John Galeotti

Gautam Gare, John Galeotti, Michael Mozer et al.

In nature, events that affect some individuals or groups but not others constitute an implicit intervention and are known as natural experiments. For example, the COVID-19 pandemic was an intervention by the coronavirus on the sub-population infected with COVID. We ask, do natural experiments occur in existing real-world datasets? If yes, how should we treat them? To detect natural experiments in data, we use causal discovery to recover the underlying causal graph and perform feature selection based on causal links. If downstream performance improves by treating the data as interventional rather than observational, we argue that this suggests the dataset contains natural experiments. We first validate this hypothesis by simulating datasets with and without natural experiments using synthetic graphs. We then perform a systematic empirical evaluation on a large suite of real-world datasets. Our results indicate that real-world datasets do contain natural experiments and we can take advantage of those natural experiments to improve model performance using causal inference. Our work represents the initial foray into this area, offering a preliminary exploration within a limited scope.

Gautam Rajendrakumar Gare, Neehar Peri, Matvei Popov et al.

Multi-Modal LLMs (MLLMs) demonstrate strong visual grounding capabilities on popular object detection benchmarks like OdinW-13 and RefCOCO. However, state-of-the-art models still struggle to generalize to out-of-distribution classes, tasks and imaging modalities not typically found in their pre-training. While in-context prompting is a common strategy to improve performance across diverse tasks, we find that it often yields lower detection accuracy than prompting with class names alone. This suggests that current MLLMs cannot yet effectively leverage few-shot visual examples and rich textual descriptions for object detection. Since frontier MLLMs are typically only accessible via APIs, and state-of-the-art open-weights models are prohibitively expensive to fine-tune on consumer-grade hardware, we instead explore black-box prompt optimization for few-shot object detection. To this end, we propose Detection Prompt Optimization (DetPO), a gradient-free test-time optimization approach that refines text-only prompts by maximizing detection accuracy on few-shot visual training examples while calibrating prediction confidence. Our proposed approach yields consistent improvements across generalist MLLMs on Roboflow20-VL and LVIS, outperforming prior black-box approaches by up to 9.7%. Our code is available at https://github.com/ggare-cmu/DetPO

FNU Abhimanyu, Andrew L. Orekhov, John Galeotti et al.

In this paper, we present a novel deep-learning model for deformable registration of ultrasound images and an unsupervised approach to training this model. Our network employs recurrent all-pairs field transforms (RAFT) and a spatial transformer network (STN) to generate displacement fields at online rates (apprx. 30 Hz) and accurately track pixel movement. We call our approach unsupervised recurrent all-pairs field transforms (U-RAFT). In this work, we use U-RAFT to track pixels in a sequence of ultrasound images to cancel out respiratory motion in lung ultrasound images. We demonstrate our method on in-vivo porcine lung videos. We show a reduction of 76% in average pixel movement in the porcine dataset using respiratory motion compensation strategy. We believe U-RAFT is a promising tool for compensating different kinds of motions like respiration and heartbeat in ultrasound images of deformable tissue.

FNU Abhimanyu, Andrew L. Orekhov, Ananya Bal et al.

This paper presents a deep-learning model for deformable registration of ultrasound images at online rates, which we call U-RAFT. As its name suggests, U-RAFT is based on RAFT, a convolutional neural network for estimating optical flow. U-RAFT, however, can be trained in an unsupervised manner and can generate synthetic images for training vessel segmentation models. We propose and compare the registration quality of different loss functions for training U-RAFT. We also show how our approach, together with a robot performing force-controlled scans, can be used to generate synthetic deformed images to significantly expand the size of a femoral vessel segmentation training dataset without the need for additional manual labeling. We validate our approach on both a silicone human tissue phantom as well as on in-vivo porcine images. We show that U-RAFT generates synthetic ultrasound images with 98% and 81% structural similarity index measure (SSIM) to the real ultrasound images for the phantom and porcine datasets, respectively. We also demonstrate that synthetic deformed images from U-RAFT can be used as a data augmentation technique for vessel segmentation models to improve intersection-over-union (IoU) segmentation performance

