Although robot-assisted cardiovascular catheterization is commonly performed for intervention of cardiovascular diseases, more studies are needed to support the procedure with automated tool segmentation. This can aid surgeons on tool tracking and visualization during intervention. Learning-based segmentation has recently offered state-of-the-art segmentation performances however, generating ground-truth signals for fully-supervised methods is labor-intensive and time consuming for the interventionists. In this study, a weakly-supervised learning method with multi-lateral pseudo labeling is proposed for tool segmentation in cardiac angiograms. The method includes a modified U-Net model with one encoder and multiple lateral-branched decoders that produce pseudo labels as supervision signals under different perturbation. The pseudo labels are self-generated through a mixed loss function and shared consistency in the decoders. We trained the model end-to-end with weakly-annotated data obtained during robotic cardiac catheterization. Experiments with the proposed model shows weakly annotated data has closer performance to when fully annotated data is used. Compared to three existing weakly-supervised methods, our approach yielded higher segmentation performance across three different cardiac angiogram data. With ablation study, we showed consistent performance under different parameters. Thus, we offer a less expensive method for real-time tool segmentation and tracking during robot-assisted cardiac catheterization.
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Comprehensive clinical documentation is crucial for effective healthcare delivery, yet it poses a significant burden on healthcare professionals, leading to burnout, increased medical errors, and compromised patient safety. This paper explores the potential of generative AI (Artificial Intelligence) to streamline the clinical documentation process, specifically focusing on generating SOAP (Subjective, Objective, Assessment, Plan) and BIRP (Behavior, Intervention, Response, Plan) notes. We present a case study demonstrating the application of natural language processing (NLP) and automatic speech recognition (ASR) technologies to transcribe patient-clinician interactions, coupled with advanced prompting techniques to generate draft clinical notes using large language models (LLMs). The study highlights the benefits of this approach, including time savings, improved documentation quality, and enhanced patient-centered care. Additionally, we discuss ethical considerations, such as maintaining patient confidentiality and addressing model biases, underscoring the need for responsible deployment of generative AI in healthcare settings. The findings suggest that generative AI has the potential to revolutionize clinical documentation practices, alleviating administrative burdens and enabling healthcare professionals to focus more on direct patient care.
Predictive biomarkers of treatment response are lacking for metastatic clear cell renal cell carcinoma (ccRCC), a tumor type that is treated with angiogenesis inhibitors, immune checkpoint inhibitors, mTOR inhibitors and a HIF2 inhibitor. The Angioscore, an RNA-based quantification of angiogenesis, is arguably the best candidate to predict anti-angiogenic (AA) response. However, the clinical adoption of transcriptomic assays faces several challenges including standardization, time delay, and high cost. Further, ccRCC tumors are highly heterogenous, and sampling multiple areas for sequencing is impractical. Here we present a novel deep learning (DL) approach to predict the Angioscore from ubiquitous histopathology slides. To overcome the lack of interpretability, one of the biggest limitations of typical DL models, our model produces a visual vascular network which is the basis of the model's prediction. To test its reliability, we applied this model to multiple cohorts including a clinical trial dataset. Our model accurately predicts the RNA-based Angioscore on multiple independent cohorts (spearman correlations of 0.77 and 0.73). Further, the predictions help unravel meaningful biology such as association of angiogenesis with grade, stage, and driver mutation status. Finally, we find our model can predict response to AA therapy, in both a real-world cohort and the IMmotion150 clinical trial. The predictive power of our model vastly exceeds that of CD31, a marker of vasculature, and nearly rivals the performance (c-index 0.66 vs 0.67) of the ground truth RNA-based Angioscore at a fraction of the cost. By providing a robust yet interpretable prediction of the Angioscore from histopathology slides alone, our approach offers insights into angiogenesis biology and AA treatment response.
