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Accurate classification of Intraductal Papillary Mucinous Neoplasms (IPMN) is essential for identifying high-risk cases that require timely intervention. In this study, we develop a federated learning framework for multi-center IPMN classification utilizing a comprehensive pancreas MRI dataset. This dataset includes 653 T1-weighted and 656 T2-weighted MRI images, accompanied by corresponding IPMN risk scores from 7 leading medical institutions, making it the largest and most diverse dataset for IPMN classification to date. We assess the performance of DenseNet-121 in both centralized and federated settings for training on distributed data. Our results demonstrate that the federated learning approach achieves high classification accuracy comparable to centralized learning while ensuring data privacy across institutions. This work marks a significant advancement in collaborative IPMN classification, facilitating secure and high-accuracy model training across multiple centers.

Federated learning (FL) enables collaborative model training across institutions without sharing sensitive data, making it an attractive solution for medical imaging tasks. However, traditional FL methods, such as Federated Averaging (FedAvg), face difficulties in generalizing across domains due to variations in imaging protocols and patient demographics across institutions. This challenge is particularly evident in pancreas MRI segmentation, where anatomical variability and imaging artifacts significantly impact performance. In this paper, we conduct a comprehensive evaluation of FL algorithms for pancreas MRI segmentation and introduce a novel approach that incorporates adaptive aggregation weights. By dynamically adjusting the contribution of each client during model aggregation, our method accounts for domain-specific differences and improves generalization across heterogeneous datasets. Experimental results demonstrate that our approach enhances segmentation accuracy and reduces the impact of domain shift compared to conventional FL methods while maintaining privacy-preserving capabilities. Significant performance improvements are observed across multiple hospitals (centers).

Colorectal cancer (CRC) is the third most common cause of cancer diagnosed in the United States and the second leading cause of cancer-related death among both genders. Notably, CRC is the leading cause of cancer in younger men less than 50 years old. Colonoscopy is considered the gold standard for the early diagnosis of CRC. Skills vary significantly among endoscopists, and a high miss rate is reported. Automated polyp segmentation can reduce the missed rates, and timely treatment is possible in the early stage. To address this challenge, we introduce \textit{\textbf{\ac{FANetv2}}}, an advanced encoder-decoder network designed to accurately segment polyps from colonoscopy images. Leveraging an initial input mask generated by Otsu thresholding, FANetv2 iteratively refines its binary segmentation masks through a novel feedback attention mechanism informed by the mask predictions of previous epochs. Additionally, it employs a text-guided approach that integrates essential information about the number (one or many) and size (small, medium, large) of polyps to further enhance its feature representation capabilities. This dual-task approach facilitates accurate polyp segmentation and aids in the auxiliary classification of polyp attributes, significantly boosting the model's performance. Our comprehensive evaluations on the publicly available BKAI-IGH and CVC-ClinicDB datasets demonstrate the superior performance of FANetv2, evidenced by high dice similarity coefficients (DSC) of 0.9186 and 0.9481, along with low Hausdorff distances of 2.83 and 3.19, respectively. The source code for FANetv2 is available at https://github.com/xxxxx/FANetv2.

Pancreatic cancer remains one of the leading causes of cancer-related mortality worldwide. Precise segmentation of pancreatic tumors from medical images is a bottleneck for effective clinical decision-making. However, achieving a high accuracy is often limited by the small size and availability of real patient data for training deep learning models. Recent approaches have employed synthetic data generation to augment training datasets. While promising, these methods may not yet meet the performance benchmarks required for real-world clinical use. This study critically evaluates the limitations of existing generative-AI based frameworks for pancreatic tumor segmentation. We conduct a series of experiments to investigate the impact of synthetic \textit{tumor size} and \textit{boundary definition} precision on model performance. Our findings demonstrate that: (1) strategically selecting a combination of synthetic tumor sizes is crucial for optimal segmentation outcomes, and (2) generating synthetic tumors with precise boundaries significantly improves model accuracy. These insights highlight the importance of utilizing refined synthetic data augmentation for enhancing the clinical utility of segmentation models in pancreatic cancer decision making including diagnosis, prognosis, and treatment plans. Our code will be available at https://github.com/lkpengcs/SynTumorAnalyzer., Comment: MICCAI Workshop AIPAD 2024

