Lyle J. Palmer

Nikhil Cherian Kurian, Victor Caquilpan Parra, Abin Shoby et al.

Age dependent performance disparities in medical image classification often arise because age acts as a confounder, linking imaging morphology with disease prevalence. In practice, disparities can manifest as overdiagnosis at ages where disease prevalence is higher and underdiagnosis at ages where prevalence is lower, and can worsen under train test shifts in the age distribution. Conventional mitigation approaches that enforce strict age invariance may suppress diagnostically meaningful information encoded in age. We therefore propose a robust framework that mitigates the effects of age-dependent confounding by targeting spurious age linked trends rather than enforcing invariance. Following a warm-up phase, we characterize sample difficulty and model its age-dependent trends in a label-conditioned manner. We decorrelate age from dominant age difficulty trends using robust, Huber weighted affinity weights, attenuating confounding-driven shortcuts while preserving clinically meaningful, nonlinear age information. We further introduce an Age Coverage Score that scales the decorrelation penalty by minibatch age variance to ensure stable optimization under limited age diversity. Across two radiology datasets, our approach reduces age dependent true and false positive disparities with minimal AUC impact and remains robust to increasing train test age distribution shifts.

Imon Banerjee, Ananth Reddy Bhimireddy, John L. Burns et al.

Background: In medical imaging, prior studies have demonstrated disparate AI performance by race, yet there is no known correlation for race on medical imaging that would be obvious to the human expert interpreting the images. Methods: Using private and public datasets we evaluate: A) performance quantification of deep learning models to detect race from medical images, including the ability of these models to generalize to external environments and across multiple imaging modalities, B) assessment of possible confounding anatomic and phenotype population features, such as disease distribution and body habitus as predictors of race, and C) investigation into the underlying mechanism by which AI models can recognize race. Findings: Standard deep learning models can be trained to predict race from medical images with high performance across multiple imaging modalities. Our findings hold under external validation conditions, as well as when models are optimized to perform clinically motivated tasks. We demonstrate this detection is not due to trivial proxies or imaging-related surrogate covariates for race, such as underlying disease distribution. Finally, we show that performance persists over all anatomical regions and frequency spectrum of the images suggesting that mitigation efforts will be challenging and demand further study. Interpretation: We emphasize that model ability to predict self-reported race is itself not the issue of importance. However, our findings that AI can trivially predict self-reported race -- even from corrupted, cropped, and noised medical images -- in a setting where clinical experts cannot, creates an enormous risk for all model deployments in medical imaging: if an AI model secretly used its knowledge of self-reported race to misclassify all Black patients, radiologists would not be able to tell using the same data the model has access to.

William Gale, Luke Oakden-Rayner, Gustavo Carneiro et al.

Current approaches to explaining the decisions of deep learning systems for medical tasks have focused on visualising the elements that have contributed to each decision. We argue that such approaches are not enough to "open the black box" of medical decision making systems because they are missing a key component that has been used as a standard communication tool between doctors for centuries: language. We propose a model-agnostic interpretability method that involves training a simple recurrent neural network model to produce descriptive sentences to clarify the decision of deep learning classifiers. We test our method on the task of detecting hip fractures from frontal pelvic x-rays. This process requires minimal additional labelling despite producing text containing elements that the original deep learning classification model was not specifically trained to detect. The experimental results show that: 1) the sentences produced by our method consistently contain the desired information, 2) the generated sentences are preferred by doctors compared to current tools that create saliency maps, and 3) the combination of visualisations and generated text is better than either alone.

William Gale, Luke Oakden-Rayner, Gustavo Carneiro et al.

We developed an automated deep learning system to detect hip fractures from frontal pelvic x-rays, an important and common radiological task. Our system was trained on a decade of clinical x-rays (~53,000 studies) and can be applied to clinical data, automatically excluding inappropriate and technically unsatisfactory studies. We demonstrate diagnostic performance equivalent to a human radiologist and an area under the ROC curve of 0.994. Translated to clinical practice, such a system has the potential to increase the efficiency of diagnosis, reduce the need for expensive additional testing, expand access to expert level medical image interpretation, and improve overall patient outcomes.

Toan Tran, Trung Pham, Gustavo Carneiro et al.

Data augmentation is an essential part of the training process applied to deep learning models. The motivation is that a robust training process for deep learning models depends on large annotated datasets, which are expensive to be acquired, stored and processed. Therefore a reasonable alternative is to be able to automatically generate new annotated training samples using a process known as data augmentation. The dominant data augmentation approach in the field assumes that new training samples can be obtained via random geometric or appearance transformations applied to annotated training samples, but this is a strong assumption because it is unclear if this is a reliable generative model for producing new training samples. In this paper, we provide a novel Bayesian formulation to data augmentation, where new annotated training points are treated as missing variables and generated based on the distribution learned from the training set. For learning, we introduce a theoretically sound algorithm --- generalised Monte Carlo expectation maximisation, and demonstrate one possible implementation via an extension of the Generative Adversarial Network (GAN). Classification results on MNIST, CIFAR-10 and CIFAR-100 show the better performance of our proposed method compared to the current dominant data augmentation approach mentioned above --- the results also show that our approach produces better classification results than similar GAN models.

Gustavo Carneiro, Luke Oakden-Rayner, Andrew P. Bradley et al.

We propose new methods for the prediction of 5-year mortality in elderly individuals using chest computed tomography (CT). The methods consist of a classifier that performs this prediction using a set of features extracted from the CT image and segmentation maps of multiple anatomic structures. We explore two approaches: 1) a unified framework based on deep learning, where features and classifier are automatically learned in a single optimisation process; and 2) a multi-stage framework based on the design and selection/extraction of hand-crafted radiomics features, followed by the classifier learning process. Experimental results, based on a dataset of 48 annotated chest CTs, show that the deep learning model produces a mean 5-year mortality prediction accuracy of 68.5%, while radiomics produces a mean accuracy that varies between 56% to 66% (depending on the feature selection/extraction method and classifier). The successful development of the proposed models has the potential to make a profound impact in preventive and personalised healthcare.