Hunting imaging biomarkers in pulmonary fibrosis: Benchmarks of the AIIB23 challenge

Airway-related quantitative imaging biomarkers are crucial for examination, diagnosis, and prognosis in pulmonary diseases. However, the manual delineation of airway trees remains prohibitively time-consuming. While significant efforts have been made towards enhancing airway modelling, current public-available datasets concentrate on lung diseases with moderate morphological variations. The intricate honeycombing patterns present in the lung tissues of fibrotic lung disease patients exacerbate the challenges, often leading to various prediction errors. To address this issue, the 'Airway-Informed Quantitative CT Imaging Biomarker for Fibrotic Lung Disease 2023' (AIIB23) competition was organized in conjunction with the official 2023 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). The airway structures were meticulously annotated by three experienced radiologists. Competitors were encouraged to develop automatic airway segmentation models with high robustness and generalization abilities, followed by exploring the most correlated QIB of mortality prediction. A training set of 120 high-resolution computerised tomography (HRCT) scans were publicly released with expert annotations and mortality status. The online validation set incorporated 52 HRCT scans from patients with fibrotic lung disease and the offline test set included 140 cases from fibrosis and COVID-19 patients. The results have shown that the capacity of extracting airway trees from patients with fibrotic lung disease could be enhanced by introducing voxel-wise weighted general union loss and continuity loss. In addition to the competitive image biomarkers for prognosis, a strong airway-derived biomarker (Hazard ratio>1.5, p<0.0001) was revealed for survival prognostication compared with existing clinical measurements, clinician assessment and AI-based biomarkers.

Predict and Interpret Health Risk using EHR through Typical Patients

Predicting health risks from electronic health records (EHR) is a topic of recent interest. Deep learning models have achieved success by modeling temporal and feature interaction. However, these methods learn insufficient representations and lead to poor performance when it comes to patients with few visits or sparse records. Inspired by the fact that doctors may compare the patient with typical patients and make decisions from similar cases, we propose a Progressive Prototypical Network (PPN) to select typical patients as prototypes and utilize their information to enhance the representation of the given patient. In particular, a progressive prototype memory and two prototype separation losses are proposed to update prototypes. Besides, a novel integration is introduced for better fusing information from patients and prototypes. Experiments on three real-world datasets demonstrate that our model brings improvement on all metrics. To make our results better understood by physicians, we developed an application at http://ppn.ai-care.top. Our code is released at https://github.com/yzhHoward/PPN.

M$^3$Fair: Mitigating Bias in Healthcare Data through Multi-Level and Multi-Sensitive-Attribute Reweighting Method

In the data-driven artificial intelligence paradigm, models heavily rely on large amounts of training data. However, factors like sampling distribution imbalance can lead to issues of bias and unfairness in healthcare data. Sensitive attributes, such as race, gender, age, and medical condition, are characteristics of individuals that are commonly associated with discrimination or bias. In healthcare AI, these attributes can play a significant role in determining the quality of care that individuals receive. For example, minority groups often receive fewer procedures and poorer-quality medical care than white individuals in US. Therefore, detecting and mitigating bias in data is crucial to enhancing health equity. Bias mitigation methods include pre-processing, in-processing, and post-processing. Among them, Reweighting (RW) is a widely used pre-processing method that performs well in balancing machine learning performance and fairness performance. RW adjusts the weights for samples within each (group, label) combination, where these weights are utilized in loss functions. However, RW is limited to considering only a single sensitive attribute when mitigating bias and assumes that each sensitive attribute is equally important. This may result in potential inaccuracies when addressing intersectional bias. To address these limitations, we propose M3Fair, a multi-level and multi-sensitive-attribute reweighting method by extending the RW method to multiple sensitive attributes at multiple levels. Our experiments on real-world datasets show that the approach is effective, straightforward, and generalizable in addressing the healthcare fairness issues.

