnoses using early diagnostic records, effectively handling irregular intervals between clinical records. Together, we envision TimelyGPT to be useful in a broad spectrum of health domains, including long-term patient health state forecasting and patient risk trajectory prediction.

  • 6 authors
·
Nov 29, 2023

Age Progression/Regression by Conditional Adversarial Autoencoder

"If I provide you a face image of mine (without telling you the actual age when I took the picture) and a large amount of face images that I crawled (containing labeled faces of different ages but not necessarily paired), can you show me what I would look like when I am 80 or what I was like when I was 5?" The answer is probably a "No." Most existing face aging works attempt to learn the transformation between age groups and thus would require the paired samples as well as the labeled query image. In this paper, we look at the problem from a generative modeling perspective such that no paired samples is required. In addition, given an unlabeled image, the generative model can directly produce the image with desired age attribute. We propose a conditional adversarial autoencoder (CAAE) that learns a face manifold, traversing on which smooth age progression and regression can be realized simultaneously. In CAAE, the face is first mapped to a latent vector through a convolutional encoder, and then the vector is projected to the face manifold conditional on age through a deconvolutional generator. The latent vector preserves personalized face features (i.e., personality) and the age condition controls progression vs. regression. Two adversarial networks are imposed on the encoder and generator, respectively, forcing to generate more photo-realistic faces. Experimental results demonstrate the appealing performance and flexibility of the proposed framework by comparing with the state-of-the-art and ground truth.

  • 3 authors
·
Feb 27, 2017

Interactive Segmentation Model for Placenta Segmentation from 3D Ultrasound images

Placenta volume measurement from 3D ultrasound images is critical for predicting pregnancy outcomes, and manual annotation is the gold standard. However, such manual annotation is expensive and time-consuming. Automated segmentation algorithms can often successfully segment the placenta, but these methods may not consistently produce robust segmentations suitable for practical use. Recently, inspired by the Segment Anything Model (SAM), deep learning-based interactive segmentation models have been widely applied in the medical imaging domain. These models produce a segmentation from visual prompts provided to indicate the target region, which may offer a feasible solution for practical use. However, none of these models are specifically designed for interactively segmenting 3D ultrasound images, which remain challenging due to the inherent noise of this modality. In this paper, we evaluate publicly available state-of-the-art 3D interactive segmentation models in contrast to a human-in-the-loop approach for the placenta segmentation task. The Dice score, normalized surface Dice, averaged symmetric surface distance, and 95-percent Hausdorff distance are used as evaluation metrics. We consider a Dice score of 0.95 a successful segmentation. Our results indicate that the human-in-the-loop segmentation model reaches this standard. Moreover, we assess the efficiency of the human-in-the-loop model as a function of the amount of prompts. Our results demonstrate that the human-in-the-loop model is both effective and efficient for interactive placenta segmentation. The code is available at https://github.com/MedICL-VU/PRISM-placenta.

  • 9 authors
·
Jul 10, 2024

Enforcing temporal consistency in Deep Learning segmentation of brain MR images

Longitudinal analysis has great potential to reveal developmental trajectories and monitor disease progression in medical imaging. This process relies on consistent and robust joint 4D segmentation. Traditional techniques are dependent on the similarity of images over time and the use of subject-specific priors to reduce random variation and improve the robustness and sensitivity of the overall longitudinal analysis. This is however slow and computationally intensive as subject-specific templates need to be rebuilt every time. The focus of this work to accelerate this analysis with the use of deep learning. The proposed approach is based on deep CNNs and incorporates semantic segmentation and provides a longitudinal relationship for the same subject. The proposed approach is based on deep CNNs and incorporates semantic segmentation and provides a longitudinal relationship for the same subject. The state of art using 3D patches as inputs to modified Unet provides results around {0.91 pm 0.5} Dice and using multi-view atlas in CNNs provide around the same results. In this work, different models are explored, each offers better accuracy and fast results while increasing the segmentation quality. These methods are evaluated on 135 scans from the EADC-ADNI Harmonized Hippocampus Protocol. Proposed CNN based segmentation approaches demonstrate how 2D segmentation using prior slices can provide similar results to 3D segmentation while maintaining good continuity in the 3D dimension and improved speed. Just using 2D modified sagittal slices provide us a better Dice and longitudinal analysis for a given subject. For the ADNI dataset, using the simple UNet CNN technique gives us {0.84 pm 0.5} and while using modified CNN techniques on the same input yields {0.89 pm 0.5}. Rate of atrophy and RMS error are calculated for several test cases using various methods and analyzed.

  • 2 authors
·
Jun 13, 2019

MiVOLO: Multi-input Transformer for Age and Gender Estimation

Age and gender recognition in the wild is a highly challenging task: apart from the variability of conditions, pose complexities, and varying image quality, there are cases where the face is partially or completely occluded. We present MiVOLO (Multi Input VOLO), a straightforward approach for age and gender estimation using the latest vision transformer. Our method integrates both tasks into a unified dual input/output model, leveraging not only facial information but also person image data. This improves the generalization ability of our model and enables it to deliver satisfactory results even when the face is not visible in the image. To evaluate our proposed model, we conduct experiments on four popular benchmarks and achieve state-of-the-art performance, while demonstrating real-time processing capabilities. Additionally, we introduce a novel benchmark based on images from the Open Images Dataset. The ground truth annotations for this benchmark have been meticulously generated by human annotators, resulting in high accuracy answers due to the smart aggregation of votes. Furthermore, we compare our model's age recognition performance with human-level accuracy and demonstrate that it significantly outperforms humans across a majority of age ranges. Finally, we grant public access to our models, along with the code for validation and inference. In addition, we provide extra annotations for used datasets and introduce our new benchmark.

  • 2 authors
·
Jul 10, 2023

The Alzheimer's Disease Prediction Of Longitudinal Evolution (TADPOLE) Challenge: Results after 1 Year Follow-up

We present the findings of "The Alzheimer's Disease Prediction Of Longitudinal Evolution" (TADPOLE) Challenge, which compared the performance of 92 algorithms from 33 international teams at predicting the future trajectory of 219 individuals at risk of Alzheimer's disease. Challenge participants were required to make a prediction, for each month of a 5-year future time period, of three key outcomes: clinical diagnosis, Alzheimer's Disease Assessment Scale Cognitive Subdomain (ADAS-Cog13), and total volume of the ventricles. The methods used by challenge participants included multivariate linear regression, machine learning methods such as support vector machines and deep neural networks, as well as disease progression models. No single submission was best at predicting all three outcomes. For clinical diagnosis and ventricle volume prediction, the best algorithms strongly outperform simple baselines in predictive ability. However, for ADAS-Cog13 no single submitted prediction method was significantly better than random guesswork. Two ensemble methods based on taking the mean and median over all predictions, obtained top scores on almost all tasks. Better than average performance at diagnosis prediction was generally associated with the additional inclusion of features from cerebrospinal fluid (CSF) samples and diffusion tensor imaging (DTI). On the other hand, better performance at ventricle volume prediction was associated with inclusion of summary statistics, such as the slope or maxima/minima of biomarkers. TADPOLE's unique results suggest that current prediction algorithms provide sufficient accuracy to exploit biomarkers related to clinical diagnosis and ventricle volume, for cohort refinement in clinical trials for Alzheimer's disease. However, results call into question the usage of cognitive test scores for patient selection and as a primary endpoint in clinical trials.

  • 96 authors
·
Feb 9, 2020

Gender inference: can chatGPT outperform common commercial tools?

An increasing number of studies use gender information to understand phenomena such as gender bias, inequity in access and participation, or the impact of the Covid pandemic response. Unfortunately, most datasets do not include self-reported gender information, making it necessary for researchers to infer gender from other information, such as names or names and country information. An important limitation of these tools is that they fail to appropriately capture the fact that gender exists on a non-binary scale, however, it remains important to evaluate and compare how well these tools perform in a variety of contexts. In this paper, we compare the performance of a generative Artificial Intelligence (AI) tool ChatGPT with three commercially available list-based and machine learning-based gender inference tools (Namsor, Gender-API, and genderize.io) on a unique dataset. Specifically, we use a large Olympic athlete dataset and report how variations in the input (e.g., first name and first and last name, with and without country information) impact the accuracy of their predictions. We report results for the full set, as well as for the subsets: medal versus non-medal winners, athletes from the largest English-speaking countries, and athletes from East Asia. On these sets, we find that Namsor is the best traditional commercially available tool. However, ChatGPT performs at least as well as Namsor and often outperforms it, especially for the female sample when country and/or last name information is available. All tools perform better on medalists versus non-medalists and on names from English-speaking countries. Although not designed for this purpose, ChatGPT may be a cost-effective tool for gender prediction. In the future, it might even be possible for ChatGPT or other large scale language models to better identify self-reported gender rather than report gender on a binary scale.

