In medical imaging, artificial intelligence (AI) is increasingly being used to automate routine tasks. However, these algorithms can exhibit and exacerbate biases which lead to disparate performances between protected groups. We investigate the impact of model choice on how imbalances in subject sex and race in training datasets affect AI-based cine cardiac magnetic resonance image segmentation. We evaluate three convolutional neural network-based models and one vision transformer model. We find significant sex bias in three of the four models and racial bias in all of the models. However, the severity and nature of the bias varies between the models, highlighting the importance of model choice when attempting to train fair AI-based segmentation models for medical imaging tasks.
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Data on neighbourhood characteristics are not typically collected in epidemiological studies. They are however useful in the study of small-area health inequalities. Neighbourhood characteristics are collected in some surveys and could be linked to the data of other studies. We propose to use kriging based on semi-variogram models to predict values at non-observed locations with the aim of constructing bespoke indices of neighbourhood characteristics to be linked to data from epidemiological studies. We perform a simulation study to assess the feasibility of the method as well as a case study using data from the RECORD study. Apart from having enough observed data at small distances to the non-observed locations, a good fitting semi-variogram, a larger range and the absence of nugget effects for the semi-variogram models are factors leading to a higher reliability.
Wide heterogeneity exists in cancer patients' survival, ranging from a few months to several decades. To accurately predict clinical outcomes, it is vital to build an accurate predictive model that relates patients' molecular profiles with patients' survival. With complex relationships between survival and high-dimensional molecular predictors, it is challenging to conduct non-parametric modeling and irrelevant predictors removing simultaneously. In this paper, we build a kernel Cox proportional hazards semi-parametric model and propose a novel regularized garrotized kernel machine (RegGKM) method to fit the model. We use the kernel machine method to describe the complex relationship between survival and predictors, while automatically removing irrelevant parametric and non-parametric predictors through a LASSO penalty. An efficient high-dimensional algorithm is developed for the proposed method. Comparison with other competing methods in simulation shows that the proposed method always has better predictive accuracy. We apply this method to analyze a multiple myeloma dataset and predict patients' death burden based on their gene expressions. Our results can help classify patients into groups with different death risks, facilitating treatment for better clinical outcomes.
Age-period-cohort (APC) analysis is one of the fundamental time-series analyses used in the social sciences. This paper evaluates APC analysis via systematic simulation in term of how well the artificial parameters are recovered. We consider three models of Bayesian regularization using normal prior distributions: the random effects model with reference to multilevel analysis, the ridge regression model equivalent to the intrinsic estimator, and the random walk model referred to as the Bayesian cohort model. The proposed simulation generates artificial data through combinations of the linear components, focusing on the fact that the identification problem affects the linear components of the three effects. Among the 13 cases of artificial data, the random walk model recovered the artificial parameters well in 10 cases, while the random effects model and the ridge regression model did so in 4 cases. The cases in which the models failed to recover the artificial parameters show the estimated linear component of the cohort effects as close to zero. In conclusion, the models of Bayesian regularization in APC analysis have a bias: the index weights have a large influence on the cohort effects and these constraints drive the linear component of the cohort effects close to zero. However, the random walk model mitigates underestimating the linear component of the cohort effects.
Bayesian cross-validation (CV) is a popular method for predictive model assessment that is simple to implement and broadly applicable. A wide range of CV schemes is available for time series applications, including generic leave-one-out (LOO) and K-fold methods, as well as specialized approaches intended to deal with serial dependence such as leave-future-out (LFO), h-block, and hv-block. Existing large-sample results show that both specialized and generic methods are applicable to models of serially-dependent data. However, large sample consistency results overlook the impact of sampling variability on accuracy in finite samples. Moreover, the accuracy of a CV scheme depends on many aspects of the procedure. We show that poor design choices can lead to elevated rates of adverse selection. In this paper, we consider the problem of identifying the regression component of an important class of models of data with serial dependence, autoregressions of order p with q exogenous regressors (ARX(p,q)), under the logarithmic scoring rule. We show that when serial dependence is present, scores computed using the joint (multivariate) density have lower variance and better model selection accuracy than the popular pointwise estimator. In addition, we present a detailed case study of the special case of ARX models with fixed autoregressive structure and variance. For this class, we derive the finite-sample distribution of the CV estimators and the model selection statistic. We conclude with recommendations for practitioners.
The rapid evolution of deep learning has significantly advanced the field of medical image analysis. However, despite these achievements, the further enhancement of deep learning models for medical image analysis faces a significant challenge due to the scarcity of large, well-annotated datasets. To address this issue, recent years have witnessed a growing emphasis on the development of data-efficient deep learning methods. This paper conducts a thorough review of data-efficient deep learning methods for medical image analysis. To this end, we categorize these methods based on the level of supervision they rely on, encompassing categories such as no supervision, inexact supervision, incomplete supervision, inaccurate supervision, and only limited supervision. We further divide these categories into finer subcategories. For example, we categorize inexact supervision into multiple instance learning and learning with weak annotations. Similarly, we categorize incomplete supervision into semi-supervised learning, active learning, and domain-adaptive learning and so on. Furthermore, we systematically summarize commonly used datasets for data efficient deep learning in medical image analysis and investigate future research directions to conclude this survey.