Shaurjya Mandal, Nutan Sharma, John Galeotti

Human mesh recovery from single images remains challenging due to inherent depth ambiguity and limited generalization across domains. While recent methods combine regression and optimization approaches, they struggle with poor initialization for test-time refinement and inefficient parameter updates during optimization. We propose a novel meta-learning framework that trains models to produce optimization-friendly initializations while incorporating uncertainty-aware adaptive updates during test-time refinement. Our approach introduces three key innovations: (1) a meta-learning strategy that simulates test-time optimization during training to learn better parameter initializations, (2) a selective parameter caching mechanism that identifies and freezes converged joints to reduce computational overhead, and (3) distribution-based adaptive updates that sample parameter changes from learned distributions, enabling robust exploration while quantifying uncertainty. Additionally, we employ stochastic approximation techniques to handle intractable gradients in complex loss landscapes. Extensive experiments on standard benchmarks demonstrate that our method achieves state-of-the-art performance, reducing MPJPE by 10.3 on 3DPW and 8.0 on Human3.6M compared to strong baselines. Our approach shows superior domain adaptation capabilities with minimal performance degradation across different environmental conditions, while providing meaningful uncertainty estimates that correlate with actual prediction errors. Combining meta-learning and adaptive optimization enables accurate mesh recovery and robust generalization to challenging scenarios.

Jana Armouti, Laura Hutchins, Jacob Duplantis et al.

Hospital readmission within 30 days of discharge is a leading driver of morbidity, mortality, and avoidable healthcare expenditure in congestive heart failure (CHF). Current clinical risk stratification tools rely primarily on non-imaging data and exhibit limited predictive performance. Point-of-care lung ultrasound (LUS) offers a sensitive, noninvasive window into the pulmonary congestion that characterizes CHF decompensation, yet its prognostic utility for readmission prediction remains largely unexplored. We present a pilot feasibility study, the first systematic machine learning study using B-mode LUS acquired during hospitalization to predict 30-day CHF readmission. Quantitative spatiotemporal embeddings are extracted from a pretrained Temporal Shift Module (TSM) ResNet-18 encoder, and interpretable biomarker features are separately evaluated. Through structured ablations over lung view, temporal representation, multi-view fusion, and cross-lung augmentation, we identify the key imaging factors driving readmission risk. Our findings reveal that (1) dependent lower-lung regions (Left-3, Right-3) carry the strongest prognostic signal, consistent with their greater susceptibility to hydrostatic congestion; (2) temporal difference features between sequential examinations substantially outperform single-timepoint representations, highlighting the importance of capturing disease trajectory; and (3) multi-view feature concatenation yields the best overall performance, with our top MLP model achieving an F1 score of 0.80 (95% CI: 0.62-0.96). Biomarker analysis further reveals that pleural-line abnormalities, including breaks and indentations, are as informative as the canonical A-line and B-line markers. These results support POCUS-derived biomarkers as practical, interpretable tools for noninvasive CHF risk stratification.

Malini Shivaram, Gautam Rajendrakumar Gare, Laura Hutchins et al.

In medical imaging, inter-observer variability among radiologists often introduces label uncertainty, particularly in modalities where visual interpretation is subjective. Lung ultrasound (LUS) is a prime example-it frequently presents a mixture of highly ambiguous regions and clearly discernible structures, making consistent annotation challenging even for experienced clinicians. In this work, we introduce a novel approach to both labeling and training AI models using expert-supplied, per-pixel confidence values. Rather than treating annotations as absolute ground truth, we design a data annotation protocol that captures the confidence that radiologists have in each labeled region, modeling the inherent aleatoric uncertainty present in real-world clinical data. We demonstrate that incorporating these confidence values during training leads to improved segmentation performance. More importantly, we show that this enhanced segmentation quality translates into better performance on downstream clinically-critical tasks-specifically, estimating S/F oxygenation ratio values, classifying S/F ratio change, and predicting 30-day patient readmission. While we empirically evaluate many methods for exposing the uncertainty to the learning model, we find that a simple approach that trains a model on binarized labels obtained with a (60%) confidence threshold works well. Importantly, high thresholds work far better than a naive approach of a 50% threshold, indicating that training on very confident pixels is far more effective. Our study systematically investigates the impact of training with varying confidence thresholds, comparing not only segmentation metrics but also downstream clinical outcomes. These results suggest that label confidence is a valuable signal that, when properly leveraged, can significantly enhance the reliability and clinical utility of AI in medical imaging.

