Novel computational workflows for natural and biomedical image processing based on hypercomplex algebras

Hypercomplex image processing extends conventional techniques in a unified paradigm encompassing algebraic and geometric principles. This work leverages quaternions and the two-dimensional orthogonal planes split framework (splitting of a quaternion - representing a pixel - into pairs of orthogonal 2D planes) for natural/biomedical image analysis through the following computational workflows and outcomes: natural/biomedical image re-colorization, natural image de-colorization, natural/biomedical image contrast enhancement, computational re-staining and stain separation in histological images, and performance gains in machine/deep learning pipelines for histological images. The workflows are analyzed separately for natural and biomedical images to showcase the effectiveness of the proposed approaches. The proposed workflows can regulate color appearance (e.g. with alternative renditions and grayscale conversion) and image contrast, be part of automated image processing pipelines (e.g. isolating stain components, boosting learning models), and assist in digital pathology applications (e.g. enhancing biomarker visibility, enabling colorblind-friendly renditions). Employing only basic arithmetic and matrix operations, this work offers a computationally accessible methodology - in the hypercomplex domain - that showcases versatility and consistency across image processing tasks and a range of computer vision and biomedical applications. The proposed non-data-driven methods achieve comparable or better results (particularly in cases involving well-known methods) to those reported in the literature, showcasing the potential of robust theoretical frameworks with practical effectiveness. Results, methods, and limitations are detailed alongside discussion of promising extensions, emphasizing the potential of feature-rich mathematical/computational frameworks for natural and biomedical images.

End-To-End Clinical Trial Matching with Large Language Models

Matching cancer patients to clinical trials is essential for advancing treatment and patient care. However, the inconsistent format of medical free text documents and complex trial eligibility criteria make this process extremely challenging and time-consuming for physicians. We investigated whether the entire trial matching process - from identifying relevant trials among 105,600 oncology-related clinical trials on clinicaltrials.gov to generating criterion-level eligibility matches - could be automated using Large Language Models (LLMs). Using GPT-4o and a set of 51 synthetic Electronic Health Records (EHRs), we demonstrate that our approach identifies relevant candidate trials in 93.3% of cases and achieves a preliminary accuracy of 88.0% when matching patient-level information at the criterion level against a baseline defined by human experts. Utilizing LLM feedback reveals that 39.3% criteria that were initially considered incorrect are either ambiguous or inaccurately annotated, leading to a total model accuracy of 92.7% after refining our human baseline. In summary, we present an end-to-end pipeline for clinical trial matching using LLMs, demonstrating high precision in screening and matching trials to individual patients, even outperforming the performance of qualified medical doctors. Our fully end-to-end pipeline can operate autonomously or with human supervision and is not restricted to oncology, offering a scalable solution for enhancing patient-trial matching in real-world settings.

Autonomous Artificial Intelligence Agents for Clinical Decision Making in Oncology

Multimodal artificial intelligence (AI) systems have the potential to enhance clinical decision-making by interpreting various types of medical data. However, the effectiveness of these models across all medical fields is uncertain. Each discipline presents unique challenges that need to be addressed for optimal performance. This complexity is further increased when attempting to integrate different fields into a single model. Here, we introduce an alternative approach to multimodal medical AI that utilizes the generalist capabilities of a large language model (LLM) as a central reasoning engine. This engine autonomously coordinates and deploys a set of specialized medical AI tools. These tools include text, radiology and histopathology image interpretation, genomic data processing, web searches, and document retrieval from medical guidelines. We validate our system across a series of clinical oncology scenarios that closely resemble typical patient care workflows. We show that the system has a high capability in employing appropriate tools (97%), drawing correct conclusions (93.6%), and providing complete (94%), and helpful (89.2%) recommendations for individual patient cases while consistently referencing relevant literature (82.5%) upon instruction. This work provides evidence that LLMs can effectively plan and execute domain-specific models to retrieve or synthesize new information when used as autonomous agents. This enables them to function as specialist, patient-tailored clinical assistants. It also simplifies regulatory compliance by allowing each component tool to be individually validated and approved. We believe, that our work can serve as a proof-of-concept for more advanced LLM-agents in the medical domain.

In-context learning enables multimodal large language models to classify cancer pathology images

Medical image classification requires labeled, task-specific datasets which are used to train deep learning networks de novo, or to fine-tune foundation models. However, this process is computationally and technically demanding. In language processing, in-context learning provides an alternative, where models learn from within prompts, bypassing the need for parameter updates. Yet, in-context learning remains underexplored in medical image analysis. Here, we systematically evaluate the model Generative Pretrained Transformer 4 with Vision capabilities (GPT-4V) on cancer image processing with in-context learning on three cancer histopathology tasks of high importance: Classification of tissue subtypes in colorectal cancer, colon polyp subtyping and breast tumor detection in lymph node sections. Our results show that in-context learning is sufficient to match or even outperform specialized neural networks trained for particular tasks, while only requiring a minimal number of samples. In summary, this study demonstrates that large vision language models trained on non-domain specific data can be applied out-of-the box to solve medical image-processing tasks in histopathology. This democratizes access of generalist AI models to medical experts without technical background especially for areas where annotated data is scarce.