Multi-site, Multi-domain Airway Tree Modeling (ATM'22): A Public Benchmark for Pulmonary Airway Segmentation

Open international challenges are becoming the de facto standard for assessing computer vision and image analysis algorithms. In recent years, new methods have extended the reach of pulmonary airway segmentation that is closer to the limit of image resolution. Since EXACT'09 pulmonary airway segmentation, limited effort has been directed to quantitative comparison of newly emerged algorithms driven by the maturity of deep learning based approaches and clinical drive for resolving finer details of distal airways for early intervention of pulmonary diseases. Thus far, public annotated datasets are extremely limited, hindering the development of data-driven methods and detailed performance evaluation of new algorithms. To provide a benchmark for the medical imaging community, we organized the Multi-site, Multi-domain Airway Tree Modeling (ATM'22), which was held as an official challenge event during the MICCAI 2022 conference. ATM'22 provides large-scale CT scans with detailed pulmonary airway annotation, including 500 CT scans (300 for training, 50 for validation, and 150 for testing). The dataset was collected from different sites and it further included a portion of noisy COVID-19 CTs with ground-glass opacity and consolidation. Twenty-three teams participated in the entire phase of the challenge and the algorithms for the top ten teams are reviewed in this paper. Quantitative and qualitative results revealed that deep learning models embedded with the topological continuity enhancement achieved superior performance in general. ATM'22 challenge holds as an open-call design, the training data and the gold standard evaluation are available upon successful registration via its homepage.

Mortality Prediction with Adaptive Feature Importance Recalibration for Peritoneal Dialysis Patients: a deep-learning-based study on a real-world longitudinal follow-up dataset

Objective: Peritoneal Dialysis (PD) is one of the most widely used life-supporting therapies for patients with End-Stage Renal Disease (ESRD). Predicting mortality risk and identifying modifiable risk factors based on the Electronic Medical Records (EMR) collected along with the follow-up visits are of great importance for personalized medicine and early intervention. Here, our objective is to develop a deep learning model for a real-time, individualized, and interpretable mortality prediction model - AICare. Method and Materials: Our proposed model consists of a multi-channel feature extraction module and an adaptive feature importance recalibration module. AICare explicitly identifies the key features that strongly indicate the outcome prediction for each patient to build the health status embedding individually. This study has collected 13,091 clinical follow-up visits and demographic data of 656 PD patients. To verify the application universality, this study has also collected 4,789 visits of 1,363 hemodialysis dialysis (HD) as an additional experiment dataset to test the prediction performance, which will be discussed in the Appendix. Results: 1) Experiment results show that AICare achieves 81.6%/74.3% AUROC and 47.2%/32.5% AUPRC for the 1-year mortality prediction task on PD/HD dataset respectively, which outperforms the state-of-the-art comparative deep learning models. 2) This study first provides a comprehensive elucidation of the relationship between the causes of mortality in patients with PD and clinical features based on an end-to-end deep learning model. 3) This study first reveals the pattern of variation in the importance of each feature in the mortality prediction based on built-in interpretability. 4) We develop a practical AI-Doctor interaction system to visualize the trajectory of patients' health status and risk indicators.

A Comprehensive Benchmark for COVID-19 Predictive Modeling Using Electronic Health Records in Intensive Care: Choosing the Best Model for COVID-19 Prognosis

The COVID-19 pandemic has posed a heavy burden to the healthcare system worldwide and caused huge social disruption and economic loss. Many deep learning models have been proposed to conduct clinical predictive tasks such as mortality prediction for COVID-19 patients in intensive care units using Electronic Health Record (EHR) data. Despite their initial success in certain clinical applications, there is currently a lack of benchmarking results to achieve a fair comparison so that we can select the optimal model for clinical use. Furthermore, there is a discrepancy between the formulation of traditional prediction tasks and real-world clinical practice in intensive care. To fill these gaps, we propose two clinical prediction tasks, Outcome-specific length-of-stay prediction and Early mortality prediction for COVID-19 patients in intensive care units. The two tasks are adapted from the naive length-of-stay and mortality prediction tasks to accommodate the clinical practice for COVID-19 patients. We propose fair, detailed, open-source data-preprocessing pipelines and evaluate 17 state-of-the-art predictive models on two tasks, including 5 machine learning models, 6 basic deep learning models and 6 deep learning predictive models specifically designed for EHR data. We provide benchmarking results using data from two real-world COVID-19 EHR datasets. Both datasets are publicly available without needing any inquiry and one dataset can be accessed on request. We provide fair, reproducible benchmarking results for two tasks. We deploy all experiment results and models on an online platform. We also allow clinicians and researchers to upload their data to the platform and get quick prediction results using our trained models. We hope our efforts can further facilitate deep learning and machine learning research for COVID-19 predictive modeling.

