Large, labeled datasets have driven deep learning methods to achieve expert-level performance on a variety of medical imaging tasks. We present CheXpert, a large dataset that contains 224,316 chest radiographs of 65,240 patients. We design a labeler to automatically detect the presence of 14 observations in radiology reports, capturing uncertainties inherent in radiograph interpretation. We investigate different approaches to using the uncertainty labels for training convolutional neural networks that output the probability of these observations given the available frontal and lateral radiographs. On a validation set of 200 chest radiographic studies which were manually annotated by 3 board-certified radiologists, we find that different uncertainty approaches are useful for different pathologies. We then evaluate our best model on a test set composed of 500 chest radiographic studies annotated by a consensus of 5 board-certified radiologists, and compare the performance of our model to that of 3 additional radiologists in the detection of 5 selected pathologies. On Cardiomegaly, Edema, and Pleural Effusion, the model ROC and PR curves lie above all 3 radiologist operating points. We release the dataset to the public as a standard benchmark to evaluate performance of chest radiograph interpretation models. 1

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A fundamental assumption of most machine learning algorithms is that the training and test data are drawn from the same underlying distribution. However, this assumption is violated in almost all practical applications: machine learning systems are regularly tested on data that are structurally different from the training set, either due to temporal correlations, particular end users, or other factors. In this work, we consider the setting where test examples are not drawn from the training distribution. Prior work has approached this problem by attempting to be robust to all possible test time distributions, which may degrade average performance, or by "peeking" at the test examples during training, which is not always feasible. In contrast, we propose to learn models that are adaptable, such that they can adapt to distribution shift at test time using a batch of unlabeled test data points. We acquire such models by learning to adapt to training batches sampled according to different sub-distributions, which simulate structural distribution shifts that may occur at test time. We introduce the problem of adaptive risk minimization (ARM), a formalization of this setting that lends itself to meta-learning methods. Compared to a variety of methods under the paradigms of empirical risk minimization and robust optimization, our approach provides substantial empirical gains on image classification problems in the presence of distribution shift. * equal contribution Preprint. Under review.

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Machine learning systems deployed in the wild are often trained on a source distribution but deployed on a different target distribution. Unlabeled data can be a powerful point of leverage for mitigating these distribution shifts, as it is frequently much more available than labeled data. However, existing distribution shift benchmarks for unlabeled data do not reflect the breadth of scenarios that arise in real-world applications. In this work, we present the Wilds 2.0 update, which extends 8 of the 10 datasets in the Wilds benchmark of distribution shifts to include curated unlabeled data that would be realistically obtainable in deployment. To maintain consistency, the labeled training, validation, and test sets, as well as the evaluation metrics, are exactly the same as in the original Wilds benchmark. These datasets span a wide range of applications (from histology to wildlife conservation), tasks (classification, regression, and detection), and modalities (photos, satellite images, microscope slides, text, molecular graphs). We systematically benchmark state-of-the-art methods that leverage unlabeled data, including domain-invariant, self-training, and self-supervised methods, and show that their success on Wilds is limited. To facilitate method development and evaluation, we provide an open-source package that automates data loading and contains all of the model architectures and methods used in this paper. Code and leaderboards are available at https://wilds.stanford.edu.

Aims: Deep learning (DL), a sub-area of artificial intelligence, has demonstrated great promise at automating diagnostic tasks in pathology, yet its translation into clinical settings has been slow. Few studies have examined its impact on pathologist performance, when embedded into clinical workflows. The identification of H. pylori on H&E stain is a tedious, imprecise task which might benefit from DL assistance. Here, we developed a DL assistant for diagnosing H. pylori in gastric biopsies and tested its impact on pathologist diagnostic accuracy and turnaround time. Methods and results: H&E-stained whole-slide images (WSI) of 303 gastric biopsies with ground truth confirmation by immunohistochemistry formed the study dataset; 47 and 126 WSI were respectively used to train and optimize our DL assistant to detect H. pylori, and 130 were used in a clinical experiment in which 3 experienced GI pathologists reviewed the same test set with and without assistance. On the test set, the assistant achieved high performance, with a WSI-level area-under-the-receiver-operating-characteristic curve (AUROC) of 0.965 (95% CI 0.934-0.987). On H. pylori-positive cases, assisted diagnoses were faster (β, the fixed effect size for assistance= -0.557, p=0.003) and much more accurate (OR=13.37, p<0.001) than unassisted diagnoses. However, assistance increased diagnostic uncertainty on H. pylori-negative cases, resulting in an overall decrease in assisted accuracy (OR=0.435, p=0.016) and negligible impact on overall turnaround time (β for assistance=0.010, p=0.860). Conclusions: DL can assist pathologists with H. pylori diagnosis, but its integration into clinical workflows requires optimization to mitigate diagnostic uncertainty as a potential consequence of assistance.