Many observational studies feature irregular longitudinal data, where the observation times are not common across individuals in the study. Further, the observation times may be related to the longitudinal outcome. In this setting, failing to account for the informative observation process may result in biased causal estimates. This can be coupled with other sources of bias, including non-randomized treatment assignments and informative censoring. This paper provides an overview of a flexible weighting method used to adjust for informative observation processes and non-randomized treatment assignments. We investigate the sensitivity of the flexible weighting method to violations of the noninformative censoring assumption, examine variable selection for the observation process weighting model, known as inverse intensity weighting, and look at the impacts of weight trimming for the flexible weighting model. We show that the flexible weighting method is sensitive to violations of the noninformative censoring assumption and show that a previously proposed extension fails under such violations. We also show that variables confounding the observation and outcome processes should always be included in the observation intensity model. Finally, we show that weight trimming should be applied in the flexible weighting model when the treatment assignment process is highly informative and driving the extreme weights. We conclude with an application of the methodology to a real data set to examine the impacts of household water sources on malaria diagnoses., Comment: 20 pages and 2 figures in main document, 8 pages and 2 figures in Supplemental Material. Submitted to Statistical Methods in Medical Research

Automated volumetric segmentation of the pancreas on cross-sectional imaging is needed for diagnosis and follow-up of pancreatic diseases. While CT-based pancreatic segmentation is more established, MRI-based segmentation methods are understudied, largely due to a lack of publicly available datasets, benchmarking research efforts, and domain-specific deep learning methods. In this retrospective study, we collected a large dataset (767 scans from 499 participants) of T1-weighted (T1W) and T2-weighted (T2W) abdominal MRI series from five centers between March 2004 and November 2022. We also collected CT scans of 1,350 patients from publicly available sources for benchmarking purposes. We developed a new pancreas segmentation method, called PanSegNet, combining the strengths of nnUNet and a Transformer network with a new linear attention module enabling volumetric computation. We tested PanSegNet's accuracy in cross-modality (a total of 2,117 scans) and cross-center settings with Dice and Hausdorff distance (HD95) evaluation metrics. We used Cohen's kappa statistics for intra and inter-rater agreement evaluation and paired t-tests for volume and Dice comparisons, respectively. For segmentation accuracy, we achieved Dice coefficients of 88.3% (std: 7.2%, at case level) with CT, 85.0% (std: 7.9%) with T1W MRI, and 86.3% (std: 6.4%) with T2W MRI. There was a high correlation for pancreas volume prediction with R^2 of 0.91, 0.84, and 0.85 for CT, T1W, and T2W, respectively. We found moderate inter-observer (0.624 and 0.638 for T1W and T2W MRI, respectively) and high intra-observer agreement scores. All MRI data is made available at https://osf.io/kysnj/. Our source code is available at https://github.com/NUBagciLab/PaNSegNet., Comment: Peer-reviewer version

Dynamic treatment regimes (DTRs) are sequences of functions that formalize the process of precision medicine. DTRs take as input patient information and output treatment recommendations. A major focus of the DTR literature has been on the estimation of optimal DTRs, the sequences of decision rules that result in the best outcome in expectation, across the complete population were they to be applied. While there is a rich literature on optimal DTR estimation, to date there has been minimal consideration of the impacts of nonadherence on these estimation procedures. Nonadherence refers to any process through that an individual's prescribed treatment does not match their true treatment. We explore the impacts of nonadherence and demonstrate that generally, when nonadherence is ignored, suboptimal regimes will be estimated. In light of these findings we propose a method for estimating optimal DTRs in the presence of nonadherence. The resulting estimators are consistent and asymptotically normal, with a double robustness property. Using simulations we demonstrate the reliability of these results, and illustrate comparable performance between the proposed estimation procedure adjusting for the impacts of nonadherence and estimators that are computed on data without nonadherence.