Solutions to vision tasks in gastrointestinal endoscopy (GIE) conventionally use image encoders pretrained in a supervised manner with ImageNet-1k as backbones. However, the use of modern self-supervised pretraining algorithms and a recent dataset of 100k unlabelled GIE images (Hyperkvasir-unlabelled) may allow for improvements. In this work, we study the fine-tuned performance of models with ResNet50 and ViT-B backbones pretrained in self-supervised and supervised manners with ImageNet-1k and Hyperkvasir-unlabelled (self-supervised only) in a range of GIE vision tasks. In addition to identifying the most suitable pretraining pipeline and backbone architecture for each task, out of those considered, our results suggest three general principles. Firstly, that self-supervised pretraining generally produces more suitable backbones for GIE vision tasks than supervised pretraining. Secondly, that self-supervised pretraining with ImageNet-1k is typically more suitable than pretraining with Hyperkvasir-unlabelled, with the notable exception of monocular depth estimation in colonoscopy. Thirdly, that ViT-Bs are more suitable in polyp segmentation and monocular depth estimation in colonoscopy, ResNet50s are more suitable in polyp detection, and both architectures perform similarly in anatomical landmark recognition and pathological finding characterisation. We hope this work draws attention to the complexity of pretraining for GIE vision tasks, informs this development of more suitable approaches than the convention, and inspires further research on this topic to help advance this development. Code available: \underline{github.com/ESandML/SSL4GIE}
The growing deployment of reinforcement learning from human feedback (RLHF) calls for a deeper theoretical investigation of its underlying models. The prevalent models of RLHF do not account for neuroscience-backed, partially-observed "internal states" that can affect human feedback, nor do they accommodate intermediate feedback during an interaction. Both of these can be instrumental in speeding up learning and improving alignment. To address these limitations, we model RLHF as reinforcement learning with partially observed reward-states (PORRL). We accommodate two kinds of feedback $-$ cardinal and dueling feedback. We first demonstrate that PORRL subsumes a wide class of RL problems, including traditional RL, RLHF, and reward machines. For cardinal feedback, we present two model-based methods (POR-UCRL, POR-UCBVI). We give both cardinal regret and sample complexity guarantees for the methods, showing that they improve over naive history-summarization. We then discuss the benefits of a model-free method like GOLF with naive history-summarization in settings with recursive internal states and dense intermediate feedback. For this purpose, we define a new history aware version of the Bellman-eluder dimension and give a new guarantee for GOLF in our setting, which can be exponentially sharper in illustrative examples. For dueling feedback, we show that a naive reduction to cardinal feedback fails to achieve sublinear dueling regret. We then present the first explicit reduction that converts guarantees for cardinal regret to dueling regret. In both feedback settings, we show that our models and guarantees generalize and extend existing ones.
Knowledge distillation (KD) has demonstrated remarkable success across various domains, but its application to medical imaging tasks, such as kidney and liver tumor segmentation, has encountered challenges. Many existing KD methods are not specifically tailored for these tasks. Moreover, prevalent KD methods often lack a careful consideration of `what' and `from where' to distill knowledge from the teacher to the student. This oversight may lead to issues like the accumulation of training bias within shallower student layers, potentially compromising the effectiveness of KD. To address these challenges, we propose Hierarchical Layer-selective Feedback Distillation (HLFD). HLFD strategically distills knowledge from a combination of middle layers to earlier layers and transfers final layer knowledge to intermediate layers at both the feature and pixel levels. This design allows the model to learn higher-quality representations from earlier layers, resulting in a robust and compact student model. Extensive quantitative evaluations reveal that HLFD outperforms existing methods by a significant margin. For example, in the kidney segmentation task, HLFD surpasses the student model (without KD) by over 10\%, significantly improving its focus on tumor-specific features. From a qualitative standpoint, the student model trained using HLFD excels at suppressing irrelevant information and can focus sharply on tumor-specific details, which opens a new pathway for more efficient and accurate diagnostic tools. Code is available \href{//github.com/vangorade/RethinkingKD_ISBI24}{here}.
Spiking neural networks (SNNs) are investigated as biologically inspired models of neural computation, distinguished by their computational capability and energy efficiency due to precise spiking times and sparse spikes with event-driven computation. A significant question is how SNNs can emulate human-like graph-based reasoning of concepts and relations, especially leveraging the temporal domain optimally. This paper reveals that SNNs, when amalgamated with synaptic delay and temporal coding, are proficient in executing (knowledge) graph reasoning. It is elucidated that spiking time can function as an additional dimension to encode relation properties via a neural-generalized path formulation. Empirical results highlight the efficacy of temporal delay in relation processing and showcase exemplary performance in diverse graph reasoning tasks. The spiking model is theoretically estimated to achieve $20\times$ energy savings compared to non-spiking counterparts, deepening insights into the capabilities and potential of biologically inspired SNNs for efficient reasoning. The code is available at //github.com/pkuxmq/GRSNN.