  • 5 authors
·
Nov 24, 2023

Deep Learning Segmentation of Ascites on Abdominal CT Scans for Automatic Volume Quantification

Purpose: To evaluate the performance of an automated deep learning method in detecting ascites and subsequently quantifying its volume in patients with liver cirrhosis and ovarian cancer. Materials and Methods: This retrospective study included contrast-enhanced and non-contrast abdominal-pelvic CT scans of patients with cirrhotic ascites and patients with ovarian cancer from two institutions, National Institutes of Health (NIH) and University of Wisconsin (UofW). The model, trained on The Cancer Genome Atlas Ovarian Cancer dataset (mean age, 60 years +/- 11 [s.d.]; 143 female), was tested on two internal (NIH-LC and NIH-OV) and one external dataset (UofW-LC). Its performance was measured by the Dice coefficient, standard deviations, and 95% confidence intervals, focusing on ascites volume in the peritoneal cavity. Results: On NIH-LC (25 patients; mean age, 59 years +/- 14 [s.d.]; 14 male) and NIH-OV (166 patients; mean age, 65 years +/- 9 [s.d.]; all female), the model achieved Dice scores of 0.855 +/- 0.061 (CI: 0.831-0.878) and 0.826 +/- 0.153 (CI: 0.764-0.887), with median volume estimation errors of 19.6% (IQR: 13.2-29.0) and 5.3% (IQR: 2.4-9.7) respectively. On UofW-LC (124 patients; mean age, 46 years +/- 12 [s.d.]; 73 female), the model had a Dice score of 0.830 +/- 0.107 (CI: 0.798-0.863) and median volume estimation error of 9.7% (IQR: 4.5-15.1). The model showed strong agreement with expert assessments, with r^2 values of 0.79, 0.98, and 0.97 across the test sets. Conclusion: The proposed deep learning method performed well in segmenting and quantifying the volume of ascites in concordance with expert radiologist assessments.

  • 7 authors
·
Jun 22, 2024

Model-free Approach to Evaluate a Censored Intermediate Outcome as a Surrogate for Overall Survival

Clinical trials or studies oftentimes require long-term and/or costly follow-up of participants to evaluate a novel treatment/drug/vaccine. There has been increasing interest in the past few decades in using short-term surrogate outcomes as a replacement of the primary outcome i.e., in using the surrogate outcome, which can potentially be observed sooner, to make inference about the treatment effect on the long-term primary outcome. Very few of the available statistical methods to evaluate a surrogate are applicable to settings where both the surrogate and the primary outcome are time-to-event outcomes subject to censoring. Methods that can handle this setting tend to require parametric assumptions or be limited to assessing only the restricted mean survival time. In this paper, we propose a non-parametric approach to evaluate a censored surrogate outcome, such as time to progression, when the primary outcome is also a censored time-to-event outcome, such as time to death, and the treatment effect of interest is the difference in overall survival. Specifically, we define the proportion of the treatment effect on the primary outcome that is explained (PTE) by the censored surrogate outcome in this context, and estimate this proportion by defining and deriving an optimal transformation of the surrogate information. Our approach provides the added advantage of relaxed assumptions to guarantee that the true PTE is within (0,1), along with being model-free. Finite sample performance of our estimators are illustrated via extensive simulation studies and a real data application examining progression-free survival as a surrogate for overall survival for patients with metastatic colorectal cancer.

  • 4 authors
·
Dec 18, 2024

ALPHA: AnomaLous Physiological Health Assessment Using Large Language Models

This study concentrates on evaluating the efficacy of Large Language Models (LLMs) in healthcare, with a specific focus on their application in personal anomalous health monitoring. Our research primarily investigates the capabilities of LLMs in interpreting and analyzing physiological data obtained from FDA-approved devices. We conducted an extensive analysis using anomalous physiological data gathered in a simulated low-air-pressure plateau environment. This allowed us to assess the precision and reliability of LLMs in understanding and evaluating users' health status with notable specificity. Our findings reveal that LLMs exhibit exceptional performance in determining medical indicators, including a Mean Absolute Error (MAE) of less than 1 beat per minute for heart rate and less than 1% for oxygen saturation (SpO2). Furthermore, the Mean Absolute Percentage Error (MAPE) for these evaluations remained below 1%, with the overall accuracy of health assessments surpassing 85%. In image analysis tasks, such as interpreting photoplethysmography (PPG) data, our specially adapted GPT models demonstrated remarkable proficiency, achieving less than 1 bpm error in cycle count and 7.28 MAE for heart rate estimation. This study highlights LLMs' dual role as health data analysis tools and pivotal elements in advanced AI health assistants, offering personalized health insights and recommendations within the future health assistant framework.

  • 7 authors
·
Nov 21, 2023

Foundation Model of Electronic Medical Records for Adaptive Risk Estimation

Hospitals struggle to predict critical outcomes. Traditional early warning systems, like NEWS and MEWS, rely on static variables and fixed thresholds, limiting their adaptability, accuracy, and personalization. We previously developed the Enhanced Transformer for Health Outcome Simulation (ETHOS), an AI model that tokenizes patient health timelines (PHTs) from EHRs and uses transformer-based architectures to predict future PHTs. ETHOS is a versatile framework for developing a wide range of applications. In this work, we develop the Adaptive Risk Estimation System (ARES) that leverages ETHOS to compute dynamic, personalized risk probabilities for clinician-defined critical events. ARES also features a personalized explainability module that highlights key clinical factors influencing risk estimates. We evaluated ARES using the MIMIC-IV v2.2 dataset together with its Emergency Department (ED) extension and benchmarked performance against both classical early warning systems and contemporary machine learning models. The entire dataset was tokenized resulting in 285,622 PHTs, comprising over 360 million tokens. ETHOS outperformed benchmark models in predicting hospital admissions, ICU admissions, and prolonged stays, achieving superior AUC scores. Its risk estimates were robust across demographic subgroups, with calibration curves confirming model reliability. The explainability module provided valuable insights into patient-specific risk factors. ARES, powered by ETHOS, advances predictive healthcare AI by delivering dynamic, real-time, personalized risk estimation with patient-specific explainability. Although our results are promising, the clinical impact remains uncertain. Demonstrating ARES's true utility in real-world settings will be the focus of our future work. We release the source code to facilitate future research.

  • 12 authors
·
Feb 9, 2025

Towards Measuring Fairness in AI: the Casual Conversations Dataset

This paper introduces a novel dataset to help researchers evaluate their computer vision and audio models for accuracy across a diverse set of age, genders, apparent skin tones and ambient lighting conditions. Our dataset is composed of 3,011 subjects and contains over 45,000 videos, with an average of 15 videos per person. The videos were recorded in multiple U.S. states with a diverse set of adults in various age, gender and apparent skin tone groups. A key feature is that each subject agreed to participate for their likenesses to be used. Additionally, our age and gender annotations are provided by the subjects themselves. A group of trained annotators labeled the subjects' apparent skin tone using the Fitzpatrick skin type scale. Moreover, annotations for videos recorded in low ambient lighting are also provided. As an application to measure robustness of predictions across certain attributes, we provide a comprehensive study on the top five winners of the DeepFake Detection Challenge (DFDC). Experimental evaluation shows that the winning models are less performant on some specific groups of people, such as subjects with darker skin tones and thus may not generalize to all people. In addition, we also evaluate the state-of-the-art apparent age and gender classification methods. Our experiments provides a thorough analysis on these models in terms of fair treatment of people from various backgrounds.

  • 6 authors
·
Apr 6, 2021

Large Language Models to Identify Social Determinants of Health in Electronic Health Records

Social determinants of health (SDoH) have an important impact on patient outcomes but are incompletely collected from the electronic health records (EHR). This study researched the ability of large language models to extract SDoH from free text in EHRs, where they are most commonly documented, and explored the role of synthetic clinical text for improving the extraction of these scarcely documented, yet extremely valuable, clinical data. 800 patient notes were annotated for SDoH categories, and several transformer-based models were evaluated. The study also experimented with synthetic data generation and assessed for algorithmic bias. Our best-performing models were fine-tuned Flan-T5 XL (macro-F1 0.71) for any SDoH, and Flan-T5 XXL (macro-F1 0.70). The benefit of augmenting fine-tuning with synthetic data varied across model architecture and size, with smaller Flan-T5 models (base and large) showing the greatest improvements in performance (delta F1 +0.12 to +0.23). Model performance was similar on the in-hospital system dataset but worse on the MIMIC-III dataset. Our best-performing fine-tuned models outperformed zero- and few-shot performance of ChatGPT-family models for both tasks. These fine-tuned models were less likely than ChatGPT to change their prediction when race/ethnicity and gender descriptors were added to the text, suggesting less algorithmic bias (p<0.05). At the patient-level, our models identified 93.8% of patients with adverse SDoH, while ICD-10 codes captured 2.0%. Our method can effectively extracted SDoH information from clinic notes, performing better compare to GPT zero- and few-shot settings. These models could enhance real-world evidence on SDoH and aid in identifying patients needing social support.