Jana Armouti, Nikhil Madaan, Rohan Panda et al. · cmu

Predicting whether a treatment leads to meaningful improvement is a central challenge in personalized medicine, particularly when disease progression manifests as subtle visual changes over time. While data-driven deep learning (DL) offers a promising route to automate such predictions, acquiring large-scale longitudinal data for each individual patient remains impractical. To address this limitation, we explore whether inter-patient variability can serve as a proxy for learning intra-patient progression. We propose LEARNER, a contrastive pretraining framework that leverages coarsely labeled inter-patient data to learn fine-grained, patient-specific representations. Using lung ultrasound (LUS) and brain MRI datasets, we demonstrate that contrastive objectives trained on coarse inter-patient differences enable models to capture subtle intra-patient changes associated with treatment response. Across both modalities, our approach improves downstream classification accuracy and F1-score compared to standard MSE pretraining, highlighting the potential of inter-patient contrastive learning for individualized outcome prediction.

Nico Zevallos, Evan Harber, Abhimanyu et al.

Advanced resuscitative technologies, such as Extra Corporeal Membrane Oxygenation (ECMO) cannulation or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), are technically difficult even for skilled medical personnel. This paper describes the core technologies that comprise a teleoperated system capable of granting femoral vascular access, which is an important step in both of these procedures and a major roadblock in their wider use in the field. These technologies include a kinematic manipulator, various sensing modalities, and a user interface. In addition, we evaluate our system on a surgical phantom as well as in-vivo porcine experiments. These resulted in, to the best of our knowledge, the first robot-assisted arterial catheterizations; a major step towards our eventual goal of automatic catheter insertion through the Seldinger technique.

Alex Ling Yu Hung, John Galeotti

Ultrasound 3D compounding is important for volumetric reconstruction, but as of yet there is no consensus on best practices for compounding. Ultrasound images depend on probe direction and the path sound waves pass through, so when multiple intersecting B-scans of the same spot from different perspectives yield different pixel values, there is not a single, ideal representation for compounding (i.e. combining) the overlapping pixel values. Current popular methods inevitably suppress or altogether leave out bright or dark regions that are useful, and potentially introduce new artifacts. In this work, we establish a new algorithm to compound the overlapping pixels from different view points in ultrasound. We uniquely leverage Laplacian and Gaussian Pyramids to preserve the maximum boundary contrast without overemphasizing noise and speckle. We evaluate our algorithm by comparing ours with previous algorithms, and we show that our approach not only preserves both light and dark details, but also somewhat suppresses artifacts, rather than amplifying them.

Alex Ling Yu Hung, Edward Chen, John Galeotti

Ultrasound image quality has continually been improving. However, when needles or other metallic objects are operating inside the tissue, the resulting reverberation artifacts can severely corrupt the surrounding image quality. Such effects are challenging for existing computer vision algorithms for medical image analysis. Needle reverberation artifacts can be hard to identify at times and affect various pixel values to different degrees. The boundaries of such artifacts are ambiguous, leading to disagreement among human experts labeling the artifacts. We propose a weakly- and semi-supervised, probabilistic needle-and-reverberation-artifact segmentation algorithm to separate the desired tissue-based pixel values from the superimposed artifacts. Our method models the intensity decay of artifact intensities and is designed to minimize the human labeling error. We demonstrate the applicability of the approach and compare it against other segmentation algorithms. Our method is capable of differentiating between the reverberations from artifact-free patches as well as of modeling the intensity fall-off in the artifacts. Our method matches state-of-the-art artifact segmentation performance and sets a new standard in estimating the per-pixel contributions of artifact vs underlying anatomy, especially in the immediately adjacent regions between reverberation lines. Our algorithm is also able to improve the performance downstream image analysis algorithms.

Alex Ling Yu Hung, Wanwen Chen, John Galeotti

Ultrasound imaging has been improving, but continues to suffer from inherent artifacts that are challenging to model, such as attenuation, shadowing, diffraction, speckle, etc. These artifacts can potentially confuse image analysis algorithms unless an attempt is made to assess the certainty of individual pixel values. Our novel confidence algorithms analyze pixel values using a directed acyclic graph based on acoustic physical properties of ultrasound imaging. We demonstrate unique capabilities of our approach and compare it against previous confidence-measurement algorithms for shadow-detection and image-compounding tasks.

