Mortality Prediction of Pulmonary Embolism Patients with Deep Learning and XGBoost

Pulmonary Embolism (PE) is a serious cardiovascular condition that remains a leading cause of mortality and critical illness, underscoring the need for enhanced diagnostic strategies. Conventional clinical methods have limited success in predicting 30-day in-hospital mortality of PE patients. In this study, we present a new algorithm, called PEP-Net, for 30-day mortality prediction of PE patients based on the initial imaging data (CT) that opportunistically integrates a 3D Residual Network (3DResNet) with Extreme Gradient Boosting (XGBoost) algorithm with patient level binary labels without annotations of the emboli and its extent. Our proposed system offers a comprehensive prediction strategy by handling class imbalance problems, reducing overfitting via regularization, and reducing the prediction variance for more stable predictions. PEP-Net was tested in a cohort of 193 volumetric CT scans diagnosed with Acute PE, and it demonstrated a superior performance by significantly outperforming baseline models (76-78\%) with an accuracy of 94.5\% (+/-0.3) and 94.0\% (+/-0.7) when the input image is either lung region (Lung-ROI) or heart region (Cardiac-ROI). Our results advance PE prognostics by using only initial imaging data, setting a new benchmark in the field. While purely deep learning models have become the go-to for many medical classification (diagnostic) tasks, combined ResNet and XGBoost models herein outperform sole deep learning models due to a potential reason for having lack of enough data.

IPMN Risk Assessment under Federated Learning Paradigm

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.

A New Logic For Pediatric Brain Tumor Segmentation

In this paper, we present a novel approach for segmenting pediatric brain tumors using a deep learning architecture, inspired by expert radiologists' segmentation strategies. Our model delineates four distinct tumor labels and is benchmarked on a held-out PED BraTS 2024 test set (i.e., pediatric brain tumor datasets introduced by BraTS). Furthermore, we evaluate our model's performance against the state-of-the-art (SOTA) model using a new external dataset of 30 patients from CBTN (Children's Brain Tumor Network), labeled in accordance with the PED BraTS 2024 guidelines. We compare segmentation outcomes with the winning algorithm from the PED BraTS 2023 challenge as the SOTA model. Our proposed algorithm achieved an average Dice score of 0.642 and an HD95 of 73.0 mm on the CBTN test data, outperforming the SOTA model, which achieved a Dice score of 0.626 and an HD95 of 84.0 mm. Our results indicate that the proposed model is a step towards providing more accurate segmentation for pediatric brain tumors, which is essential for evaluating therapy response and monitoring patient progress.

Adaptive Aggregation Weights for Federated Segmentation of Pancreas MRI

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).

Towards Synergistic Deep Learning Models for Volumetric Cirrhotic Liver Segmentation in MRIs

Liver cirrhosis, a leading cause of global mortality, requires precise segmentation of ROIs for effective disease monitoring and treatment planning. Existing segmentation models often fail to capture complex feature interactions and generalize across diverse datasets. To address these limitations, we propose a novel synergistic theory that leverages complementary latent spaces for enhanced feature interaction modeling. Our proposed architecture, nnSynergyNet3D integrates continuous and discrete latent spaces for 3D volumes and features auto-configured training. This approach captures both fine-grained and coarse features, enabling effective modeling of intricate feature interactions. We empirically validated nnSynergyNet3D on a private dataset of 628 high-resolution T1 abdominal MRI scans from 339 patients. Our model outperformed the baseline nnUNet3D by approximately 2%. Additionally, zero-shot testing on healthy liver CT scans from the public LiTS dataset demonstrated superior cross-modal generalization capabilities. These results highlight the potential of synergistic latent space models to improve segmentation accuracy and robustness, thereby enhancing clinical workflows by ensuring consistency across CT and MRI modalities.

Large-Scale Multi-Center CT and MRI Segmentation of Pancreas with Deep Learning

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.