  • 14 authors
·
Aug 11, 2023

A study of a deterministic model for meningitis epidemic

A compartmental deterministic model that allows (1) immunity from two stages of infection and carriage, and (2) disease induced death, is used in studying the dynamics of meningitis epidemic process in a closed population. It allows for difference in the transmission rate of infection to a susceptible by a carrier and an infective. It is generalized to allow a proportion ({\phi}) of those susceptibles infected to progress directly to infectives in stage I. Both models are used in this study. The threshold conditions for the spread of carrier and infectives in stage I are derived for the two models. Sensitivity analysis is performed on the reproductive number derived from the next generation matrix. The case-carrier ratio profile for various parameters and threshold values are shown. So also are the graphs of the total number ever infected as influenced by {\epsilon} and {\phi}. The infection transmission rate (eta), the odds in favor of a carrier, over an infective, in transmitting an infection to a susceptible ({\epsilon}) and the carrier conversion rate ({\phi}) to an infective in stage I, are identified as key parameters that should be subject of attention for any control intervention strategy. The case-carrier ratio profiles provide evidence of a critical case-carrier ratio attained before the number of reported cases grows to an epidemic level. They also provide visual evidence of epidemiological context, in this case, epidemic incidence (in later part of dry season) and endemic incidence (during rainy season). Results from total proportion ever infected suggest that the model, in which {\phi}=0 obtained, can adequately represent, in essence, the generalized model for this study.

  • 2 authors
·
Mar 31, 2023

Putting People in their Place: Monocular Regression of 3D People in Depth

Given an image with multiple people, our goal is to directly regress the pose and shape of all the people as well as their relative depth. Inferring the depth of a person in an image, however, is fundamentally ambiguous without knowing their height. This is particularly problematic when the scene contains people of very different sizes, e.g. from infants to adults. To solve this, we need several things. First, we develop a novel method to infer the poses and depth of multiple people in a single image. While previous work that estimates multiple people does so by reasoning in the image plane, our method, called BEV, adds an additional imaginary Bird's-Eye-View representation to explicitly reason about depth. BEV reasons simultaneously about body centers in the image and in depth and, by combing these, estimates 3D body position. Unlike prior work, BEV is a single-shot method that is end-to-end differentiable. Second, height varies with age, making it impossible to resolve depth without also estimating the age of people in the image. To do so, we exploit a 3D body model space that lets BEV infer shapes from infants to adults. Third, to train BEV, we need a new dataset. Specifically, we create a "Relative Human" (RH) dataset that includes age labels and relative depth relationships between the people in the images. Extensive experiments on RH and AGORA demonstrate the effectiveness of the model and training scheme. BEV outperforms existing methods on depth reasoning, child shape estimation, and robustness to occlusion. The code and dataset are released for research purposes.

  • 6 authors
·
Dec 15, 2021

SynthRAD2023 Grand Challenge dataset: generating synthetic CT for radiotherapy

Purpose: Medical imaging has become increasingly important in diagnosing and treating oncological patients, particularly in radiotherapy. Recent advances in synthetic computed tomography (sCT) generation have increased interest in public challenges to provide data and evaluation metrics for comparing different approaches openly. This paper describes a dataset of brain and pelvis computed tomography (CT) images with rigidly registered CBCT and MRI images to facilitate the development and evaluation of sCT generation for radiotherapy planning. Acquisition and validation methods: The dataset consists of CT, CBCT, and MRI of 540 brains and 540 pelvic radiotherapy patients from three Dutch university medical centers. Subjects' ages ranged from 3 to 93 years, with a mean age of 60. Various scanner models and acquisition settings were used across patients from the three data-providing centers. Details are available in CSV files provided with the datasets. Data format and usage notes: The data is available on Zenodo (https://doi.org/10.5281/zenodo.7260705) under the SynthRAD2023 collection. The images for each subject are available in nifti format. Potential applications: This dataset will enable the evaluation and development of image synthesis algorithms for radiotherapy purposes on a realistic multi-center dataset with varying acquisition protocols. Synthetic CT generation has numerous applications in radiation therapy, including diagnosis, treatment planning, treatment monitoring, and surgical planning.

  • 9 authors
·
Mar 28, 2023

TotalSegmentator MRI: Robust Sequence-independent Segmentation of Multiple Anatomic Structures in MRI

Since the introduction of TotalSegmentator CT, there is demand for a similar robust automated MRI segmentation tool that can be applied across all MRI sequences and anatomic structures. In this retrospective study, a nnU-Net model (TotalSegmentator) was trained on MRI and CT examinations to segment 80 anatomic structures relevant for use cases such as organ volumetry, disease characterization, surgical planning and opportunistic screening. Examinations were randomly sampled from routine clinical studies to represent real-world examples. Dice scores were calculated between the predicted segmentations and expert radiologist reference standard segmentations to evaluate model performance on an internal test set, two external test sets and against two publicly available models, and TotalSegmentator CT. The model was applied to an internal dataset containing abdominal MRIs to investigate age-dependent volume changes. A total of 1143 examinations (616 MRIs, 527 CTs) (median age 61 years, IQR 50-72) were split into training (n=1088, CT and MRI) and an internal test set (n=55; only MRI), two external test sets (AMOS, n=20; CHAOS, n=20; only MRI), and an internal aging-study dataset of 8672 abdominal MRIs (median age 59 years, IQR 45-70) were included. The model showed a Dice Score of 0.839 on the internal test set and outperformed two other models (Dice Score, 0.862 versus 0.759; and 0.838 versus 0.560; p<.001 for both). The proposed open-source, easy-to-use model allows for automatic, robust segmentation of 80 structures, extending the capabilities of TotalSegmentator to MRIs of any sequence. The ready-to-use online tool is available at https://totalsegmentator.com, the model at https://github.com/wasserth/TotalSegmentator, and the dataset at https://zenodo.org/records/14710732.

  • 19 authors
·
May 29, 2024

Improving the utility of locally differentially private protocols for longitudinal and multidimensional frequency estimates

This paper investigates the problem of collecting multidimensional data throughout time (i.e., longitudinal studies) for the fundamental task of frequency estimation under Local Differential Privacy (LDP) guarantees. Contrary to frequency estimation of a single attribute, the multidimensional aspect demands particular attention to the privacy budget. Besides, when collecting user statistics longitudinally, privacy progressively degrades. Indeed, the "multiple" settings in combination (i.e., many attributes and several collections throughout time) impose several challenges, for which this paper proposes the first solution for frequency estimates under LDP. To tackle these issues, we extend the analysis of three state-of-the-art LDP protocols (Generalized Randomized Response -- GRR, Optimized Unary Encoding -- OUE, and Symmetric Unary Encoding -- SUE) for both longitudinal and multidimensional data collections. While the known literature uses OUE and SUE for two rounds of sanitization (a.k.a. memoization), i.e., L-OUE and L-SUE, respectively, we analytically and experimentally show that starting with OUE and then with SUE provides higher data utility (i.e., L-OSUE). Also, for attributes with small domain sizes, we propose Longitudinal GRR (L-GRR), which provides higher utility than the other protocols based on unary encoding. Last, we also propose a new solution named Adaptive LDP for LOngitudinal and Multidimensional FREquency Estimates (ALLOMFREE), which randomly samples a single attribute to be sent with the whole privacy budget and adaptively selects the optimal protocol, i.e., either L-GRR or L-OSUE. As shown in the results, ALLOMFREE consistently and considerably outperforms the state-of-the-art L-SUE and L-OUE protocols in the quality of the frequency estimates.

  • 4 authors
·
Nov 8, 2021

From Cradle to Cane: A Two-Pass Framework for High-Fidelity Lifespan Face Aging

Face aging has become a crucial task in computer vision, with applications ranging from entertainment to healthcare. However, existing methods struggle with achieving a realistic and seamless transformation across the entire lifespan, especially when handling large age gaps or extreme head poses. The core challenge lies in balancing age accuracy and identity preservation--what we refer to as the Age-ID trade-off. Most prior methods either prioritize age transformation at the expense of identity consistency or vice versa. In this work, we address this issue by proposing a two-pass face aging framework, named Cradle2Cane, based on few-step text-to-image (T2I) diffusion models. The first pass focuses on solving age accuracy by introducing an adaptive noise injection (AdaNI) mechanism. This mechanism is guided by including prompt descriptions of age and gender for the given person as the textual condition. Also, by adjusting the noise level, we can control the strength of aging while allowing more flexibility in transforming the face. However, identity preservation is weakly ensured here to facilitate stronger age transformations. In the second pass, we enhance identity preservation while maintaining age-specific features by conditioning the model on two identity-aware embeddings (IDEmb): SVR-ArcFace and Rotate-CLIP. This pass allows for denoising the transformed image from the first pass, ensuring stronger identity preservation without compromising the aging accuracy. Both passes are jointly trained in an end-to-end way. Extensive experiments on the CelebA-HQ test dataset, evaluated through Face++ and Qwen-VL protocols, show that our Cradle2Cane outperforms existing face aging methods in age accuracy and identity consistency. Code is available at https://github.com/byliutao/Cradle2Cane.

