David Chen

Jielin Qiu, Peide Huang, Makiya Nakashima et al.

Self-supervised learning is crucial for clinical imaging applications, given the lack of explicit labels in healthcare. However, conventional approaches that rely on precise vision-language alignment are not always feasible in complex clinical imaging modalities, such as cardiac magnetic resonance (CMR). CMR provides a comprehensive visualization of cardiac anatomy, physiology, and microstructure, making it challenging to interpret. Additionally, CMR reports require synthesizing information from sequences of images and different views, resulting in potentially weak alignment between the study and diagnosis report pair. To overcome these challenges, we propose \textbf{CMRformer}, a multimodal learning framework to jointly learn sequences of CMR images and associated cardiologist's reports. Moreover, one of the major obstacles to improving CMR study is the lack of large, publicly available datasets. To bridge this gap, we collected a large \textbf{CMR dataset}, which consists of 13,787 studies from clinical cases. By utilizing our proposed CMRformer and our collected dataset, we achieved remarkable performance in real-world clinical tasks, such as CMR image retrieval and diagnosis report retrieval. Furthermore, the learned representations are evaluated to be practically helpful for downstream applications, such as disease classification. Our work could potentially expedite progress in the CMR study and lead to more accurate and effective diagnosis and treatment.

Makiya Nakashima, Inyeop Jang, Ramesh Basnet et al.

Training deep learning models on cardiac magnetic resonance imaging (CMR) can be a challenge due to the small amount of expert generated labels and inherent complexity of data source. Self-supervised contrastive learning (SSCL) has recently been shown to boost performance in several medical imaging tasks. However, it is unclear how much the pre-trained representation reflects the primary organ of interest compared to spurious surrounding tissue. In this work, we evaluate the optimal method of incorporating prior knowledge of anatomy into a SSCL training paradigm. Specifically, we evaluate using a segmentation network to explicitly local the heart in CMR images, followed by SSCL pretraining in multiple diagnostic tasks. We find that using a priori knowledge of anatomy can greatly improve the downstream diagnostic performance. Furthermore, SSCL pre-training with in-domain data generally improved downstream performance and more human-like saliency compared to end-to-end training and ImageNet pre-trained networks. However, introducing anatomic knowledge to pre-training generally does not have significant impact.

Sahil Sethi, David Chen, Michael C. Burkhart et al.

Prototype-based neural networks offer interpretable predictions by comparing inputs to learned, representative signal patterns anchored in training data. While such models have shown promise in the classification of physiological data, it remains unclear whether their prototypes capture an underlying structure that aligns with broader clinical phenotypes. We use a prototype-based deep learning model trained for multi-label ECG classification using the PTB-XL dataset. Then without modification we performed inference on the MIMIC-IV clinical database. We assess whether individual prototypes, trained solely for classification, are associated with hospital discharge diagnoses in the form of phecodes in this external population. Individual prototypes demonstrate significantly stronger and more specific associations with clinical outcomes compared to the classifier's class predictions, NLP-extracted concepts, or broader prototype classes across all phecode categories. Prototype classes with mixed significance patterns exhibit significantly greater intra-class distances (p $<$ 0.0001), indicating the model learned to differentiate clinically meaningful variations within diagnostic categories. The prototypes achieve strong predictive performance across diverse conditions, with AUCs ranging from 0.89 for atrial fibrillation to 0.91 for heart failure, while also showing substantial signal for non-cardiac conditions such as sepsis and renal disease. These findings suggest that prototype-based models can support interpretable digital phenotyping from physiologic time-series data, providing transferable intermediate phenotypes that capture clinically meaningful physiologic signatures beyond their original training objectives.

Nicole Meng, Caleb Manicke, David Chen et al.

Adversarial examples represent a serious issue for the application of machine learning models in many sensitive domains. For generating adversarial examples, decision based black-box attacks are one of the most practical techniques as they only require query access to the model. One of the most recently proposed state-of-the-art decision based black-box attacks is Triangle Attack (TA). In this paper, we offer a high-level description of TA and explain potential theoretical limitations. We then propose a new decision based black-box attack, Triangle Attack with Reinforcement Learning (TARL). Our new attack addresses the limits of TA by leveraging reinforcement learning. This creates an attack that can achieve similar, if not better, attack accuracy than TA with half as many queries on state-of-the-art classifiers and defenses across ImageNet and CIFAR-10.

Zizhuo Zhang, Lian Wen, Shaoyang Zhang et al.

In the burgeoning field of artificial intelligence (AI), understanding the capabilities and limitations of programming-oriented models is crucial. This paper presents a novel evaluation of the programming proficiency of Generative Pretrained Transformer (GPT) models, specifically GPT-3.5 and GPT-4, against coding problems of varying difficulty levels drawn from Codewars. The experiments reveal a distinct boundary at the 3kyu level, beyond which these GPT models struggle to provide solutions. These findings led to the proposal of a measure for coding problem complexity that incorporates both problem difficulty and the time required for solution. The research emphasizes the need for validation and creative thinking capabilities in AI models to better emulate human problem-solving techniques. Future work aims to refine this proposed complexity measure, enhance AI models with these suggested capabilities, and develop an objective measure for programming problem difficulty. The results of this research offer invaluable insights for improving AI programming capabilities and advancing the frontier of AI problem-solving abilities.

Sunyang Fu, David Chen, Huan He et al.

Background Concept extraction, a subdomain of natural language processing (NLP) with a focus on extracting concepts of interest, has been adopted to computationally extract clinical information from text for a wide range of applications ranging from clinical decision support to care quality improvement. Objectives In this literature review, we provide a methodology review of clinical concept extraction, aiming to catalog development processes, available methods and tools, and specific considerations when developing clinical concept extraction applications. Methods Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was conducted for retrieving EHR-based information extraction articles written in English and published from January 2009 through June 2019 from Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and the ACM Digital Library. Results A total of 6,686 publications were retrieved. After title and abstract screening, 228 publications were selected. The methods used for developing clinical concept extraction applications were discussed in this review.