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A major barrier to deploying healthcare AI models is their trustworthiness. One form of trustworthiness is a model's robustness across different subgroups: while existing models may exhibit expert-level performance on aggregate metrics, they often rely on non-causal features, leading to errors in hidden subgroups. To take a step closer towards trustworthy seizure onset detection from EEG, we propose to leverage annotations that are produced by healthcare personnel in routine clinical workflows -- which we refer to as workflow notes -- that include multiple event descriptions beyond seizures. Using workflow notes, we first show that by scaling training data to an unprecedented level of 68,920 EEG hours, seizure onset detection performance significantly improves (+12.3 AUROC points) compared to relying on smaller training sets with expensive manual gold-standard labels. Second, we reveal that our binary seizure onset detection model underperforms on clinically relevant subgroups (e.g., up to a margin of 6.5 AUROC points between pediatrics and adults), while having significantly higher false positives on EEG clips showing non-epileptiform abnormalities compared to any EEG clip (+19 FPR points). To improve model robustness to hidden subgroups, we train a multilabel model that classifies 26 attributes other than seizures, such as spikes, slowing, and movement artifacts. We find that our multilabel model significantly improves overall seizure onset detection performance (+5.9 AUROC points) while greatly improving performance among subgroups (up to +8.3 AUROC points), and decreases false positives on non-epileptiform abnormalities by 8 FPR points. Finally, we propose a clinical utility metric based on false positives per 24 EEG hours and find that our multilabel model improves this clinical utility metric by a factor of 2x across different clinical settings.

A critical enabler for progress in neuromorphic computing research is the ability to transparently evaluate different neuromorphic solutions on important tasks and to compare them to state-of-the-art conventional solutions. The Intel Neuromorphic Deep Noise Suppression Challenge (Intel N-DNS Challenge), inspired by the Microsoft DNS Challenge, tackles a ubiquitous and commercially relevant task: real-time audio denoising. Audio denoising is likely to reap the benefits of neuromorphic computing due to its low-bandwidth, temporal nature and its relevance for low-power devices. The Intel N-DNS Challenge consists of two tracks: a simulation-based algorithmic track to encourage algorithmic innovation, and a neuromorphic hardware (Loihi 2) track to rigorously evaluate solutions. For both tracks, we specify an evaluation methodology based on energy, latency, and resource consumption in addition to output audio quality. We make the Intel N-DNS Challenge dataset scripts and evaluation code freely accessible, encourage community participation with monetary prizes, and release a neuromorphic baseline solution which shows promising audio quality, high power efficiency, and low resource consumption when compared to Microsoft NsNet2 and a proprietary Intel denoising model used in production. We hope the Intel N-DNS Challenge will hasten innovation in neuromorphic algorithms research, especially in the area of training tools and methods for real-time signal processing. We expect the winners of the challenge will demonstrate that for problems like audio denoising, significant gains in power and resources can be realized on neuromorphic devices available today compared to conventional state-of-the-art solutions., Comment: 13 pages, 4 figures, 1 table

Image augmentations are quintessential for effective visual representation learning across self-supervised learning techniques. While augmentation strategies for natural imaging have been studied extensively, medical images are vastly different from their natural counterparts. Thus, it is unknown whether common augmentation strategies employed in Siamese representation learning generalize to medical images and to what extent. To address this challenge, in this study, we systematically assess the effect of various augmentations on the quality and robustness of the learned representations. We train and evaluate Siamese Networks for abnormality detection on chest X-Rays across three large datasets (MIMIC-CXR, CheXpert and VinDR-CXR). We investigate the efficacy of the learned representations through experiments involving linear probing, fine-tuning, zero-shot transfer, and data efficiency. Finally, we identify a set of augmentations that yield robust representations that generalize well to both out-of-distribution data and diseases, while outperforming supervised baselines using just zero-shot transfer and linear probes by up to 20%. Our code is available at https://github.com/StanfordMIMI/siaug., Comment: Equal contributions. Oral paper at MIDL 2023. Additional experiments in appendix in V2. Keywords: Data Augmentations, Self-Supervised Learning, Medical Imaging, Chest X-rays, Siamese Representation Learning