  • 10 authors
·
Jun 25, 2025

Latent Diffusion Autoencoders: Toward Efficient and Meaningful Unsupervised Representation Learning in Medical Imaging

This study presents Latent Diffusion Autoencoder (LDAE), a novel encoder-decoder diffusion-based framework for efficient and meaningful unsupervised learning in medical imaging, focusing on Alzheimer disease (AD) using brain MR from the ADNI database as a case study. Unlike conventional diffusion autoencoders operating in image space, LDAE applies the diffusion process in a compressed latent representation, improving computational efficiency and making 3D medical imaging representation learning tractable. To validate the proposed approach, we explore two key hypotheses: (i) LDAE effectively captures meaningful semantic representations on 3D brain MR associated with AD and ageing, and (ii) LDAE achieves high-quality image generation and reconstruction while being computationally efficient. Experimental results support both hypotheses: (i) linear-probe evaluations demonstrate promising diagnostic performance for AD (ROC-AUC: 90%, ACC: 84%) and age prediction (MAE: 4.1 years, RMSE: 5.2 years); (ii) the learned semantic representations enable attribute manipulation, yielding anatomically plausible modifications; (iii) semantic interpolation experiments show strong reconstruction of missing scans, with SSIM of 0.969 (MSE: 0.0019) for a 6-month gap. Even for longer gaps (24 months), the model maintains robust performance (SSIM > 0.93, MSE < 0.004), indicating an ability to capture temporal progression trends; (iv) compared to conventional diffusion autoencoders, LDAE significantly increases inference throughput (20x faster) while also enhancing reconstruction quality. These findings position LDAE as a promising framework for scalable medical imaging applications, with the potential to serve as a foundation model for medical image analysis. Code available at https://github.com/GabrieleLozupone/LDAE

  • 6 authors
·
Apr 11, 2025 2

Anatomical Foundation Models for Brain MRIs

Deep Learning (DL) in neuroimaging has become increasingly relevant for detecting neurological conditions and neurodegenerative disorders. One of the most predominant biomarkers in neuroimaging is represented by brain age, which has been shown to be a good indicator for different conditions, such as Alzheimer's Disease. Using brain age for weakly supervised pre-training of DL models in transfer learning settings has also recently shown promising results, especially when dealing with data scarcity of different conditions. On the other hand, anatomical information of brain MRIs (e.g. cortical thickness) can provide important information for learning good representations that can be transferred to many downstream tasks. In this work, we propose AnatCL, an anatomical foundation model for brain MRIs that i.) leverages anatomical information in a weakly contrastive learning approach, and ii.) achieves state-of-the-art performances across many different downstream tasks. To validate our approach we consider 12 different downstream tasks for the diagnosis of different conditions such as Alzheimer's Disease, autism spectrum disorder, and schizophrenia. Furthermore, we also target the prediction of 10 different clinical assessment scores using structural MRI data. Our findings show that incorporating anatomical information during pre-training leads to more robust and generalizable representations. Pre-trained models can be found at: https://github.com/EIDOSLAB/AnatCL.

  • 4 authors
·
Aug 7, 2024

Unraveling Downstream Gender Bias from Large Language Models: A Study on AI Educational Writing Assistance

Large Language Models (LLMs) are increasingly utilized in educational tasks such as providing writing suggestions to students. Despite their potential, LLMs are known to harbor inherent biases which may negatively impact learners. Previous studies have investigated bias in models and data representations separately, neglecting the potential impact of LLM bias on human writing. In this paper, we investigate how bias transfers through an AI writing support pipeline. We conduct a large-scale user study with 231 students writing business case peer reviews in German. Students are divided into five groups with different levels of writing support: one classroom group with feature-based suggestions and four groups recruited from Prolific -- a control group with no assistance, two groups with suggestions from fine-tuned GPT-2 and GPT-3 models, and one group with suggestions from pre-trained GPT-3.5. Using GenBit gender bias analysis, Word Embedding Association Tests (WEAT), and Sentence Embedding Association Test (SEAT) we evaluate the gender bias at various stages of the pipeline: in model embeddings, in suggestions generated by the models, and in reviews written by students. Our results demonstrate that there is no significant difference in gender bias between the resulting peer reviews of groups with and without LLM suggestions. Our research is therefore optimistic about the use of AI writing support in the classroom, showcasing a context where bias in LLMs does not transfer to students' responses.

  • 6 authors
·
Nov 6, 2023

The Minimum Information about CLinical Artificial Intelligence Checklist for Generative Modeling Research (MI-CLAIM-GEN)

Recent advances in generative models, including large language models (LLMs), vision language models (VLMs), and diffusion models, have accelerated the field of natural language and image processing in medicine and marked a significant paradigm shift in how biomedical models can be developed and deployed. While these models are highly adaptable to new tasks, scaling and evaluating their usage presents new challenges not addressed in previous frameworks. In particular, the ability of these models to produce useful outputs with little to no specialized training data ("zero-" or "few-shot" approaches), as well as the open-ended nature of their outputs, necessitate the development of new guidelines for robust reporting of clinical generative model research. In response to gaps in standards and best practices for the development of clinical AI tools identified by US Executive Order 141103 and several emerging national networks for clinical AI evaluation, we begin to formalize some of these guidelines by building on the original MI-CLAIM checklist. The new checklist, MI-CLAIM-GEN (Table 1), aims to address differences in training, evaluation, interpretability, and reproducibility of new generative models compared to non-generative ("predictive") AI models. This MI-CLAIM-GEN checklist also seeks to clarify cohort selection reporting with unstructured clinical data and adds additional items on alignment with ethical standards for clinical AI research.

  • 18 authors
·
Mar 4, 2024

ACES: Automatic Cohort Extraction System for Event-Stream Datasets

Reproducibility remains a significant challenge in machine learning (ML) for healthcare. In this field, datasets, model pipelines, and even task/cohort definitions are often private, leading to a significant barrier in sharing, iterating, and understanding ML results on electronic health record (EHR) datasets. In this paper, we address a significant part of this problem by introducing the Automatic Cohort Extraction System for Event-Stream Datasets (ACES). This tool is designed to simultaneously simplify the development of task/cohorts for ML in healthcare and enable the reproduction of these cohorts, both at an exact level for single datasets and at a conceptual level across datasets. To accomplish this, ACES provides (1) a highly intuitive and expressive configuration language for defining both dataset-specific concepts and dataset-agnostic inclusion/exclusion criteria, and (2) a pipeline to automatically extract patient records that meet these defined criteria from real-world data. ACES can be automatically applied to any dataset in either the Medical Event Data Standard (MEDS) or EventStreamGPT (ESGPT) formats, or to *any* dataset for which the necessary task-specific predicates can be extracted in an event-stream form. ACES has the potential to significantly lower the barrier to entry for defining ML tasks, redefine the way researchers interact with EHR datasets, and significantly improve the state of reproducibility for ML studies in this modality. ACES is available at https://github.com/justin13601/aces.

  • 4 authors
·
Jun 28, 2024

Empirical Risk Minimization under Random Censorship: Theory and Practice

We consider the classic supervised learning problem, where a continuous non-negative random label Y (i.e. a random duration) is to be predicted based upon observing a random vector X valued in R^d with dgeq 1 by means of a regression rule with minimum least square error. In various applications, ranging from industrial quality control to public health through credit risk analysis for instance, training observations can be right censored, meaning that, rather than on independent copies of (X,Y), statistical learning relies on a collection of ngeq 1 independent realizations of the triplet (X, ; min{Y,; C},; δ), where C is a nonnegative r.v. with unknown distribution, modeling censorship and δ=I{Yleq C} indicates whether the duration is right censored or not. As ignoring censorship in the risk computation may clearly lead to a severe underestimation of the target duration and jeopardize prediction, we propose to consider a plug-in estimate of the true risk based on a Kaplan-Meier estimator of the conditional survival function of the censorship C given X, referred to as Kaplan-Meier risk, in order to perform empirical risk minimization. It is established, under mild conditions, that the learning rate of minimizers of this biased/weighted empirical risk functional is of order O_{P}(log(n)/n) when ignoring model bias issues inherent to plug-in estimation, as can be attained in absence of censorship. Beyond theoretical results, numerical experiments are presented in order to illustrate the relevance of the approach developed.

