Workforce optimization plays a crucial role in efficient organizational operations where decision-making may span several different administrative and time scales. Existing work focuses on specific sub-problems such as resource allocation and facility location, which are solved with heuristics like local-search and, more recently, deep reinforcement learning. However, these may not accurately represent real-world scenarios where such sub-problems are not fully independent. Our aim is to fill this gap by creating a simulator that models a unified workforce optimization problem. Specifically, we designed a modular simulator to support the development of reinforcement learning methods for integrated workforce optimization problems. We focus on three interdependent aspects: personnel dispatch, workforce management, and personnel positioning. The simulator provides configurable pa-rameterizations to help explore dynamic scenarios with varying levels of stochasticity and non-stationarity. To facilitate benchmarking and ablation studies, we also include heuristic and RL baselines for the above mentioned aspects.

To restore proper blood flow in blocked coronary arteries via angioplasty procedure, accurate placement of devices such as catheters, balloons, and stents under live fluoroscopy or diagnostic angiography is crucial. Identified balloon markers help in enhancing stent visibility in X-ray sequences, while the catheter tip aids in precise navigation and co-registering vessel structures, reducing the need for contrast in angiography. However, accurate detection of these devices in interventional X-ray sequences faces significant challenges, particularly due to occlusions from contrasted vessels and other devices and distractions from surrounding, resulting in the failure to track such small objects. While most tracking methods rely on spatial correlation of past and current appearance, they often lack strong motion comprehension essential for navigating through these challenging conditions, and fail to effectively detect multiple instances in the scene. To overcome these limitations, we propose a self-supervised learning approach that enhances its spatio-temporal understanding by incorporating supplementary cues and learning across multiple representation spaces on a large dataset. Followed by that, we introduce a generic real-time tracking framework that effectively leverages the pretrained spatio-temporal network and also takes the historical appearance and trajectory data into account. This results in enhanced localization of multiple instances of device landmarks. Our method outperforms state-of-the-art methods in interventional X-ray device tracking, especially stability and robustness, achieving an 87% reduction in max error for balloon marker detection and a 61% reduction in max error for catheter tip detection.

Early screening for cancer has proven to improve the survival rate and spare patients from intensive and costly treatments due to late diagnosis. Cancer screening in the healthy population involves an initial risk stratification step to determine the screening method and frequency, primarily to optimize resource allocation by targeting screening towards individuals who draw most benefit. For most screening programs, age and clinical risk factors such as family history are part of the initial risk stratification algorithm. In this paper, we focus on developing a blood marker-based risk stratification approach, which could be used to identify patients with elevated cancer risk to be encouraged for taking a diagnostic test or participate in a screening program. We demonstrate that the combination of simple, widely available blood tests, such as complete blood count and complete metabolic panel, could potentially be used to identify patients at risk for colorectal, liver, and lung cancers with areas under the ROC curve of 0.76, 0.85, 0.78, respectively. Furthermore, we hypothesize that such an approach could not only be used as pre-screening risk assessment for individuals but also as population health management tool, for example to better interrogate the cancer risk in certain sub-populations.

Cardiac magnetic resonance imaging (CMR), considered the gold standard for noninvasive cardiac assessment, is a diverse and complex modality requiring a wide variety of image processing tasks for comprehensive assessment of cardiac morphology and function. Advances in deep learning have enabled the development of state-of-the-art (SoTA) models for these tasks. However, model training is challenging due to data and label scarcity, especially in the less common imaging sequences. Moreover, each model is often trained for a specific task, with no connection between related tasks. In this work, we introduce a vision foundation model trained for CMR assessment, that is trained in a self-supervised fashion on 36 million CMR images. We then finetune the model in supervised way for 9 clinical tasks typical to a CMR workflow, across classification, segmentation, landmark localization, and pathology detection. We demonstrate improved accuracy and robustness across all tasks, over a range of available labeled dataset sizes. We also demonstrate improved few-shot learning with fewer labeled samples, a common challenge in medical image analyses. We achieve an out-of-box performance comparable to SoTA for most clinical tasks. The proposed method thus presents a resource-efficient, unified framework for CMR assessment, with the potential to accelerate the development of deep learning-based solutions for image analysis tasks, even with few annotated data available.

In contemporary radiotherapy planning (RTP), a key module leaf sequencing is predominantly addressed by optimization-based approaches. In this paper, we propose a novel deep reinforcement learning (DRL) model termed as Reinforced Leaf Sequencer (RLS) in a multi-agent framework for leaf sequencing. The RLS model offers improvements to time-consuming iterative optimization steps via large-scale training and can control movement patterns through the design of reward mechanisms. We have conducted experiments on four datasets with four metrics and compared our model with a leading optimization sequencer. Our findings reveal that the proposed RLS model can achieve reduced fluence reconstruction errors, and potential faster convergence when integrated in an optimization planner. Additionally, RLS has shown promising results in a full artificial intelligence RTP pipeline. We hope this pioneer multi-agent RL leaf sequencer can foster future research on machine learning for RTP.

An accurate detection and tracking of devices such as guiding catheters in live X-ray image acquisitions is an essential prerequisite for endovascular cardiac interventions. This information is leveraged for procedural guidance, e.g., directing stent placements. To ensure procedural safety and efficacy, there is a need for high robustness no failures during tracking. To achieve that, one needs to efficiently tackle challenges, such as: device obscuration by contrast agent or other external devices or wires, changes in field-of-view or acquisition angle, as well as the continuous movement due to cardiac and respiratory motion. To overcome the aforementioned challenges, we propose a novel approach to learn spatio-temporal features from a very large data cohort of over 16 million interventional X-ray frames using self-supervision for image sequence data. Our approach is based on a masked image modeling technique that leverages frame interpolation based reconstruction to learn fine inter-frame temporal correspondences. The features encoded in the resulting model are fine-tuned downstream. Our approach achieves state-of-the-art performance and in particular robustness compared to ultra optimized reference solutions (that use multi-stage feature fusion, multi-task and flow regularization). The experiments show that our method achieves 66.31% reduction in maximum tracking error against reference solutions (23.20% when flow regularization is used); achieving a success score of 97.95% at a 3x faster inference speed of 42 frames-per-second (on GPU). The results encourage the use of our approach in various other tasks within interventional image analytics that require effective understanding of spatio-temporal semantics.