Multivariate biosignals are prevalent in many medical domains, such as electroencephalography, polysomnography, and electrocardiography. Modeling spatiotemporal dependencies in multivariate biosignals is challenging due to (1) long-range temporal dependencies and (2) complex spatial correlations between the electrodes. To address these challenges, we propose representing multivariate biosignals as time-dependent graphs and introduce GraphS4mer, a general graph neural network (GNN) architecture that improves performance on biosignal classification tasks by modeling spatiotemporal dependencies in biosignals. Specifically, (1) we leverage the Structured State Space architecture, a state-of-the-art deep sequence model, to capture long-range temporal dependencies in biosignals and (2) we propose a graph structure learning layer in GraphS4mer to learn dynamically evolving graph structures in the data. We evaluate our proposed model on three distinct biosignal classification tasks and show that GraphS4mer consistently improves over existing models, including (1) seizure detection from electroencephalographic signals, outperforming a previous GNN with self-supervised pre-training by 3.1 points in AUROC; (2) sleep staging from polysomnographic signals, a 4.1 points improvement in macro-F1 score compared to existing sleep staging models; and (3) 12-lead electrocardiogram classification, outperforming previous state-of-the-art models by 2.7 points in macro-F1 score., Comment: Published as a conference paper at CHIL 2023

Attention--or attribution--maps methods are methods designed to highlight regions of the model's input that were discriminative for its predictions. However, different attention maps methods can highlight different regions of the input, with sometimes contradictory explanations for a prediction. This effect is exacerbated when the training set is small. This indicates that either the model learned incorrect representations or that the attention maps methods did not accurately estimate the model's representations. We propose an unsupervised fine-tuning method that optimizes the consistency of attention maps and show that it improves both classification performance and the quality of attention maps. We propose an implementation for two state-of-the-art attention computation methods, Grad-CAM and Guided Backpropagation, which relies on an input masking technique. We also show results on Grad-CAM and Integrated Gradients in an ablation study. We evaluate this method on our own dataset of event detection in continuous video recordings of hospital patients aggregated and curated for this work. As a sanity check, we also evaluate the proposed method on PASCAL VOC and SVHN. With the proposed method, with small training sets, we achieve a 6.6 points lift of F1 score over the baselines on our video dataset, a 2.9 point lift of F1 score on PASCAL, and a 1.8 points lift of mean Intersection over Union over Grad-CAM for weakly supervised detection on PASCAL. Those improved attention maps may help clinicians better understand vision model predictions and ease the deployment of machine learning systems into clinical care. We share part of the code for this article at the following repository: https://github.com/alimirzazadeh/SemisupervisedAttention., Comment: WACV 2023

Self supervised contrastive learning based pretraining allows development of robust and generalized deep learning models with small, labeled datasets, reducing the burden of label generation. This paper aims to evaluate the effect of CL based pretraining on the performance of referrable vs non referrable diabetic retinopathy (DR) classification. We have developed a CL based framework with neural style transfer (NST) augmentation to produce models with better representations and initializations for the detection of DR in color fundus images. We compare our CL pretrained model performance with two state of the art baseline models pretrained with Imagenet weights. We further investigate the model performance with reduced labeled training data (down to 10 percent) to test the robustness of the model when trained with small, labeled datasets. The model is trained and validated on the EyePACS dataset and tested independently on clinical data from the University of Illinois, Chicago (UIC). Compared to baseline models, our CL pretrained FundusNet model had higher AUC (CI) values (0.91 (0.898 to 0.930) vs 0.80 (0.783 to 0.820) and 0.83 (0.801 to 0.853) on UIC data). At 10 percent labeled training data, the FundusNet AUC was 0.81 (0.78 to 0.84) vs 0.58 (0.56 to 0.64) and 0.63 (0.60 to 0.66) in baseline models, when tested on the UIC dataset. CL based pretraining with NST significantly improves DL classification performance, helps the model generalize well (transferable from EyePACS to UIC data), and allows training with small, annotated datasets, therefore reducing ground truth annotation burden of the clinicians.