  • 3 authors
·
Jun 5, 2019

Math Agents: Computational Infrastructure, Mathematical Embedding, and Genomics

The advancement in generative AI could be boosted with more accessible mathematics. Beyond human-AI chat, large language models (LLMs) are emerging in programming, algorithm discovery, and theorem proving, yet their genomics application is limited. This project introduces Math Agents and mathematical embedding as fresh entries to the "Moore's Law of Mathematics", using a GPT-based workflow to convert equations from literature into LaTeX and Python formats. While many digital equation representations exist, there's a lack of automated large-scale evaluation tools. LLMs are pivotal as linguistic user interfaces, providing natural language access for human-AI chat and formal languages for large-scale AI-assisted computational infrastructure. Given the infinite formal possibility spaces, Math Agents, which interact with math, could potentially shift us from "big data" to "big math". Math, unlike the more flexible natural language, has properties subject to proof, enabling its use beyond traditional applications like high-validation math-certified icons for AI alignment aims. This project aims to use Math Agents and mathematical embeddings to address the ageing issue in information systems biology by applying multiscalar physics mathematics to disease models and genomic data. Generative AI with episodic memory could help analyse causal relations in longitudinal health records, using SIR Precision Health models. Genomic data is suggested for addressing the unsolved Alzheimer's disease problem.

  • 4 authors
·
Jul 4, 2023

MIRA: Medical Time Series Foundation Model for Real-World Health Data

A unified foundation model for medical time series -- pretrained on open access and ethics board-approved medical corpora -- offers the potential to reduce annotation burdens, minimize model customization, and enable robust transfer across clinical institutions, modalities, and tasks, particularly in data-scarce or privacy-constrained environments. However, existing generalist time series foundation models struggle to handle medical time series data due to their inherent challenges, including irregular intervals, heterogeneous sampling rates, and frequent missing values. To address these challenges, we introduce MIRA, a unified foundation model specifically designed for medical time series forecasting. MIRA incorporates a Continuous-Time Rotary Positional Encoding that enables fine-grained modeling of variable time intervals, a frequency-specific mixture-of-experts layer that routes computation across latent frequency regimes to further promote temporal specialization, and a Continuous Dynamics Extrapolation Block based on Neural ODE that models the continuous trajectory of latent states, enabling accurate forecasting at arbitrary target timestamps. Pretrained on a large-scale and diverse medical corpus comprising over 454 billion time points collect from publicly available datasets, MIRA achieves reductions in forecasting errors by an average of 10% and 7% in out-of-distribution and in-distribution scenarios, respectively, when compared to other zero-shot and fine-tuned baselines. We also introduce a comprehensive benchmark spanning multiple downstream clinical tasks, establishing a foundation for future research in medical time series modeling.

  • 11 authors
·
Jun 9, 2025

Accuracy of a Vision-Language Model on Challenging Medical Cases

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

  • 4 authors
·
Nov 9, 2023

MLE convergence speed to information projection of exponential family: Criterion for model dimension and sample size -- complete proof version--

For a parametric model of distributions, the closest distribution in the model to the true distribution located outside the model is considered. Measuring the closeness between two distributions with the Kullback-Leibler (K-L) divergence, the closest distribution is called the "information projection." The estimation risk of the maximum likelihood estimator (MLE) is defined as the expectation of K-L divergence between the information projection and the predictive distribution with plugged-in MLE. Here, the asymptotic expansion of the risk is derived up to n^{-2}-order, and the sufficient condition on the risk for the Bayes error rate between the true distribution and the information projection to be lower than a specified value is investigated. Combining these results, the "p-n criterion" is proposed, which determines whether the MLE is sufficiently close to the information projection for the given model and sample. In particular, the criterion for an exponential family model is relatively simple and can be used for a complex model with no explicit form of normalizing constant. This criterion can constitute a solution to the sample size or model acceptance problem. Use of the p-n criteria is demonstrated for two practical datasets. The relationship between the results and information criteria is also studied.

  • 1 authors
·
May 19, 2021

Tumor Detection, Segmentation and Classification Challenge on Automated 3D Breast Ultrasound: The TDSC-ABUS Challenge

Breast cancer is one of the most common causes of death among women worldwide. Early detection helps in reducing the number of deaths. Automated 3D Breast Ultrasound (ABUS) is a newer approach for breast screening, which has many advantages over handheld mammography such as safety, speed, and higher detection rate of breast cancer. Tumor detection, segmentation, and classification are key components in the analysis of medical images, especially challenging in the context of 3D ABUS due to the significant variability in tumor size and shape, unclear tumor boundaries, and a low signal-to-noise ratio. The lack of publicly accessible, well-labeled ABUS datasets further hinders the advancement of systems for breast tumor analysis. Addressing this gap, we have organized the inaugural Tumor Detection, Segmentation, and Classification Challenge on Automated 3D Breast Ultrasound 2023 (TDSC-ABUS2023). This initiative aims to spearhead research in this field and create a definitive benchmark for tasks associated with 3D ABUS image analysis. In this paper, we summarize the top-performing algorithms from the challenge and provide critical analysis for ABUS image examination. We offer the TDSC-ABUS challenge as an open-access platform at https://tdsc-abus2023.grand-challenge.org/ to benchmark and inspire future developments in algorithmic research.

  • 37 authors
·
Jan 26, 2025

Refine Medical Diagnosis Using Generation Augmented Retrieval and Clinical Practice Guidelines

Current medical language models, adapted from large language models (LLMs), typically predict ICD code-based diagnosis from electronic health records (EHRs) because these labels are readily available. However, ICD codes do not capture the nuanced, context-rich reasoning clinicians use for diagnosis. Clinicians synthesize diverse patient data and reference clinical practice guidelines (CPGs) to make evidence-based decisions. This misalignment limits the clinical utility of existing models. We introduce GARMLE-G, a Generation-Augmented Retrieval framework that grounds medical language model outputs in authoritative CPGs. Unlike conventional Retrieval-Augmented Generation based approaches, GARMLE-G enables hallucination-free outputs by directly retrieving authoritative guideline content without relying on model-generated text. It (1) integrates LLM predictions with EHR data to create semantically rich queries, (2) retrieves relevant CPG knowledge snippets via embedding similarity, and (3) fuses guideline content with model output to generate clinically aligned recommendations. A prototype system for hypertension diagnosis was developed and evaluated on multiple metrics, demonstrating superior retrieval precision, semantic relevance, and clinical guideline adherence compared to RAG-based baselines, while maintaining a lightweight architecture suitable for localized healthcare deployment. This work provides a scalable, low-cost, and hallucination-free method for grounding medical language models in evidence-based clinical practice, with strong potential for broader clinical deployment.

  • 8 authors
·
Jun 22, 2025

GDC Cohort Copilot: An AI Copilot for Curating Cohorts from the Genomic Data Commons

Motivation: The Genomic Data Commons (GDC) provides access to high quality, harmonized cancer genomics data through a unified curation and analysis platform centered around patient cohorts. While GDC users can interactively create complex cohorts through the graphical Cohort Builder, users (especially new ones) may struggle to find specific cohort descriptors across hundreds of possible fields and properties. However, users may be better able to describe their desired cohort in free-text natural language. Results: We introduce GDC Cohort Copilot, an open-source copilot tool for curating cohorts from the GDC. GDC Cohort Copilot automatically generates the GDC cohort filter corresponding to a user-input natural language description of their desired cohort, before exporting the cohort back to the GDC for further analysis. An interactive user interface allows users to further refine the generated cohort. We develop and evaluate multiple large language models (LLMs) for GDC Cohort Copilot and demonstrate that our locally-served, open-source GDC Cohort LLM achieves better results than GPT-4o prompting in generating GDC cohorts. Availability and implementation: The standalone docker image for GDC Cohort Copilot is available at https://quay.io/repository/cdis/gdc-cohort-copilot. Source code is available at https://github.com/uc-cdis/gdc-cohort-copilot. GDC Cohort LLM weights are available at https://huggingface.co/uc-ctds.

  • 5 authors
·
Jul 2, 2025

GenHPF: General Healthcare Predictive Framework with Multi-task Multi-source Learning

Despite the remarkable progress in the development of predictive models for healthcare, applying these algorithms on a large scale has been challenging. Algorithms trained on a particular task, based on specific data formats available in a set of medical records, tend to not generalize well to other tasks or databases in which the data fields may differ. To address this challenge, we propose General Healthcare Predictive Framework (GenHPF), which is applicable to any EHR with minimal preprocessing for multiple prediction tasks. GenHPF resolves heterogeneity in medical codes and schemas by converting EHRs into a hierarchical textual representation while incorporating as many features as possible. To evaluate the efficacy of GenHPF, we conduct multi-task learning experiments with single-source and multi-source settings, on three publicly available EHR datasets with different schemas for 12 clinically meaningful prediction tasks. Our framework significantly outperforms baseline models that utilize domain knowledge in multi-source learning, improving average AUROC by 1.2%P in pooled learning and 2.6%P in transfer learning while also showing comparable results when trained on a single EHR dataset. Furthermore, we demonstrate that self-supervised pretraining using multi-source datasets is effective when combined with GenHPF, resulting in a 0.6%P AUROC improvement compared to models without pretraining. By eliminating the need for preprocessing and feature engineering, we believe that this work offers a solid framework for multi-task and multi-source learning that can be leveraged to speed up the scaling and usage of predictive algorithms in healthcare.