Radiologists produce unstructured data that could be valuable for clinical care when consumed by information systems. However, variability in style limits usage. Study compares performance of system using domain-adapted language model (RadLing) and general-purpose large language model (GPT-4) in extracting common data elements (CDE) from thoracic radiology reports. Three radiologists annotated a retrospective dataset of 1300 thoracic reports (900 training, 400 test) and mapped to 21 pre-selected relevant CDEs. RadLing was used to generate embeddings for sentences and identify CDEs using cosine-similarity, which were mapped to values using light-weight mapper. GPT-4 system used OpenAI's general-purpose embeddings to identify relevant CDEs and used GPT-4 to map to values. The output CDE:value pairs were compared to the reference standard; an identical match was considered true positive. Precision (positive predictive value) was 96% (2700/2824) for RadLing and 99% (2034/2047) for GPT-4. Recall (sensitivity) was 94% (2700/2876) for RadLing and 70% (2034/2887) for GPT-4; the difference was statistically significant (P<.001). RadLing's domain-adapted embeddings were more sensitive in CDE identification (95% vs 71%) and its light-weight mapper had comparable precision in value assignment (95.4% vs 95.0%). RadLing system exhibited higher performance than GPT-4 system in extracting CDEs from radiology reports. RadLing system's domain-adapted embeddings outperform general-purpose embeddings from OpenAI in CDE identification and its light-weight value mapper achieves comparable precision to large GPT-4. RadLing system offers operational advantages including local deployment and reduced runtime costs. Domain-adapted RadLing system surpasses GPT-4 system in extracting common data elements from radiology reports, while providing benefits of local deployment and lower costs.

Among all the sub-sections in a typical radiology report, the Clinical Indications, Findings, and Impression often reflect important details about the health status of a patient. The information included in Impression is also often covered in Findings. While Findings and Impression can be deduced by inspecting the image, Clinical Indications often require additional context. The cognitive task of interpreting medical images remains the most critical and often time-consuming step in the radiology workflow. Instead of generating an end-to-end radiology report, in this paper, we focus on generating the Findings from automated interpretation of medical images, specifically chest X-rays (CXRs). Thus, this work focuses on reducing the workload of radiologists who spend most of their time either writing or narrating the Findings. Unlike past research, which addresses radiology report generation as a single-step image captioning task, we have further taken into consideration the complexity of interpreting CXR images and propose a two-step approach: (a) detecting the regions with abnormalities in the image, and (b) generating relevant text for regions with abnormalities by employing a generative large language model (LLM). This two-step approach introduces a layer of interpretability and aligns the framework with the systematic reasoning that radiologists use when reviewing a CXR.

Chest radiography is the most common radiographic examination performed in daily clinical practice for the detection of various heart and lung abnormalities. The large amount of data to be read and reported, with more than 100 studies per day for a single radiologist, poses a challenge in consistently maintaining high interpretation accuracy. The introduction of large-scale public datasets has led to a series of novel systems for automated abnormality classification. However, the labels of these datasets were obtained using natural language processed medical reports, yielding a large degree of label noise that can impact the performance. In this study, we propose novel training strategies that handle label noise from such suboptimal data. Prior label probabilities were measured on a subset of training data re-read by 4 board-certified radiologists and were used during training to increase the robustness of the training model to the label noise. Furthermore, we exploit the high comorbidity of abnormalities observed in chest radiography and incorporate this information to further reduce the impact of label noise. Additionally, anatomical knowledge is incorporated by training the system to predict lung and heart segmentation, as well as spatial knowledge labels. To deal with multiple datasets and images derived from various scanners that apply different post-processing techniques, we introduce a novel image normalization strategy. Experiments were performed on an extensive collection of 297,541 chest radiographs from 86,876 patients, leading to a state-of-the-art performance level for 17 abnormalities from 2 datasets. With an average AUC score of 0.880 across all abnormalities, our proposed training strategies can be used to significantly improve performance scores.

3-D image registration, which involves aligning two or more images, is a critical step in a variety of medical applications from diagnosis to therapy. Image registration is commonly performed by optimizing an image matching metric as a cost function. However this task is challenging due to the non-convex nature of the matching metric over the plausible registration parameter space and insufficient approches for a robust optimization. As a result, current approaches are often customized to a specific problem and sensitive to image quality and artifacts. In this paper, we propose a completely different approach to image registration, inspired by how experts perform the task. We first cast the image registration problem as a "strategic learning" process, where the goal is to find the best sequence of motion actions (e.g. up, down, etc) that yields image alignment. Within this approach, an artificial agent is learned, modeled using deep convolutional neural networks, with 3D raw image data as the input, and the next optimal action as the output. To copy with the dimensionality of the problem, we propose a greedy supervised approach for an end-to-end training, coupled with attention-driven hierarchical strategy. The resulting registration approach inherently encodes both a data-driven matching metric and an optimal registration strategy (policy). We demonstrate on two 3-D/3-D medical image registration examples with drastically different nature of challenges, that the artificial agent outperforms several state-of-the-art registration methods by a large margin in terms of both accuracy and robustness.