HeAR -- Health Acoustic Representations

Health acoustic sounds such as coughs and breaths are known to contain useful health signals with significant potential for monitoring health and disease, yet are underexplored in the medical machine learning community. The existing deep learning systems for health acoustics are often narrowly trained and evaluated on a single task, which is limited by data and may hinder generalization to other tasks. To mitigate these gaps, we develop HeAR, a scalable self-supervised learning-based deep learning system using masked autoencoders trained on a large dataset of 313 million two-second long audio clips. Through linear probes, we establish HeAR as a state-of-the-art health audio embedding model on a benchmark of 33 health acoustic tasks across 6 datasets. By introducing this work, we hope to enable and accelerate further health acoustics research.

Optimizing Audio Augmentations for Contrastive Learning of Health-Related Acoustic Signals

Health-related acoustic signals, such as cough and breathing sounds, are relevant for medical diagnosis and continuous health monitoring. Most existing machine learning approaches for health acoustics are trained and evaluated on specific tasks, limiting their generalizability across various healthcare applications. In this paper, we leverage a self-supervised learning framework, SimCLR with a Slowfast NFNet backbone, for contrastive learning of health acoustics. A crucial aspect of optimizing Slowfast NFNet for this application lies in identifying effective audio augmentations. We conduct an in-depth analysis of various audio augmentation strategies and demonstrate that an appropriate augmentation strategy enhances the performance of the Slowfast NFNet audio encoder across a diverse set of health acoustic tasks. Our findings reveal that when augmentations are combined, they can produce synergistic effects that exceed the benefits seen when each is applied individually.

ELIXR: Towards a general purpose X-ray artificial intelligence system through alignment of large language models and radiology vision encoders

Our approach, which we call Embeddings for Language/Image-aligned X-Rays, or ELIXR, leverages a language-aligned image encoder combined or grafted onto a fixed LLM, PaLM 2, to perform a broad range of tasks. We train this lightweight adapter architecture using images paired with corresponding free-text radiology reports from the MIMIC-CXR dataset. ELIXR achieved state-of-the-art performance on zero-shot chest X-ray (CXR) classification (mean AUC of 0.850 across 13 findings), data-efficient CXR classification (mean AUCs of 0.893 and 0.898 across five findings (atelectasis, cardiomegaly, consolidation, pleural effusion, and pulmonary edema) for 1% (~2,200 images) and 10% (~22,000 images) training data), and semantic search (0.76 normalized discounted cumulative gain (NDCG) across nineteen queries, including perfect retrieval on twelve of them). Compared to existing data-efficient methods including supervised contrastive learning (SupCon), ELIXR required two orders of magnitude less data to reach similar performance. ELIXR also showed promise on CXR vision-language tasks, demonstrating overall accuracies of 58.7% and 62.5% on visual question answering and report quality assurance tasks, respectively. These results suggest that ELIXR is a robust and versatile approach to CXR AI.

Predicting Cardiovascular Disease Risk using Photoplethysmography and Deep Learning

Cardiovascular diseases (CVDs) are responsible for a large proportion of premature deaths in low- and middle-income countries. Early CVD detection and intervention is critical in these populations, yet many existing CVD risk scores require a physical examination or lab measurements, which can be challenging in such health systems due to limited accessibility. Here we investigated the potential to use photoplethysmography (PPG), a sensing technology available on most smartphones that can potentially enable large-scale screening at low cost, for CVD risk prediction. We developed a deep learning PPG-based CVD risk score (DLS) to predict the probability of having major adverse cardiovascular events (MACE: non-fatal myocardial infarction, stroke, and cardiovascular death) within ten years, given only age, sex, smoking status and PPG as predictors. We compared the DLS with the office-based refit-WHO score, which adopts the shared predictors from WHO and Globorisk scores (age, sex, smoking status, height, weight and systolic blood pressure) but refitted on the UK Biobank (UKB) cohort. In UKB cohort, DLS's C-statistic (71.1%, 95% CI 69.9-72.4) was non-inferior to office-based refit-WHO score (70.9%, 95% CI 69.7-72.2; non-inferiority margin of 2.5%, p<0.01). The calibration of the DLS was satisfactory, with a 1.8% mean absolute calibration error. Adding DLS features to the office-based score increased the C-statistic by 1.0% (95% CI 0.6-1.4). DLS predicts ten-year MACE risk comparable with the office-based refit-WHO score. It provides a proof-of-concept and suggests the potential of a PPG-based approach strategies for community-based primary prevention in resource-limited regions.

Explainable Deep Learning in Healthcare: A Methodological Survey from an Attribution View

The increasing availability of large collections of electronic health record (EHR) data and unprecedented technical advances in deep learning (DL) have sparked a surge of research interest in developing DL based clinical decision support systems for diagnosis, prognosis, and treatment. Despite the recognition of the value of deep learning in healthcare, impediments to further adoption in real healthcare settings remain due to the black-box nature of DL. Therefore, there is an emerging need for interpretable DL, which allows end users to evaluate the model decision making to know whether to accept or reject predictions and recommendations before an action is taken. In this review, we focus on the interpretability of the DL models in healthcare. We start by introducing the methods for interpretability in depth and comprehensively as a methodological reference for future researchers or clinical practitioners in this field. Besides the methods' details, we also include a discussion of advantages and disadvantages of these methods and which scenarios each of them is suitable for, so that interested readers can know how to compare and choose among them for use. Moreover, we discuss how these methods, originally developed for solving general-domain problems, have been adapted and applied to healthcare problems and how they can help physicians better understand these data-driven technologies. Overall, we hope this survey can help researchers and practitioners in both artificial intelligence (AI) and clinical fields understand what methods we have for enhancing the interpretability of their DL models and choose the optimal one accordingly.

