PSO-Net: Development of an automated psoriasis assessment system using attention-based interpretable deep neural networks

Psoriasis is a chronic skin condition that requires long-term treatment and monitoring. Although, the Psoriasis Area and Severity Index (PASI) is utilized as a standard measurement to assess psoriasis severity in clinical trials, it has many drawbacks such as (1) patient burden for in-person clinic visits for assessment of psoriasis, (2) time required for investigator scoring and (3) variability of inter- and intra-rater scoring. To address these drawbacks, we propose a novel and interpretable deep learning architecture called PSO-Net, which maps digital images from different anatomical regions to derive attention-based scores. Regional scores are further combined to estimate an absolute PASI score. Moreover, we devise a novel regression activation map for interpretability through ranking attention scores. Using this approach, we achieved inter-class correlation scores of 82.2% [95% CI: 77- 87%] and 87.8% [95% CI: 84-91%] with two different clinician raters, respectively.

Arges: Spatio-Temporal Transformer for Ulcerative Colitis Severity Assessment in Endoscopy Videos

Accurate assessment of disease severity from endoscopy videos in ulcerative colitis (UC) is crucial for evaluating drug efficacy in clinical trials. Severity is often measured by the Mayo Endoscopic Subscore (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score. However, expert MES/UCEIS annotation is time-consuming and susceptible to inter-rater variability, factors addressable by automation. Automation attempts with frame-level labels face challenges in fully-supervised solutions due to the prevalence of video-level labels in clinical trials. CNN-based weakly-supervised models (WSL) with end-to-end (e2e) training lack generalization to new disease scores and ignore spatio-temporal information crucial for accurate scoring. To address these limitations, we propose "Arges", a deep learning framework that utilizes a transformer with positional encoding to incorporate spatio-temporal information from frame features to estimate disease severity scores in endoscopy video. Extracted features are derived from a foundation model (ArgesFM), pre-trained on a large diverse dataset from multiple clinical trials (61M frames, 3927 videos). We evaluate four UC disease severity scores, including MES and three UCEIS component scores. Test set evaluation indicates significant improvements, with F1 scores increasing by 4.1% for MES and 18.8%, 6.6%, 3.8% for the three UCEIS component scores compared to state-of-the-art methods. Prospective validation on previously unseen clinical trial data further demonstrates the model's successful generalization.