William Whiteley

Hang Dong, Víctor Suárez-Paniagua, Huayu Zhang et al. · oxford

Computational text phenotyping is the practice of identifying patients with certain disorders and traits from clinical notes. Rare diseases are challenging to be identified due to few cases available for machine learning and the need for data annotation from domain experts. We propose a method using ontologies and weak supervision, with recent pre-trained contextual representations from Bi-directional Transformers (e.g. BERT). The ontology-based framework includes two steps: (i) Text-to-UMLS, extracting phenotypes by contextually linking mentions to concepts in Unified Medical Language System (UMLS), with a Named Entity Recognition and Linking (NER+L) tool, SemEHR, and weak supervision with customised rules and contextual mention representation; (ii) UMLS-to-ORDO, matching UMLS concepts to rare diseases in Orphanet Rare Disease Ontology (ORDO). The weakly supervised approach is proposed to learn a phenotype confirmation model to improve Text-to-UMLS linking, without annotated data from domain experts. We evaluated the approach on three clinical datasets, MIMIC-III discharge summaries, MIMIC-III radiology reports, and NHS Tayside brain imaging reports from two institutions in the US and the UK, with annotations. The improvements in the precision were pronounced (by over 30% to 50% absolute score for Text-to-UMLS linking), with almost no loss of recall compared to the existing NER+L tool, SemEHR. Results on radiology reports from MIMIC-III and NHS Tayside were consistent with the discharge summaries. The overall pipeline processing clinical notes can extract rare disease cases, mostly uncaptured in structured data (manually assigned ICD codes). We discuss the usefulness of the weak supervision approach and propose directions for future studies.

Hang Dong, Matúš Falis, William Whiteley et al.

Clinical coding is the task of transforming medical information in a patient's health records into structured codes so that they can be used for statistical analysis. This is a cognitive and time-consuming task that follows a standard process in order to achieve a high level of consistency. Clinical coding could potentially be supported by an automated system to improve the efficiency and accuracy of the process. We introduce the idea of automated clinical coding and summarise its challenges from the perspective of Artificial Intelligence (AI) and Natural Language Processing (NLP), based on the literature, our project experience over the past two and half years (late 2019 - early 2022), and discussions with clinical coding experts in Scotland and the UK. Our research reveals the gaps between the current deep learning-based approach applied to clinical coding and the need for explainability and consistency in real-world practice. Knowledge-based methods that represent and reason the standard, explainable process of a task may need to be incorporated into deep learning-based methods for clinical coding. Automated clinical coding is a promising task for AI, despite the technical and organisational challenges. Coders are needed to be involved in the development process. There is much to achieve to develop and deploy an AI-based automated system to support coding in the next five years and beyond.

Beatrice Alex, Claire Grover, Arlene Casey et al.

We present GS-BrainText, a curated dataset of 8,511 brain radiology reports from the Generation Scotland cohort, of which 2,431 are annotated for 24 brain disease phenotypes. This multi-site dataset spans five Scottish NHS health boards and includes broad age representation (mean age 58, median age 53), making it uniquely valuable for developing and evaluating generalisable clinical natural language processing (NLP) algorithms and tools. Expert annotations were performed by a multidisciplinary clinical team using an annotation schema, with 10-100% double annotation per NHS health board and rigorous quality assurance. Benchmark evaluation using EdIE-R, an existing rule-based NLP system developed in conjunction with the annotation schema, revealed some performance variation across health boards (F1: 86.13-98.13), phenotypes (F1: 22.22-100) and age groups (F1: 87.01-98.13), highlighting critical challenges in generalisation of NLP tools. The GS-BrainText dataset addresses a significant gap in available UK clinical text resources and provides a valuable resource for the study of linguistic variation, diagnostic uncertainty expression and the impact of data characteristics on NLP system performance.

Arlene Casey, Emma Davidson, Michael Poon et al.

NLP has a significant role in advancing healthcare and has been found to be key in extracting structured information from radiology reports. Understanding recent developments in NLP application to radiology is of significance but recent reviews on this are limited. This study systematically assesses recent literature in NLP applied to radiology reports. Our automated literature search yields 4,799 results using automated filtering, metadata enriching steps and citation search combined with manual review. Our analysis is based on 21 variables including radiology characteristics, NLP methodology, performance, study, and clinical application characteristics. We present a comprehensive analysis of the 164 publications retrieved with each categorised into one of 6 clinical application categories. Deep learning use increases but conventional machine learning approaches are still prevalent. Deep learning remains challenged when data is scarce and there is little evidence of adoption into clinical practice. Despite 17% of studies reporting greater than 0.85 F1 scores, it is hard to comparatively evaluate these approaches given that most of them use different datasets. Only 14 studies made their data and 15 their code available with 10 externally validating results. Automated understanding of clinical narratives of the radiology reports has the potential to enhance the healthcare process but reproducibility and explainability of models are important if the domain is to move applications into clinical use. More could be done to share code enabling validation of methods on different institutional data and to reduce heterogeneity in reporting of study properties allowing inter-study comparisons. Our results have significance for researchers providing a systematic synthesis of existing work to build on, identify gaps, opportunities for collaboration and avoid duplication.