Continuous monitoring of trained ML models to determine when their predictions should and should not be trusted is essential for their safe deployment. Such a framework ought to be high-performing, explainable, post-hoc and actionable. We propose TRUST-LAPSE, a "mistrust" scoring framework for continuous model monitoring. We assess the trustworthiness of each input sample's model prediction using a sequence of latent-space embeddings. Specifically, (a) our latent-space mistrust score estimates mistrust using distance metrics (Mahalanobis distance) and similarity metrics (cosine similarity) in the latent-space and (b) our sequential mistrust score determines deviations in correlations over the sequence of past input representations in a non-parametric, sliding-window based algorithm for actionable continuous monitoring. We evaluate TRUST-LAPSE via two downstream tasks: (1) distributionally shifted input detection, and (2) data drift detection. We evaluate across diverse domains - audio and vision using public datasets and further benchmark our approach on challenging, real-world electroencephalograms (EEG) datasets for seizure detection. Our latent-space mistrust scores achieve state-of-the-art results with AUROCs of 84.1 (vision), 73.9 (audio), and 77.1 (clinical EEGs), outperforming baselines by over 10 points. We expose critical failures in popular baselines that remain insensitive to input semantic content, rendering them unfit for real-world model monitoring. We show that our sequential mistrust scores achieve high drift detection rates; over 90% of the streams show < 20% error for all domains. Through extensive qualitative and quantitative evaluations, we show that our mistrust scores are more robust and provide explainability for easy adoption into practice., Comment: Keywords: Mistrust Scores, Latent-Space, Model monitoring, Trustworthy AI, Explainable AI, Semantic-guided AI

Domain generalization in medical image classification is an important problem for trustworthy machine learning to be deployed in healthcare. We find that existing approaches for domain generalization which utilize ground-truth abnormality segmentations to control feature attributions have poor out-of-distribution (OOD) performance relative to the standard baseline of empirical risk minimization (ERM). We investigate what regions of an image are important for medical image classification and show that parts of the background, that which is not contained in the abnormality segmentation, provides helpful signal. We then develop a new task-specific mask which covers all relevant regions. Utilizing this new segmentation mask significantly improves the performance of the existing methods on the OOD test sets. To obtain better generalization results than ERM, we find it necessary to scale up the training data size in addition to the usage of these task-specific masks., Comment: 6 pages, 2 figures

The collection and curation of large-scale medical datasets from multiple institutions is essential for training accurate deep learning models, but privacy concerns often hinder data sharing. Federated learning (FL) is a promising solution that enables privacy-preserving collaborative learning among different institutions, but it generally suffers from performance deterioration due to heterogeneous data distributions and a lack of quality labeled data. In this paper, we present a robust and label-efficient self-supervised FL framework for medical image analysis. Our method introduces a novel Transformer-based self-supervised pre-training paradigm that pre-trains models directly on decentralized target task datasets using masked image modeling, to facilitate more robust representation learning on heterogeneous data and effective knowledge transfer to downstream models. Extensive empirical results on simulated and real-world medical imaging non-IID federated datasets show that masked image modeling with Transformers significantly improves the robustness of models against various degrees of data heterogeneity. Notably, under severe data heterogeneity, our method, without relying on any additional pre-training data, achieves an improvement of 5.06%, 1.53% and 4.58% in test accuracy on retinal, dermatology and chest X-ray classification compared to the supervised baseline with ImageNet pre-training. In addition, we show that our federated self-supervised pre-training methods yield models that generalize better to out-of-distribution data and perform more effectively when fine-tuning with limited labeled data, compared to existing FL algorithms. The code is available at https://github.com/rui-yan/SSL-FL., Comment: Code and trained models are available at: https://github.com/rui-yan/SSL-FL

