Data reuse enables cost-efficient randomized trials of medical AI models

Randomized controlled trials (RCTs) are indispensable for establishing the clinical value of medical artificial-intelligence (AI) tools, yet their high cost and long timelines hinder timely validation as new models emerge rapidly. Here, we propose BRIDGE, a data-reuse RCT design for AI-based risk models. AI risk models support a broad range of interventions, including screening, treatment selection, and clinical alerts. BRIDGE trials recycle participant-level data from completed trials of AI models when legacy and updated models make concordant predictions, thereby reducing the enrollment requirement for subsequent trials. We provide a practical checklist for investigators to assess whether reusing data from previous trials allows for valid causal inference and preserves type I error. Using real-world datasets across breast cancer, cardiovascular disease, and sepsis, we demonstrate concordance between successive AI models, with up to 64.8% overlap in top 5% high-risk cohorts. We then simulate a series of breast cancer screening studies, where our design reduced required enrollment by 46.6%--saving over US$2.8 million--while maintaining 80% power. By transforming trials into adaptive, modular studies, our proposed design makes Level I evidence generation feasible for every model iteration, thereby accelerating cost-effective translation of AI into routine care.

Atlas: Multi-Scale Attention Improves Long Context Image Modeling

Efficiently modeling massive images is a long-standing challenge in machine learning. To this end, we introduce Multi-Scale Attention (MSA). MSA relies on two key ideas, (i) multi-scale representations (ii) bi-directional cross-scale communication. MSA creates O(log N) scales to represent the image across progressively coarser features and leverages cross-attention to propagate information across scales. We then introduce Atlas, a novel neural network architecture based on MSA. We demonstrate that Atlas significantly improves the compute-performance tradeoff of long-context image modeling in a high-resolution variant of ImageNet 100. At 1024px resolution, Atlas-B achieves 91.04% accuracy, comparable to ConvNext-B (91.92%) while being 4.3x faster. Atlas is 2.95x faster and 7.38% better than FasterViT, 2.25x faster and 4.96% better than LongViT. In comparisons against MambaVision-S, we find Atlas-S achieves 5%, 16% and 32% higher accuracy at 1024px, 2048px and 4096px respectively, while obtaining similar runtimes. Code for reproducing our experiments and pretrained models is available at https://github.com/yalalab/atlas.