Hang Dong, Víctor Suárez-Paniagua, William Whiteley et al.

Diagnostic or procedural coding of clinical notes aims to derive a coded summary of disease-related information about patients. Such coding is usually done manually in hospitals but could potentially be automated to improve the efficiency and accuracy of medical coding. Recent studies on deep learning for automated medical coding achieved promising performances. However, the explainability of these models is usually poor, preventing them to be used confidently in supporting clinical practice. Another limitation is that these models mostly assume independence among labels, ignoring the complex correlation among medical codes which can potentially be exploited to improve the performance. We propose a Hierarchical Label-wise Attention Network (HLAN), which aimed to interpret the model by quantifying importance (as attention weights) of words and sentences related to each of the labels. Secondly, we propose to enhance the major deep learning models with a label embedding (LE) initialisation approach, which learns a dense, continuous vector representation and then injects the representation into the final layers and the label-wise attention layers in the models. We evaluated the methods using three settings on the MIMIC-III discharge summaries: full codes, top-50 codes, and the UK NHS COVID-19 shielding codes. Experiments were conducted to compare HLAN and LE initialisation to the state-of-the-art neural network based methods. HLAN achieved the best Micro-level AUC and $F_1$ on the top-50 code prediction and comparable results on the NHS COVID-19 shielding code prediction to other models. By highlighting the most salient words and sentences for each label, HLAN showed more meaningful and comprehensive model interpretation compared to its downgraded baselines and the CNN-based models. LE initialisation consistently boosted most deep learning models for automated medical coding.

William Whiteley, Vladimir Panin, Chuanyu Zhou et al.

Direct reconstruction of positron emission tomography (PET) data using deep neural networks is a growing field of research. Initial results are promising, but often the networks are complex, memory utilization inefficient, produce relatively small 2D image slices (e.g., 128x128), and low count rate reconstructions are of varying quality. This paper proposes FastPET, a novel direct reconstruction convolutional neural network that is architecturally simple, memory space efficient, works for non-trivial 3D image volumes and is capable of processing a wide spectrum of PET data including low-dose and multi-tracer applications. FastPET uniquely operates on a histo-image (i.e., image-space) representation of the raw data enabling it to reconstruct 3D image volumes 67x faster than Ordered subsets Expectation Maximization (OSEM). We detail the FastPET method trained on whole-body and low-dose whole-body data sets and explore qualitative and quantitative aspects of reconstructed images from clinical and phantom studies. Additionally, we explore the application of FastPET on a neurology data set containing multiple different tracers. The results show that not only are the reconstructions very fast, but the images are high quality and lower noise than iterative reconstructions.

William Whiteley, Wing K. Luk, Jens Gregor

Purpose: Neural network image reconstruction directly from measurement data is a relatively new field of research, that until now has been limited to producing small single-slice images (e.g., 1x128x128). This paper proposes a novel and more efficient network design for Positron Emission Tomography called DirectPET which is capable of reconstructing multi-slice image volumes (i.e., 16x400x400) from sinograms. Approach: Large-scale direct neural network reconstruction is accomplished by addressing the associated memory space challenge through the introduction of a specially designed Radon inversion layer. Using patient data, we compare the proposed method to the benchmark Ordered Subsets Expectation Maximization (OSEM) algorithm using signal-to-noise ratio, bias, mean absolute error and structural similarity measures. In addition, line profiles and full-width half-maximum measurements are provided for a sample of lesions. Results: DirectPET is shown capable of producing images that are quantitatively and qualitatively similar to the OSEM target images in a fraction of the time. We also report on an experiment where DirectPET is trained to map low count raw data to normal count target images demonstrating the method's ability to maintain image quality under a low dose scenario. Conclusion: The ability of DirectPET to quickly reconstruct high-quality, multi-slice image volumes suggests potential clinical viability of the method. However, design parameters and performance boundaries need to be fully established before adoption can be considered.

Philip John Gorinski, Honghan Wu, Claire Grover et al.

This work investigates multiple approaches to Named Entity Recognition (NER) for text in Electronic Health Record (EHR) data. In particular, we look into the application of (i) rule-based, (ii) deep learning and (iii) transfer learning systems for the task of NER on brain imaging reports with a focus on records from patients with stroke. We explore the strengths and weaknesses of each approach, develop rules and train on a common dataset, and evaluate each system's performance on common test sets of Scottish radiology reports from two sources (brain imaging reports in ESS -- Edinburgh Stroke Study data collected by NHS Lothian as well as radiology reports created in NHS Tayside). Our comparison shows that a hand-crafted system is the most accurate way to automatically label EHR, but machine learning approaches can provide a feasible alternative where resources for a manual system are not readily available.