Despite its tremendous value for the diagnosis, treatment monitoring and surveillance of children with cancer, whole body staging with positron emission tomography (PET) is time consuming and associated with considerable radiation exposure. 100x (1% of the standard clinical dosage) ultra-low-dose/ultra-fast whole-body PET reconstruction has the potential for cancer imaging with unprecedented speed and improved safety, but it cannot be achieved by the naive use of machine learning techniques. In this study, we utilize the global similarity between baseline and follow-up PET and magnetic resonance (MR) images to develop Masked-LMCTrans, a longitudinal multi-modality co-attentional CNN-Transformer that provides interaction and joint reasoning between serial PET/MRs of the same patient. We mask the tumor area in the referenced baseline PET and reconstruct the follow-up PET scans. In this manner, Masked-LMCTrans reconstructs 100x almost-zero radio-exposure whole-body PET that was not possible before. The technique also opens a new pathway for longitudinal radiology imaging reconstruction, a significantly under-explored area to date. Our model was trained and tested with Stanford PET/MRI scans of pediatric lymphoma patients and evaluated externally on PET/MRI images from T\"ubingen University. The high image quality of the reconstructed 100x whole-body PET images resulting from the application of Masked-LMCTrans will substantially advance the development of safer imaging approaches and shorter exam-durations for pediatric patients, as well as expand the possibilities for frequent longitudinal monitoring of these patients by PET., Comment: This submission has been removed by arXiv administrators because the submitter did not have the right to assign the license at the time of submission

Measures to predict 30-day readmission are considered an important quality factor for hospitals as accurate predictions can reduce the overall cost of care by identifying high risk patients before they are discharged. While recent deep learning-based studies have shown promising empirical results on readmission prediction, several limitations exist that may hinder widespread clinical utility, such as (a) only patients with certain conditions are considered, (b) existing approaches do not leverage data temporality, (c) individual admissions are assumed independent of each other, which is unrealistic, (d) prior studies are usually limited to single source of data and single center data. To address these limitations, we propose a multimodal, modality-agnostic spatiotemporal graph neural network (MM-STGNN) for prediction of 30-day all-cause hospital readmission that fuses multimodal in-patient longitudinal data. By training and evaluating our methods using longitudinal chest radiographs and electronic health records from two independent centers, we demonstrate that MM-STGNN achieves AUROC of 0.79 on both primary and external datasets. Furthermore, MM-STGNN significantly outperforms the current clinical reference standard, LACE+ score (AUROC=0.61), on the primary dataset. For subset populations of patients with heart and vascular disease, our model also outperforms baselines on predicting 30-day readmission (e.g., 3.7 point improvement in AUROC in patients with heart disease). Lastly, qualitative model interpretability analysis indicates that while patients' primary diagnoses were not explicitly used to train the model, node features crucial for model prediction directly reflect patients' primary diagnoses. Importantly, our MM-STGNN is agnostic to node feature modalities and could be utilized to integrate multimodal data for triaging patients in various downstream resource allocation tasks.

Objective. Mammography reports document the diagnosis of patients' conditions. However, many reports contain non-standard terms (non-BI-RADS descriptors) and incomplete statements, which can lead to conclusions that are not well-supported by the reported findings. Our aim was to develop a tool to detect such discrepancies by comparing the reported conclusions to those that would be expected based on the reported radiology findings. Materials and Methods. A deidentified data set from an academic hospital containing 258 mammography reports supplemented by 120 reports found on the web was used for training and evaluation. Spell checking and term normalization was used to unambiguously determine the reported BI-RADS descriptors. The resulting data were input into seven classifiers that classify mammography reports, based on their Findings sections, into seven BI-RADS final assessment categories. Finally, the semantic similarity score of a report to each BI-RADS category is reported. Results. Our term normalization algorithm correctly identified 97% of the BI-RADS descriptors in mammography reports. Our system provided 76% precision and 83% recall in correctly classifying the reports according to BI-RADS final assessment category. Discussion. The strength of our approach relies on providing high importance to BI-RADS terms in the summarization phase, on the semantic similarity that considers the complex data representation, and on the classification into all seven BI-RADs categories. Conclusion. BI-RADS descriptors and expected final assessment categories could be automatically detected by our approach with fairly good accuracy, which could be used to make users aware that their reported findings do not match well with their conclusion., Comment: 11 single spaced pages(current version is double spaced), 3 tables, 4 figures

