Deep Generative Classifiers for Thoracic Disease Diagnosis with Chest X-ray Images

Thoracic diseases are very serious health problems that plague a large number of people. Chest X-ray is currently one of the most popular methods to diagnose thoracic diseases, playing an important role in the healthcare workflow. However, reading the chest X-ray images and giving an accurate diagnosis remain challenging tasks for expert radiologists. With the success of deep learning in computer vision, a growing number of deep neural network architectures were applied to chest X-ray image classification. However, most of the previous deep neural network classifiers were based on deterministic architectures which are usually very noise-sensitive and are likely to aggravate the overfitting issue. In this paper, to make a deep architecture more robust to noise and to reduce overfitting, we propose using deep generative classifiers to automatically diagnose thorax diseases from the chest X-ray images. Unlike the traditional deterministic classifier, a deep generative classifier has a distribution middle layer in the deep neural network. A sampling layer then draws a random sample from the distribution layer and input it to the following layer for classification. The classifier is generative because the class label is generated from samples of a related distribution. Through training the model with a certain amount of randomness, the deep generative classifiers are expected to be robust to noise and can reduce overfitting and then achieve good performances. We implemented our deep generative classifiers based on a number of well-known deterministic neural network architectures, and tested our models on the chest X-ray14 dataset. The results demonstrated the superiority of deep generative classifiers compared with the corresponding deep deterministic classifiers.

Using Clinical Narratives and Structured Data to Identify Distant Recurrences in Breast Cancer

Accurately identifying distant recurrences in breast cancer from the Electronic Health Records (EHR) is important for both clinical care and secondary analysis. Although multiple applications have been developed for computational phenotyping in breast cancer, distant recurrence identification still relies heavily on manual chart review. In this study, we aim to develop a model that identifies distant recurrences in breast cancer using clinical narratives and structured data from EHR. We apply MetaMap to extract features from clinical narratives and also retrieve structured clinical data from EHR. Using these features, we train a support vector machine model to identify distant recurrences in breast cancer patients. We train the model using 1,396 double-annotated subjects and validate the model using 599 double-annotated subjects. In addition, we validate the model on a set of 4,904 single-annotated subjects as a generalization test. We obtained a high area under curve (AUC) score of 0.92 (SD=0.01) in the cross-validation using the training dataset, then obtained AUC scores of 0.95 and 0.93 in the held-out test and generalization test using 599 and 4,904 samples respectively. Our model can accurately and efficiently identify distant recurrences in breast cancer by combining features extracted from unstructured clinical narratives and structured clinical data.

Natural Language Processing for EHR-Based Computational Phenotyping

This article reviews recent advances in applying natural language processing (NLP) to Electronic Health Records (EHRs) for computational phenotyping. NLP-based computational phenotyping has numerous applications including diagnosis categorization, novel phenotype discovery, clinical trial screening, pharmacogenomics, drug-drug interaction (DDI) and adverse drug event (ADE) detection, as well as genome-wide and phenome-wide association studies. Significant progress has been made in algorithm development and resource construction for computational phenotyping. Among the surveyed methods, well-designed keyword search and rule-based systems often achieve good performance. However, the construction of keyword and rule lists requires significant manual effort, which is difficult to scale. Supervised machine learning models have been favored because they are capable of acquiring both classification patterns and structures from data. Recently, deep learning and unsupervised learning have received growing attention, with the former favored for its performance and the latter for its ability to find novel phenotypes. Integrating heterogeneous data sources have become increasingly important and have shown promise in improving model performance. Often better performance is achieved by combining multiple modalities of information. Despite these many advances, challenges and opportunities remain for NLP-based computational phenotyping, including better model interpretability and generalizability, and proper characterization of feature relations in clinical narratives