Many sequential decision settings in healthcare feature funnel structures characterized by a series of stages, such as screenings or evaluations, where the number of patients who advance to each stage progressively decreases and decisions become increasingly costly. For example, an oncologist may first conduct a breast exam, followed by a mammogram for patients with concerning exams, followed by a biopsy for patients with concerning mammograms. A key challenge is that the ground truth outcome, such as the biopsy result, is only revealed at the end of this funnel. The selective censoring of the ground truth can introduce statistical biases in risk estimation, especially in underserved patient groups, whose outcomes are more frequently censored. We develop a Bayesian model for funnel decision structures, drawing from prior work on selective labels and censoring. We first show in synthetic settings that our model is able to recover the true parameters and predict outcomes for censored patients more accurately than baselines. We then apply our model to a dataset of emergency department visits, where in-hospital mortality is observed only for those who are admitted to either the hospital or ICU. We find that there are gender-based differences in hospital and ICU admissions. In particular, our model estimates that the mortality risk threshold to admit women to the ICU is higher for women (5.1%) than for men (4.5%).

Phyllodes tumors (PTs) are rare fibroepithelial breast lesions that are difficult to classify preoperatively due to their radiological similarity to benign fibroadenomas. This often leads to unnecessary surgical excisions. To address this, we propose a multimodal deep learning framework that integrates breast ultrasound (BUS) images with structured clinical data to improve diagnostic accuracy. We developed a dual-branch neural network that extracts and fuses features from ultrasound images and patient metadata from 81 subjects with confirmed PTs. Class-aware sampling and subject-stratified 5-fold cross-validation were applied to prevent class imbalance and data leakage. The results show that our proposed multimodal method outperforms unimodal baselines in classifying benign versus borderline/malignant PTs. Among six image encoders, ConvNeXt and ResNet18 achieved the best performance in the multimodal setting, with AUC-ROC scores of 0.9427 and 0.9349, and F1-scores of 0.6720 and 0.7294, respectively. This study demonstrates the potential of multimodal AI to serve as a non-invasive diagnostic tool, reducing unnecessary biopsies and improving clinical decision-making in breast tumor management.

Tissue biopsy is the gold standard for diagnosing many diseases, involving the extraction of diseased tissue for histopathology analysis by expert pathologists. However, this procedure has two main limitations: 1) Manual sampling through tissue biopsy is prone to inaccuracies; 2) The extraction process is followed by a time-consuming pathology test. To address these limitations, we present a compact, accurate, and maneuverable robotic insertion platform to overcome the limitations in traditional histopathology. Our platform is capable of steering a variety of tools with different sizes, including needle for tissue extraction and optical fibers for vibrational spectroscopy applications. This system facilitates the guidance of end-effector to the tissue and assists surgeons in navigating to the biopsy target area for multi-modal diagnosis. In this paper, we outline the general concept of our device, followed by a detailed description of its mechanical design and control scheme. We conclude with the validation of the system through a series of tests, including positioning accuracy, admittance performance, and tool insertion efficacy.

Thyroid cancer is among the most common cancers in the United States. Thyroid nodules are frequently detected through ultrasound (US) imaging, and some require further evaluation via fine-needle aspiration (FNA) biopsy. Despite its effectiveness, FNA often leads to unnecessary biopsies of benign nodules, causing patient discomfort and anxiety. To address this, the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) has been developed to reduce benign biopsies. However, such systems are limited by interobserver variability. Recent deep learning approaches have sought to improve risk stratification, but they often fail to utilize the rich temporal and spatial context provided by US cine clips, which contain dynamic global information and surrounding structural changes across various views. In this work, we propose the Spatio-Temporal Cross Attention for Cine Thyroid Ultrasound Time Series Classification (STACT-Time) model, a novel representation learning framework that integrates imaging features from US cine clips with features from segmentation masks automatically generated by a pretrained model. By leveraging self-attention and cross-attention mechanisms, our model captures the rich temporal and spatial context of US cine clips while enhancing feature representation through segmentation-guided learning. Our model improves malignancy prediction compared to state-of-the-art models, achieving a cross-validation precision of 0.91 (plus or minus 0.02) and an F1 score of 0.89 (plus or minus 0.02). By reducing unnecessary biopsies of benign nodules while maintaining high sensitivity for malignancy detection, our model has the potential to enhance clinical decision-making and improve patient outcomes.