In a clinical setting, epilepsy patients are monitored via video electroencephalogram (EEG) tests. A video EEG records what the patient experiences on videotape while an EEG device records their brainwaves. Currently, there are no existing automated methods for tracking the patient's location during a seizure, and video recordings of hospital patients are substantially different from publicly available video benchmark datasets. For example, the camera angle can be unusual, and patients can be partially covered with bedding sheets and electrode sets. Being able to track a patient in real-time with video EEG would be a promising innovation towards improving the quality of healthcare. Specifically, an automated patient detection system could supplement clinical oversight and reduce the resource-intensive efforts of nurses and doctors who need to continuously monitor patients. We evaluate an ImageNet pre-trained Mask R-CNN, a standard deep learning model for object detection, on the task of patient detection using our own curated dataset of 45 videos of hospital patients. The dataset was aggregated and curated for this work. We show that without fine-tuning, ImageNet pre-trained Mask R-CNN models perform poorly on such data. By fine-tuning the models with a subset of our dataset, we observe a substantial improvement in patient detection performance, with a mean average precision of 0.64. We show that the results vary substantially depending on the video clip.

Despite the routine use of electronic health record (EHR) data by radiologists to contextualize clinical history and inform image interpretation, the majority of deep learning architectures for medical imaging are unimodal, i.e., they only learn features from pixel-level information. Recent research revealing how race can be recovered from pixel data alone highlights the potential for serious biases in models which fail to account for demographics and other key patient attributes. Yet the lack of imaging datasets which capture clinical context, inclusive of demographics and longitudinal medical history, has left multimodal medical imaging underexplored. To better assess these challenges, we present RadFusion, a multimodal, benchmark dataset of 1794 patients with corresponding EHR data and high-resolution computed tomography (CT) scans labeled for pulmonary embolism. We evaluate several representative multimodal fusion models and benchmark their fairness properties across protected subgroups, e.g., gender, race/ethnicity, age. Our results suggest that integrating imaging and EHR data can improve classification performance and robustness without introducing large disparities in the true positive rate between population groups., Comment: RadFusion dataset: https://stanfordaimi.azurewebsites.net/datasets/3a7548a4-8f65-4ab7-85fa-3d68c9efc1bd

Artificial intelligence (AI) provides a promising substitution for streamlining COVID-19 diagnoses. However, concerns surrounding security and trustworthiness impede the collection of large-scale representative medical data, posing a considerable challenge for training a well-generalised model in clinical practices. To address this, we launch the Unified CT-COVID AI Diagnostic Initiative (UCADI), where the AI model can be distributedly trained and independently executed at each host institution under a federated learning framework (FL) without data sharing. Here we show that our FL model outperformed all the local models by a large yield (test sensitivity /specificity in China: 0.973/0.951, in the UK: 0.730/0.942), achieving comparable performance with a panel of professional radiologists. We further evaluated the model on the hold-out (collected from another two hospitals leaving out the FL) and heterogeneous (acquired with contrast materials) data, provided visual explanations for decisions made by the model, and analysed the trade-offs between the model performance and the communication costs in the federated training process. Our study is based on 9,573 chest computed tomography scans (CTs) from 3,336 patients collected from 23 hospitals located in China and the UK. Collectively, our work advanced the prospects of utilising federated learning for privacy-preserving AI in digital health., Comment: Nature Machine Intelligence