Explainable Transformer Prototypes for Medical Diagnoses

Deployments of artificial intelligence in medical diagnostics mandate not just accuracy and efficacy but also trust, emphasizing the need for explainability in machine decisions. The recent trend in automated medical image diagnostics leans towards the deployment of Transformer-based architectures, credited to their impressive capabilities. Since the self-attention feature of transformers contributes towards identifying crucial regions during the classification process, they enhance the trustability of the methods. However, the complex intricacies of these attention mechanisms may fall short of effectively pinpointing the regions of interest directly influencing AI decisions. Our research endeavors to innovate a unique attention block that underscores the correlation between 'regions' rather than 'pixels'. To address this challenge, we introduce an innovative system grounded in prototype learning, featuring an advanced self-attention mechanism that goes beyond conventional ad-hoc visual explanation techniques by offering comprehensible visual insights. A combined quantitative and qualitative methodological approach was used to demonstrate the effectiveness of the proposed method on the large-scale NIH chest X-ray dataset. Experimental results showed that our proposed method offers a promising direction for explainability, which can lead to the development of more trustable systems, which can facilitate easier and rapid adoption of such technology into routine clinics. The code is available at www.github.com/NUBagcilab/r2r_proto.

EMIT-Diff: Enhancing Medical Image Segmentation via Text-Guided Diffusion Model

Large-scale, big-variant, and high-quality data are crucial for developing robust and successful deep-learning models for medical applications since they potentially enable better generalization performance and avoid overfitting. However, the scarcity of high-quality labeled data always presents significant challenges. This paper proposes a novel approach to address this challenge by developing controllable diffusion models for medical image synthesis, called EMIT-Diff. We leverage recent diffusion probabilistic models to generate realistic and diverse synthetic medical image data that preserve the essential characteristics of the original medical images by incorporating edge information of objects to guide the synthesis process. In our approach, we ensure that the synthesized samples adhere to medically relevant constraints and preserve the underlying structure of imaging data. Due to the random sampling process by the diffusion model, we can generate an arbitrary number of synthetic images with diverse appearances. To validate the effectiveness of our proposed method, we conduct an extensive set of medical image segmentation experiments on multiple datasets, including Ultrasound breast (+13.87%), CT spleen (+0.38%), and MRI prostate (+7.78%), achieving significant improvements over the baseline segmentation methods. For the first time, to our best knowledge, the promising results demonstrate the effectiveness of our EMIT-Diff for medical image segmentation tasks and show the feasibility of introducing a first-ever text-guided diffusion model for general medical image segmentation tasks. With carefully designed ablation experiments, we investigate the influence of various data augmentation ratios, hyper-parameter settings, patch size for generating random merging mask settings, and combined influence with different network architectures.

Radiomics Boosts Deep Learning Model for IPMN Classification

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).

Ensuring Trustworthy Medical Artificial Intelligence through Ethical and Philosophical Principles

Artificial intelligence (AI) methods have great potential to revolutionize numerous medical care by enhancing the experience of medical experts and patients. AI based computer-assisted diagnosis tools can have a tremendous benefit if they can outperform or perform similarly to the level of a clinical expert. As a result, advanced healthcare services can be affordable in developing nations, and the problem of a lack of expert medical practitioners can be addressed. AI based tools can save time, resources, and overall cost for patient treatment. Furthermore, in contrast to humans, AI can uncover complex relations in the data from a large set of inputs and even lead to new evidence-based knowledge in medicine. However, integrating AI in healthcare raises several ethical and philosophical concerns, such as bias, transparency, autonomy, responsibility and accountability, which must be addressed before integrating such tools into clinical settings. In this article, we emphasize recent advances in AI-assisted medical image analysis, existing standards, and the significance of comprehending ethical issues and best practices for the applications of AI in clinical settings. We cover the technical and ethical challenges of AI and the implications of deploying AI in hospitals and public organizations. We also discuss promising key measures and techniques to address the ethical challenges, data scarcity, racial bias, lack of transparency, and algorithmic bias. Finally, we provide our recommendation and future directions for addressing the ethical challenges associated with AI in healthcare applications, with the goal of deploying AI into the clinical settings to make the workflow more efficient, accurate, accessible, transparent, and reliable for the patient worldwide.