Ying Ding

Yan Han, Gregory Holste, Ying Ding et al.

Before the recent success of deep learning methods for automated medical image analysis, practitioners used handcrafted radiomic features to quantitatively describe local patches of medical images. However, extracting discriminative radiomic features relies on accurate pathology localization, which is difficult to acquire in real-world settings. Despite advances in disease classification and localization from chest X-rays, many approaches fail to incorporate clinically-informed domain knowledge. For these reasons, we propose a Radiomics-Guided Transformer (RGT) that fuses \textit{global} image information with \textit{local} knowledge-guided radiomics information to provide accurate cardiopulmonary pathology localization and classification \textit{without any bounding box annotations}. RGT consists of an image Transformer branch, a radiomics Transformer branch, and fusion layers that aggregate image and radiomic information. Using the learned self-attention of its image branch, RGT extracts a bounding box for which to compute radiomic features, which are further processed by the radiomics branch; learned image and radiomic features are then fused and mutually interact via cross-attention layers. Thus, RGT utilizes a novel end-to-end feedback loop that can bootstrap accurate pathology localization only using image-level disease labels. Experiments on the NIH ChestXRay dataset demonstrate that RGT outperforms prior works in weakly supervised disease localization (by an average margin of 3.6\% over various intersection-over-union thresholds) and classification (by 1.1\% in average area under the receiver operating characteristic curve). We publicly release our codes and pre-trained models at \url{https://github.com/VITA-Group/chext}.

Gregory Holste, Ziyu Jiang, Ajay Jaiswal et al.

Pruning has emerged as a powerful technique for compressing deep neural networks, reducing memory usage and inference time without significantly affecting overall performance. However, the nuanced ways in which pruning impacts model behavior are not well understood, particularly for long-tailed, multi-label datasets commonly found in clinical settings. This knowledge gap could have dangerous implications when deploying a pruned model for diagnosis, where unexpected model behavior could impact patient well-being. To fill this gap, we perform the first analysis of pruning's effect on neural networks trained to diagnose thorax diseases from chest X-rays (CXRs). On two large CXR datasets, we examine which diseases are most affected by pruning and characterize class "forgettability" based on disease frequency and co-occurrence behavior. Further, we identify individual CXRs where uncompressed and heavily pruned models disagree, known as pruning-identified exemplars (PIEs), and conduct a human reader study to evaluate their unifying qualities. We find that radiologists perceive PIEs as having more label noise, lower image quality, and higher diagnosis difficulty. This work represents a first step toward understanding the impact of pruning on model behavior in deep long-tailed, multi-label medical image classification. All code, model weights, and data access instructions can be found at https://github.com/VITA-Group/PruneCXR.

Lang Zeng, Jipeng Zhang, Wei Chen et al.

The aim of dynamic prediction is to provide individualized risk predictions over time, which are updated as new data become available. In pursuit of constructing a dynamic prediction model for a progressive eye disorder, age-related macular degeneration (AMD), we propose a time-dependent Cox survival neural network (tdCoxSNN) to predict its progression using longitudinal fundus images. tdCoxSNN builds upon the time-dependent Cox model by utilizing a neural network to capture the non-linear effect of time-dependent covariates on the survival outcome. Moreover, by concurrently integrating a convolutional neural network (CNN) with the survival network, tdCoxSNN can directly take longitudinal images as input. We evaluate and compare our proposed method with joint modeling and landmarking approaches through extensive simulations. We applied the proposed approach to two real datasets. One is a large AMD study, the Age-Related Eye Disease Study (AREDS), in which more than 50,000 fundus images were captured over a period of 12 years for more than 4,000 participants. Another is a public dataset of the primary biliary cirrhosis (PBC) disease, where multiple lab tests were longitudinally collected to predict the time-to-liver transplant. Our approach demonstrates commendable predictive performance in both simulation studies and the analysis of the two real datasets.

Ajay Jaiswal, Kumar Ashutosh, Justin F Rousseau et al.