MMMNA-Net for Overall Survival Time Prediction of Brain Tumor Patients

Overall survival (OS) time is one of the most important evaluation indices for gliomas situations. Multimodal Magnetic Resonance Imaging (MRI) scans play an important role in the study of glioma prognosis OS time. Several deep learning-based methods are proposed for the OS time prediction on multi-modal MRI problems. However, these methods usually fuse multi-modal information at the beginning or at the end of the deep learning networks and lack the fusion of features from different scales. In addition, the fusion at the end of networks always adapts global with global (eg. fully connected after concatenation of global average pooling output) or local with local (eg. bilinear pooling), which loses the information of local with global. In this paper, we propose a novel method for multi-modal OS time prediction of brain tumor patients, which contains an improved nonlocal features fusion module introduced on different scales. Our method obtains a relative 8.76% improvement over the current state-of-art method (0.6989 vs. 0.6426 on accuracy). Extensive testing demonstrates that our method could adapt to situations with missing modalities. The code is available at https://github.com/TangWen920812/mmmna-net.

RPLHR-CT Dataset and Transformer Baseline for Volumetric Super-Resolution from CT Scans

In clinical practice, anisotropic volumetric medical images with low through-plane resolution are commonly used due to short acquisition time and lower storage cost. Nevertheless, the coarse resolution may lead to difficulties in medical diagnosis by either physicians or computer-aided diagnosis algorithms. Deep learning-based volumetric super-resolution (SR) methods are feasible ways to improve resolution, with convolutional neural networks (CNN) at their core. Despite recent progress, these methods are limited by inherent properties of convolution operators, which ignore content relevance and cannot effectively model long-range dependencies. In addition, most of the existing methods use pseudo-paired volumes for training and evaluation, where pseudo low-resolution (LR) volumes are generated by a simple degradation of their high-resolution (HR) counterparts. However, the domain gap between pseudo- and real-LR volumes leads to the poor performance of these methods in practice. In this paper, we build the first public real-paired dataset RPLHR-CT as a benchmark for volumetric SR, and provide baseline results by re-implementing four state-of-the-art CNN-based methods. Considering the inherent shortcoming of CNN, we also propose a transformer volumetric super-resolution network (TVSRN) based on attention mechanisms, dispensing with convolutions entirely. This is the first research to use a pure transformer for CT volumetric SR. The experimental results show that TVSRN significantly outperforms all baselines on both PSNR and SSIM. Moreover, the TVSRN method achieves a better trade-off between the image quality, the number of parameters, and the running time. Data and code are available at https://github.com/smilenaxx/RPLHR-CT.

Transformer Lesion Tracker

Evaluating lesion progression and treatment response via longitudinal lesion tracking plays a critical role in clinical practice. Automated approaches for this task are motivated by prohibitive labor costs and time consumption when lesion matching is done manually. Previous methods typically lack the integration of local and global information. In this work, we propose a transformer-based approach, termed Transformer Lesion Tracker (TLT). Specifically, we design a Cross Attention-based Transformer (CAT) to capture and combine both global and local information to enhance feature extraction. We also develop a Registration-based Anatomical Attention Module (RAAM) to introduce anatomical information to CAT so that it can focus on useful feature knowledge. A Sparse Selection Strategy (SSS) is presented for selecting features and reducing memory footprint in Transformer training. In addition, we use a global regression to further improve model performance. We conduct experiments on a public dataset to show the superiority of our method and find that our model performance has improved the average Euclidean center error by at least 14.3% (6mm vs. 7mm) compared with the state-of-the-art (SOTA). Code is available at https://github.com/TangWen920812/TLT.

MedFACT: Modeling Medical Feature Correlations in Patient Health Representation Learning via Feature Clustering

In healthcare prediction tasks, it is essential to exploit the correlations between medical features and learn better patient health representations. Existing methods try to estimate feature correlations only from data, or increase the quality of estimation by introducing task-specific medical knowledge. However, such methods either are difficult to estimate the feature correlations due to insufficient training samples, or cannot be generalized to other tasks due to reliance on specific knowledge. There are medical research revealing that not all the medical features are strongly correlated. Thus, to address the issues, we expect to group up strongly correlated features and learn feature correlations in a group-wise manner to reduce the learning complexity without losing generality. In this paper, we propose a general patient health representation learning framework MedFACT. We estimate correlations via measuring similarity between temporal patterns of medical features with kernel methods, and cluster features with strong correlations into groups. The feature group is further formulated as a correlation graph, and we employ graph convolutional networks to conduct group-wise feature interactions for better representation learning. Experiments on two real-world datasets demonstrate the superiority of MedFACT. The discovered medical findings are also confirmed by literature, providing valuable medical insights and explanations.