Oliver Aalami

Fan Wu, Tsai-Ning Wang, Nicolas Zumarraga et al. · eth-zurich, harvard

Auscultation is a vital diagnostic tool, yet its utility is often limited by subjective interpretation. While general-purpose Audio-Language Models (ALMs) excel in general domains, they struggle with the nuances of physiological signals. We propose a framework that aligns multi-site auscultation recordings directly with a frozen Large Language Model (LLM) embedding space via gated cross-attention. By leveraging the LLM's latent world knowledge, our approach moves beyond isolated classification toward holistic, patient-level assessment. On the CaReSound benchmark, our model achieves a state-of-the-art 0.865 F1-macro and 0.952 BERTScore. We demonstrate that lightweight, domain-specific encoders rival large-scale ALMs and that multi-site aggregation provides spatial redundancy that mitigates temporal truncation. This alignment of medical acoustics with text foundations offers a scalable path for bridging signal processing and clinical assessment.

Philipp Zagar, Vishnu Ravi, Lauren Aalami et al.

The ability of large language models (LLMs) to transform, interpret, and comprehend vast quantities of heterogeneous data presents a significant opportunity to enhance data-driven care delivery. However, the sensitive nature of protected health information (PHI) raises valid concerns about data privacy and trust in remote LLM platforms. In addition, the cost associated with cloud-based artificial intelligence (AI) services continues to impede widespread adoption. To address these challenges, we propose a shift in the LLM execution environment from opaque, centralized cloud providers to a decentralized and dynamic fog computing architecture. By executing open-weight LLMs in more trusted environments, such as the user's edge device or a fog layer within a local network, we aim to mitigate the privacy, trust, and financial challenges associated with cloud-based LLMs. We further present SpeziLLM, an open-source framework designed to facilitate rapid and seamless leveraging of different LLM execution layers and lowering barriers to LLM integration in digital health applications. We demonstrate SpeziLLM's broad applicability across six digital health applications, showcasing its versatility in various healthcare settings.

Patrick Langer, Thomas Kaar, Max Rosenblattl et al.

LLMs have emerged as powerful tools for interpreting multimodal data. In medicine, they hold particular promise for synthesizing large volumes of clinical information into actionable insights and digital health applications. Yet, a major limitation remains their inability to handle time series. To overcome this gap, we present OpenTSLM, a family of Time Series Language Models (TSLMs) created by integrating time series as a native modality to pretrained LLMs, enabling reasoning over multiple time series of any length. We investigate two architectures for OpenTSLM. The first, OpenTSLM-SoftPrompt, models time series implicitly by concatenating learnable time series tokens with text tokens via soft prompting. Although parameter-efficient, we hypothesize that explicit time series modeling scales better and outperforms implicit approaches. We thus introduce OpenTSLM-Flamingo, which integrates time series with text via cross-attention. We benchmark both variants against baselines that treat time series as text tokens or plots, across a suite of text-time-series Chain-of-Thought (CoT) reasoning tasks. We introduce three datasets: HAR-CoT, Sleep-CoT, and ECG-QA-CoT. Across all, OpenTSLM models outperform baselines, reaching 69.9 F1 in sleep staging and 65.4 in HAR, compared to 9.05 and 52.2 for finetuned text-only models. Notably, even 1B-parameter OpenTSLM models surpass GPT-4o (15.47 and 2.95). OpenTSLM-Flamingo matches OpenTSLM-SoftPrompt in performance and outperforms on longer sequences, while maintaining stable memory requirements. By contrast, SoftPrompt grows exponentially in memory with sequence length, requiring around 110 GB compared to 40 GB VRAM when training on ECG-QA with LLaMA-3B. Expert reviews by clinicians find strong reasoning capabilities exhibited by OpenTSLMs on ECG-QA. To facilitate further research, we provide all code, datasets, and models open-source.

Adrit Rao, Malte Jensen, Andrea T. Fisher et al.