AI-powered Medical Imaging has recently achieved enormous attention due to its ability to provide fast-paced healthcare diagnoses. However, it usually suffers from a lack of high-quality datasets due to high annotation cost, inter-observer variability, human annotator error, and errors in computer-generated labels. Deep learning models trained on noisy labelled datasets are sensitive to the noise type and lead to less generalization on the unseen samples. To address this challenge, we propose a Robust Stochastic Knowledge Distillation (RoS-KD) framework which mimics the notion of learning a topic from multiple sources to ensure deterrence in learning noisy information. More specifically, RoS-KD learns a smooth, well-informed, and robust student manifold by distilling knowledge from multiple teachers trained on overlapping subsets of training data. Our extensive experiments on popular medical imaging classification tasks (cardiopulmonary disease and lesion classification) using real-world datasets, show the performance benefit of RoS-KD, its ability to distill knowledge from many popular large networks (ResNet-50, DenseNet-121, MobileNet-V2) in a comparatively small network, and its robustness to adversarial attacks (PGD, FSGM). More specifically, RoS-KD achieves >2% and >4% improvement on F1-score for lesion classification and cardiopulmonary disease classification tasks, respectively, when the underlying student is ResNet-18 against recent competitive knowledge distillation baseline. Additionally, on cardiopulmonary disease classification task, RoS-KD outperforms most of the SOTA baselines by ~1% gain in AUC score.

Dawei Li, Shu Yang, Zhen Tan et al.

Recent advancements in large language models (LLMs) have achieved promising performances across various applications. Nonetheless, the ongoing challenge of integrating long-tail knowledge continues to impede the seamless adoption of LLMs in specialized domains. In this work, we introduce DALK, a.k.a. Dynamic Co-Augmentation of LLMs and KG, to address this limitation and demonstrate its ability on studying Alzheimer's Disease (AD), a specialized sub-field in biomedicine and a global health priority. With a synergized framework of LLM and KG mutually enhancing each other, we first leverage LLM to construct an evolving AD-specific knowledge graph (KG) sourced from AD-related scientific literature, and then we utilize a coarse-to-fine sampling method with a novel self-aware knowledge retrieval approach to select appropriate knowledge from the KG to augment LLM inference capabilities. The experimental results, conducted on our constructed AD question answering (ADQA) benchmark, underscore the efficacy of DALK. Additionally, we perform a series of detailed analyses that can offer valuable insights and guidelines for the emerging topic of mutually enhancing KG and LLM. We will release the code and data at https://github.com/David-Li0406/DALK.

Muhammad Zain Raza, Jiawei Xu, Terence Lim et al.

Thematic Analysis (TA) is a fundamental method in healthcare research for analyzing transcript data, but it is resource-intensive and difficult to scale for large, complex datasets. This study investigates the potential of large language models (LLMs) to augment the inductive TA process in high-stakes healthcare settings. Focusing on interview transcripts from parents of children with Anomalous Aortic Origin of a Coronary Artery (AAOCA), a rare congenital heart disease, we propose an LLM-Enhanced Thematic Analysis (LLM-TA) pipeline. Our pipeline integrates an affordable state-of-the-art LLM (GPT-4o mini), LangChain, and prompt engineering with chunking techniques to analyze nine detailed transcripts following the inductive TA framework. We evaluate the LLM-generated themes against human-generated results using thematic similarity metrics, LLM-assisted assessments, and expert reviews. Results demonstrate that our pipeline outperforms existing LLM-assisted TA methods significantly. While the pipeline alone has not yet reached human-level quality in inductive TA, it shows great potential to improve scalability, efficiency, and accuracy while reducing analyst workload when working collaboratively with domain experts. We provide practical recommendations for incorporating LLMs into high-stakes TA workflows and emphasize the importance of close collaboration with domain experts to address challenges related to real-world applicability and dataset complexity. https://github.com/jiaweixu98/LLM-TA

Song Wang, Liyan Tang, Mingquan Lin et al.

Radiology report generation aims to produce computer-aided diagnoses to alleviate the workload of radiologists and has drawn increasing attention recently. However, previous deep learning methods tend to neglect the mutual influences between medical findings, which can be the bottleneck that limits the quality of generated reports. In this work, we propose to mine and represent the associations among medical findings in an informative knowledge graph and incorporate this prior knowledge with radiology report generation to help improve the quality of generated reports. Experiment results demonstrate the superior performance of our proposed method on the IU X-ray dataset with a ROUGE-L of 0.384$\pm$0.007 and CIDEr of 0.340$\pm$0.011. Compared with previous works, our model achieves an average of 1.6% improvement (2.0% and 1.5% improvements in CIDEr and ROUGE-L, respectively). The experiments suggest that prior knowledge can bring performance gains to accurate radiology report generation. We will make the code publicly available at https://github.com/bionlplab/report_generation_amia2022.

