Evidence Is All You Need: Ordering Imaging Studies via Language Model Alignment with the ACR Appropriateness Criteria

Diagnostic imaging studies are an increasingly important component of the workup and management of acutely presenting patients. However, ordering appropriate imaging studies according to evidence-based medical guidelines is a challenging task with a high degree of variability between healthcare providers. To address this issue, recent work has investigated if generative AI and large language models can be leveraged to help clinicians order relevant imaging studies for patients. However, it is challenging to ensure that these tools are correctly aligned with medical guidelines, such as the American College of Radiology's Appropriateness Criteria (ACR AC). In this study, we introduce a framework to intelligently leverage language models by recommending imaging studies for patient cases that are aligned with evidence-based guidelines. We make available a novel dataset of patient "one-liner" scenarios to power our experiments, and optimize state-of-the-art language models to achieve an accuracy on par with clinicians in image ordering. Finally, we demonstrate that our language model-based pipeline can be used as intelligent assistants by clinicians to support image ordering workflows and improve the accuracy of imaging study ordering according to the ACR AC. Our work demonstrates and validates a strategy to leverage AI-based software to improve trustworthy clinical decision making in alignment with expert evidence-based guidelines.

Learning-Based Radiomic Prediction of Type 2 Diabetes Mellitus Using Image-Derived Phenotypes

Early diagnosis of Type 2 Diabetes Mellitus (T2DM) is crucial to enable timely therapeutic interventions and lifestyle modifications. As medical imaging data become more widely available for many patient populations, we sought to investigate whether image-derived phenotypic data could be leveraged in tabular learning classifier models to predict T2DM incidence without the use of invasive blood lab measurements. We show that both neural network and decision tree models that use image-derived phenotypes can predict patient T2DM status with recall scores as high as 87.6%. We also propose the novel use of these same architectures as 'SynthA1c encoders' that are able to output interpretable values mimicking blood hemoglobin A1C empirical lab measurements. Finally, we demonstrate that T2DM risk prediction model sensitivity to small perturbations in input vector components can be used to predict performance on covariates sampled from previously unseen patient populations.

Machine learning in cardiovascular flows modeling: Predicting pulse wave propagation from non-invasive clinical measurements using physics-informed deep learning

Advances in computational science offer a principled pipeline for predictive modeling of cardiovascular flows and aspire to provide a valuable tool for monitoring, diagnostics and surgical planning. Such models can be nowadays deployed on large patient-specific topologies of systemic arterial networks and return detailed predictions on flow patterns, wall shear stresses, and pulse wave propagation. However, their success heavily relies on tedious pre-processing and calibration procedures that typically induce a significant computational cost, thus hampering their clinical applicability. In this work we put forth a machine learning framework that enables the seamless synthesis of non-invasive in-vivo measurement techniques and computational flow dynamics models derived from first physical principles. We illustrate this new paradigm by showing how one-dimensional models of pulsatile flow can be used to constrain the output of deep neural networks such that their predictions satisfy the conservation of mass and momentum principles. Once trained on noisy and scattered clinical data of flow and wall displacement, these networks can return physically consistent predictions for velocity, pressure and wall displacement pulse wave propagation, all without the need to employ conventional simulators. A simple post-processing of these outputs can also provide a cheap and effective way for estimating Windkessel model parameters that are required for the calibration of traditional computational models. The effectiveness of the proposed techniques is demonstrated through a series of prototype benchmarks, as well as a realistic clinical case involving in-vivo measurements near the aorta/carotid bifurcation of a healthy human subject.