  • 10 authors
·
Jul 20, 2022

A Demographic-Conditioned Variational Autoencoder for fMRI Distribution Sampling and Removal of Confounds

Objective: fMRI and derived measures such as functional connectivity (FC) have been used to predict brain age, general fluid intelligence, psychiatric disease status, and preclinical neurodegenerative disease. However, it is not always clear that all demographic confounds, such as age, sex, and race, have been removed from fMRI data. Additionally, many fMRI datasets are restricted to authorized researchers, making dissemination of these valuable data sources challenging. Methods: We create a variational autoencoder (VAE)-based model, DemoVAE, to decorrelate fMRI features from demographics and generate high-quality synthetic fMRI data based on user-supplied demographics. We train and validate our model using two large, widely used datasets, the Philadelphia Neurodevelopmental Cohort (PNC) and Bipolar and Schizophrenia Network for Intermediate Phenotypes (BSNIP). Results: We find that DemoVAE recapitulates group differences in fMRI data while capturing the full breadth of individual variations. Significantly, we also find that most clinical and computerized battery fields that are correlated with fMRI data are not correlated with DemoVAE latents. An exception are several fields related to schizophrenia medication and symptom severity. Conclusion: Our model generates fMRI data that captures the full distribution of FC better than traditional VAE or GAN models. We also find that most prediction using fMRI data is dependent on correlation with, and prediction of, demographics. Significance: Our DemoVAE model allows for generation of high quality synthetic data conditioned on subject demographics as well as the removal of the confounding effects of demographics. We identify that FC-based prediction tasks are highly influenced by demographic confounds.

  • 10 authors
·
May 13, 2024

Dolphin v1.0 Technical Report

Ultrasound is crucial in modern medicine but faces challenges like operator dependence, image noise, and real-time scanning, hindering AI integration. While large multimodal models excel in other medical imaging areas, they struggle with ultrasound's complexities. To address this, we introduce Dolphin v1.0 (V1) and its reasoning-augmented version, Dolphin R1-the first large-scale multimodal ultrasound foundation models unifying diverse clinical tasks in a single vision-language framework.To tackle ultrasound variability and noise, we curated a 2-million-scale multimodal dataset, combining textbook knowledge, public data, synthetic samples, and general corpora. This ensures robust perception, generalization, and clinical adaptability.The Dolphin series employs a three-stage training strategy: domain-specialized pretraining, instruction-driven alignment, and reinforcement-based refinement. Dolphin v1.0 delivers reliable performance in classification, detection, regression, and report generation. Dolphin R1 enhances diagnostic inference, reasoning transparency, and interpretability through reinforcement learning with ultrasound-specific rewards.Evaluated on U2-Bench across eight ultrasound tasks, Dolphin R1 achieves a U2-score of 0.5835-over twice the second-best model (0.2968) setting a new state of the art. Dolphin v1.0 also performs competitively, validating the unified framework. Comparisons show reasoning-enhanced training significantly improves diagnostic accuracy, consistency, and interpretability, highlighting its importance for high-stakes medical AI.

  • 19 authors
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Sep 30, 2025

A Differentially Private Kaplan-Meier Estimator for Privacy-Preserving Survival Analysis

This paper presents a differentially private approach to Kaplan-Meier estimation that achieves accurate survival probability estimates while safeguarding individual privacy. The Kaplan-Meier estimator is widely used in survival analysis to estimate survival functions over time, yet applying it to sensitive datasets, such as clinical records, risks revealing private information. To address this, we introduce a novel algorithm that applies time-indexed Laplace noise, dynamic clipping, and smoothing to produce a privacy-preserving survival curve while maintaining the cumulative structure of the Kaplan-Meier estimator. By scaling noise over time, the algorithm accounts for decreasing sensitivity as fewer individuals remain at risk, while dynamic clipping and smoothing prevent extreme values and reduce fluctuations, preserving the natural shape of the survival curve. Our results, evaluated on the NCCTG lung cancer dataset, show that the proposed method effectively lowers root mean squared error (RMSE) and enhances accuracy across privacy budgets (epsilon). At epsilon = 10, the algorithm achieves an RMSE as low as 0.04, closely approximating non-private estimates. Additionally, membership inference attacks reveal that higher epsilon values (e.g., epsilon geq 6) significantly reduce influential points, particularly at higher thresholds, lowering susceptibility to inference attacks. These findings confirm that our approach balances privacy and utility, advancing privacy-preserving survival analysis.

  • 3 authors
·
Dec 6, 2024

Comparing Machines and Children: Using Developmental Psychology Experiments to Assess the Strengths and Weaknesses of LaMDA Responses

Developmental psychologists have spent decades devising experiments to test the intelligence and knowledge of infants and children, tracing the origin of crucial concepts and capacities. Moreover, experimental techniques in developmental psychology have been carefully designed to discriminate the cognitive capacities that underlie particular behaviors. We propose that using classical experiments from child development is a particularly effective way to probe the computational abilities of AI models, in general, and LLMs in particular. First, the methodological techniques of developmental psychology, such as the use of novel stimuli to control for past experience or control conditions to determine whether children are using simple associations, can be equally helpful for assessing the capacities of LLMs. In parallel, testing LLMs in this way can tell us whether the information that is encoded in text is sufficient to enable particular responses, or whether those responses depend on other kinds of information, such as information from exploration of the physical world. In this work we adapt classical developmental experiments to evaluate the capabilities of LaMDA, a large language model from Google. We propose a novel LLM Response Score (LRS) metric which can be used to evaluate other language models, such as GPT. We find that LaMDA generates appropriate responses that are similar to those of children in experiments involving social understanding, perhaps providing evidence that knowledge of these domains is discovered through language. On the other hand, LaMDA's responses in early object and action understanding, theory of mind, and especially causal reasoning tasks are very different from those of young children, perhaps showing that these domains require more real-world, self-initiated exploration and cannot simply be learned from patterns in language input.

  • 5 authors
·
May 18, 2023

WaveStitch: Flexible and Fast Conditional Time Series Generation with Diffusion Models

Generating temporal data under conditions is crucial for forecasting, imputation, and generative tasks. Such data often has metadata and partially observed signals that jointly influence the generated values. However, existing methods face three key limitations: (1) they condition on either the metadata or observed values, but rarely both together; (2) they adopt either training-time approaches that fail to generalize to unseen scenarios, or inference-time approaches that ignore metadata; and (3) they suffer from trade-offs between generation speed and temporal coherence across time windows--choosing either slow but coherent autoregressive methods or fast but incoherent parallel ones. We propose WaveStitch, a novel diffusion-based method to overcome these hurdles through: (1) dual-sourced conditioning on both metadata and partially observed signals; (2) a hybrid training-inference architecture, incorporating metadata during training and observations at inference via gradient-based guidance; and (3) a novel pipeline-style paradigm that generates time windows in parallel while preserving coherence through an inference-time conditional loss and a stitching mechanism. Across diverse datasets, WaveStitch demonstrates adaptability to arbitrary patterns of observed signals, achieving 1.81x lower mean-squared-error compared to the state-of-the-art, and generates data up to 166.48x faster than autoregressive methods while maintaining coherence. Our code is available at: https://github.com/adis98/WaveStitch

  • 4 authors
·
Mar 8, 2025

Artificial Intelligence for Personalized Prediction of Alzheimer's Disease Progression: A Survey of Methods, Data Challenges, and Future Directions

Alzheimer's Disease (AD) is marked by significant inter-individual variability in its progression, complicating accurate prognosis and personalized care planning. This heterogeneity underscores the critical need for predictive models capable of forecasting patient-specific disease trajectories. Artificial Intelligence (AI) offers powerful tools to address this challenge by analyzing complex, multi-modal, and longitudinal patient data. This paper provides a comprehensive survey of AI methodologies applied to personalized AD progression prediction. We review key approaches including state-space models for capturing temporal dynamics, deep learning techniques like Recurrent Neural Networks for sequence modeling, Graph Neural Networks (GNNs) for leveraging network structures, and the emerging concept of AI-driven digital twins for individualized simulation. Recognizing that data limitations often impede progress, we examine common challenges such as high dimensionality, missing data, and dataset imbalance. We further discuss AI-driven mitigation strategies, with a specific focus on synthetic data generation using Variational Autoencoders (VAEs) and Generative Adversarial Networks (GANs) to augment and balance datasets. The survey synthesizes the strengths and limitations of current approaches, emphasizing the trend towards multimodal integration and the persistent need for model interpretability and generalizability. Finally, we identify critical open challenges, including robust external validation, clinical integration, and ethical considerations, and outline promising future research directions such as hybrid models, causal inference, and federated learning. This review aims to consolidate current knowledge and guide future efforts in developing clinically relevant AI tools for personalized AD prognostication.

