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Healthcare datasets are becoming larger and more complex, necessitating the development of accurate and generalizable AI models for medical applications. Unstructured datasets, including medical imaging, electrocardiograms, and natural language data, are gaining attention with advancements in deep convolutional neural networks and large language models. However, estimating the generalizability of these models to new healthcare settings without extensive validation on external data remains challenging. In experiments across 13 datasets including X-rays, CTs, ECGs, clinical discharge summaries, and lung auscultation data, our results demonstrate that model performance is frequently overestimated by up to 20% on average due to shortcut learning of hidden data acquisition biases (DAB). Shortcut learning refers to a phenomenon in which an AI model learns to solve a task based on spurious correlations present in the data as opposed to features directly related to the task itself. We propose an open source, bias-corrected external accuracy estimate, PEst, that better estimates external accuracy to within 4% on average by measuring and calibrating for DAB-induced shortcut learning. [ABSTRACT FROM AUTHOR]

The complexity of generating radiotherapy treatments demands a rigorous quality assurance (QA) process to ensure patient safety and to avoid clinically significant errors. Machine learning classifiers have been explored to augment the scope and efficiency of the traditional radiotherapy treatment planning QA process. However, one important gap in relying on classifiers for QA of radiotherapy treatment plans is the lack of understanding behind a specific classifier prediction. We develop explanation methods to understand the decisions of two automated QA classifiers: (1) a region of interest (ROI) segmentation/labeling classifier, and (2) a treatment plan acceptance classifier. For each classifier, a local interpretable model-agnostic explanation (LIME) framework and a novel adaption of team-based Shapley values framework are constructed. We test these methods in datasets for two radiotherapy treatment sites (prostate and breast), and demonstrate the importance of evaluating QA classifiers using interpretable machine learning approaches. We additionally develop a notion of explanation consistency to assess classifier performance. Our explanation method allows for easy visualization and human expert assessment of classifier decisions in radiotherapy QA. Notably, we find that our team-based Shapley approach is more consistent than LIME. The ability to explain and validate automated decision-making is critical in medical treatments. This analysis allows us to conclude that both QA classifiers are moderately trustworthy and can be used to confirm expert decisions, though the current QA classifiers should not be viewed as a replacement for the human QA process. [ABSTRACT FROM AUTHOR]

Purpose: High-quality radiotherapy (RT) planning for children and young adults with primary brain tumours is essential to minimize the risk of late treatment effects. The feasibility of using automated machine-learning (ML) to aid RT planning in this population has not previously been studied.Methods and Materials: We developed a ML model that identifies learned relationships between image features and expected dose in a training set of 95 patients with a primary brain tumour treated with focal radiotherapy to a dose of 54 Gy in 30 fractions. This ML method was then used to create predicted dose distributions for 15 previously-treated brain tumour patients across two institutions, as a testing set. Dosimetry to target volumes and organs-at-risk (OARs) were compared between the clinically-delivered (human-generated) plans versus the ML plans.Results: The ML method was able to create deliverable plans in all 15 patients in the testing set. All ML plans were generated within 30 min of initiating planning. Planning target volume coverage with 95% of the prescription dose was attained in all plans. OAR doses were similar across most structures evaluated; mean doses to brain and left temporal lobe were lower in ML plans than manual plans (mean difference to left temporal, - 2.3 Gy, p = 0.006; mean differences to brain, - 1.3 Gy, p = 0.017), whereas mean doses to right cochlea and lenses were higher in ML plans (+ 1.6-2.2 Gy, p < 0.05 for each).Conclusions: Use of an automated ML method to aid RT planning for children and young adults with primary brain tumours is dosimetrically feasible and can be successfully used to create high-quality 54 Gy RT plans. Further evaluation after clinical implementation is planned. [ABSTRACT FROM AUTHOR]

Atlas-based machine learning (ML) for radiation therapy (RT) treatment planning is effective at tailoring dose distributions to account for unique patient anatomies by selecting the most appropriate patients from the training database (atlases) to inform dose prediction for new patients. However, variations in clinical practice between the training dataset and a new patient to be planned may impact ML performance by confounding atlas selection. In this study, we simulated various contouring practices in prostate cancer RT to investigate the impact of changing input data on atlas-based ML treatment planning. We generated 225 ML plans for nine bespoke contouring protocol scenarios (reduced target margins, modified organ-at-risk (OAR) definitions, and inclusion of optional OARs less represented in the training database) on 25 patient datasets by applying a single, previously trained and validated ML model for prostate cancer followed by dose mimicking to create a final deliverable plan. ML treatment plans for each scenario were compared to base ML treatment plans that followed a contouring protocol consistent with the model training data. ML performance was evaluated based on atlas distance metrics that are calculated during ML dose prediction. There were significant changes between atlases selected for the base ML treatment plans and treatment plans when planning target volume margins were reduced and/or optional OARs were included. The deliverability of ML predicted dose distributions based on gamma analysis between predicted and mimicked final deliverable dose showed significant differences for seven out of eight scenarios compared with the base ML treatment plans. Overall, there were small but statistically significant dosimetric changes in predicted and mimicked dose with addition of optional OAR contours. This work presents a framework for benchmarking and performance monitoring of ML treatment planning algorithms in the context of evolving clinical practices. [ABSTRACT FROM AUTHOR]