Dietary intake data are routinely drawn upon to explore diet-health relationships. However, these data are often subject to measurement error, distorting the true relationships. Beyond measurement error, there are likely complex synergistic and sometimes antagonistic interactions between different dietary components, complicating the relationships between diet and health outcomes. Flexible models are required to capture the nuance that these complex interactions introduce. This complexity makes research on diet-health relationships an appealing candidate for the application of machine learning techniques, and in particular, neural networks. Neural networks are computational models that are able to capture highly complex, nonlinear relationships so long as sufficient data are available. While these models have been applied in many domains, the impacts of measurement error on the performance of predictive modeling has not been systematically investigated. However, dietary intake data are typically collected using self-report methods and are prone to large amounts of measurement error. In this work, we demonstrate the ways in which measurement error erodes the performance of neural networks, and illustrate the care that is required for leveraging these models in the presence of error. We demonstrate the role that sample size and replicate measurements play on model performance, indicate a motivation for the investigation of transformations to additivity, and illustrate the caution required to prevent model overfitting. While the past performance of neural networks across various domains make them an attractive candidate for examining diet-health relationships, our work demonstrates that substantial care and further methodological development are both required to observe increased predictive performance when applying these techniques, compared to more traditional statistical procedures.

Intraductal Papillary Mucinous Neoplasm (IPMN) cysts are pre-malignant pancreas lesions, and they can progress into pancreatic cancer. Therefore, detecting and stratifying their risk level is of ultimate importance for effective treatment planning and disease control. However, this is a highly challenging task because of the diverse and irregular shape, texture, and size of the IPMN cysts as well as the pancreas. In this study, we propose a novel computer-aided diagnosis pipeline for IPMN risk classification from multi-contrast MRI scans. Our proposed analysis framework includes an efficient volumetric self-adapting segmentation strategy for pancreas delineation, followed by a newly designed deep learning-based classification scheme with a radiomics-based predictive approach. We test our proposed decision-fusion model in multi-center data sets of 246 multi-contrast MRI scans and obtain superior performance to the state of the art (SOTA) in this field. Our ablation studies demonstrate the significance of both radiomics and deep learning modules for achieving the new SOTA performance compared to international guidelines and published studies (81.9\% vs 61.3\% in accuracy). Our findings have important implications for clinical decision-making. In a series of rigorous experiments on multi-center data sets (246 MRI scans from five centers), we achieved unprecedented performance (81.9\% accuracy)., Comment: 10 pages, MICCAI MLMI 2023

The focus of precision medicine is on decision support, often in the form of dynamic treatment regimes (DTRs), which are sequences of decision rules. At each decision point, the decision rules determine the next treatment according to the patient's baseline characteristics, the information on treatments and responses accrued by that point, and the patient's current health status, including symptom severity and other measures. However, DTR estimation with ordinal outcomes is rarely studied, and rarer still in the context of interference - where one patient's treatment may affect another's outcome. In this paper, we introduce the weighted proportional odds model (WPOM): a regression-based, approximate doubly-robust approach to single-stage DTR estimation for ordinal outcomes. This method also accounts for the possibility of interference between individuals sharing a household through the use of covariate balancing weights derived from joint propensity scores. Examining different types of balancing weights, we verify the approximate double robustness of WPOM with our adjusted weights via simulation studies. We further extend WPOM to multi-stage DTR estimation with household interference, namely dWPOM (dynamic WPOM). Lastly, we demonstrate our proposed methodology in the analysis of longitudinal survey data from the Population Assessment of Tobacco and Health study, which motivates this work. Furthermore, considering interference, we provide optimal treatment strategies for households to achieve smoking cessation of the pair in the household.