  • 4 authors
·
Apr 29, 2025

Enhanced Mortality Prediction In Patients With Subarachnoid Haemorrhage Using A Deep Learning Model Based On The Initial CT Scan

PURPOSE: Subarachnoid hemorrhage (SAH) entails high morbidity and mortality rates. Convolutional neural networks (CNN), a form of deep learning, are capable of generating highly accurate predictions from imaging data. Our objective was to predict mortality in SAH patients by processing the initial CT scan on a CNN based algorithm. METHODS: Retrospective multicentric study of a consecutive cohort of patients with SAH between 2011-2022. Demographic, clinical and radiological variables were analyzed. Pre-processed baseline CT scan images were used as the input for training a CNN using AUCMEDI Framework. Our model's architecture leverages the DenseNet-121 structure, employing transfer learning principles. The output variable was mortality in the first three months. Performance of the model was evaluated by statistical parameters conventionally used in studies involving artificial intelligence methods. RESULTS: Images from 219 patients were processed, 175 for training and validation of the CNN and 44 for its evaluation. 52%(115/219) of patients were female, and the median age was 58(SD=13.06) years. 18.5%(39/219) were idiopathic SAH. Mortality rate was 28.5%(63/219). The model showed good accuracy at predicting mortality in SAH patients exclusively using the images of the initial CT scan (Accuracy=74%, F1=75% and AUC=82%). CONCLUSION: Modern image processing techniques based on AI and CNN make possible to predict mortality in SAH patients with high accuracy using CT scan images as the only input. These models might be optimized by including more data and patients resulting in better training, development and performance on tasks which are beyond the skills of conventional clinical knowledge.

  • 9 authors
·
Aug 25, 2023

SANSformers: Self-Supervised Forecasting in Electronic Health Records with Attention-Free Models

Despite the proven effectiveness of Transformer neural networks across multiple domains, their performance with Electronic Health Records (EHR) can be nuanced. The unique, multidimensional sequential nature of EHR data can sometimes make even simple linear models with carefully engineered features more competitive. Thus, the advantages of Transformers, such as efficient transfer learning and improved scalability are not always fully exploited in EHR applications. Addressing these challenges, we introduce SANSformer, an attention-free sequential model designed with specific inductive biases to cater for the unique characteristics of EHR data. In this work, we aim to forecast the demand for healthcare services, by predicting the number of patient visits to healthcare facilities. The challenge amplifies when dealing with divergent patient subgroups, like those with rare diseases, which are characterized by unique health trajectories and are typically smaller in size. To address this, we employ a self-supervised pretraining strategy, Generative Summary Pretraining (GSP), which predicts future summary statistics based on past health records of a patient. Our models are pretrained on a health registry of nearly one million patients, then fine-tuned for specific subgroup prediction tasks, showcasing the potential to handle the multifaceted nature of EHR data. In evaluation, SANSformer consistently surpasses robust EHR baselines, with our GSP pretraining method notably amplifying model performance, particularly within smaller patient subgroups. Our results illuminate the promising potential of tailored attention-free models and self-supervised pretraining in refining healthcare utilization predictions across various patient demographics.

  • 6 authors
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Aug 31, 2021

ChildDiffusion: Unlocking the Potential of Generative AI and Controllable Augmentations for Child Facial Data using Stable Diffusion and Large Language Models

In this research work we have proposed high-level ChildDiffusion framework capable of generating photorealistic child facial samples and further embedding several intelligent augmentations on child facial data using short text prompts, detailed textual guidance from LLMs, and further image to image transformation using text guidance control conditioning thus providing an opportunity to curate fully synthetic large scale child datasets. The framework is validated by rendering high-quality child faces representing ethnicity data, micro expressions, face pose variations, eye blinking effects, facial accessories, different hair colours and styles, aging, multiple and different child gender subjects in a single frame. Addressing privacy concerns regarding child data acquisition requires a comprehensive approach that involves legal, ethical, and technological considerations. Keeping this in view this framework can be adapted to synthesise child facial data which can be effectively used for numerous downstream machine learning tasks. The proposed method circumvents common issues encountered in generative AI tools, such as temporal inconsistency and limited control over the rendered outputs. As an exemplary use case we have open-sourced child ethnicity data consisting of 2.5k child facial samples of five different classes which includes African, Asian, White, South Asian/ Indian, and Hispanic races by deploying the model in production inference phase. The rendered data undergoes rigorous qualitative as well as quantitative tests to cross validate its efficacy and further fine-tuning Yolo architecture for detecting and classifying child ethnicity as an exemplary downstream machine learning task.

  • 3 authors
·
Jun 17, 2024

SADM: Sequence-Aware Diffusion Model for Longitudinal Medical Image Generation

Human organs constantly undergo anatomical changes due to a complex mix of short-term (e.g., heartbeat) and long-term (e.g., aging) factors. Evidently, prior knowledge of these factors will be beneficial when modeling their future state, i.e., via image generation. However, most of the medical image generation tasks only rely on the input from a single image, thus ignoring the sequential dependency even when longitudinal data is available. Sequence-aware deep generative models, where model input is a sequence of ordered and timestamped images, are still underexplored in the medical imaging domain that is featured by several unique challenges: 1) Sequences with various lengths; 2) Missing data or frame, and 3) High dimensionality. To this end, we propose a sequence-aware diffusion model (SADM) for the generation of longitudinal medical images. Recently, diffusion models have shown promising results in high-fidelity image generation. Our method extends this new technique by introducing a sequence-aware transformer as the conditional module in a diffusion model. The novel design enables learning longitudinal dependency even with missing data during training and allows autoregressive generation of a sequence of images during inference. Our extensive experiments on 3D longitudinal medical images demonstrate the effectiveness of SADM compared with baselines and alternative methods. The code is available at https://github.com/ubc-tea/SADM-Longitudinal-Medical-Image-Generation.

  • 5 authors
·
Dec 15, 2022

TotalSegmentator: robust segmentation of 104 anatomical structures in CT images

We present a deep learning segmentation model that can automatically and robustly segment all major anatomical structures in body CT images. In this retrospective study, 1204 CT examinations (from the years 2012, 2016, and 2020) were used to segment 104 anatomical structures (27 organs, 59 bones, 10 muscles, 8 vessels) relevant for use cases such as organ volumetry, disease characterization, and surgical or radiotherapy planning. The CT images were randomly sampled from routine clinical studies and thus represent a real-world dataset (different ages, pathologies, scanners, body parts, sequences, and sites). The authors trained an nnU-Net segmentation algorithm on this dataset and calculated Dice similarity coefficients (Dice) to evaluate the model's performance. The trained algorithm was applied to a second dataset of 4004 whole-body CT examinations to investigate age dependent volume and attenuation changes. The proposed model showed a high Dice score (0.943) on the test set, which included a wide range of clinical data with major pathologies. The model significantly outperformed another publicly available segmentation model on a separate dataset (Dice score, 0.932 versus 0.871, respectively). The aging study demonstrated significant correlations between age and volume and mean attenuation for a variety of organ groups (e.g., age and aortic volume; age and mean attenuation of the autochthonous dorsal musculature). The developed model enables robust and accurate segmentation of 104 anatomical structures. The annotated dataset (https://doi.org/10.5281/zenodo.6802613) and toolkit (https://www.github.com/wasserth/TotalSegmentator) are publicly available.

  • 12 authors
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Aug 11, 2022

Retrieval Augmented Generation Evaluation for Health Documents

Safe and trustworthy use of Large Language Models (LLM) in the processing of healthcare documents and scientific papers could substantially help clinicians, scientists and policymakers in overcoming information overload and focusing on the most relevant information at a given moment. Retrieval Augmented Generation (RAG) is a promising method to leverage the potential of LLMs while enhancing the accuracy of their outcomes. This report assesses the potentials and shortcomings of such approaches in the automatic knowledge synthesis of different types of documents in the health domain. To this end, it describes: (1) an internally developed proof of concept pipeline that employs state-of-the-art practices to deliver safe and trustable analysis for healthcare documents and scientific papers called RAGEv (Retrieval Augmented Generation Evaluation); (2) a set of evaluation tools for LLM-based document retrieval and generation; (3) a benchmark dataset to verify the accuracy and veracity of the results called RAGEv-Bench. It concludes that careful implementations of RAG techniques could minimize most of the common problems in the use of LLMs for document processing in the health domain, obtaining very high scores both on short yes/no answers and long answers. There is a high potential for incorporating it into the day-to-day work of policy support tasks, but additional efforts are required to obtain a consistent and trustworthy tool.

