Katy Blumer

Katy Blumer, Subhashini Venugopalan, Michael P. Brenner et al.

We analyze a dataset of retinal images using linear probes: linear regression models trained on some "target" task, using embeddings from a deep convolutional (CNN) model trained on some "source" task as input. We use this method across all possible pairings of 93 tasks in the UK Biobank dataset of retinal images, leading to ~164k different models. We analyze the performance of these linear probes by source and target task and by layer depth. We observe that representations from the middle layers of the network are more generalizable. We find that some target tasks are easily predicted irrespective of the source task, and that some other target tasks are more accurately predicted from correlated source tasks than from embeddings trained on the same task.

Boris Babenko, Siva Balasubramanian, Katy E. Blumer et al.

Background: Patients with neovascular age-related macular degeneration (AMD) can avoid vision loss via certain therapy. However, methods to predict the progression to neovascular age-related macular degeneration (nvAMD) are lacking. Purpose: To develop and validate a deep learning (DL) algorithm to predict 1-year progression of eyes with no, early, or intermediate AMD to nvAMD, using color fundus photographs (CFP). Design: Development and validation of a DL algorithm. Methods: We trained a DL algorithm to predict 1-year progression to nvAMD, and used 10-fold cross-validation to evaluate this approach on two groups of eyes in the Age-Related Eye Disease Study (AREDS): none/early/intermediate AMD, and intermediate AMD (iAMD) only. We compared the DL algorithm to the manually graded 4-category and 9-step scales in the AREDS dataset. Main outcome measures: Performance of the DL algorithm was evaluated using the sensitivity at 80% specificity for progression to nvAMD. Results: The DL algorithm's sensitivity for predicting progression to nvAMD from none/early/iAMD (78+/-6%) was higher than manual grades from the 9-step scale (67+/-8%) or the 4-category scale (48+/-3%). For predicting progression specifically from iAMD, the DL algorithm's sensitivity (57+/-6%) was also higher compared to the 9-step grades (36+/-8%) and the 4-category grades (20+/-0%). Conclusions: Our DL algorithm performed better in predicting progression to nvAMD than manual grades. Future investigations are required to test the application of this DL algorithm in a real-world clinical setting.

Maithra Raghu, Katy Blumer, Greg Corrado et al.

In a wide array of areas, algorithms are matching and surpassing the performance of human experts, leading to consideration of the roles of human judgment and algorithmic prediction in these domains. The discussion around these developments, however, has implicitly equated the specific task of prediction with the general task of automation. We argue here that automation is broader than just a comparison of human versus algorithmic performance on a task; it also involves the decision of which instances of the task to give to the algorithm in the first place. We develop a general framework that poses this latter decision as an optimization problem, and we show how basic heuristics for this optimization problem can lead to performance gains even on heavily-studied applications of AI in medicine. Our framework also serves to highlight how effective automation depends crucially on estimating both algorithmic and human error on an instance-by-instance basis, and our results show how improvements in these error estimation problems can yield significant gains for automation as well.

Maithra Raghu, Katy Blumer, Rory Sayres et al.

The issue of disagreements amongst human experts is a ubiquitous one in both machine learning and medicine. In medicine, this often corresponds to doctor disagreements on a patient diagnosis. In this work, we show that machine learning models can be trained to give uncertainty scores to data instances that might result in high expert disagreements. In particular, they can identify patient cases that would benefit most from a medical second opinion. Our central methodological finding is that Direct Uncertainty Prediction (DUP), training a model to predict an uncertainty score directly from the raw patient features, works better than Uncertainty Via Classification, the two-step process of training a classifier and postprocessing the output distribution to give an uncertainty score. We show this both with a theoretical result, and on extensive evaluations on a large scale medical imaging application.

Ryan Poplin, Avinash V. Varadarajan, Katy Blumer et al.

Traditionally, medical discoveries are made by observing associations and then designing experiments to test these hypotheses. However, observing and quantifying associations in images can be difficult because of the wide variety of features, patterns, colors, values, shapes in real data. In this paper, we use deep learning, a machine learning technique that learns its own features, to discover new knowledge from retinal fundus images. Using models trained on data from 284,335 patients, and validated on two independent datasets of 12,026 and 999 patients, we predict cardiovascular risk factors not previously thought to be present or quantifiable in retinal images, such as such as age (within 3.26 years), gender (0.97 AUC), smoking status (0.71 AUC), HbA1c (within 1.39%), systolic blood pressure (within 11.23mmHg) as well as major adverse cardiac events (0.70 AUC). We further show that our models used distinct aspects of the anatomy to generate each prediction, such as the optic disc or blood vessels, opening avenues of further research.