Timothy R. Smith

Mathilde Gajda Faanes, David Bouget, Asgeir S. Jakola et al.

T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) scans are important for diagnosis, treatment planning and monitoring of brain tumors. Depending on the brain tumor type, the FLAIR hyperintensity volume is an important measure to asses the tumor volume or surrounding edema, and an automatic segmentation of this would be useful in the clinic. In this study, around 5000 FLAIR images of various tumors types and acquisition time points from different centers were used to train a unified FLAIR hyperintensity segmentation model using an Attention U-Net architecture. The performance was compared against dataset specific models, and was validated on different tumor types, acquisition time points and against BraTS. The unified model achieved an average Dice score of 88.65\% for pre-operative meningiomas, 80.08% for pre-operative metastasis, 90.92% for pre-operative and 84.60% for post-operative gliomas from BraTS, and 84.47% for pre-operative and 61.27\% for post-operative lower grade gliomas. In addition, the results showed that the unified model achieved comparable segmentation performance to the dataset specific models on their respective datasets, and enables generalization across tumor types and acquisition time points, which facilitates the deployment in a clinical setting. The model is integrated into Raidionics, an open-source software for CNS tumor analysis.

Patrick Emedom-Nnamdi, Timothy R. Smith, Jukka-Pekka Onnela et al.

We propose a nonparametric additive model for estimating interpretable value functions in reinforcement learning, with an application in optimizing postoperative recovery through personalized, adaptive recommendations. While reinforcement learning has achieved significant success in various domains, recent methods often rely on black-box approaches such as neural networks, which hinder the examination of individual feature contributions to a decision-making policy. Our novel method offers a flexible technique for estimating action-value functions without explicit parametric assumptions, overcoming the limitations of the linearity assumption of classical algorithms. By incorporating local kernel regression and basis expansion, we obtain a sparse, additive representation of the action-value function, enabling local approximation and retrieval of nonlinear, independent contributions of select state features and the interactions between joint feature pairs. We validate our approach through a simulation study and apply it to spine disease recovery, uncovering recommendations aligned with clinical knowledge. This method bridges the gap between flexible machine learning techniques and the interpretability required in healthcare applications, paving the way for more personalized interventions.

David Bouget, Mathilde Gajda Faanes, Asgeir Store Jakola et al.

Magnetic resonance (MR) imaging is essential for evaluating central nervous system (CNS) tumors, guiding surgical planning, treatment decisions, and assessing postoperative outcomes and complication risks. While recent work has advanced automated tumor segmentation and report generation, most efforts have focused on preoperative data, with limited attention to postoperative imaging analysis. This study introduces a comprehensive pipeline for standardized postsurtical reporting in CNS tumors. Using the Attention U-Net architecture, segmentation models were trained for the preoperative (non-enhancing) tumor core, postoperative contrast-enhancing residual tumor, and resection cavity. Additionally, MR sequence classification and tumor type identification for contrast-enhancing lesions were explored using the DenseNet architecture. The models were integrated into a reporting pipeline, following the RANO 2.0 guidelines. Training was conducted on multicentric datasets comprising 2000 to 7000 patients, using a 5-fold cross-validation. Evaluation included patient-, voxel-, and object-wise metrics, with benchmarking against the latest BraTS challenge results. The segmentation models achieved average voxel-wise Dice scores of 87%, 66%, 70%, and 77% for the tumor core, non-enhancing tumor core, contrast-enhancing residual tumor, and resection cavity, respectively. Classification models reached 99.5% balanced accuracy in MR sequence classification and 80% in tumor type classification. The pipeline presented in this study enables robust, automated segmentation, MR sequence classification, and standardized report generation aligned with RANO 2.0 guidelines, enhancing postoperative evaluation and clinical decision-making. The proposed models and methods were integrated into Raidionics, open-source software platform for CNS tumor analysis, now including a dedicated module for postsurgical analysis.