In situ tissue biopsy with an endoluminal catheter is an efficient approach for disease diagnosis, featuring low invasiveness and few complications. However, the endoluminal catheter struggles to adjust the biopsy direction by distal endoscope bending or proximal twisting for tissue sampling within the tortuous luminal organs, due to friction-induced hysteresis and narrow spaces. Here, we propose a pneumatically-driven robotic catheter enabling the adjustment of the sampling direction without twisting the catheter for an accurate in situ omnidirectional biopsy. The distal end of the robotic catheter consists of a pneumatic bending actuator for the catheter's deployment in torturous luminal organs and a pneumatic rotatable biopsy mechanism (PRBM). By hierarchical airflow control, the PRBM can adjust the biopsy direction under low airflow and deploy the biopsy needle with higher airflow, allowing for rapid omnidirectional sampling of tissue in situ. This paper describes the design, modeling, and characterization of the proposed robotic catheter, including repeated deployment assessments of the biopsy needle, puncture force measurement, and validation via phantom tests. The PRBM prototype has six sampling directions evenly distributed across 360 degrees when actuated by a positive pressure of 0.3 MPa. The pneumatically-driven robotic catheter provides a novel biopsy strategy, potentially facilitating in situ multidirectional biopsies in tortuous luminal organs with minimum invasiveness.

Background: Automated classification of thyroid Fine Needle Aspiration Biopsy (FNAB) images faces challenges in limited data, inter-observer variability, and computational cost. Efficient, interpretable models are crucial for clinical support. Objective: To develop and externally validate a deep learning system for multi-class thyroid FNAB image classification into three key categories directly guiding post-biopsy treatment in Vietnam: Benign (Bethesda II), Indeterminate/Suspicious (BI, III, IV, V), and Malignant (BVI), achieving high diagnostic accuracy with low computational overhead. Methods: Our pipeline features: (1) YOLOv10 cell cluster detection for informative sub-region extraction/noise reduction; (2) curriculum learning sequencing localized crops to full images for multi-scale capture; (3) adaptive lightweight EfficientNetB0 (4M parameters) balancing performance/efficiency; and (4) a Transformer-inspired module for multi-scale/multi-region analysis. External validation used 1,015 independent FNAB images. Results: ThyroidEffi Basic achieved macro F1 of 89.19% and AUCs of 0.98 (Benign), 0.95 (Indeterminate/Suspicious), 0.96 (Malignant) on the internal test set. External validation yielded AUCs of 0.9495 (Benign), 0.7436 (Indeterminate/Suspicious), 0.8396 (Malignant). ThyroidEffi Premium improved macro F1 to 89.77%. Grad-CAM highlighted key diagnostic regions, confirming interpretability. The system processed 1000 cases in 30 seconds, demonstrating feasibility on widely accessible hardware. Conclusions: This work demonstrates that high-accuracy, interpretable thyroid FNAB image classification is achievable with minimal computational demands.

Computed tomography (CT)-guided needle biopsies are critical for diagnosing a range of conditions, including lung cancer, but present challenges such as limited in-bore space, prolonged procedure times, and radiation exposure. Robotic assistance offers a promising solution by improving needle trajectory accuracy, reducing radiation exposure, and enabling real-time adjustments. In our previous work, we introduced a redundant robotic platform designed for dexterous needle insertion within the confined CT bore. However, its limited base mobility restricts flexible deployment in clinical settings. In this study, we present an improved 11-degree-of-freedom (DOF) robotic system that integrates a 6-DOF robotic base with a 5-DOF cable-driven end-effector, significantly enhancing workspace flexibility and precision. With the hyper-redundant degrees of freedom, we introduce a weighted inverse kinematics controller with a two-stage priority scheme for large-scale movement and fine in-bore adjustments, along with a null-space control strategy to optimize dexterity. We validate our system through both simulation and real-world experiments, demonstrating superior tracking accuracy and enhanced manipulability in CT-guided procedures. The study provides a strong case for hyper-redundancy and null-space control formulations for robot-assisted needle biopsy scenarios.