Yan Han, Chongyan Chen, Liyan Tang et al.

Chest X-ray becomes one of the most common medical diagnoses due to its noninvasiveness. The number of chest X-ray images has skyrocketed, but reading chest X-rays still have been manually performed by radiologists, which creates huge burnouts and delays. Traditionally, radiomics, as a subfield of radiology that can extract a large number of quantitative features from medical images, demonstrates its potential to facilitate medical imaging diagnosis before the deep learning era. In this paper, we develop an end-to-end framework, ChexRadiNet, that can utilize the radiomics features to improve the abnormality classification performance. Specifically, ChexRadiNet first applies a light-weight but efficient triplet-attention mechanism to classify the chest X-rays and highlight the abnormal regions. Then it uses the generated class activation map to extract radiomic features, which further guides our model to learn more robust image features. After a number of iterations and with the help of radiomic features, our framework can converge to more accurate image regions. We evaluate the ChexRadiNet framework using three public datasets: NIH ChestX-ray, CheXpert, and MIMIC-CXR. We find that ChexRadiNet outperforms the state-of-the-art on both disease detection (0.843 in AUC) and localization (0.679 in T(IoU) = 0.1). We will make the code publicly available at https://github.com/bionlplab/lung_disease_detection_amia2021, with the hope that this method can facilitate the development of automatic systems with a higher-level understanding of the radiological world.

Kyle Cox, Jiawei Xu, Yikun Han et al.

An interesting behavior in large language models (LLMs) is prompt sensitivity. When provided with different but semantically equivalent versions of the same prompt, models may produce very different distributions of answers. This suggests that the uncertainty reflected in a model's output distribution for one prompt may not reflect the model's uncertainty about the meaning of the prompt. We model prompt sensitivity as a type of generalization error, and show that sampling across the semantic ``concept space'' with paraphrasing perturbations improves uncertainty calibration without compromising accuracy. Additionally, we introduce a new metric for uncertainty decomposition in black-box LLMs that improves upon entropy-based decomposition by modeling semantic continuities in natural language generation. We show that this decomposition metric can be used to quantify how much LLM uncertainty is attributed to prompt sensitivity. Our work introduces a new way to improve uncertainty calibration in prompt-sensitive language models, and provides evidence that some LLMs fail to exhibit consistent general reasoning about the meanings of their inputs.

Song Wang, Yiliang Zhou, Ziqiang Han et al.

Data accuracy is essential for scientific research and policy development. The National Violent Death Reporting System (NVDRS) data is widely used for discovering the patterns and causes of death. Recent studies suggested the annotation inconsistencies within the NVDRS and the potential impact on erroneous suicide-cause attributions. We present an empirical Natural Language Processing (NLP) approach to detect annotation inconsistencies and adopt a cross-validation-like paradigm to identify problematic instances. We analyzed 267,804 suicide death incidents between 2003 and 2020 from the NVDRS. Our results showed that incorporating the target state's data into training the suicide-crisis classifier brought an increase of 5.4% to the F-1 score on the target state's test set and a decrease of 1.1% on other states' test set. To conclude, we demonstrated the annotation inconsistencies in NVDRS's death investigation notes, identified problematic instances, evaluated the effectiveness of correcting problematic instances, and eventually proposed an NLP improvement solution.

Philip DiGiacomo, Haoyang Wang, Jinrui Fang et al.

As AI chatbots gain adoption in clinical medicine, developing effective frameworks for complex, emerging diseases presents significant challenges. We developed and evaluated six Retrieval-Augmented Generation (RAG) corpus configurations for Long COVID (LC) clinical question answering, ranging from expert-curated sources to large-scale literature databases. Our evaluation employed an LLM-as-a-judge framework across faithfulness, relevance, and comprehensiveness metrics using LongCOVID-CQ, a novel dataset of expert-generated clinical questions. Our RAG corpus configuration combining clinical guidelines with high-quality systematic reviews consistently outperformed both narrow single-guideline approaches and large-scale literature databases. Our findings suggest that for emerging diseases, retrieval grounded in curated secondary reviews provides an optimal balance between narrow consensus documents and unfiltered primary literature, supporting clinical decision-making while avoiding information overload and oversimplified guidance. We propose Guide-RAG, a chatbot system and accompanying evaluation framework that integrates both curated expert knowledge and comprehensive literature databases to effectively answer LC clinical questions.