Artificial intelligence allows automatic extraction of imaging biomarkers from already-acquired radiologic images. This paradigm of opportunistic imaging adds value to medical imaging without additional imaging costs or patient radiation exposure. However, many open-source image analysis solutions lack rigorous validation while commercial solutions lack transparency, leading to unexpected failures when deployed. Here, we report development and validation for two of the first fully open-sourced, FDA-510(k)-cleared deep learning pipelines to mitigate both challenges: Abdominal Aortic Quantification (AAQ) and Bone Mineral Density (BMD) estimation are both offered within the Comp2Comp package for opportunistic analysis of computed tomography scans. AAQ segments the abdominal aorta to assess aneurysm size; BMD segments vertebral bodies to estimate trabecular bone density and osteoporosis risk. AAQ-derived maximal aortic diameters were compared against radiologist ground-truth measurements on 258 patient scans enriched for abdominal aortic aneurysms from four external institutions. BMD binary classifications (low vs. normal bone density) were compared against concurrent DXA scan ground truths obtained on 371 patient scans from four external institutions. AAQ had an overall mean absolute error of 1.57 mm (95% CI 1.38-1.80 mm). BMD had a sensitivity of 81.0% (95% CI 74.0-86.8%) and specificity of 78.4% (95% CI 72.3-83.7%). Comp2Comp AAQ and BMD demonstrated sufficient accuracy for clinical use. Open-sourcing these algorithms improves transparency of typically opaque FDA clearance processes, allows hospitals to test the algorithms before cumbersome clinical pilots, and provides researchers with best-in-class methods.

Paul Schmiedmayer, Adrit Rao, Philipp Zagar et al.

Objective: To enhance health literacy and accessibility of health information for a diverse patient population by developing a patient-centered artificial intelligence (AI) solution using large language models (LLMs) and Fast Healthcare Interoperability Resources (FHIR) application programming interfaces (APIs). Materials and Methods: The research involved developing LLM on FHIR, an open-source mobile application allowing users to interact with their health records using LLMs. The app is built on Stanford's Spezi ecosystem and uses OpenAI's GPT-4. A pilot study was conducted with the SyntheticMass patient dataset and evaluated by medical experts to assess the app's effectiveness in increasing health literacy. The evaluation focused on the accuracy, relevance, and understandability of the LLM's responses to common patient questions. Results: LLM on FHIR demonstrated varying but generally high degrees of accuracy and relevance in providing understandable health information to patients. The app effectively translated medical data into patient-friendly language and was able to adapt its responses to different patient profiles. However, challenges included variability in LLM responses and the need for precise filtering of health data. Discussion and Conclusion: LLMs offer significant potential in improving health literacy and making health records more accessible. LLM on FHIR, as a pioneering application in this field, demonstrates the feasibility and challenges of integrating LLMs into patient care. While promising, the implementation and pilot also highlight risks such as inconsistent responses and the importance of replicable output. Future directions include better resource identification mechanisms and executing LLMs on-device to enhance privacy and reduce costs.

Cyril Zakka, Joseph Cho, Gracia Fahed et al.

Clinicians spend large amounts of time on clinical documentation, and inefficiencies impact quality of care and increase clinician burnout. Despite the promise of electronic medical records (EMR), the transition from paper-based records has been negatively associated with clinician wellness, in part due to poor user experience, increased burden of documentation, and alert fatigue. In this study, we present Almanac Copilot, an autonomous agent capable of assisting clinicians with EMR-specific tasks such as information retrieval and order placement. On EHR-QA, a synthetic evaluation dataset of 300 common EHR queries based on real patient data, Almanac Copilot obtains a successful task completion rate of 74% (n = 221 tasks) with a mean score of 2.45 over 3 (95% CI:2.34-2.56). By automating routine tasks and streamlining the documentation process, our findings highlight the significant potential of autonomous agents to mitigate the cognitive load imposed on clinicians by current EMR systems.

Leon Nissen, Philipp Zagar, Vishnu Ravi et al.

