Automatic and standardized surgical reporting for central nervous system tumors

Magnetic resonance (MR) imaging is essential for evaluating central nervous system (CNS) tumors, guiding surgical planning, treatment decisions, and assessing postoperative outcomes and complication risks. While recent work has advanced automated tumor segmentation and report generation, most efforts have focused on preoperative data, with limited attention to postoperative imaging analysis. This study introduces a comprehensive pipeline for standardized postsurtical reporting in CNS tumors. Using the Attention U-Net architecture, segmentation models were trained for the preoperative (non-enhancing) tumor core, postoperative contrast-enhancing residual tumor, and resection cavity. Additionally, MR sequence classification and tumor type identification for contrast-enhancing lesions were explored using the DenseNet architecture. The models were integrated into a reporting pipeline, following the RANO 2.0 guidelines. Training was conducted on multicentric datasets comprising 2000 to 7000 patients, using a 5-fold cross-validation. Evaluation included patient-, voxel-, and object-wise metrics, with benchmarking against the latest BraTS challenge results. The segmentation models achieved average voxel-wise Dice scores of 87%, 66%, 70%, and 77% for the tumor core, non-enhancing tumor core, contrast-enhancing residual tumor, and resection cavity, respectively. Classification models reached 99.5% balanced accuracy in MR sequence classification and 80% in tumor type classification. The pipeline presented in this study enables robust, automated segmentation, MR sequence classification, and standardized report generation aligned with RANO 2.0 guidelines, enhancing postoperative evaluation and clinical decision-making. The proposed models and methods were integrated into Raidionics, open-source software platform for CNS tumor analysis, now including a dedicated module for postsurgical analysis.

Nonparametric Additive Value Functions: Interpretable Reinforcement Learning with an Application to Surgical Recovery

We propose a nonparametric additive model for estimating interpretable value functions in reinforcement learning. Learning effective adaptive clinical interventions that rely on digital phenotyping features is a major for concern medical practitioners. With respect to spine surgery, different post-operative recovery recommendations concerning patient mobilization can lead to significant variation in patient recovery. While reinforcement learning has achieved widespread success in domains such as games, recent methods heavily rely on black-box methods, such neural networks. Unfortunately, these methods hinder the ability of examining the contribution each feature makes in producing the final suggested decision. While such interpretations are easily provided in classical algorithms such as Least Squares Policy Iteration, basic linearity assumptions prevent learning higher-order flexible interactions between features. In this paper, we present a novel method that offers a flexible technique for estimating action-value functions without making explicit parametric assumptions regarding their additive functional form. This nonparametric estimation strategy relies on incorporating local kernel regression and basis expansion to obtain a sparse, additive representation of the action-value function. Under this approach, we are able to locally approximate the action-value function and retrieve the nonlinear, independent contribution of select features as well as joint feature pairs. We validate the proposed approach with a simulation study, and, in an application to spine disease, uncover recovery recommendations that are inline with related clinical knowledge.