Identifying physiological and behavioral markers for mental health conditions is a longstanding challenge in psychiatry. Depression and suicidal ideation, in particular, lack objective biomarkers, with screening and diagnosis primarily relying on self-reports and clinical interviews. Here, we investigate eye tracking as a potential marker modality for screening purposes. Eye movements are directly modulated by neuronal networks and have been associated with attentional and mood-related patterns; however, their predictive value for depression and suicidality remains unclear. We recorded eye-tracking sequences from 126 young adults as they read and responded to affective sentences, and subsequently developed a deep learning framework to predict their clinical status. The proposed model included separate branches for trials of positive and negative sentiment, and used 2D time-series representations to account for both intra-trial and inter-trial variations. We were able to identify depression and suicidal ideation with an area under the receiver operating curve (AUC) of 0.793 (95% CI: 0.765-0.819) against healthy controls, and suicidality specifically with 0.826 AUC (95% CI: 0.797-0.852). The model also exhibited moderate, yet significant, accuracy in differentiating depressed from suicidal participants, with 0.609 AUC (95% CI 0.571-0.646). Discriminative patterns emerge more strongly when assessing the data relative to response generation than relative to the onset time of the final word of the sentences. The most pronounced effects were observed for negative-sentiment sentences, that are congruent to depressed and suicidal participants. Our findings highlight eye tracking as an objective tool for mental health assessment and underscore the modulatory impact of emotional stimuli on cognitive processes affecting oculomotor control.

Foundational models have emerged as powerful tools for addressing various tasks in clinical settings. However, their potential development to breast ultrasound analysis remains untapped. In this paper, we present BUSGen, the first foundational generative model specifically designed for breast ultrasound image analysis. Pretrained on over 3.5 million breast ultrasound images, BUSGen has acquired extensive knowledge of breast structures, pathological features, and clinical variations. With few-shot adaptation, BUSGen can generate repositories of realistic and informative task-specific data, facilitating the development of models for a wide range of downstream tasks. Extensive experiments highlight BUSGen's exceptional adaptability, significantly exceeding real-data-trained foundational models in breast cancer screening, diagnosis, and prognosis. In breast cancer early diagnosis, our approach outperformed all board-certified radiologists (n=9), achieving an average sensitivity improvement of 16.5% (P-value<0.0001). Additionally, we characterized the scaling effect of using generated data which was as effective as the collected real-world data for training diagnostic models. Moreover, extensive experiments demonstrated that our approach improved the generalization ability of downstream models. Importantly, BUSGen protected patient privacy by enabling fully de-identified data sharing, making progress forward in secure medical data utilization. An online demo of BUSGen is available at https://aibus.bio.

Emergency department (ED) crowding is a global public health issue that has been repeatedly associated with increased mortality. Predicting future service demand would enable preventative measures aiming to eliminate crowding along with it's detrimental effects. Recent findings in our ED indicate that occupancy ratios exceeding 90% are associated with increased 10-day mortality. In this paper, we aim to predict these crisis periods using retrospective data from a large Nordic ED with a LightGBM model. We provide predictions for the whole ED and individually for it's different operational sections. We demonstrate that afternoon crowding can be predicted at 11 a.m. with an AUC of 0.82 (95% CI 0.78-0.86) and at 8 a.m. with an AUC up to 0.79 (95% CI 0.75-0.83). Consequently we show that forecasting mortality-associated crowding using anonymous administrative data is feasible.

Breast magnetic resonance imaging (MRI) is the imaging technique with the highest sensitivity for detecting breast cancer and is routinely used for women at high risk. Despite the comprehensive multiparametric protocol of breast MRI, existing artificial intelligence-based studies predominantly rely on single sequences and have limited validation. Here we report a large mixture-of-modality-experts model (MOME) that integrates multiparametric MRI information within a unified structure, offering a noninvasive method for personalized breast cancer management. We have curated the largest multiparametric breast MRI dataset, involving 5,205 patients from three hospitals in the north, southeast, and southwest of China, for the development and extensive evaluation of our model. MOME demonstrated accurate and robust identification of breast cancer. It achieved comparable performance for malignancy recognition to that of four senior radiologists and significantly outperformed a junior radiologist, with 0.913 AUROC, 0.948 AUPRC, 0.905 F1 score, and 0.723 MCC. Our findings suggest that MOME could reduce the need for biopsies in BI-RADS 4 patients with a ratio of 7.3%, classify triple-negative breast cancer with an AUROC of 0.709, and predict pathological complete response to neoadjuvant chemotherapy with an AUROC of 0.694. The model further supports scalable and interpretable inference, adapting to missing modalities and providing decision explanations by highlighting lesions and measuring modality contributions. MOME exemplifies a discriminative, robust, scalable, and interpretable multimodal model, paving the way for noninvasive, personalized management of breast cancer patients based on multiparametric breast imaging data.