AbstractLaura Zanotti's Quantum Entanglements offers something unique to the burgeoning literature surrounding quantum physics, social science, and international relations. Rather than emphasizing the materiality of the science, it expressly aims its focus toward those already engaged in relationality, critical practice, and the politics of ontologies–even/especially for those not especially interested in science qua science. Zanotti's book calls for a fundamental rethink of the widespread influence of substantialism, even in the places that self-identify as rejecting it as a philosophical position. By positioning Newtonian thought as a metaphor, rather than a mimetic representation of scientific reality, Quantum Entanglements widens the applicability of quantum thinking to areas seemingly far removed from these debates. This article engages Zanotti's work by reading her insights into three different areas of IR scholarship where her ideas could be particularly useful –temporality, scholarly positionality, and the ontology of war. For each I suggest conceptual developments building on the critique of substantialism and emphasis on quantum entanglement. These developments emphasize the inextricability and ontological challenge of entanglement, as well as centering intellectual and political modesty and human/non-human relationality as ways forward for thinking international politics. [ABSTRACT FROM AUTHOR]

Enabling automated pipelines, image analysis and big data methodology in cancer clinics requires thorough understanding of the data. Automated quality assurance steps could improve the efficiency and robustness of these methods by verifying possible data biases. In particular, in head and neck (H&N) computed-tomography (CT) images, dental artifacts (DA) obscure visualization of structures and the accuracy of Hounsfield units; a challenge for image analysis tasks, including radiomics, where poor image quality can lead to systemic biases. In this work we analyze the performance of three-dimensional convolutional neural networks (CNN) trained to classify DA statuses. 1538 patient images were scored by a single observer as DA positive or negative. Stratified five-fold cross validation was performed to train and test CNNs using various isotropic resampling grids (643, 1283 and 2563), with CNN depths designed to produce 323, 163, and 83 machine generated features. These parameters were selected to determine if more computationally efficient CNNs could be utilized to achieve the same performance. The area under the precision recall curve (PR-AUC) was used to assess CNN performance. The highest PR-AUC (0.92 ± 0.03) was achieved with a CNN depth = 5, resampling grid = 256. The CNN performance with 2563 resampling grid size is not significantly better than 643 and 1283 after 20 epochs, which had PR-AUC = 0.89 ± 0.03 (p -value = 0.28) and 0.91 ± 0.02 (p -value = 0.93) at depths of 3 and 4, respectively. Our experiments demonstrate the potential to automate specific quality assurance tasks required for unbiased and robust automated pipeline and image analysis research. Additionally, we determined that there is an opportunity to simplify CNNs with smaller resampling grids to make the process more amenable to very large datasets that will be available in the future. [ABSTRACT FROM AUTHOR]

Purpose: To test the use of well‐studied and widely used classification methods alongside newly developed data‐filtering techniques specifically designed for imbalanced‐data classification in order to demonstrate proof of principle for an automated radiation therapy (RT) quality assurance process on prostate cancer treatment. Methods: A series of acceptable (majority class, n = 61) and erroneous (minority class, n = 12) RT plans as well as a disjoint set of acceptable plans used to develop features (n = 273) were used to develop a dataset for testing. A series of five widely used imbalanced‐data classification algorithms were tested with a modularized guided undersampling procedure that includes ensemble‐outlier filtering and normalized‐cut sampling. Results: Hybrid methods including either ensemble‐outlier filtering or both filtering and normalized‐cut sampling yielded the strongest performance in identifying unacceptable treatment plans. Specifically, five methods demonstrated superior performance in both area under the receiver operating characteristics curve and false positive rate when the true positive rate is equal to one. Furthermore, ensemble‐outlier filtering significantly improved results in all but one hybrid method (p < 0.01). Finally, ensemble‐outlier filtering methods identified four minority instances that were considered outliers in over 96% of cross‐validation iterations. Such instances may be considered distinct planning errors and merit additional inspection, providing potential areas of improvement for the planning process. Conclusions: Traditional imbalanced‐data classification methods combined with ensemble‐outlier filtering and normalized‐cut sampling provide a powerful framework for identifying erroneous RT treatment plans. The proposed methodology yielded strong classification performance and identified problematic instances with high accuracy. [ABSTRACT FROM AUTHOR]