Edward Chen, Tejas Sudharshan Mathai, Vinit Sarode et al.

Identifying landmarks in the femoral area is crucial for ultrasound (US) -based robot-guided catheter insertion, and their presentation varies when imaged with different scanners. As such, the performance of past deep learning-based approaches is also narrowly limited to the training data distribution; this can be circumvented by fine-tuning all or part of the model, yet the effects of fine-tuning are seldom discussed. In this work, we study the US-based segmentation of multiple classes through transfer learning by fine-tuning different contiguous blocks within the model, and evaluating on a gamut of US data from different scanners and settings. We propose a simple method for predicting generalization on unseen datasets and observe statistically significant differences between the fine-tuning methods while working towards domain generalization.

Jiahong Ouyang, Tejas Sudharshan Mathai, Kira Lathrop et al.

Optical Coherence Tomography (OCT) is an imaging modality that has been widely adopted for visualizing corneal, retinal and limbal tissue structure with micron resolution. It can be used to diagnose pathological conditions of the eye, and for developing pre-operative surgical plans. In contrast to the posterior retina, imaging the anterior tissue structures, such as the limbus and cornea, results in B-scans that exhibit increased speckle noise patterns and imaging artifacts. These artifacts, such as shadowing and specularity, pose a challenge during the analysis of the acquired volumes as they substantially obfuscate the location of tissue interfaces. To deal with the artifacts and speckle noise patterns and accurately segment the shallowest tissue interface, we propose a cascaded neural network framework, which comprises of a conditional Generative Adversarial Network (cGAN) and a Tissue Interface Segmentation Network (TISN). The cGAN pre-segments OCT B-scans by removing undesired specular artifacts and speckle noise patterns just above the shallowest tissue interface, and the TISN combines the original OCT image with the pre-segmentation to segment the shallowest interface. We show the applicability of the cascaded framework to corneal datasets, demonstrate that it precisely segments the shallowest corneal interface, and also show its generalization capacity to limbal datasets. We also propose a hybrid framework, wherein the cGAN pre-segmentation is passed to a traditional image analysis-based segmentation algorithm, and describe the improved segmentation performance. To the best of our knowledge, this is the first approach to remove severe specular artifacts and speckle noise patterns (prior to the shallowest interface) that affects the interpretation of anterior segment OCT datasets, thereby resulting in the accurate segmentation of the shallowest tissue interface.

Tejas Sudharshan Mathai, Kira Lathrop, John Galeotti

Accurate and repeatable delineation of corneal tissue interfaces is necessary for surgical planning during anterior segment interventions, such as Keratoplasty. Designing an approach to identify interfaces, which generalizes to datasets acquired from different Optical Coherence Tomographic (OCT) scanners, is paramount. In this paper, we present a Convolutional Neural Network (CNN) based framework called CorNet that can accurately segment three corneal interfaces across datasets obtained with different scan settings from different OCT scanners. Extensive validation of the approach was conducted across all imaged datasets. To the best of our knowledge, this is the first deep learning based approach to segment both anterior and posterior corneal tissue interfaces. Our errors are 2x lower than non-proprietary state-of-the-art corneal tissue interface segmentation algorithms, which include image analysis-based and deep learning approaches.

Tejas Sudharshan Mathai, Lingbo Jin, Vijay Gorantla et al.

Ultra High Frequency Ultrasound (UHFUS) enables the visualization of highly deformable small and medium vessels in the hand. Intricate vessel-based measurements, such as intimal wall thickness and vessel wall compliance, require sub-millimeter vessel tracking between B-scans. Our fast GPU-based approach combines the advantages of local phase analysis, a distance-regularized level set, and an Extended Kalman Filter (EKF), to rapidly segment and track the deforming vessel contour. We validated on 35 UHFUS sequences of vessels in the hand, and we show the transferability of the approach to 5 more diverse datasets acquired by a traditional High Frequency Ultrasound (HFUS) machine. To the best of our knowledge, this is the first algorithm capable of rapidly segmenting and tracking deformable vessel contours in 2D UHFUS images. It is also the fastest and most accurate system for 2D HFUS images.