Computer-assisted systems are becoming broadly used in medicine. In endoscopy, most research focuses on the automatic detection of polyps or other pathologies, but localization and navigation of the endoscope are completely performed manually by physicians. To broaden this research and bring spatial Artificial Intelligence to endoscopies, data from complete procedures is needed. This paper introduces the Endomapper dataset, the first collection of complete endoscopy sequences acquired during regular medical practice, making secondary use of medical data. Its main purpose is to facilitate the development and evaluation of Visual Simultaneous Localization and Mapping (VSLAM) methods in real endoscopy data. The dataset contains more than 24 hours of video. It is the first endoscopic dataset that includes endoscope calibration as well as the original calibration videos. Meta-data and annotations associated with the dataset vary from the anatomical landmarks, procedure labeling, segmentations, reconstructions, simulated sequences with ground truth and same patient procedures. The software used in this paper is publicly available.
The task of assigning diagnostic ICD codes to patient hospital admissions is typically performed by expert human coders. Efforts towards automated ICD coding are dominated by supervised deep learning models. However, difficulties in learning to predict the large number of rare codes remain a barrier to adoption in clinical practice. In this work, we leverage off-the-shelf pre-trained generative large language models (LLMs) to develop a practical solution that is suitable for zero-shot and few-shot code assignment. Unsupervised pre-training alone does not guarantee precise knowledge of the ICD ontology and specialist clinical coding task, therefore we frame the task as information extraction, providing a description of each coded concept and asking the model to retrieve related mentions. For efficiency, rather than iterating over all codes, we leverage the hierarchical nature of the ICD ontology to sparsely search for relevant codes. Then, in a second stage, which we term 'meta-refinement', we utilise GPT-4 to select a subset of the relevant labels as predictions. We validate our method using Llama-2, GPT-3.5 and GPT-4 on the CodiEsp dataset of ICD-coded clinical case documents. Our tree-search method achieves state-of-the-art performance on rarer classes, achieving the best macro-F1 of 0.225, whilst achieving slightly lower micro-F1 of 0.157, compared to 0.216 and 0.219 respectively from PLM-ICD. To the best of our knowledge, this is the first method for automated ICD coding requiring no task-specific learning.
In the field of semi-supervised medical image segmentation, the shortage of labeled data is the fundamental problem. How to effectively learn image features from unlabeled images to improve segmentation accuracy is the main research direction in this field. Traditional self-training methods can partially solve the problem of insufficient labeled data by generating pseudo labels for iterative training. However, noise generated due to the model's uncertainty during training directly affects the segmentation results. Therefore, we added sample-level and pixel-level uncertainty to stabilize the training process based on the self-training framework. Specifically, we saved several moments of the model during pre-training, and used the difference between their predictions on unlabeled samples as the sample-level uncertainty estimate for that sample. Then, we gradually add unlabeled samples from easy to hard during training. At the same time, we added a decoder with different upsampling methods to the segmentation network and used the difference between the outputs of the two decoders as pixel-level uncertainty. In short, we selectively retrained unlabeled samples and assigned pixel-level uncertainty to pseudo labels to optimize the self-training process. We compared the segmentation results of our model with five semi-supervised approaches on the public 2017 ACDC dataset and 2018 Prostate dataset. Our proposed method achieves better segmentation performance on both datasets under the same settings, demonstrating its effectiveness, robustness, and potential transferability to other medical image segmentation tasks. Keywords: Medical image segmentation, semi-supervised learning, self-training, uncertainty estimation
Markov chain Monte Carlo (MCMC) is a commonly used method for approximating expectations with respect to probability distributions. Uncertainty assessment for MCMC estimators is essential in practical applications. Moreover, for multivariate functions of a Markov chain, it is important to estimate not only the auto-correlation for each component but also to estimate cross-correlations, in order to better assess sample quality, improve estimates of effective sample size, and use more effective stopping rules. Berg and Song [2022] introduced the moment least squares (momentLS) estimator, a shape-constrained estimator for the autocovariance sequence from a reversible Markov chain, for univariate functions of the Markov chain. Based on this sequence estimator, they proposed an estimator of the asymptotic variance of the sample mean from MCMC samples. In this study, we propose novel autocovariance sequence and asymptotic variance estimators for Markov chain functions with multiple components, based on the univariate momentLS estimators from Berg and Song [2022]. We demonstrate strong consistency of the proposed auto(cross)-covariance sequence and asymptotic variance matrix estimators. We conduct empirical comparisons of our method with other state-of-the-art approaches on simulated and real-data examples, using popular samplers including the random-walk Metropolis sampler and the No-U-Turn sampler from STAN.
With observational data alone, causal structure learning is a challenging problem. The task becomes easier when having access to data collected from perturbations of the underlying system, even when the nature of these is unknown. Existing methods either do not allow for the presence of latent variables or assume that these remain unperturbed. However, these assumptions are hard to justify if the nature of the perturbations is unknown. We provide results that enable scoring causal structures in the setting with additive, but unknown interventions. Specifically, we propose a maximum-likelihood estimator in a structural equation model that exploits system-wide invariances to output an equivalence class of causal structures from perturbation data. Furthermore, under certain structural assumptions on the population model, we provide a simple graphical characterization of all the DAGs in the interventional equivalence class. We illustrate the utility of our framework on synthetic data as well as real data involving California reservoirs and protein expressions. The software implementation is available as the Python package \emph{utlvce}.
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