Charles Lu

Charles Lu, Anastasios N. Angelopoulos, Stuart Pomerantz · berkeley

The regulatory approval and broad clinical deployment of medical AI have been hampered by the perception that deep learning models fail in unpredictable and possibly catastrophic ways. A lack of statistically rigorous uncertainty quantification is a significant factor undermining trust in AI results. Recent developments in distribution-free uncertainty quantification present practical solutions for these issues by providing reliability guarantees for black-box models on arbitrary data distributions as formally valid finite-sample prediction intervals. Our work applies these new uncertainty quantification methods -- specifically conformal prediction -- to a deep-learning model for grading the severity of spinal stenosis in lumbar spine MRI. We demonstrate a technique for forming ordinal prediction sets that are guaranteed to contain the correct stenosis severity within a user-defined probability (confidence interval). On a dataset of 409 MRI exams processed by the deep-learning model, the conformal method provides tight coverage with small prediction set sizes. Furthermore, we explore the potential clinical applicability of flagging cases with high uncertainty predictions (large prediction sets) by quantifying an increase in the prevalence of significant imaging abnormalities (e.g. motion artifacts, metallic artifacts, and tumors) that could degrade confidence in predictive performance when compared to a random sample of cases.

Charles Lu, Ken Chang, Praveer Singh et al.

Breast cancer is the most common cancers and early detection from mammography screening is crucial in improving patient outcomes. Assessing mammographic breast density is clinically important as the denser breasts have higher risk and are more likely to occlude tumors. Manual assessment by experts is both time-consuming and subject to inter-rater variability. As such, there has been increased interest in the development of deep learning methods for mammographic breast density assessment. Despite deep learning having demonstrated impressive performance in several prediction tasks for applications in mammography, clinical deployment of deep learning systems in still relatively rare; historically, mammography Computer-Aided Diagnoses (CAD) have over-promised and failed to deliver. This is in part due to the inability to intuitively quantify uncertainty of the algorithm for the clinician, which would greatly enhance usability. Conformal prediction is well suited to increase reliably and trust in deep learning tools but they lack realistic evaluations on medical datasets. In this paper, we present a detailed analysis of three possible applications of conformal prediction applied to medical imaging tasks: distribution shift characterization, prediction quality improvement, and subgroup fairness analysis. Our results show the potential of distribution-free uncertainty quantification techniques to enhance trust on AI algorithms and expedite their translation to usage.

Charles Lu, Syed Rakin Ahmed, Praveer Singh et al.

Estimating the test performance of software AI-based medical devices under distribution shifts is crucial for evaluating the safety, efficiency, and usability prior to clinical deployment. Due to the nature of regulated medical device software and the difficulty in acquiring large amounts of labeled medical datasets, we consider the task of predicting the test accuracy of an arbitrary black-box model on an unlabeled target domain without modification to the original training process or any distributional assumptions of the original source data (i.e. we treat the model as a "black-box" and only use the predicted output responses). We propose a "black-box" test estimation technique based on conformal prediction and evaluate it against other methods on three medical imaging datasets (mammography, dermatology, and histopathology) under several clinically relevant types of distribution shift (institution, hardware scanner, atlas, hospital). We hope that by promoting practical and effective estimation techniques for black-box models, manufacturers of medical devices will develop more standardized and realistic evaluation procedures to improve the robustness and trustworthiness of clinical AI tools.

Charles Lu, Andreanne Lemay, Ken Chang et al.

Deep learning has the potential to automate many clinically useful tasks in medical imaging. However translation of deep learning into clinical practice has been hindered by issues such as lack of the transparency and interpretability in these "black box" algorithms compared to traditional statistical methods. Specifically, many clinical deep learning models lack rigorous and robust techniques for conveying certainty (or lack thereof) in their predictions -- ultimately limiting their appeal for extensive use in medical decision-making. Furthermore, numerous demonstrations of algorithmic bias have increased hesitancy towards deployment of deep learning for clinical applications. To this end, we explore how conformal predictions can complement existing deep learning approaches by providing an intuitive way of expressing uncertainty while facilitating greater transparency to clinical users. In this paper, we conduct field interviews with radiologists to assess possible use-cases for conformal predictors. Using insights gathered from these interviews, we devise two clinical use-cases and empirically evaluate several methods of conformal predictions on a dermatology photography dataset for skin lesion classification. We show how to modify conformal predictions to be more adaptive to subgroup differences in patient skin tones through equalized coverage. Finally, we compare conformal prediction against measures of epistemic uncertainty.

Sharut Gupta, Praveer Singh, Ken Chang et al.

Model brittleness is a key concern when deploying deep learning models in real-world medical settings. A model that has high performance at one institution may suffer a significant decline in performance when tested at other institutions. While pooling datasets from multiple institutions and retraining may provide a straightforward solution, it is often infeasible and may compromise patient privacy. An alternative approach is to fine-tune the model on subsequent institutions after training on the original institution. Notably, this approach degrades model performance at the original institution, a phenomenon known as catastrophic forgetting. In this paper, we develop an approach to address catastrophic forget-ting based on elastic weight consolidation combined with modulation of batch normalization statistics under two scenarios: first, for expanding the domain from one imaging system's data to another imaging system's, and second, for expanding the domain from a large multi-institutional dataset to another single institution dataset. We show that our approach outperforms several other state-of-the-art approaches and provide theoretical justification for the efficacy of batch normalization modulation. The results of this study are generally applicable to the deployment of any clinical deep learning model which requires domain expansion.