Rapid triage of suspected stroke needs accurate, bedside-deployable tools; EEG is promising but underused at first contact. We present an adaptive multitask EEG classifier that converts 32-channel signals to power spectral density features (Welch), uses a recurrent-convolutional network (GRU-TCN) to predict stroke type (healthy, ischemic, hemorrhagic), hemispheric lateralization, and severity, and applies a deep Q-network (DQN) to tune decision thresholds in real time. Using a patient-wise split of the UCLH Stroke EIT/EEG data set (44 recordings; about 26 acute stroke, 10 controls), the primary outcome was stroke-type performance; secondary outcomes were severity and lateralization. The baseline GRU-TCN reached 89.3% accuracy (F1 92.8%) for stroke type, about 96.9% (F1 95.9%) for severity, and about 96.7% (F1 97.4%) for lateralization. With DQN threshold adaptation, stroke-type accuracy increased to about 98.0% (F1 97.7%). We also tested robustness on an independent, low-density EEG cohort (ZJU4H) and report paired patient-level statistics. Analyses follow STARD 2015 guidance for diagnostic accuracy studies (index test: GRU-TCN+DQN; reference standard: radiology/clinical diagnosis; patient-wise evaluation). Adaptive thresholding shifts the operating point to clinically preferred sensitivity-specificity trade-offs, while integrated scalp-map and spectral visualizations support interpretability.

Quantitative assessment of treatment response in Advanced Prostate Cancer (APC) with bone metastases remains an unmet clinical need. Whole-Body Diffusion-Weighted MRI (WB-DWI) provides two response biomarkers: Total Diffusion Volume (TDV) and global Apparent Diffusion Coefficient (gADC). However, tracking post-treatment changes of TDV and gADC from manually delineated lesions is cumbersome and increases inter-reader variability. We developed a software to automate this process. Core technologies include: (i) a weakly-supervised Residual U-Net model generating a skeleton probability map to isolate bone; (ii) a statistical framework for WB-DWI intensity normalisation, obtaining a signal-normalised b=900s/mm^2 (b900) image; and (iii) a shallow convolutional neural network that processes outputs from (i) and (ii) to generate a mask of suspected bone lesions, characterised by higher b900 signal intensity due to restricted water diffusion. This mask is applied to the gADC map to extract TDV and gADC statistics. We tested the tool using expert-defined metastatic bone disease delineations on 66 datasets, assessed repeatability of imaging biomarkers (N=10), and compared software-based response assessment with a construct reference standard (N=118). Average dice score between manual and automated delineations was 0.6 for lesions within pelvis and spine, with an average surface distance of 2mm. Relative differences for log-transformed TDV (log-TDV) and median gADC were 8.8% and 5%, respectively. Repeatability analysis showed coefficients of variation of 4.6% for log-TDV and 3.5% for median gADC, with intraclass correlation coefficients of 0.94 or higher. The software achieved 80.5% accuracy, 84.3% sensitivity, and 85.7% specificity in assessing response to treatment. Average computation time was 90s per scan.

Large language models (LLMs) are increasingly used to extract clinical data from electronic health records (EHRs), offering significant improvements in scalability and efficiency for real-world data (RWD) curation in oncology. However, the adoption of LLMs introduces new challenges in ensuring the reliability, accuracy, and fairness of extracted data, which are essential for research, regulatory, and clinical applications. Existing quality assurance frameworks for RWD and artificial intelligence do not fully address the unique error modes and complexities associated with LLM-extracted data. In this paper, we propose a comprehensive framework for evaluating the quality of clinical data extracted by LLMs. The framework integrates variable-level performance benchmarking against expert human abstraction, automated verification checks for internal consistency and plausibility, and replication analyses comparing LLM-extracted data to human-abstracted datasets or external standards. This multidimensional approach enables the identification of variables most in need of improvement, systematic detection of latent errors, and confirmation of dataset fitness-for-purpose in real-world research. Additionally, the framework supports bias assessment by stratifying metrics across demographic subgroups. By providing a rigorous and transparent method for assessing LLM-extracted RWD, this framework advances industry standards and supports the trustworthy use of AI-powered evidence generation in oncology research and practice.

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.

Accurate morphometric assessment of cartilage-such as thickness/volume-via MRI is essential for monitoring knee osteoarthritis. Segmenting cartilage remains challenging and dependent on extensive expert-annotated datasets, which are heavily subjected to inter-reader variability. Recent advancements in Visual Foundational Models (VFM), especially memory-based approaches, offer opportunities for improving generalizability and robustness. This study introduces a deep learning (DL) method for cartilage and meniscus segmentation from 3D MRIs using interactive, memory-based VFMs. To improve spatial awareness and convergence, we incorporated a Hybrid Shuffling Strategy (HSS) during training and applied a segmentation mask propagation technique to enhance annotation efficiency. We trained four AI models-a CNN-based 3D-VNet, two automatic transformer-based models (SaMRI2D and SaMRI3D), and a transformer-based promptable memory-based VFM (SAMRI-2)-on 3D knee MRIs from 270 patients using public and internal datasets and evaluated on 57 external cases, including multi-radiologist annotations and different data acquisitions. Model performance was assessed against reference standards using Dice Score (DSC) and Intersection over Union (IoU), with additional morphometric evaluations to further quantify segmentation accuracy. SAMRI-2 model, trained with HSS, outperformed all other models, achieving an average DSC improvement of 5 points, with a peak improvement of 12 points for tibial cartilage. It also demonstrated the lowest cartilage thickness errors, reducing discrepancies by up to threefold. Notably, SAMRI-2 maintained high performance with as few as three user clicks per volume, reducing annotation effort while ensuring anatomical precision. This memory-based VFM with spatial awareness offers a novel approach for reliable AI-assisted knee MRI segmentation, advancing DL in musculoskeletal imaging.

