BackgroundChest radiograph interpretation is critical for the detection of thoracic diseases, including tuberculosis and lung cancer, which affect millions of people worldwide each year. This time-consuming task typically requires expert radiologists to read the images, leading to fatigue-based diagnostic error and lack of diagnostic expertise in areas of the world where radiologists are not available. Recently, deep learning approaches have been able to achieve expert-level performance in medical image interpretation tasks, powered by large network architectures and fueled by the emergence of large labeled datasets. The purpose of this study is to investigate the performance of a deep learning algorithm on the detection of pathologies in chest radiographs compared with practicing radiologists.Methods and findingsWe developed CheXNeXt, a convolutional neural network to concurrently detect the presence of 14 different pathologies, including pneumonia, pleural effusion, pulmonary masses, and nodules in frontal-view chest radiographs. CheXNeXt was trained and internally validated on the ChestX-ray8 dataset, with a held-out validation set consisting of 420 images, sampled to contain at least 50 cases of each of the original pathology labels. On this validation set, the majority vote of a panel of 3 board-certified cardiothoracic specialist radiologists served as reference standard. We compared CheXNeXt’s discriminative performance on the validation set to the performance of 9 radiologists using the area under the receiver operating characteristic curve (AUC). The radiologists included 6 board-certified radiologists (average experience 12 years, range 4–28 years) and 3 senior radiology residents, from 3 academic institutions. We found that CheXNeXt achieved radiologist-level performance on 11 pathologies and did not achieve radiologist-level performance on 3 pathologies. The radiologists achieved statistically significantly higher AUC performance on cardiomegaly, emphysema, and hiatal hernia, with AUCs of 0.888 (95% confidence interval [CI] 0.863–0.910), 0.911 (95% CI 0.866–0.947), and 0.985 (95% CI 0.974–0.991), respectively, whereas CheXNeXt’s AUCs were 0.831 (95% CI 0.790–0.870), 0.704 (95% CI 0.567–0.833), and 0.851 (95% CI 0.785–0.909), respectively. CheXNeXt performed better than radiologists in detecting atelectasis, with an AUC of 0.862 (95% CI 0.825–0.895), statistically significantly higher than radiologists' AUC of 0.808 (95% CI 0.777–0.838); there were no statistically significant differences in AUCs for the other 10 pathologies. The average time to interpret the 420 images in the validation set was substantially longer for the radiologists (240 minutes) than for CheXNeXt (1.5 minutes). The main limitations of our study are that neither CheXNeXt nor the radiologists were permitted to use patient history or review prior examinations and that evaluation was limited to a dataset from a single institution.ConclusionsIn this study, we developed and validated a deep learning algorithm that classified clinically ...

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The Impression section of a radiology report summarizes crucial radiology findings in natural language and plays a central role in communicating these findings to physicians. However, the process of generating impressions by summarizing findings is time-consuming for radiologists and prone to errors. We propose to automate the generation of radiology impressions with neural sequence-to-sequence learning. We further propose a customized neural model for this task which learns to encode the study background information and use this information to guide the decoding process. On a large dataset of radiology reports collected from actual hospital studies, our model outperforms existing non-neural and neural baselines under the ROUGE metrics. In a blind experiment, a board-certified radiologist indicated that 67% of sampled system summaries are at least as good as the corresponding humanwritten summaries, suggesting significant clinical validity. To our knowledge our work represents the first attempt in this direction.

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We propose a method for supervised learning with multiple sets of features (“views”). The multiview problem is especially important in biology and medicine, where “-omics” data, such as genomics, proteomics, and radiomics, are measured on a common set of samples. “Cooperative learning” combines the usual squared-error loss of predictions with an “agreement” penalty to encourage the predictions from different data views to agree. By varying the weight of the agreement penalty, we get a continuum of solutions that include the well-known early and late fusion approaches. Cooperative learning chooses the degree of agreement (or fusion) in an adaptive manner, using a validation set or cross-validation to estimate test set prediction error. One version of our fitting procedure is modular, where one can choose different fitting mechanisms (e.g., lasso, random forests, boosting, or neural networks) appropriate for different data views. In the setting of cooperative regularized linear regression, the method combines the lasso penalty with the agreement penalty, yielding feature sparsity. The method can be especially powerful when the different data views share some underlying relationship in their signals that can be exploited to boost the signals. We show that cooperative learning achieves higher predictive accuracy on simulated data and real multiomics examples of labor-onset prediction. By leveraging aligned signals and allowing flexible fitting mechanisms for different modalities, cooperative learning offers a powerful approach to multiomics data fusion.

We present Natural Gradient Boosting (NG-Boost), an algorithm which brings probabilistic prediction capability to gradient boosting in a generic way. Predictive uncertainty estimation is crucial in many applications such as healthcare and weather forecasting. Probabilistic prediction, which is the approach where the model outputs a full probability distribution over the entire outcome space, is a natural way to quantify those uncertainties. Gradient Boosting Machines have been widely successful in prediction tasks on structured input data, but a simple boosting solution for probabilistic prediction of real valued outputs is yet to be made. NGBoost is a gradient boosting approach which uses the Natural Gradient to address technical challenges that makes generic probabilistic prediction hard with existing gradient boosting methods. Our approach is modular with respect to the choice of base learner, probability distribution, and scoring rule. We show empirically on several regression datasets that NG-Boost provides competitive predictive performance of both uncertainty estimates and traditional metrics.

The use of machine learning systems to support decision making in healthcare raises questions as to what extent these systems may introduce or exacerbate disparities in care for historically underrepresented and mistreated groups, due to biases implicitly embedded in observational data in electronic health records. To address this problem in the context of clinical risk prediction models, we develop an augmented counterfactual fairness criteria to extend the group fairness criteria of equalized odds to an individual level. We do so by requiring that the same prediction be made for a patient, and a counterfactual patient resulting from changing a sensitive attribute, if the factual and counterfactual outcomes do not differ. We investigate the extent to which the augmented counterfactual fairness criteria may be applied to develop fair models for prolonged inpatient length of stay and mortality with observational electronic health records data. As the fairness criteria is illdefined without knowledge of the data generating process, we use a variational autoencoder to perform counterfactual inference in the context of an assumed causal graph. While our technique provides a means to trade off maintenance of fairness with reduction in predictive performance in the context of a learned generative model, further work is needed to assess the generality of this approach.

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