The role of artificial intelligence (AI) in pathology has evolved from aiding diagnostics to uncovering predictive morphological patterns in whole slide images (WSIs). Recently, foundation models (FMs) leveraging self-supervised pre-training have been widely advocated as a universal solution for diverse downstream tasks. However, open questions remain about their clinical applicability and generalization advantages over end-to-end learning using task-specific (TS) models. Here, we focused on AI with clinical-grade performance for prostate cancer diagnosis and Gleason grading. We present the largest validation of AI for this task, using over 100,000 core needle biopsies from 7,342 patients across 15 sites in 11 countries. We compared two FMs with a fully end-to-end TS model in a multiple instance learning framework. Our findings challenge assumptions that FMs universally outperform TS models. While FMs demonstrated utility in data-scarce scenarios, their performance converged with - and was in some cases surpassed by - TS models when sufficient labeled training data were available. Notably, extensive task-specific training markedly reduced clinically significant misgrading, misdiagnosis of challenging morphologies, and variability across different WSI scanners. Additionally, FMs used up to 35 times more energy than the TS model, raising concerns about their sustainability. Our results underscore that while FMs offer clear advantages for rapid prototyping and research, their role as a universal solution for clinically applicable medical AI remains uncertain. For high-stakes clinical applications, rigorous validation and consideration of task-specific training remain critically important. We advocate for integrating the strengths of FMs and end-to-end learning to achieve robust and resource-efficient AI pathology solutions fit for clinical use.

Purpose: We present a virtual model to optimize point of entry (POE) in lung biopsy planning systems. Our model allows to compute the quality of a biopsy sample taken from potential POE, taking into account the margin of error that arises from discrepancies between the orientation in the planning simulation and the actual orientation during the operation. Additionally, the study examines the impact of the characteristics of the lesion. Methods: The quality of the biopsy is given by a heatmap projected onto the skeleton of a patient-specific model of airways. The skeleton provides a 3D representation of airways structure, while the heatmap intensity represents the potential amount of tissue that it could be extracted from each POE. This amount of tissue is determined by the intersection of the lesion with a cone that represents the uncertainty area in the introduction of biopsy instruments. The cone, lesion, and skeleton are modelled as graphical objects that define a 3D scene of the intervention. Results: We have simulated different settings of the intervention scene from a single anatomy extracted from a CT scan and two lesions with regular and irregular shapes. The different scenarios are simulated by systematic rotation of each lesion placed at different distances from airways. Analysis of the heatmaps for the different settings show a strong impact of lesion orientation for irregular shape and the distance for both shapes. Conclusion: The proposed heatmaps help to visually assess the optimal POE and identify whether multiple optimal POEs exist in different zones of the bronchi. They also allow us to model the maximum allowable error in navigation systems and study which variables have the greatest influence on the success of the operation. Additionally, they help determine at what point this influence could potentially jeopardize the operation.

As global life expectancy increases, so does the burden of chronic diseases, yet individuals exhibit considerable variability in the rate at which they age. Identifying biomarkers that distinguish fast from slow ageing is crucial for understanding the biology of ageing, enabling early disease detection, and improving prevention strategies. Using contrastive deep learning, we show that skin biopsy images alone are sufficient to determine an individual's age. We then use visual features in histopathology slides of the skin biopsies to construct a novel biomarker of ageing. By linking with comprehensive health registers in Denmark, we demonstrate that visual features in histopathology slides of skin biopsies predict mortality and the prevalence of chronic age-related diseases. Our work highlights how routinely collected health data can provide additional value when used together with deep learning, by creating a new biomarker for ageing which can be actively used to determine mortality over time.