Arjun Soin

Arjun Soin, Jameson Merkow, Jin Long et al.

Clinical Artificial lntelligence (AI) applications are rapidly expanding worldwide, and have the potential to impact to all areas of medical practice. Medical imaging applications constitute a vast majority of approved clinical AI applications. Though healthcare systems are eager to adopt AI solutions a fundamental question remains: \textit{what happens after the AI model goes into production?} We use the CheXpert and PadChest public datasets to build and test a medical imaging AI drift monitoring workflow to track data and model drift without contemporaneous ground truth. We simulate drift in multiple experiments to compare model performance with our novel multi-modal drift metric, which uses DICOM metadata, image appearance representation from a variational autoencoder (VAE), and model output probabilities as input. Through experimentation, we demonstrate a strong proxy for ground truth performance using unsupervised distributional shifts in relevant metadata, predicted probabilities, and VAE latent representation. Our key contributions include (1) proof-of-concept for medical imaging drift detection that includes the use of VAE and domain specific statistical methods, (2) a multi-modal methodology to measure and unify drift metrics, (3) new insights into the challenges and solutions to observe deployed medical imaging AI, and (4) creation of open-source tools that enable others to easily run their own workflows and scenarios. This work has important implications. It addresses the concerning translation gap found in continuous medical imaging AI model monitoring common in dynamic healthcare environments.

Michael Fitzke, Conrad Stack, Andre Dourson et al.

This work describes the development and real-world deployment of a deep learning-based AI system for evaluating canine and feline radiographs across a broad range of findings and abnormalities. We describe a new semi-supervised learning approach that combines NLP-derived labels with self-supervised training leveraging more than 2.5 million x-ray images. Finally we describe the clinical deployment of the model including system architecture, real-time performance evaluation and data drift detection.

Anirudh Joshi, Sabri Eyuboglu, Shih-Cheng Huang et al.

FDG PET/CT imaging is a resource intensive examination critical for managing malignant disease and is particularly important for longitudinal assessment during therapy. Approaches to automate longtudinal analysis present many challenges including lack of available longitudinal datasets, managing complex large multimodal imaging examinations, and need for detailed annotations for traditional supervised machine learning. In this work we develop OncoNet, novel machine learning algorithm that assesses treatment response from a 1,954 pairs of sequential FDG PET/CT exams through weak supervision using the standard uptake values (SUVmax) in associated radiology reports. OncoNet demonstrates an AUROC of 0.86 and 0.84 on internal and external institution test sets respectively for determination of change between scans while also showing strong agreement to clinical scoring systems with a kappa score of 0.8. We also curated a dataset of 1,954 paired FDG PET/CT exams designed for response assessment for the broader machine learning in healthcare research community. Automated assessment of radiographic response from FDG PET/CT with OncoNet could provide clinicians with a valuable tool to rapidly and consistently interpret change over time in longitudinal multi-modal imaging exams.

Arjun Soin, Pratik Bhatu, Rohit Takhar et al.

Adoption of artificial intelligence medical imaging applications is often impeded by barriers between healthcare systems and algorithm developers given that access to both private patient data and commercial model IP is important to perform pre-deployment evaluation. This work investigates a framework for secure, privacy-preserving and AI-enabled medical imaging inference using CrypTFlow2, a state-of-the-art end-to-end compiler allowing cryptographically secure 2-party Computation (2PC) protocols between the machine learning model vendor and target patient data owner. A common DenseNet-121 chest x-ray diagnosis model was evaluated on multi-institutional chest radiographic imaging datasets both with and without CrypTFlow2 on two test sets spanning seven sites across the US and India, and comprising 1,149 chest x-ray images. We measure comparative AUROC performance between secure and insecure inference in multiple pathology classification tasks, and explore model output distributional shifts and resource constraints introduced by secure model inference. Secure inference with CrypTFlow2 demonstrated no significant difference in AUROC for all diagnoses, and model outputs from secure and insecure inference methods were distributionally equivalent. The use of CrypTFlow2 may allow off-the-shelf secure 2PC between healthcare systems and AI model vendors for medical imaging, without changes in performance, and can facilitate scalable pre-deployment infrastructure for real-world secure model evaluation without exposure to patient data or model IP.