To determine if a convolutional neural network (CNN) deep learning model can accurately segment acute ischemic changes on non-contrast CT compared to neuroradiologists. Non-contrast CT (NCCT) examinations from 232 acute ischemic stroke patients who were enrolled in the DEFUSE 3 trial were included in this study. Three experienced neuroradiologists independently segmented hypodensity that reflected the ischemic core on each scan. The neuroradiologist with the most experience (expert A) served as the ground truth for deep learning model training. Two additional neuroradiologists (experts B and C) segmentations were used for data testing. The 232 studies were randomly split into training and test sets. The training set was further randomly divided into 5 folds with training and validation sets. A 3-dimensional CNN architecture was trained and optimized to predict the segmentations of expert A from NCCT. The performance of the model was assessed using a set of volume, overlap, and distance metrics using non-inferiority thresholds of 20%, 3ml, and 3mm. The optimized model trained on expert A was compared to test experts B and C. We used a one-sided Wilcoxon signed-rank test to test for the non-inferiority of the model-expert compared to the inter-expert agreement. The final model performance for the ischemic core segmentation task reached a performance of 0.46+-0.09 Surface Dice at Tolerance 5mm and 0.47+-0.13 Dice when trained on expert A. Compared to the two test neuroradiologists the model-expert agreement was non-inferior to the inter-expert agreement, p < 0.05. The CNN accurately delineates the hypodense ischemic core on NCCT in acute ischemic stroke patients with an accuracy comparable to neuroradiologists.

Performance metrics for medical image segmentation models are used to measure the agreement between the reference annotation and the predicted segmentation. Usually, overlap metrics, such as the Dice, are used as a metric to evaluate the performance of these models in order for results to be comparable. However, there is a mismatch between the distributions of cases and difficulty level of segmentation tasks in public data sets compared to clinical practice. Common metrics fail to measure the impact of this mismatch, especially for clinical data sets that include low signal pathologies, a difficult segmentation task, and uncertain, small, or empty reference annotations. This limitation may result in ineffective research of machine learning practitioners in designing and optimizing models. Dimensions of evaluating clinical value include consideration of the uncertainty of reference annotations, independence from reference annotation volume size, and evaluation of classification of empty reference annotations. We study how uncertain, small, and empty reference annotations influence the value of metrics for medical image segmentation on an in-house data set regardless of the model. We examine metrics behavior on the predictions of a standard deep learning framework in order to identify metrics with clinical value. We compare to a public benchmark data set (BraTS 2019) with a high-signal pathology and certain, larger, and no empty reference annotations. We may show machine learning practitioners, how uncertain, small, or empty reference annotations require a rethinking of the evaluation and optimizing procedures. The evaluation code was released to encourage further analysis of this topic. https://github.com/SophieOstmeier/UncertainSmallEmpty.git

In many predictive decision-making scenarios, such as credit scoring and academic testing, a decision-maker must construct a model (predicting some outcome) that accounts for agents' incentives to "game" their features in order to receive better decisions. Whereas the strategic classification literature generally assumes that agents' outcomes are not causally dependent on their features (and thus strategic behavior is a form of lying), we join concurrent work in modeling agents' outcomes as a function of their changeable attributes. Our formulation is the first to incorporate a crucial phenomenon: when agents act to change observable features, they may as a side effect perturb hidden features that causally affect their true outcomes. We consider three distinct desiderata for a decision-maker's model: accurately predicting agents' post-gaming outcomes (accuracy), incentivizing agents to improve these outcomes (improvement), and, in the linear setting, estimating the visible coefficients of the true causal model (causal precision). As our main contribution, we provide the first algorithms for learning accuracy-optimizing, improvement-optimizing, and causal-precision-optimizing linear regression models directly from data, without prior knowledge of agents' possible actions. These algorithms circumvent the hardness result of Miller et al. (2019) by allowing the decision maker to observe agents' responses to a sequence of decision rules, in effect inducing agents to perform causal interventions for free.

Given data drawn from an unknown distribution, $D$, to what extent is it possible to ``amplify'' this dataset and output an even larger set of samples that appear to have been drawn from $D$? We formalize this question as follows: an $(n,m)$ $\text{amplification procedure}$ takes as input $n$ independent draws from an unknown distribution $D$, and outputs a set of $m > n$ ``samples''. An amplification procedure is valid if no algorithm can distinguish the set of $m$ samples produced by the amplifier from a set of $m$ independent draws from $D$, with probability greater than $2/3$. Perhaps surprisingly, in many settings, a valid amplification procedure exists, even when the size of the input dataset, $n$, is significantly less than what would be necessary to learn $D$ to non-trivial accuracy. Specifically we consider two fundamental settings: the case where $D$ is an arbitrary discrete distribution supported on $\le k$ elements, and the case where $D$ is a $d$-dimensional Gaussian with unknown mean, and fixed covariance. In the first case, we show that an $\left(n, n + \Theta(\frac{n}{\sqrt{k}})\right)$ amplifier exists. In particular, given $n=O(\sqrt{k})$ samples from $D$, one can output a set of $m=n+1$ datapoints, whose total variation distance from the distribution of $m$ i.i.d. draws from $D$ is a small constant, despite the fact that one would need quadratically more data, $n=\Theta(k)$, to learn $D$ up to small constant total variation distance. In the Gaussian case, we show that an $\left(n,n+\Theta(\frac{n}{\sqrt{d}} )\right)$ amplifier exists, even though learning the distribution to small constant total variation distance requires $\Theta(d)$ samples. In both the discrete and Gaussian settings, we show that these results are tight, to constant factors. Beyond these results, we formalize a number of curious directions for future research along this vein.