Addressing the Real-world Class Imbalance Problem in Dermatology

Class imbalance is a common problem in medical diagnosis, causing a standard classifier to be biased towards the common classes and perform poorly on the rare classes. This is especially true for dermatology, a specialty with thousands of skin conditions but many of which have rare prevalence in the real world. Motivated by recent advances, we explore few-shot learning methods as well as conventional class imbalance techniques for the skin condition recognition problem and propose an evaluation setup to fairly assess the real-world utility of such approaches. When compared to conventional class imbalance techniques, we find that few-shot learning methods are not as performant as those conventional methods, but combining the two approaches using a novel ensemble leads to improvement in model performance, especially for rare classes. We conclude that the ensemble can be useful to address the class imbalance problem, yet progress here can further be accelerated by the use of real-world evaluation setups for benchmarking new methods.

What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams

Open domain question answering (OpenQA) tasks have been recently attracting more and more attention from the natural language processing (NLP) community. In this work, we present the first free-form multiple-choice OpenQA dataset for solving medical problems, MedQA, collected from the professional medical board exams. It covers three languages: English, simplified Chinese, and traditional Chinese, and contains 12,723, 34,251, and 14,123 questions for the three languages, respectively. We implement both rule-based and popular neural methods by sequentially combining a document retriever and a machine comprehension model. Through experiments, we find that even the current best method can only achieve 36.7\%, 42.0\%, and 70.1\% of test accuracy on the English, traditional Chinese, and simplified Chinese questions, respectively. We expect MedQA to present great challenges to existing OpenQA systems and hope that it can serve as a platform to promote much stronger OpenQA models from the NLP community in the future.

CheXpert++: Approximating the CheXpert labeler for Speed,Differentiability, and Probabilistic Output

It is often infeasible or impossible to obtain ground truth labels for medical data. To circumvent this, one may build rule-based or other expert-knowledge driven labelers to ingest data and yield silver labels absent any ground-truth training data. One popular such labeler is CheXpert, a labeler that produces diagnostic labels for chest X-ray radiology reports. CheXpert is very useful, but is relatively computationally slow, especially when integrated with end-to-end neural pipelines, is non-differentiable so can't be used in any applications that require gradients to flow through the labeler, and does not yield probabilistic outputs, which limits our ability to improve the quality of the silver labeler through techniques such as active learning. In this work, we solve all three of these problems with $\texttt{CheXpert++}$, a BERT-based, high-fidelity approximation to CheXpert. $\texttt{CheXpert++}$ achieves 99.81\% parity with CheXpert, which means it can be reliably used as a drop-in replacement for CheXpert, all while being significantly faster, fully differentiable, and probabilistic in output. Error analysis of $\texttt{CheXpert++}$ also demonstrates that $\texttt{CheXpert++}$ has a tendency to actually correct errors in the CheXpert labels, with $\texttt{CheXpert++}$ labels being more often preferred by a clinician over CheXpert labels (when they disagree) on all but one disease task. To further demonstrate the utility of these advantages in this model, we conduct a proof-of-concept active learning study, demonstrating we can improve accuracy on an expert labeled random subset of report sentences by approximately 8\% over raw, unaltered CheXpert by using one-iteration of active-learning inspired re-training. These findings suggest that simple techniques in co-learning and active learning can yield high-quality labelers under minimal, and controllable human labeling demands.

Entity-Enriched Neural Models for Clinical Question Answering

We explore state-of-the-art neural models for question answering on electronic medical records and improve their ability to generalize better on previously unseen (paraphrased) questions at test time. We enable this by learning to predict logical forms as an auxiliary task along with the main task of answer span detection. The predicted logical forms also serve as a rationale for the answer. Further, we also incorporate medical entity information in these models via the ERNIE architecture. We train our models on the large-scale emrQA dataset and observe that our multi-task entity-enriched models generalize to paraphrased questions ~5% better than the baseline BERT model.

Weakly Supervised Context Encoder using DICOM metadata in Ultrasound Imaging

Modern deep learning algorithms geared towards clinical adaption rely on a significant amount of high fidelity labeled data. Low-resource settings pose challenges like acquiring high fidelity data and becomes the bottleneck for developing artificial intelligence applications. Ultrasound images, stored in Digital Imaging and Communication in Medicine (DICOM) format, have additional metadata data corresponding to ultrasound image parameters and medical exams. In this work, we leverage DICOM metadata from ultrasound images to help learn representations of the ultrasound image. We demonstrate that the proposed method outperforms the non-metadata based approaches across different downstream tasks.