The deployment of Large Language Models (LLM) on mobile devices offers significant potential for medical applications, enhancing privacy, security, and cost-efficiency by eliminating reliance on cloud-based services and keeping sensitive health data local. However, the performance and accuracy of on-device LLMs in real-world medical contexts remain underexplored. In this study, we benchmark publicly available on-device LLMs using the AMEGA dataset, evaluating accuracy, computational efficiency, and thermal limitation across various mobile devices. Our results indicate that compact general-purpose models like Phi-3 Mini achieve a strong balance between speed and accuracy, while medically fine-tuned models such as Med42 and Aloe attain the highest accuracy. Notably, deploying LLMs on older devices remains feasible, with memory constraints posing a greater challenge than raw processing power. Our study underscores the potential of on-device LLMs for healthcare while emphasizing the need for more efficient inference and models tailored to real-world clinical reasoning.

Adrit Rao, Jongchan Park, Sanghyun Woo et al.

When the trained physician interprets medical images, they understand the clinical importance of visual features. By applying cognitive attention, they apply greater focus onto clinically relevant regions while disregarding unnecessary features. The use of computer vision to automate the classification of medical images is widely studied. However, the standard convolutional neural network (CNN) does not necessarily employ subconscious feature relevancy evaluation techniques similar to the trained medical specialist and evaluates features more generally. Self-attention mechanisms enable CNNs to focus more on semantically important regions or aggregated relevant context with long-range dependencies. By using attention, medical image analysis systems can potentially become more robust by focusing on more important clinical feature regions. In this paper, we provide a comprehensive comparison of various state-of-the-art self-attention mechanisms across multiple medical image analysis tasks. Through both quantitative and qualitative evaluations along with a clinical user-centric survey study, we aim to provide a deeper understanding of the effects of self-attention in medical computer vision tasks.

Adrit Rao, Kevin Battenfield, Oliver Aalami

Peripheral Arterial Disease (PAD) is a common form of arterial occlusive disease that is challenging to evaluate at the point-of-care. Hand-held dopplers are the most ubiquitous device used to evaluate circulation and allows providers to audibly "listen" to the blood flow. Providers use the audible feedback to subjectively assess whether the sound characteristics are consistent with Monophasic, Biphasic, or Triphasic waveforms. Subjective assessment of doppler sounds raises suspicion of PAD and leads to further testing, often delaying definitive treatment. Misdiagnoses are also possible with subjective interpretation of doppler waveforms. This paper presents a Deep Learning system that has the ability to predict waveform phasicity through analysis of hand-held doppler sounds. We collected 268 four-second recordings on an iPhone taken during a formal vascular lab study in patients with cardiovascular disease. Our end-to-end system works by converting input sound into a spectrogram which visually represents frequency changes in temporal patterns. This conversion enables visual differentiation between the phasicity classes. With these changes present, a custom trained Convolutional Neural Network (CNN) is used for prediction through learned feature extraction. The performance of the model was evaluated via calculation of the F1 score and accuracy metrics. The system received an F1 score of 90.57% and an accuracy of 96.23%. Our Deep Learning system is not computationally expensive and has the ability for integration within several applications. When used in a clinic, this system has the capability of preventing misdiagnosis and gives practitioners a second opinion that can be useful in the evaluation of PAD.

Varun Shenoy, Elizabeth Foster, Lauren Aalami et al.

Postoperative wound complications are a significant cause of expense for hospitals, doctors, and patients. Hence, an effective method to diagnose the onset of wound complications is strongly desired. Algorithmically classifying wound images is a difficult task due to the variability in the appearance of wound sites. Convolutional neural networks (CNNs), a subgroup of artificial neural networks that have shown great promise in analyzing visual imagery, can be leveraged to categorize surgical wounds. We present a multi-label CNN ensemble, Deepwound, trained to classify wound images using only image pixels and corresponding labels as inputs. Our final computational model can accurately identify the presence of nine labels: drainage, fibrinous exudate, granulation tissue, surgical site infection, open wound, staples, steri strips, and sutures. Our model achieves receiver operating curve (ROC) area under curve (AUC) scores, sensitivity, specificity, and F1 scores superior to prior work in this area. Smartphones provide a means to deliver accessible wound care due to their increasing ubiquity. Paired with deep neural networks, they offer the capability to provide clinical insight to assist surgeons during postoperative care. We also present a mobile application frontend to Deepwound that assists patients in tracking their wound and surgical recovery from the comfort of their home.