Cognitive diagnosis is a fundamental and critical task in learning assessment, which aims to infer students' proficiency on knowledge concepts from their response logs. Current works assume each knowledge concept will certainly be tested and covered by multiple exercises. However, whether online or offline courses, it's hardly feasible to completely cover all knowledge concepts in several exercises. Restricted tests lead to undiscovered knowledge deficits, especially untested knowledge concepts(UKCs). In this paper, we propose a novel \underline{Dis}entangling Heterogeneous \underline{K}nowledge \underline{C}ognitive \underline{D}iagnosis framework on untested knowledge(DisKCD). Specifically, we leverage course grades, exercise questions, and resources to learn the potential representations of students, exercises, and knowledge concepts. In particular, knowledge concepts are disentangled into tested and untested based on the limiting actual exercises. We construct a heterogeneous relation graph network via students, exercises, tested knowledge concepts(TKCs), and UKCs. Then, through a hierarchical heterogeneous message-passing mechanism, the fine-grained relations are incorporated into the embeddings of the entities. Finally, the embeddings will be applied to multiple existing cognitive diagnosis models to infer students' proficiency on UKCs. Experimental results on real-world datasets show that the proposed model can effectively improve the performance of the task of diagnosing students' proficiency on UKCs. Our anonymous code is available at //anonymous.4open.science/r/DisKCD.
Comparative diagnostic in brain tumor evaluation makes possible to use the available information of a medical center to compare similar cases when a new patient is evaluated. By leveraging Artificial Intelligence models, the proposed system is able of retrieving the most similar cases of brain tumors for a given query. The primary objective is to enhance the diagnostic process by generating more accurate representations of medical images, with a particular focus on patient-specific normal features and pathologies. The proposed model uses Artificial Intelligence to detect patient features to recommend the most similar cases from a database. The system not only suggests similar cases but also balances the representation of healthy and abnormal features in its design. This not only encourages the generalization of its use but also aids clinicians in their decision-making processes. We conducted a comparative analysis of our approach in relation to similar studies. The proposed architecture obtains a Dice coefficient of 0.474 in both tumoral and healthy regions of the patients, which outperforms previous literature. Our proposed model excels at extracting and combining anatomical and pathological features from brain \glspl{mr}, achieving state-of-the-art results while relying on less expensive label information. This substantially reduces the overall cost of the training process. This paper provides substantial grounds for further exploration of the broader applicability and optimization of the proposed architecture to enhance clinical decision-making. The novel approach presented in this work marks a significant advancement in the field of medical diagnosis, particularly in the context of Artificial Intelligence-assisted image retrieval, and promises to reduce costs and improve the quality of patient care using Artificial Intelligence as a support tool instead of a black box system.
Understanding causality helps to structure interventions to achieve specific goals and enables predictions under interventions. With the growing importance of learning causal relationships, causal discovery tasks have transitioned from using traditional methods to infer potential causal structures from observational data to the field of pattern recognition involved in deep learning. The rapid accumulation of massive data promotes the emergence of causal search methods with brilliant scalability. Existing summaries of causal discovery methods mainly focus on traditional methods based on constraints, scores and FCMs, there is a lack of perfect sorting and elaboration for deep learning-based methods, also lacking some considers and exploration of causal discovery methods from the perspective of variable paradigms. Therefore, we divide the possible causal discovery tasks into three types according to the variable paradigm and give the definitions of the three tasks respectively, define and instantiate the relevant datasets for each task and the final causal model constructed at the same time, then reviews the main existing causal discovery methods for different tasks. Finally, we propose some roadmaps from different perspectives for the current research gaps in the field of causal discovery and point out future research directions.
Human doctors with well-structured medical knowledge can diagnose a disease merely via a few conversations with patients about symptoms. In contrast, existing knowledge-grounded dialogue systems often require a large number of dialogue instances to learn as they fail to capture the correlations between different diseases and neglect the diagnostic experience shared among them. To address this issue, we propose a more natural and practical paradigm, i.e., low-resource medical dialogue generation, which can transfer the diagnostic experience from source diseases to target ones with a handful of data for adaptation. It is capitalized on a commonsense knowledge graph to characterize the prior disease-symptom relations. Besides, we develop a Graph-Evolving Meta-Learning (GEML) framework that learns to evolve the commonsense graph for reasoning disease-symptom correlations in a new disease, which effectively alleviates the needs of a large number of dialogues. More importantly, by dynamically evolving disease-symptom graphs, GEML also well addresses the real-world challenges that the disease-symptom correlations of each disease may vary or evolve along with more diagnostic cases. Extensive experiment results on the CMDD dataset and our newly-collected Chunyu dataset testify the superiority of our approach over state-of-the-art approaches. Besides, our GEML can generate an enriched dialogue-sensitive knowledge graph in an online manner, which could benefit other tasks grounded on knowledge graph.
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