Justin F Rousseau

Ajay Jaiswal, Kumar Ashutosh, Justin F Rousseau et al.

AI-powered Medical Imaging has recently achieved enormous attention due to its ability to provide fast-paced healthcare diagnoses. However, it usually suffers from a lack of high-quality datasets due to high annotation cost, inter-observer variability, human annotator error, and errors in computer-generated labels. Deep learning models trained on noisy labelled datasets are sensitive to the noise type and lead to less generalization on the unseen samples. To address this challenge, we propose a Robust Stochastic Knowledge Distillation (RoS-KD) framework which mimics the notion of learning a topic from multiple sources to ensure deterrence in learning noisy information. More specifically, RoS-KD learns a smooth, well-informed, and robust student manifold by distilling knowledge from multiple teachers trained on overlapping subsets of training data. Our extensive experiments on popular medical imaging classification tasks (cardiopulmonary disease and lesion classification) using real-world datasets, show the performance benefit of RoS-KD, its ability to distill knowledge from many popular large networks (ResNet-50, DenseNet-121, MobileNet-V2) in a comparatively small network, and its robustness to adversarial attacks (PGD, FSGM). More specifically, RoS-KD achieves >2% and >4% improvement on F1-score for lesion classification and cardiopulmonary disease classification tasks, respectively, when the underlying student is ResNet-18 against recent competitive knowledge distillation baseline. Additionally, on cardiopulmonary disease classification task, RoS-KD outperforms most of the SOTA baselines by ~1% gain in AUC score.

Xizhi Wu, Nelly Estefanie Garduno-Rapp, Justin F Rousseau et al.

Unlike most primary headaches, secondary headaches need specialized care and can have devastating consequences if not treated promptly. Clinical guidelines highlight several 'red flag' features, such as thunderclap onset, meningismus, papilledema, focal neurologic deficits, signs of temporal arteritis, systemic illness, and the 'worst headache of their life' presentation. Despite these guidelines, determining which patients require urgent evaluation remains challenging in primary care settings. Clinicians often work with limited time, incomplete information, and diverse symptom presentations, which can lead to under-recognition and inappropriate care. We present a large language model (LLM)-based multi-agent clinical decision support system built on an orchestrator-specialist architecture, designed to perform explicit and interpretable secondary headache diagnosis from free-text clinical vignettes. The multi-agent system decomposes diagnosis into seven domain-specialized agents, each producing a structured and evidence-grounded rationale, while a central orchestrator performs task decomposition and coordinates agent routing. We evaluated the multi-agent system using 90 expert-validated secondary headache cases and compared its performance with a single-LLM baseline across two prompting strategies: question-based prompting (QPrompt) and clinical practice guideline-based prompting (GPrompt). We tested five open-source LLMs (Qwen-30B, GPT-OSS-20B, Qwen-14B, Qwen-8B, and Llama-3.1-8B), and found that the orchestrated multi-agent system with GPrompt consistently achieved the highest F1 scores, with larger gains in smaller models. These findings demonstrate that structured multi-agent reasoning improves accuracy beyond prompt engineering alone and offers a transparent, clinically aligned approach for explainable decision support in secondary headache diagnosis.

Redoan Rahman, Jooyeong Kang, Justin F Rousseau et al.

This paper applies multiple machine learning (ML) algorithms to a dataset of de-identified COVID-19 patients provided by the COVID-19 Research Database. The dataset consists of 20,878 COVID-positive patients, among which 9,177 patients died in the year 2020. This paper aims to understand and interpret the association of socio-economic characteristics of patients with their mortality instead of maximizing prediction accuracy. According to our analysis, a patients households annual and disposable income, age, education, and employment status significantly impacts a machine learning models prediction. We also observe several individual patient data, which gives us insight into how the feature values impact the prediction for that data point. This paper analyzes the global and local interpretation of machine learning models on socio-economic data of COVID patients.

Ruiqi Deng, Geoffrey Martin, Tony Wang et al.

Clinical practice guidelines (CPGs) provide evidence-based recommendations for patient care; however, integrating them into Artificial Intelligence (AI) remains challenging. Previous approaches, such as rule-based systems, face significant limitations, including poor interpretability, inconsistent adherence to guidelines, and narrow domain applicability. To address this, we develop and validate CPGPrompt, an auto-prompting system that converts narrative clinical guidelines into large language models (LLMs). Our framework translates CPGs into structured decision trees and utilizes an LLM to dynamically navigate them for patient case evaluation. Synthetic vignettes were generated across three domains (headache, lower back pain, and prostate cancer) and distributed into four categories to test different decision scenarios. System performance was assessed on both binary specialty-referral decisions and fine-grained pathway-classification tasks. The binary specialty referral classification achieved consistently strong performance across all domains (F1: 0.85-1.00), with high recall (1.00 $\pm$ 0.00). In contrast, multi-class pathway assignment showed reduced performance, with domain-specific variations: headache (F1: 0.47), lower back pain (F1: 0.72), and prostate cancer (F1: 0.77). Domain-specific performance differences reflected the structure of each guideline. The headache guideline highlighted challenges with negation handling. The lower back pain guideline required temporal reasoning. In contrast, prostate cancer pathways benefited from quantifiable laboratory tests, resulting in more reliable decision-making.