Clinical Text Summarization with Syntax-Based Negation and Semantic Concept Identification

In the era of clinical information explosion, a good strategy for clinical text summarization is helpful to improve the clinical workflow. The ideal summarization strategy can preserve important information in the informative but less organized, ill-structured clinical narrative texts. Instead of using pure statistical learning approaches, which are difficult to interpret and explain, we utilized knowledge of computational linguistics with human experts-curated biomedical knowledge base to achieve the interpretable and meaningful clinical text summarization. Our research objective is to use the biomedical ontology with semantic information, and take the advantage from the language hierarchical structure, the constituency tree, in order to identify the correct clinical concepts and the corresponding negation information, which is critical for summarizing clinical concepts from narrative text. We achieved the clinically acceptable performance for both negation detection and concept identification, and the clinical concepts with common negated patterns can be identified and negated by the proposed method.

Human-centric Metric for Accelerating Pathology Reports Annotation

Pathology reports contain useful information such as the main involved organ, diagnosis, etc. These information can be identified from the free text reports and used for large-scale statistical analysis or serve as annotation for other modalities such as pathology slides images. However, manual classification for a huge number of reports on multiple tasks is labor-intensive. In this paper, we have developed an automatic text classifier based on BERT and we propose a human-centric metric to evaluate the model. According to the model confidence, we identify low-confidence cases that require further expert annotation and high-confidence cases that are automatically classified. We report the percentage of low-confidence cases and the performance of automatically classified cases. On the high-confidence cases, the model achieves classification accuracy comparable to pathologists. This leads a potential of reducing 80% to 98% of the manual annotation workload.

Representation Learning for Electronic Health Records

Information in electronic health records (EHR), such as clinical narratives, examination reports, lab measurements, demographics, and other patient encounter entries, can be transformed into appropriate data representations that can be used for downstream clinical machine learning tasks using representation learning. Learning better representations is critical to improve the performance of downstream tasks. Due to the advances in machine learning, we now can learn better and meaningful representations from EHR through disentangling the underlying factors inside data and distilling large amounts of information and knowledge from heterogeneous EHR sources. In this chapter, we first introduce the background of learning representations and reasons why we need good EHR representations in machine learning for medicine and healthcare in Section 1. Next, we explain the commonly-used machine learning and evaluation methods for representation learning using a deep learning approach in Section 2. Following that, we review recent related studies of learning patient state representation from EHR for clinical machine learning tasks in Section 3. Finally, in Section 4 we discuss more techniques, studies, and challenges for learning natural language representations when free texts, such as clinical notes, examination reports, or biomedical literature are used. We also discuss challenges and opportunities in these rapidly growing research fields.

Machine Learning for Clinical Predictive Analytics

In this chapter, we provide a brief overview of applying machine learning techniques for clinical prediction tasks. We begin with a quick introduction to the concepts of machine learning and outline some of the most common machine learning algorithms. Next, we demonstrate how to apply the algorithms with appropriate toolkits to conduct machine learning experiments for clinical prediction tasks. The objectives of this chapter are to (1) understand the basics of machine learning techniques and the reasons behind why they are useful for solving clinical prediction problems, (2) understand the intuition behind some machine learning models, including regression, decision trees, and support vector machines, and (3) understand how to apply these models to clinical prediction problems using publicly available datasets via case studies.

Multimodal Multitask Representation Learning for Pathology Biobank Metadata Prediction

Metadata are general characteristics of the data in a well-curated and condensed format, and have been proven to be useful for decision making, knowledge discovery, and also heterogeneous data organization of biobank. Among all data types in the biobank, pathology is the key component of the biobank and also serves as the gold standard of diagnosis. To maximize the utility of biobank and allow the rapid progress of biomedical science, it is essential to organize the data with well-populated pathology metadata. However, manual annotation of such information is tedious and time-consuming. In the study, we develop a multimodal multitask learning framework to predict four major slide-level metadata of pathology images. The framework learns generalizable representations across tissue slides, pathology reports, and case-level structured data. We demonstrate improved performance across all four tasks with the proposed method compared to a single modal single task baseline on two test sets, one external test set from a distinct data source (TCGA) and one internal held-out test set (TTH). In the test sets, the performance improvements on the averaged area under receiver operating characteristic curve across the four tasks are 16.48% and 9.05% on TCGA and TTH, respectively. Such pathology metadata prediction system may be adopted to mitigate the effort of expert annotation and ultimately accelerate the data-driven research by better utilization of the pathology biobank.

Multimodal Volume-Aware Detection and Segmentation for Brain Metastases Radiosurgery

Stereotactic radiosurgery (SRS), which delivers high doses of irradiation in a single or few shots to small targets, has been a standard of care for brain metastases. While very effective, SRS currently requires manually intensive delineation of tumors. In this work, we present a deep learning approach for automated detection and segmentation of brain metastases using multimodal imaging and ensemble neural networks. In order to address small and multiple brain metastases, we further propose a volume-aware Dice loss which optimizes model performance using the information of lesion size. This work surpasses current benchmark levels and demonstrates a reliable AI-assisted system for SRS treatment planning for multiple brain metastases.

Publicly Available Clinical BERT Embeddings

Contextual word embedding models such as ELMo (Peters et al., 2018) and BERT (Devlin et al., 2018) have dramatically improved performance for many natural language processing (NLP) tasks in recent months. However, these models have been minimally explored on specialty corpora, such as clinical text; moreover, in the clinical domain, no publicly-available pre-trained BERT models yet exist. In this work, we address this need by exploring and releasing BERT models for clinical text: one for generic clinical text and another for discharge summaries specifically. We demonstrate that using a domain-specific model yields performance improvements on three common clinical NLP tasks as compared to nonspecific embeddings. These domain-specific models are not as performant on two clinical de-identification tasks, and argue that this is a natural consequence of the differences between de-identified source text and synthetically non de-identified task text.

Clinically Accurate Chest X-Ray Report Generation

The automatic generation of radiology reports given medical radiographs has significant potential to operationally and clinically improve patient care. A number of prior works have focused on this problem, employing advanced methods from computer vision and natural language generation to produce readable reports. However, these works often fail to account for the particular nuances of the radiology domain, and, in particular, the critical importance of clinical accuracy in the resulting generated reports. In this work, we present a domain-aware automatic chest X-Ray radiology report generation system which first predicts what topics will be discussed in the report, then conditionally generates sentences corresponding to these topics. The resulting system is fine-tuned using reinforcement learning, considering both readability and clinical accuracy, as assessed by the proposed Clinically Coherent Reward. We verify this system on two datasets, Open-I and MIMIC-CXR, and demonstrate that our model offers marked improvements on both language generation metrics and CheXpert assessed accuracy over a variety of competitive baselines.