  • 11 authors
·
May 7, 2025

Enhancing Child Vocalization Classification in Multi-Channel Child-Adult Conversations Through Wav2vec2 Children ASR Features

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that often emerges in early childhood. ASD assessment typically involves an observation protocol including note-taking and ratings of child's social behavior conducted by a trained clinician. A robust machine learning (ML) model that is capable of labeling adult and child audio has the potential to save significant time and labor in manual coding children's behaviors. This may assist clinicians capture events of interest, better communicate events with parents, and educate new clinicians. In this study, we leverage the self-supervised learning model, Wav2Vec 2.0 (W2V2), pretrained on 4300h of home recordings of children under 5 years old, to build a unified system that performs both speaker diarization (SD) and vocalization classification (VC) tasks. We apply this system to two-channel audio recordings of brief 3-5 minute clinician-child interactions using the Rapid-ABC corpus. We propose a novel technique by introducing auxiliary features extracted from W2V2-based automatic speech recognition (ASR) system for children under 4 years old to improve children's VC task. We test our proposed method of improving children's VC task on two corpora (Rapid-ABC and BabbleCor) and observe consistent improvements. Furthermore, we reach, or perhaps outperform, the state-of-the-art performance of BabbleCor.

  • 3 authors
·
Sep 13, 2023

Foresight -- Generative Pretrained Transformer (GPT) for Modelling of Patient Timelines using EHRs

Background: Electronic Health Records hold detailed longitudinal information about each patient's health status and general clinical history, a large portion of which is stored within the unstructured text. Existing approaches focus mostly on structured data and a subset of single-domain outcomes. We explore how temporal modelling of patients from free text and structured data, using deep generative transformers can be used to forecast a wide range of future disorders, substances, procedures or findings. Methods: We present Foresight, a novel transformer-based pipeline that uses named entity recognition and linking tools to convert document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events such as disorders, substances, procedures and findings. We processed the entire free-text portion from three different hospital datasets totalling 811336 patients covering both physical and mental health. Findings: On tests in two UK hospitals (King's College Hospital, South London and Maudsley) and the US MIMIC-III dataset precision@10 0.68, 0.76 and 0.88 was achieved for forecasting the next disorder in a patient timeline, while precision@10 of 0.80, 0.81 and 0.91 was achieved for forecasting the next biomedical concept. Foresight was also validated on 34 synthetic patient timelines by five clinicians and achieved relevancy of 97% for the top forecasted candidate disorder. As a generative model, it can forecast follow-on biomedical concepts for as many steps as required. Interpretation: Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials and clinical research to study the progression of disorders, simulate interventions and counterfactuals, and educational purposes.

  • 12 authors
·
Dec 13, 2022

Deep reproductive feature generation framework for the diagnosis of COVID-19 and viral pneumonia using chest X-ray images

The rapid and accurate detection of COVID-19 cases is critical for timely treatment and preventing the spread of the disease. In this study, a two-stage feature extraction framework using eight state-of-the-art pre-trained deep Convolutional Neural Networks (CNNs) and an autoencoder is proposed to determine the health conditions of patients (COVID-19, Normal, Viral Pneumonia) based on chest X-rays. The X-ray scans are divided into four equally sized sections and analyzed by deep pre-trained CNNs. Subsequently, an autoencoder with three hidden layers is trained to extract reproductive features from the concatenated ouput of CNNs. To evaluate the performance of the proposed framework, three different classifiers, which are single-layer perceptron (SLP), multi-layer perceptron (MLP), and support vector machine (SVM) are used. Furthermore, the deep CNN architectures are used to create benchmark models and trained on the same dataset for comparision. The proposed framework outperforms other frameworks wih pre-trained feature extractors in binary classification and shows competitive results in three-class classification. The proposed methodology is task-independent and suitable for addressing various problems. The results show that the discriminative features are a subset of the reproductive features, suggesting that extracting task-independent features is superior to the extraction only task-based features. The flexibility and task-independence of the reproductive features make the conceptive information approach more favorable. The proposed methodology is novel and shows promising results for analyzing medical image data.

  • 4 authors
·
Apr 20, 2023

Machine Learning with Multitype Protected Attributes: Intersectional Fairness through Regularisation

Ensuring equitable treatment (fairness) across protected attributes (such as gender or ethnicity) is a critical issue in machine learning. Most existing literature focuses on binary classification, but achieving fairness in regression tasks-such as insurance pricing or hiring score assessments-is equally important. Moreover, anti-discrimination laws also apply to continuous attributes, such as age, for which many existing methods are not applicable. In practice, multiple protected attributes can exist simultaneously; however, methods targeting fairness across several attributes often overlook so-called "fairness gerrymandering", thereby ignoring disparities among intersectional subgroups (e.g., African-American women or Hispanic men). In this paper, we propose a distance covariance regularisation framework that mitigates the association between model predictions and protected attributes, in line with the fairness definition of demographic parity, and that captures both linear and nonlinear dependencies. To enhance applicability in the presence of multiple protected attributes, we extend our framework by incorporating two multivariate dependence measures based on distance covariance: the previously proposed joint distance covariance (JdCov) and our novel concatenated distance covariance (CCdCov), which effectively address fairness gerrymandering in both regression and classification tasks involving protected attributes of various types. We discuss and illustrate how to calibrate regularisation strength, including a method based on Jensen-Shannon divergence, which quantifies dissimilarities in prediction distributions across groups. We apply our framework to the COMPAS recidivism dataset and a large motor insurance claims dataset.

  • 5 authors
·
Sep 9, 2025

Disentanglement and Assessment of Shortcuts in Ophthalmological Retinal Imaging Exams

Diabetic retinopathy (DR) is a leading cause of vision loss in working-age adults. While screening reduces the risk of blindness, traditional imaging is often costly and inaccessible. Artificial intelligence (AI) algorithms present a scalable diagnostic solution, but concerns regarding fairness and generalization persist. This work evaluates the fairness and performance of image-trained models in DR prediction, as well as the impact of disentanglement as a bias mitigation technique, using the diverse mBRSET fundus dataset. Three models, ConvNeXt V2, DINOv2, and Swin V2, were trained on macula images to predict DR and sensitive attributes (SAs) (e.g., age and gender/sex). Fairness was assessed between subgroups of SAs, and disentanglement was applied to reduce bias. All models achieved high DR prediction performance in diagnosing (up to 94% AUROC) and could reasonably predict age and gender/sex (91% and 77% AUROC, respectively). Fairness assessment suggests disparities, such as a 10% AUROC gap between age groups in DINOv2. Disentangling SAs from DR prediction had varying results, depending on the model selected. Disentanglement improved DINOv2 performance (2% AUROC gain), but led to performance drops in ConvNeXt V2 and Swin V2 (7% and 3%, respectively). These findings highlight the complexity of disentangling fine-grained features in fundus imaging and emphasize the importance of fairness in medical imaging AI to ensure equitable and reliable healthcare solutions.

  • 5 authors
·
Jul 13, 2025

Fairness and Robustness of CLIP-Based Models for Chest X-rays

Motivated by the strong performance of CLIP-based models in natural image-text domains, recent efforts have adapted these architectures to medical tasks, particularly in radiology, where large paired datasets of images and reports, such as chest X-rays, are available. While these models have shown encouraging results in terms of accuracy and discriminative performance, their fairness and robustness in the different clinical tasks remain largely underexplored. In this study, we extensively evaluate six widely used CLIP-based models on chest X-ray classification using three publicly available datasets: MIMIC-CXR, NIH-CXR14, and NEATX. We assess the models fairness across six conditions and patient subgroups based on age, sex, and race. Additionally, we assess the robustness to shortcut learning by evaluating performance on pneumothorax cases with and without chest drains. Our results indicate performance gaps between patients of different ages, but more equitable results for the other attributes. Moreover, all models exhibit lower performance on images without chest drains, suggesting reliance on spurious correlations. We further complement the performance analysis with a study of the embeddings generated by the models. While the sensitive attributes could be classified from the embeddings, we do not see such patterns using PCA, showing the limitations of these visualisation techniques when assessing models. Our code is available at https://github.com/TheoSourget/clip_cxr_fairness

  • 6 authors
·
Jul 28, 2025

ROBBIE: Robust Bias Evaluation of Large Generative Language Models

As generative large language models (LLMs) grow more performant and prevalent, we must develop comprehensive enough tools to measure and improve their fairness. Different prompt-based datasets can be used to measure social bias across multiple text domains and demographic axes, meaning that testing LLMs on more datasets can potentially help us characterize their biases more fully, and better ensure equal and equitable treatment of marginalized demographic groups. In this work, our focus is two-fold: (1) Benchmarking: a comparison of 6 different prompt-based bias and toxicity metrics across 12 demographic axes and 5 families of generative LLMs. Out of those 6 metrics, AdvPromptSet and HolisticBiasR are novel datasets proposed in the paper. The comparison of those benchmarks gives us insights about the bias and toxicity of the compared models. Therefore, we explore the frequency of demographic terms in common LLM pre-training corpora and how this may relate to model biases. (2) Mitigation: we conduct a comprehensive study of how well 3 bias/toxicity mitigation techniques perform across our suite of measurements. ROBBIE aims to provide insights for practitioners while deploying a model, emphasizing the need to not only measure potential harms, but also understand how they arise by characterizing the data, mitigate harms once found, and balance any trade-offs. We open-source our analysis code in hopes of encouraging broader measurements of bias in future LLMs.

  • 10 authors
·
Nov 29, 2023