J. Titano

Daniel Ranti, Katie Hanss, Shan Zhao et al.

The purpose of this study is to analyze the efficacy of transfer learning techniques and transformer-based models as applied to medical natural language processing (NLP) tasks, specifically radiological text classification. We used 1,977 labeled head CT reports, from a corpus of 96,303 total reports, to evaluate the efficacy of pretraining using general domain corpora and a combined general and medical domain corpus with a bidirectional representations from transformers (BERT) model for the purpose of radiological text classification. Model performance was benchmarked to a logistic regression using bag-of-words vectorization and a long short-term memory (LSTM) multi-label multi-class classification model, and compared to the published literature in medical text classification. The BERT models using either set of pretrained checkpoints outperformed the logistic regression model, achieving sample-weighted average F1-scores of 0.87 and 0.87 for the general domain model and the combined general and biomedical-domain model. General text transfer learning may be a viable technique to generate state-of-the-art results within medical NLP tasks on radiological corpora, outperforming other deep models such as LSTMs. The efficacy of pretraining and transformer-based models could serve to facilitate the creation of groundbreaking NLP models in the uniquely challenging data environment of medical text.

John R. Zech, Marcus A. Badgeley, Manway Liu et al.

Early results in using convolutional neural networks (CNNs) on x-rays to diagnose disease have been promising, but it has not yet been shown that models trained on x-rays from one hospital or one group of hospitals will work equally well at different hospitals. Before these tools are used for computer-aided diagnosis in real-world clinical settings, we must verify their ability to generalize across a variety of hospital systems. A cross-sectional design was used to train and evaluate pneumonia screening CNNs on 158,323 chest x-rays from NIH (n=112,120 from 30,805 patients), Mount Sinai (42,396 from 12,904 patients), and Indiana (n=3,807 from 3,683 patients). In 3 / 5 natural comparisons, performance on chest x-rays from outside hospitals was significantly lower than on held-out x-rays from the original hospital systems. CNNs were able to detect where an x-ray was acquired (hospital system, hospital department) with extremely high accuracy and calibrate predictions accordingly. The performance of CNNs in diagnosing diseases on x-rays may reflect not only their ability to identify disease-specific imaging findings on x-rays, but also their ability to exploit confounding information. Estimates of CNN performance based on test data from hospital systems used for model training may overstate their likely real-world performance.