The biologically inspired spiking neurons used in neuromorphic computing are nonlinear filters with dynamic state variables -- very different from the stateless neuron models used in deep learning. The next version of Intel's neuromorphic research processor, Loihi 2, supports a wide range of stateful spiking neuron models with fully programmable dynamics. Here we showcase advanced spiking neuron models that can be used to efficiently process streaming data in simulation experiments on emulated Loihi 2 hardware. In one example, Resonate-and-Fire (RF) neurons are used to compute the Short Time Fourier Transform (STFT) with similar computational complexity but 47x less output bandwidth than the conventional STFT. In another example, we describe an algorithm for optical flow estimation using spatiotemporal RF neurons that requires over 90x fewer operations than a conventional DNN-based solution. We also demonstrate promising preliminary results using backpropagation to train RF neurons for audio classification tasks. Finally, we show that a cascade of Hopf resonators - a variant of the RF neuron - replicates novel properties of the cochlea and motivates an efficient spike-based spectrogram encoder.

Federated learning enables multiple institutions to collaboratively train machine learning models on their local data in a privacy-preserving way. However, its distributed nature often leads to significant heterogeneity in data distributions across institutions. In this paper, we investigate the deleterious impact of a taxonomy of data heterogeneity regimes on federated learning methods, including quantity skew, label distribution skew, and imaging acquisition skew. We show that the performance degrades with the increasing degrees of data heterogeneity. We present several mitigation strategies to overcome performance drops from data heterogeneity, including weighted average for data quantity skew, weighted loss and batch normalization averaging for label distribution skew. The proposed optimizations to federated learning methods improve their capability of handling heterogeneity across institutions, which provides valuable guidance for the deployment of federated learning in real clinical applications.

Federated learning is an emerging research paradigm for enabling collaboratively training deep learning models without sharing patient data. However, the data from different institutions are usually heterogeneous across institutions, which may reduce the performance of models trained using federated learning. In this study, we propose a novel heterogeneity-aware federated learning method, SplitAVG, to overcome the performance drops from data heterogeneity in federated learning. Unlike previous federated methods that require complex heuristic training or hyper parameter tuning, our SplitAVG leverages the simple network split and feature map concatenation strategies to encourage the federated model training an unbiased estimator of the target data distribution. We compare SplitAVG with seven state-of-the-art federated learning methods, using centrally hosted training data as the baseline on a suite of both synthetic and real-world federated datasets. We find that the performance of models trained using all the comparison federated learning methods degraded significantly with the increasing degrees of data heterogeneity. In contrast, SplitAVG method achieves comparable results to the baseline method under all heterogeneous settings, that it achieves 96.2% of the accuracy and 110.4% of the mean absolute error obtained by the baseline in a diabetic retinopathy binary classification dataset and a bone age prediction dataset, respectively, on highly heterogeneous data partitions. We conclude that SplitAVG method can effectively overcome the performance drops from variability in data distributions across institutions. Experimental results also show that SplitAVG can be adapted to different base networks and generalized to various types of medical imaging tasks.

Collaborative learning, which enables collaborative and decentralized training of deep neural networks at multiple institutions in a privacy-preserving manner, is rapidly emerging as a valuable technique in healthcare applications. However, its distributed nature often leads to significant heterogeneity in data distributions across institutions. In this paper, we present a novel generative replay strategy to address the challenge of data heterogeneity in collaborative learning methods. Different from traditional methods that directly aggregating the model parameters, we leverage generative adversarial learning to aggregate the knowledge from all the local institutions. Specifically, instead of directly training a model for task performance, we develop a novel dual model architecture: a primary model learns the desired task, and an auxiliary "generative replay model" allows aggregating knowledge from the heterogenous clients. The auxiliary model is then broadcasted to the central sever, to regulate the training of primary model with an unbiased target distribution. Experimental results demonstrate the capability of the proposed method in handling heterogeneous data across institutions. On highly heterogeneous data partitions, our model achieves ~4.88% improvement in the prediction accuracy on a diabetic retinopathy classification dataset, and ~49.8% reduction of mean absolution value on a Bone Age prediction dataset, respectively, compared to the state-of-the art collaborative learning methods., Comment: Published as a journal paper at Medical Image Analysis 2022