Optical injection locking of integrated ring lasers promises to be a key technology of the future, but it is still lacking experimental verification. In this paper we present two monolithically integrated photonic circuits that experimentally realize Optically injection locking of ring lasers. The presented circuits pave the way for future application in Quantum Key Distribution and coherent communication

Current data augmentation techniques and transformations are well suited for improving the size and quality of natural image datasets but are not yet optimized for medical imaging. We hypothesize that sub-optimal data augmentations can easily distort or occlude medical images, leading to false positives or negatives during patient diagnosis, prediction, or therapy/surgery evaluation. In our experimental results, we found that utilizing commonly used intensity-based data augmentation distorts the MRI scans and leads to texture information loss, thus negatively affecting the overall performance of classification. Additionally, we observed that commonly used data augmentation methods cannot be used with a plug-and-play approach in medical imaging, and requires manual tuning and adjustment.

Early detection of precancerous cysts or neoplasms, i.e., Intraductal Papillary Mucosal Neoplasms (IPMN), in pancreas is a challenging and complex task, and it may lead to a more favourable outcome. Once detected, grading IPMNs accurately is also necessary, since low-risk IPMNs can be under surveillance program, while high-risk IPMNs have to be surgically resected before they turn into cancer. Current standards (Fukuoka and others) for IPMN classification show significant intra- and inter-operator variability, beside being error-prone, making a proper diagnosis unreliable. The established progress in artificial intelligence, through the deep learning paradigm, may provide a key tool for an effective support to medical decision for pancreatic cancer. In this work, we follow this trend, by proposing a novel AI-based IPMN classifier that leverages the recent success of transformer networks in generalizing across a wide variety of tasks, including vision ones. We specifically show that our transformer-based model exploits pre-training better than standard convolutional neural networks, thus supporting the sought architectural universalism of transformers in vision, including the medical image domain and it allows for a better interpretation of the obtained results.

In precision medicine, Dynamic Treatment Regimes (DTRs) are treatment protocols that adapt over time in response to a patient's observed characteristics. A DTR is a set of decision functions that takes an individual patient's information as arguments and outputs an action to be taken. Building on observed data, the aim is to identify the DTR that optimizes expected patient outcomes. Multiple methods have been proposed for optimal DTR estimation with continuous outcomes. However, optimal DTR estimation with binary outcomes is more complicated and has received comparatively little attention. Solving a system of weighted generalized estimating equations, we propose a new balancing weight criterion to overcome the misspecification of generalized linear models' nuisance components. We construct binary pseudo-outcomes, and develop a doubly-robust and easy-to-use method to estimate an optimal DTR with binary outcomes. We also outline the underlying theory, which relies on the balancing property of the weights; provide simulation studies that verify the double-robustness of our method; and illustrate the method in studying the effects of e-cigarette usage on smoking cessation, using observational data from the Population Assessment of Tobacco and Health (PATH) study.

The presence of measurement error is a widespread issue which, when ignored, can render the results of an analysis unreliable. Numerous corrections for the effects of measurement error have been proposed and studied, often under the assumption of a normally distributed, additive measurement error model. One such method is simulation extrapolation, or SIMEX. In many situations observed data are non-symmetric, heavy-tailed, or otherwise highly non-normal. In these settings, correction techniques relying on the assumption of normality are undesirable. We propose an extension to the simulation extrapolation method which is nonparametric in the sense that no specific distributional assumptions are required on the error terms. The technique is implemented when either validation data or replicate measurements are available, and is designed to be immediately accessible for those familiar with simulation extrapolation.

Measurement error is a pervasive issue which renders the results of an analysis unreliable. The measurement error literature contains numerous correction techniques, which can be broadly divided into those which aim to produce exactly consistent estimators, and those which are only approximately consistent. While consistency is a desirable property, it is typically attained only under specific model assumptions. Two techniques, regression calibration and simulation extrapolation, are used frequently in a wide variety of parametric and semiparametric settings. However, in many settings these methods are only approximately consistent. We generalize these corrections, relaxing assumptions placed on replicate measurements. Under regularity conditions, the estimators are shown to be asymptotically normal, with a sandwich estimator for the asymptotic variance. Through simulation, we demonstrate the improved performance of the modified estimators, over the standard techniques, when these assumptions are violated. We motivate these corrections using the Framingham Heart Study, and apply the generalized techniques to an analysis of these data.