IMPORTANCE Mammography screening currently relies on subjective human interpretation. Artificial intelligence (AI) advances could be used to increase mammography screening accuracy by reducing missed cancers and false positives. OBJECTIVE To evaluate whether AI can overcome human mammography interpretation limitations with a rigorous, unbiased evaluation of machine learning algorithms. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic accuracy study conducted between September 2016 and November 2017, an international, crowdsourced challenge was hosted to foster AI algorithm development focused on interpreting screening mammography. More than 1100 participants comprising 126 teams from 44 countries participated. Analysis began November 18, 2016. MAIN OUTCOMES AND MEASUREMENTS Algorithms used images alone (challenge 1) or combined images, previous examinations (if available), and clinical and demographic risk factor data (challenge 2) and output a score that translated to cancer yes/no within 12 months. Algorithm accuracy for breast cancer detection was evaluated using area under the curve and algorithm specificity compared with radiologists' specificity with radiologists' sensitivity set at 85.9% (United States) and 83.9% (Sweden). An ensemble method aggregating top-performing AI algorithms and radiologists' recall assessment was developed and evaluated. RESULTS Overall, 144 231 screening mammograms from 85 580 US women (952 cancer positive Յ12 months from screening) were used for algorithm training and validation. A second independent validation cohort included 166 578 examinations from 68 008 Swedish women (780 cancer positive). The top-performing algorithm achieved an area under the curve of 0.858 (United States) and 0.903 (Sweden) and 66.2% (United States) and 81.2% (Sweden) specificity at the radiologists' sensitivity, lower than community-practice radiologists' specificity of 90.5% (United States) and 98.5% (Sweden). Combining top-performing algorithms and US radiologist assessments resulted in a higher area under the curve of 0.942 and achieved a significantly improved specificity (92.0%) at the same sensitivity. CONCLUSIONS AND RELEVANCE While no single AI algorithm outperformed radiologists, an ensemble of AI algorithms combined with radiologist assessment in a single-reader screening environment improved overall accuracy. This study underscores the potential of using machine (continued)

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One of the key factors of enabling machine learning models to comprehend and solve real-world tasks is to leverage multimodal data. Unfortunately, annotation of multimodal data is challenging and expensive. Recently, self-supervised multimodal methods that combine vision and language were proposed to learn multimodal representations without annotation. However, these methods choose to ignore the presence of high levels of noise and thus yield sub-optimal results. In this work, we show that the problem of noise estimation for multimodal data can be reduced to a multimodal density estimation task. Using multimodal density estimation, we propose a noise estimation building block for multimodal representation learning that is based strictly on the inherent correlation between different modalities. We demonstrate how our noise estimation can be broadly integrated and achieves comparable results to state-of-the-art performance on five different benchmark datasets for two challenging multimodal tasks: Video Question Answering and Text-To-Video Retrieval.

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