Methodological advancements to automate the generation of differential diagnosis (DDx) to predict a list of potential diseases as differentials given patients' symptom descriptions are critical to clinical reasoning and applications such as decision support. However, providing reasoning or interpretation for these differential diagnoses is more meaningful. Fortunately, large language models (LLMs) possess powerful language processing abilities and have been proven effective in various related tasks. Motivated by this potential, we investigate the use of LLMs for interpretable DDx. First, we develop a new DDx dataset with expert-derived interpretation on 570 public clinical notes. Second, we propose a novel framework, named Dual-Inf, that enables LLMs to conduct bidirectional inference for interpretation. Both human and automated evaluation demonstrate the effectiveness of Dual-Inf in predicting differentials and diagnosis explanations. Specifically, the performance improvement of Dual-Inf over the baseline methods exceeds 32% w.r.t. BERTScore in DDx interpretation. Furthermore, experiments verify that Dual-Inf (1) makes fewer errors in interpretation, (2) has great generalizability, (3) is promising for rare disease diagnosis and explanation.

Predicting human gaze behavior within computer vision is integral for developing interactive systems that can anticipate user attention, address fundamental questions in cognitive science, and hold implications for fields like human-computer interaction (HCI) and augmented/virtual reality (AR/VR) systems. Despite methodologies introduced for modeling human eye gaze behavior, applying these models to medical imaging for scanpath prediction remains unexplored. Our proposed system aims to predict eye gaze sequences from radiology reports and CXR images, potentially streamlining data collection and enhancing AI systems using larger datasets. However, predicting human scanpaths on medical images presents unique challenges due to the diverse nature of abnormal regions. Our model predicts fixation coordinates and durations critical for medical scanpath prediction, outperforming existing models in the computer vision community. Utilizing a two-stage training process and large publicly available datasets, our approach generates static heatmaps and eye gaze videos aligned with radiology reports, facilitating comprehensive analysis. We validate our approach by comparing its performance with state-of-the-art methods and assessing its generalizability among different radiologists, introducing novel strategies to model radiologists' search patterns during CXR image diagnosis. Based on the radiologist's evaluation, MedGaze can generate human-like gaze sequences with a high focus on relevant regions over the CXR images. It sometimes also outperforms humans in terms of redundancy and randomness in the scanpaths.

The potential of artificial intelligence (AI) in digital pathology is limited by technical inconsistencies in the production of whole slide images (WSIs), leading to degraded AI performance and posing a challenge for widespread clinical application as fine-tuning algorithms for each new site is impractical. Changes in the imaging workflow can also lead to compromised diagnoses and patient safety risks. We evaluated whether physical color calibration of scanners can standardize WSI appearance and enable robust AI performance. We employed a color calibration slide in four different laboratories and evaluated its impact on the performance of an AI system for prostate cancer diagnosis on 1,161 WSIs. Color standardization resulted in consistently improved AI model calibration and significant improvements in Gleason grading performance. The study demonstrates that physical color calibration provides a potential solution to the variation introduced by different scanners, making AI-based cancer diagnostics more reliable and applicable in clinical settings.

Background: Postpartum hemorrhage remains one of the largest causes of maternal morbidity and mortality in the United States. Objective: The aim of this paper is to use machine learning techniques to identify patients at risk for postpartum hemorrhage at obstetric delivery. Methods: Women aged 18 to 55 years delivering at a major academic center from July 2013 to October 2018 were included for analysis (N 30,867). A total of 497 variables were collected from the electronic medical record including the following: demographic information; obstetric, medical, surgical, and family history; vital signs; laboratory results; labor medication exposures; and delivery outcomes. Postpartum hemorrhage was defined as a blood loss of 1000 mL at the time of delivery, regardless of delivery method, with 2179 (7.1%) positive cases observed.

While the Gleason grading system has been the most reliable tool for the prognosis of prostate cancer since its development, its clinical application remains limited. A study examined the impact of an artificial intelligence (AI)-assisted approach to prostate cancer grading and quantification. The findings were published in JAMA Network Open. This diagnostic study was conducted from August 2, 2017, to December 30, 2019. The study consisted of 589 men (mean age, 63.8 years) with biopsy-confirmed prostate cancer who received care in the University of Wisconsin Health System between January 1, 2005, and February 28, 2017.

Objectives: In recent years, the scientific community has focused on the development of Computer-Aided Diagnosis (CAD) tools that could improve bone fractures' classification. However, the results of the classification of fractures in subtypes with the proposed datasets were far from optimal. This paper proposes a very recent and outperforming deep learning technique, the Vision Transformer (ViT), in order to improve the fracture classification, by exploiting its self-attention mechanism. Methods: 4207 manually annotated images were used and distributed, by following the AO/OTA classification, in different fracture types, the largest labeled dataset of proximal femur fractures used in literature. The ViT architecture was used and compared with a classic Convolutional Neural Network (CNN) and a multistage architecture composed by successive CNNs in cascade. To demonstrate the reliability of this approach, 1) the attention maps were used to visualize the most relevant areas of the images, 2) the performance of a generic CNN and ViT was also compared through unsupervised learning techniques, and 3) 11 specialists were asked to evaluate and classify 150 proximal femur fractures' images with and without the help of the ViT. Results: The ViT was able to correctly predict 83% of the test images. Precision, recall and F1-score were 0.77 (CI 0.64-0.90), 0.76 (CI 0.62-0.91) and 0.77 (CI 0.64-0.89), respectively. The average specialists' diagnostic improvement was 29%. Conclusions: This paper showed the potential of Transformers in bone fracture classification. For the first time, good results were obtained in sub-fractures with the largest and richest dataset ever.