Auditing Significance, Metric Choice, and Demographic Fairness in Medical AI Challenges

Open challenges have become the de facto standard for comparative ranking of medical AI methods. Despite their importance, medical AI leaderboards exhibit three persistent limitations: (1) score gaps are rarely tested for statistical significance, so rank stability is unknown; (2) single averaged metrics are applied to every organ, hiding clinically important boundary errors; (3) performance across intersecting demographics is seldom reported, masking fairness and equity gaps. We introduce RankInsight, an open-source toolkit that seeks to address these limitations. RankInsight (1) computes pair-wise significance maps that show the nnU-Net family outperforms Vision-Language and MONAI submissions with high statistical certainty; (2) recomputes leaderboards with organ-appropriate metrics, reversing the order of the top four models when Dice is replaced by NSD for tubular structures; and (3) audits intersectional fairness, revealing that more than half of the MONAI-based entries have the largest gender-race discrepancy on our proprietary Johns Hopkins Hospital dataset. The RankInsight toolkit is publicly released and can be directly applied to past, ongoing, and future challenges. It enables organizers and participants to publish rankings that are statistically sound, clinically meaningful, and demographically fair.

Edge-Parallel Graph Encoder Embedding

New algorithms for embedding graphs have reduced the asymptotic complexity of finding low-dimensional representations. One-Hot Graph Encoder Embedding (GEE) uses a single, linear pass over edges and produces an embedding that converges asymptotically to the spectral embedding. The scaling and performance benefits of this approach have been limited by a serial implementation in an interpreted language. We refactor GEE into a parallel program in the Ligra graph engine that maps functions over the edges of the graph and uses lock-free atomic instrutions to prevent data races. On a graph with 1.8B edges, this results in a 500 times speedup over the original implementation and a 17 times speedup over a just-in-time compiled version.