Federated learning is an emerging research paradigm enabling collaborative training of machine learning models among different organizations while keeping data private at each institution. Despite recent progress, there remain fundamental challenges such as the lack of convergence and the potential for catastrophic forgetting across real-world heterogeneous devices. In this paper, we demonstrate that self-attention-based architectures (e.g., Transformers) are more robust to distribution shifts and hence improve federated learning over heterogeneous data. Concretely, we conduct the first rigorous empirical investigation of different neural architectures across a range of federated algorithms, real-world benchmarks, and heterogeneous data splits. Our experiments show that simply replacing convolutional networks with Transformers can greatly reduce catastrophic forgetting of previous devices, accelerate convergence, and reach a better global model, especially when dealing with heterogeneous data. We release our code and pretrained models at https://github.com/Liangqiong/ViT-FL-main to encourage future exploration in robust architectures as an alternative to current research efforts on the optimization front., Comment: Published as a conference paper at CVPR 2022

Optimization plays a key role in the training of deep neural networks. Deciding when to stop training can have a substantial impact on the performance of the network during inference. Under certain conditions, the generalization error can display a double descent pattern during training: the learning curve is non-monotonic and seemingly diverges before converging again after additional epochs. This optimization pattern can lead to early stopping procedures to stop training before the second convergence and consequently select a suboptimal set of parameters for the network, with worse performance during inference. In this work, in addition to confirming that double descent occurs with small datasets and noisy labels as evidenced by others, we show that noisy labels must be present both in the training and generalization sets to observe a double descent pattern. We also show that the learning rate has an influence on double descent, and study how different optimizers and optimizer parameters influence the apparition of double descent. Finally, we show that increasing the learning rate can create an aliasing effect that masks the double descent pattern without suppressing it. We study this phenomenon through extensive experiments on variants of CIFAR-10 and show that they translate to a real world application: the forecast of seizure events in epileptic patients from continuous electroencephalographic recordings.

Chest X-rays of coronavirus disease 2019 (COVID-19) patients are frequently obtained to determine the extent of lung disease and are a valuable source of data for creating artificial intelligence models. Most work to date assessing disease severity on chest imaging has focused on segmenting computed tomography (CT) images; however, given that CTs are performed much less frequently than chest X-rays for COVID-19 patients, automated lung lesion segmentation on chest X-rays could be clinically valuable. There currently exists a universal shortage of chest X-rays with ground truth COVID-19 lung lesion annotations, and manually contouring lung opacities is a tedious, labor-intensive task. To accelerate severity detection and augment the amount of publicly available chest X-ray training data for supervised deep learning (DL) models, we leverage existing annotated CT images to generate frontal projection "chest X-ray" images for training COVID-19 chest X-ray models. In this paper, we propose an automated pipeline for segmentation of COVID-19 lung lesions on chest X-rays comprised of a Mask R-CNN trained on a mixed dataset of open-source chest X-rays and coronal X-ray projections computed from annotated volumetric CTs. On a test set containing 40 chest X-rays of COVID-19 positive patients, our model achieved IoU scores of 0.81 $\pm$ 0.03 and 0.79 $\pm$ 0.03 when trained on a dataset of 60 chest X-rays and on a mixed dataset of 10 chest X-rays and 50 projections from CTs, respectively. Our model far outperforms current baselines with limited supervised training and may assist in automated COVID-19 severity quantification on chest X-rays., Comment: 8 pages, 5 figures

