IV Ramakrishnan

Yunfan Li, Himanshu Gupta, Haibin Ling et al.

Cholecystectomy (gallbladder removal) is one of the most common procedures in the US, with more than 1.2M procedures annually. Compared with classical open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with significantly shorter recovery period, and hence is the preferred method. However, LC is also associated with an increase in bile duct injuries (BDIs), resulting in significant morbidity and mortality. The primary cause of BDIs from LCs is misidentification of the cystic duct with the bile duct. Critical view of safety (CVS) is the most effective of safety protocols, which is said to be achieved during the surgery if certain criteria are met. However, due to suboptimal understanding and implementation of CVS, the BDI rates have remained stable over the last three decades. In this paper, we develop deep-learning techniques to automate the assessment of CVS in LCs. An innovative aspect of our research is on developing specialized learning techniques by incorporating domain knowledge to compensate for the limited training data available in practice. In particular, our CVS assessment process involves a fusion of two segmentation maps followed by an estimation of a certain region of interest based on anatomical structures close to the gallbladder, and then finally determination of each of the three CVS criteria via rule-based assessment of structural information. We achieved a gain of over 11.8% in mIoU on relevant classes with our two-stream semantic segmentation approach when compared to a single-model baseline, and 1.84% in mIoU with our proposed Sobel loss function when compared to a Transformer-based baseline model. For CVS criteria, we achieved up to 16% improvement and, for the overall CVS assessment, we achieved 5% improvement in balanced accuracy compared to DeepCVS under the same experiment settings.

Ibrahim Hammoud, Prateek Prasanna, IV Ramakrishnan et al.

Early prediction of patients at risk of clinical deterioration can help physicians intervene and alter their clinical course towards better outcomes. In addition to the accuracy requirement, early warning systems must make the predictions early enough to give physicians enough time to intervene. Interpretability is also one of the challenges when building such systems since being able to justify the reasoning behind model decisions is desirable in clinical practice. In this work, we built an interpretable model for the early prediction of various adverse clinical events indicative of clinical deterioration. The model is evaluated on two datasets and four clinical events. The first dataset is collected in a predominantly COVID-19 positive population at Stony Brook Hospital. The second dataset is the MIMIC III dataset. The model was trained to provide early warning scores for ventilation, ICU transfer, and mortality prediction tasks on the Stony Brook Hospital dataset and to predict mortality and the need for vasopressors on the MIMIC III dataset. Our model first separates each feature into multiple ranges and then uses logistic regression with lasso penalization to select the subset of ranges for each feature. The model training is completely automated and doesn't require expert knowledge like other early warning scores. We compare our model to the Modified Early Warning Score (MEWS) and quick SOFA (qSOFA), commonly used in hospitals. We show that our model outperforms these models in the area under the receiver operating characteristic curve (AUROC) while having a similar or better median detection time on all clinical events, even when using fewer features. Unlike MEWS and qSOFA, our model can be entirely automated without requiring any manually recorded features. We also show that discretization improves model performance by comparing our model to a baseline logistic regression model.