Jiawei Xu, Yonggeon Lee, Anthony Elkommos Youssef et al.

This study addresses the challenge of predicting post-stroke rigidity by emphasizing feature interactions through graph-based explainable AI. Post-stroke rigidity, characterized by increased muscle tone and stiffness, significantly affects survivors' mobility and quality of life. Despite its prevalence, early prediction remains limited, delaying intervention. We analyze 519K stroke hospitalization records from the Healthcare Cost and Utilization Project dataset, where 43% of patients exhibited rigidity. We compare traditional approaches such as Logistic Regression, XGBoost, and Transformer with graph-based models like Graphormer and Graph Attention Network. These graph models inherently capture feature interactions and incorporate intrinsic or post-hoc explainability. Our results show that graph-based methods outperform others (AUROC 0.75), identifying key predictors such as NIH Stroke Scale and APR-DRG mortality risk scores. They also uncover interactions missed by conventional models. This research provides a novel application of graph-based XAI in stroke prognosis, with potential to guide early identification and personalized rehabilitation strategies.

Zhuoyi Shang, Yanwei Liu, Jinxia Liu et al.

For general users, training a neural network from scratch is usually challenging and labor-intensive. Fortunately, neural network zoos enable them to find a well-performing model for directly use or fine-tuning it in their local environments. Although current model retrieval solutions attempt to convert neural network models into vectors to avoid complex multiple inference processes required for model selection, it is still difficult to choose a suitable model due to inaccurate vectorization and biased correlation alignment between the query dataset and models. From the perspective of knowledge consistency, i.e., whether the knowledge possessed by the model can meet the needs of query tasks, we propose a model retrieval scheme, named Know2Vec, that acts as a black-box retrieval proxy for model zoo. Know2Vec first accesses to models via a black-box interface in advance, capturing vital decision knowledge from models while ensuring their privacy. Next, it employs an effective encoding technique to transform the knowledge into precise model vectors. Secondly, it maps the user's query task to a knowledge vector by probing the semantic relationships within query samples. Furthermore, the proxy ensures the knowledge-consistency between query vector and model vectors within their alignment space, which is optimized through the supervised learning with diverse loss functions, and finally it can identify the most suitable model for a given task during the inference stage. Extensive experiments show that our Know2Vec achieves superior retrieval accuracy against the state-of-the-art methods in diverse neural network retrieval tasks.

Mingquan Lin, Tianhao Li, Zhaoyi Sun et al.

Purpose: Limited studies exploring concrete methods or approaches to tackle and enhance model fairness in the radiology domain. Our proposed AI model utilizes supervised contrastive learning to minimize bias in CXR diagnosis. Materials and Methods: In this retrospective study, we evaluated our proposed method on two datasets: the Medical Imaging and Data Resource Center (MIDRC) dataset with 77,887 CXR images from 27,796 patients collected as of April 20, 2023 for COVID-19 diagnosis, and the NIH Chest X-ray (NIH-CXR) dataset with 112,120 CXR images from 30,805 patients collected between 1992 and 2015. In the NIH-CXR dataset, thoracic abnormalities include atelectasis, cardiomegaly, effusion, infiltration, mass, nodule, pneumonia, pneumothorax, consolidation, edema, emphysema, fibrosis, pleural thickening, or hernia. Our proposed method utilizes supervised contrastive learning with carefully selected positive and negative samples to generate fair image embeddings, which are fine-tuned for subsequent tasks to reduce bias in chest X-ray (CXR) diagnosis. We evaluated the methods using the marginal AUC difference ($δ$ mAUC). Results: The proposed model showed a significant decrease in bias across all subgroups when compared to the baseline models, as evidenced by a paired T-test (p<0.0001). The $δ$ mAUC obtained by our method were 0.0116 (95\% CI, 0.0110-0.0123), 0.2102 (95% CI, 0.2087-0.2118), and 0.1000 (95\% CI, 0.0988-0.1011) for sex, race, and age on MIDRC, and 0.0090 (95\% CI, 0.0082-0.0097) for sex and 0.0512 (95% CI, 0.0512-0.0532) for age on NIH-CXR, respectively. Conclusion: Employing supervised contrastive learning can mitigate bias in CXR diagnosis, addressing concerns of fairness and reliability in deep learning-based diagnostic methods.