Automated seizure detection and classification from electroencephalography (EEG) can greatly improve seizure diagnosis and treatment. However, several modeling challenges remain unaddressed in prior automated seizure detection and classification studies: (1) representing non-Euclidean data structure in EEGs, (2) accurately classifying rare seizure types, and (3) lacking a quantitative interpretability approach to measure model ability to localize seizures. In this study, we address these challenges by (1) representing the spatiotemporal dependencies in EEGs using a graph neural network (GNN) and proposing two EEG graph structures that capture the electrode geometry or dynamic brain connectivity, (2) proposing a self-supervised pre-training method that predicts preprocessed signals for the next time period to further improve model performance, particularly on rare seizure types, and (3) proposing a quantitative model interpretability approach to assess a model's ability to localize seizures within EEGs. When evaluating our approach on seizure detection and classification on a large public dataset, we find that our GNN with self-supervised pre-training achieves 0.875 Area Under the Receiver Operating Characteristic Curve on seizure detection and 0.749 weighted F1-score on seizure classification, outperforming previous methods for both seizure detection and classification. Moreover, our self-supervised pre-training strategy significantly improves classification of rare seizure types. Furthermore, quantitative interpretability analysis shows that our GNN with self-supervised pre-training precisely localizes 25.4% focal seizures, a 21.9 point improvement over existing CNNs. Finally, by superimposing the identified seizure locations on both raw EEG signals and EEG graphs, our approach could provide clinicians with an intuitive visualization of localized seizure regions., Comment: Published as a conference paper at ICLR 2022

Model brittleness is a key concern when deploying deep learning models in real-world medical settings. A model that has high performance at one institution may suffer a significant decline in performance when tested at other institutions. While pooling datasets from multiple institutions and retraining may provide a straightforward solution, it is often infeasible and may compromise patient privacy. An alternative approach is to fine-tune the model on subsequent institutions after training on the original institution. Notably, this approach degrades model performance at the original institution, a phenomenon known as catastrophic forgetting. In this paper, we develop an approach to address catastrophic forget-ting based on elastic weight consolidation combined with modulation of batch normalization statistics under two scenarios: first, for expanding the domain from one imaging system's data to another imaging system's, and second, for expanding the domain from a large multi-institutional dataset to another single institution dataset. We show that our approach outperforms several other state-of-the-art approaches and provide theoretical justification for the efficacy of batch normalization modulation. The results of this study are generally applicable to the deployment of any clinical deep learning model which requires domain expansion., Comment: First three authors contributed equally

Suboptimal generalization of machine learning models on unseen data is a key challenge which hampers the clinical applicability of such models to medical imaging. Although various methods such as domain adaptation and domain generalization have evolved to combat this challenge, learning robust and generalizable representations is core to medical image understanding, and continues to be a problem. Here, we propose STRAP (Style TRansfer Augmentation for histoPathology), a form of data augmentation based on random style transfer from non-medical style source such as artistic paintings, for learning domain-agnostic visual representations in computational pathology. Style transfer replaces the low-level texture content of an image with the uninformative style of randomly selected style source image, while preserving the original high-level semantic content. This improves robustness to domain shift and can be used as a simple yet powerful tool for learning domain-agnostic representations. We demonstrate that STRAP leads to state-of-the-art performance, particularly in the presence of domain shifts, on two particular classification tasks in computational pathology.

Labeled data is a critical resource for training and evaluating machine learning models. However, many real-life datasets are only partially labeled. We propose a semi-supervised machine learning training strategy to improve event detection performance on sequential data, such as video recordings, when only sparse labels are available, such as event start times without their corresponding end times. Our method uses noisy guesses of the events' end times to train event detection models. Depending on how conservative these guesses are, mislabeled samples may be introduced into the training set. We further propose a mathematical model for explaining and estimating the evolution of the classification performance for increasingly noisier end time estimates. We show that neural networks can improve their detection performance by leveraging more training data with less conservative approximations despite the higher proportion of incorrect labels. We adapt sequential versions of CIFAR-10 and MNIST, and use the Berkeley MHAD and HMBD51 video datasets to empirically evaluate our method, and find that our risk-tolerant strategy outperforms conservative estimates by 3.5 points of mean average precision for CIFAR, 30 points for MNIST, 3 points for MHAD, and 14 points for HMBD51. Then, we leverage the proposed training strategy to tackle a real-life application: processing continuous video recordings of epilepsy patients, and show that our method outperforms baseline labeling methods by 17 points of average precision, and reaches a classification performance similar to that of fully supervised models. We share part of the code for this article.