Radiation therapy is an integral part of cancer treatment, but to date it remains highly manual. Plans are created through optimization of dose volume objectives that specify intent to minimize, maximize, or achieve a prescribed dose level to clinical targets and organs. Optimization is NP-hard, requiring highly iterative and manual initialization procedures. We present a proof-of-concept for a method to automatically infer the radiation dose directly from the patient's treatment planning image based on a database of previous patients with corresponding clinical treatment plans. Our method uses regression forests augmented with density estimation over the most informative features to learn an automatic atlas-selection metric that is tailored to dose prediction. We validate our approach on 276 patients from 3 clinical treatment plan sites (whole breast, breast cavity, and prostate), with an overall dose prediction accuracies of 78.68%, 64.76%, 86.83% under the Gamma metric. [ABSTRACT FROM AUTHOR]

Copyright of American Journal of Potato Research is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of American Journal of Potato Research is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Choice experiments and experimental auctions have become popular mechanisms for estimating willingness to pay (WTP). However, these methods have primarily been used for estimating WTP for single units of goods. We analyze the results from experimental auctions and choice experiments in the context of multiple quantities of a quasi-public good (animal welfare product). We show that the use of WTP values for a single unit of a product, a common practice in experimental valuation literature, can result in underestimation of aggregate demand. We use and compare open ended choice experiments (OECE), second price Vickrey auctions, and random Nth price auctions as mechanisms for valuing WTP. Our results also suggest that individual level demand estimates from OECE are less elastic than demand estimates from uniform price auctions. [ABSTRACT FROM AUTHOR]

Radiation therapy is used to treat cancer patients around the world. High quality treatment plans maximally radiate the targets while minimally radiating healthy organs at risk. In order to judge plan quality and safety, segmentations of the targets and organs at risk are created, and the amount of radiation that will be delivered to each structure is estimated prior to treatment. If the targets or organs at risk are mislabelled, or the segmentations are of poor quality, the safety of the radiation doses will be erroneously reviewed and an unsafe plan could proceed. We propose a technique to automatically label groups of segmentations of different structures from a radiation therapy plan for the joint purposes of providing quality assurance and data mining. Given one or more segmentations and an associated image we seek to assign medically meaningful labels to each segmentation and report the confidence of that label. Our method uses random forests to learn joint distributions over the training features, and then exploits a set of learned potential group configurations to build a conditional random field (CRF) that ensures the assignment of labels is consistent across the group of segmentations. The CRF is then solved via a constrained assignment problem. We validate our method on 1574 plans, consisting of 17\thinspace579 segmentations, demonstrating an overall classification accuracy of 91.58%. Our results also demonstrate the stability of RF with respect to tree depth and the number of splitting variables in large data sets. [ABSTRACT FROM AUTHOR]

We explore the application of genetic algorithms (GA) to deformable models through the proposition of a novel method for medical image segmentation that combines GA with nonconvex, localized, medial-based shape statistics. We replace the more typical gradient descent optimizer used in deformable models with GA, and the convex, implicit, global shape statistics with nonconvex, explicit, localized ones. Specifically, we propose GA to reduce typical deformable model weaknesses pertaining to model initialization, pose estimation and local minima, through the simultaneous evolution of a large number of models. Furthermore, we constrain the evolution, and thus reduce the size of the search-space, by using statistically-based deformable models whose deformations are intuitive (stretch, bulge, bend) and are driven in terms of localized principal modes of variation, instead of modes of variation across the entire shape that often fail to capture localized shape changes. Although GA are not guaranteed to achieve the global optima, our method compares favorably to the prevalent optimization techniques, convex/nonconvex gradient-based optimizers and to globally optimal graph-theoretic combinatorial optimization techniques, when applied to the task of corpus callosum segmentation in 50 mid-sagittal brain magnetic resonance images. [ABSTRACT FROM PUBLISHER]

A method for visualizing manifold-valued medical image data is proposed. The method operates on images in which each pixel is assumed to be sampled from an underlying manifold. For example, each pixel may contain a high dimensional vector, such as the time activity curve (TAC) in a dynamic positron emission tomography (dPET) or a dynamic single photon emission computed tomography (dSPECT) image, or the positive semi-definite tensor in a diffusion tensor magnetic resonance image (DTMRI). A nonlinear mapping reduces the dimensionality of the pixel data to achieve two goals: distance preservation and embedding into a perceptual color space. We use multidimensional scaling distance-preserving mapping to render similar pixels (e.g., DT or TAC pixels) with perceptually similar colors. The 3D CIELAB perceptual color space is adopted as the range of the distance preserving mapping, with a final similarity transform mapping colors to a maximum gamut size. Similarity between pixels is either determined analytically as geodesics on the manifold of pixels or is approximated using manifold learning techniques. In particular, dissimilarity between DTMRI pixels is evaluated via a Log-Euclidean Riemannian metric respecting the manifold of the rank 3, second-order positive semi-definite DTs, whereas the dissimilarity between TACs is approximated via ISOMAP. We demonstrate our approach via artificial high-dimensional, manifold-valued data, as well as case studies of normal and pathological clinical brain and heart DTMRI, dPET, and dSPECT images. Our results demonstrate the effectiveness of our approach in capturing, in a perceptually meaningful way, important features in the data. [ABSTRACT FROM AUTHOR]

Copyright of American Journal of Potato Research is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)