Purpose: Subarachnoid haemorrhage is a potentially fatal consequence of intracranial aneurysm rupture, however, it is difficult to predict if aneurysms will rupture. Prophylactic treatment of an intracranial aneurysm also involves risk, hence identifying rupture-prone aneurysms is of substantial clinical importance. This systematic review aims to evaluate the performance of machine learning algorithms for predicting intracranial aneurysm rupture risk. Methods: MEDLINE, Embase, Cochrane Library and Web of Science were searched until December 2023. Studies incorporating any machine learning algorithm to predict the risk of rupture of an intracranial aneurysm were included. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). PROSPERO registration: CRD42023452509. Results: Out of 10,307 records screened, 20 studies met the eligibility criteria for this review incorporating a total of 20,286 aneurysm cases. The machine learning models gave a 0.66-0.90 range for performance accuracy. The models were compared to current clinical standards in six studies and gave mixed results. Most studies posed high or unclear risks of bias and concerns for applicability, limiting the inferences that can be drawn from them. There was insufficient homogenous data for a meta-analysis. Conclusions: Machine learning can be applied to predict the risk of rupture for intracranial aneurysms. However, the evidence does not comprehensively demonstrate superiority to existing practice, limiting its role as a clinical adjunct. Further prospective multicentre studies of recent machine learning tools are needed to prove clinical validation before they are implemented in the clinic.

Human trust is critical for trustworthy AI adoption. Trust is commonly understood as an attitude, but we cannot accurately measure this, nor manage it. We conflate trust in the overall system, ML, and ML's component parts; so most users do not understand the leap of faith they take when they trust ML. Current efforts to build trust explain ML's process, which can be hard for non-ML experts to comprehend because it is complex, and explanations are unrelated to their own (unarticulated) mental models. We propose an innovative way of directly building intrinsic trust in ML, by discerning and measuring the Leap of Faith (LoF) taken when a user trusts ML. Our LoF matrix identifies where an ML model aligns to a user's own mental model. This match is rigorously yet practically identified by feeding the user's data and objective function both into an ML model and an expert-validated rules-based AI model, a verified point of reference that can be tested a priori against a user's own mental model. The LoF matrix visually contrasts the models' outputs, so the remaining ML-reasoning leap of faith can be discerned. Our proposed trust metrics measure for the first time whether users demonstrate trust through their actions, and we link deserved trust to outcomes. Our contribution is significant because it enables empirical assessment and management of ML trust drivers, to support trustworthy ML adoption. Our approach is illustrated with a long-term high-stakes field study: a 3-month pilot of a sleep-improvement system with embedded AI.

Background Generating radiologic findings from chest radiographs is pivotal in medical image analysis. The emergence of OpenAI's generative pretrained transformer, GPT-4 with vision (GPT-4V)[1], has opened new perspectives on the potential for automated image-text pair generation. However, the application of GPT-4V to real-world chest radiography is yet to be thoroughly examined. Purpose To investigate GPT-4V's capability to generate radiologic findings from real-world chest radiographs. Materials and Methods In this retrospective study, 100 chest radiographs with free-text radiology reports were annotated by a cohort of radiologists, two attending physicians and three residents, to establish a reference standard.

Purpose: Autonomous navigation of devices in endovascular interventions can decrease operation times, improve decision-making during surgery, and reduce operator radiation exposure while increasing access to treatment. This systematic review explores recent literature to assess the impact, challenges, and opportunities artificial intelligence (AI) has for the autonomous endovascular intervention navigation. Methods: PubMed and IEEEXplore databases were queried. Eligibility criteria included studies investigating the use of AI in enabling the autonomous navigation of catheters/guidewires in endovascular interventions. Following PRISMA, articles were assessed using QUADAS-2. PROSPERO: CRD42023392259. Results: Among 462 studies, fourteen met inclusion criteria. Reinforcement learning (9/14, 64%) and learning from demonstration (7/14, 50%) were used as data-driven models for autonomous navigation. Studies predominantly utilised physical phantoms (10/14, 71%) and in silico (4/14, 29%) models. Experiments within or around the blood vessels of the heart were reported by the majority of studies (10/14, 71%), while simple non-anatomical vessel platforms were used in three studies (3/14, 21%), and the porcine liver venous system in one study. We observed that risk of bias and poor generalisability were present across studies. No procedures were performed on patients in any of the studies reviewed. Studies lacked patient selection criteria, reference standards, and reproducibility, resulting in low clinical evidence levels. Conclusions: AI's potential in autonomous endovascular navigation is promising, but in an experimental proof-of-concept stage, with a technology readiness level of 3. We highlight that reference standards with well-identified performance metrics are crucial to allow for comparisons of data-driven algorithms proposed in the years to come.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. To develop, test, and validate a deep learning (DL) tool that improves upon a previous feature-based CT image processing bone mineral density (BMD) algorithm and compare it against the manual reference standard. This single-center, retrospective study included manual L1 trabecular Hounsfield unit (HU) measurements from abdominal CT scans of 11,035 patients (mean age, 58 [SD] 12 years; 6311 women) as the reference standard.