Huimin Xu, Yi Bu, Meijun Liu et al.

Power dynamics influence every aspect of scientific collaboration. Team power dynamics can be measured by team power level and team power hierarchy. Team power level is conceptualized as the average level of the possession of resources, expertise, or decision-making authorities of a team. Team power hierarchy represents the vertical differences of the possessions of resources in a team. In Science of Science, few studies have looked at scientific collaboration from the perspective of team power dynamics. This research examines how team power dynamics affect team impact to fill the research gap. In this research, all co-authors of one publication are treated as one team. Team power level and team power hierarchy of one team are measured by the mean and Gini index of career age of co-authors in this team. Team impact is quantified by citations of a paper authored by this team. By analyzing over 7.7 million teams from Science (e.g., Computer Science, Physics), Social Sciences (e.g., Sociology, Library & Information Science), and Arts & Humanities (e.g., Art), we find that flat team structure is associated with higher team impact, especially when teams have high team power level. These findings have been repeated in all five disciplines except Art, and are consistent in various types of teams from Computer Science including teams from industry or academia, teams with different gender groups, teams with geographical contrast, and teams with distinct size.

Yan Han, Chongyan Chen, Ahmed Tewfik et al.

Building a highly accurate predictive model for classification and localization of abnormalities in chest X-rays usually requires a large number of manually annotated labels and pixel regions (bounding boxes) of abnormalities. However, it is expensive to acquire such annotations, especially the bounding boxes. Recently, contrastive learning has shown strong promise in leveraging unlabeled natural images to produce highly generalizable and discriminative features. However, extending its power to the medical image domain is under-explored and highly non-trivial, since medical images are much less amendable to data augmentations. In contrast, their prior knowledge, as well as radiomic features, is often crucial. To bridge this gap, we propose an end-to-end semi-supervised knowledge-augmented contrastive learning framework, that simultaneously performs disease classification and localization tasks. The key knob of our framework is a unique positive sampling approach tailored for the medical images, by seamlessly integrating radiomic features as a knowledge augmentation. Specifically, we first apply an image encoder to classify the chest X-rays and to generate the image features. We next leverage Grad-CAM to highlight the crucial (abnormal) regions for chest X-rays (even when unannotated), from which we extract radiomic features. The radiomic features are then passed through another dedicated encoder to act as the positive sample for the image features generated from the same chest X-ray. In this way, our framework constitutes a feedback loop for image and radiomic modality features to mutually reinforce each other. Their contrasting yields knowledge-augmented representations that are both robust and interpretable. Extensive experiments on the NIH Chest X-ray dataset demonstrate that our approach outperforms existing baselines in both classification and localization tasks.

Zhe Sun, Ting Wang, Ke Deng et al.

Motivation: Single cell transcriptome sequencing (scRNA-Seq) has become a revolutionary tool to study cellular and molecular processes at single cell resolution. Among existing technologies, the recently developed droplet-based platform enables efficient parallel processing of thousands of single cells with direct counting of transcript copies using Unique Molecular Identifier (UMI). Despite the technology advances, statistical methods and computational tools are still lacking for analyzing droplet-based scRNA-Seq data. Particularly, model-based approaches for clustering large-scale single cell transcriptomic data are still under-explored. Methods: We developed DIMM-SC, a Dirichlet Mixture Model for clustering droplet-based Single Cell transcriptomic data. This approach explicitly models UMI count data from scRNA-Seq experiments and characterizes variations across different cell clusters via a Dirichlet mixture prior. An expectation-maximization algorithm is used for parameter inference. Results: We performed comprehensive simulations to evaluate DIMM-SC and compared it with existing clustering methods such as K-means, CellTree and Seurat. In addition, we analyzed public scRNA-Seq datasets with known cluster labels and in-house scRNA-Seq datasets from a study of systemic sclerosis with prior biological knowledge to benchmark and validate DIMM-SC. Both simulation studies and real data applications demonstrated that overall, DIMM-SC achieves substantially improved clustering accuracy and much lower clustering variability compared to other existing clustering methods. More importantly, as a model-based approach, DIMM-SC is able to quantify the clustering uncertainty for each single cell, facilitating rigorous statistical inference and biological interpretations, which are typically unavailable from existing clustering methods.