arXiv subjects

Ivana Drobnjak

Publications and source records attributed to Ivana Drobnjak.

12 recordsLinked to original sources

arXiv2026

AI-driven Optimisation of Quality of Recovery (QoR) in Remote Patient Monitoring

Remote patient monitoring depends on patient-reported data to capture the subjective dimension of recovery that devices cannot measure. The Quality of Recovery (QoR-15) survey is the gold-standard instrument for this purpose. It was designed and validated for occasional in-hospital assessment, yet remote monitoring now administers it to patients daily. In our own post-surgical deployment, only 55% of patients submitted the survey more than 14 days of 30 monitoring days. We developed QoR-compact, a five-item daily input for the RPM prediction pathway. Setting a deployment-driven target of one-third of the daily items, we exhaustively evaluated all 3,003 five-question subsets of the QoR-15 and tested whether the best of them matches the full instrument in predicting near-term postoperative recovery severity. QoR-compact achieves a mean AUC-ROC of 0.968 (95% CI 0.915-0.988), statistically comparable to the 0.964 baseline obtained with one-third of the items. Patient-level backtesting indicates that it tracks readmission events as faithfully as the full form. Its five items span the physical and psychological axes of recovery: Q3 (feeling rested), Q9 (feeling comfortable and in control), Q10 (general well-being), Q12 (severe pain), and Q14 (feeling worried or anxious). The QoR-15 remains the gold-standard measure of recovery; QoR-compact complements it as a shorter daily input designed for prediction. This parity provides the basis for a prospective study of whether a lighter daily input is, in turn, completed more consistently. External validation on larger cohorts is required before clinical use.

cs.AI↗

arXiv2026

Multi-Modal AI for Remote Patient Monitoring in Cancer Care

For patients undergoing systemic cancer therapy, the time between clinic visits is full of uncertainties and risks of unmonitored side effects. To bridge this gap in care, we developed and prospectively trialed a multi-modal AI framework for remote patient monitoring (RPM). This system integrates multi-modal data from the HALO-X platform, such as demographics, wearable sensors, daily surveys, and clinical events. Our observational trial is one of the largest of its kind and has collected over 2.1 million data points (6,080 patient-days) of monitoring from 84 patients. We developed and adapted a multi-modal AI model to handle the asynchronous and incomplete nature of real-world RPM data, forecasting a continuous risk of future adverse events. The model achieved an accuracy of 83.9% (AUROC=0.70). Notably, the model identified previous treatments, wellness check-ins, and daily maximum heart rate as key predictive features. A case study demonstrated the model's ability to provide early warnings by outputting escalating risk profiles prior to the event. This work establishes the feasibility of multi-modal AI RPM for cancer care and offers a path toward more proactive patient support.(Accepted at Europe NeurIPS 2025 Multimodal Representation Learning for Healthcare Workshop. Best Paper Poster Award.)

cs.LG↗

arXiv2025

Towards Multimodal Representation Learning in Paediatric Kidney Disease

Paediatric kidney disease varies widely in its presentation and progression, which calls for continuous monitoring of renal function. Using electronic health records collected between 2019 and 2025 at Great Ormond Street Hospital, a leading UK paediatric hospital, we explored a temporal modelling approach that integrates longitudinal laboratory sequences with demographic information. A recurrent neural model trained on these data was used to predict whether a child would record an abnormal serum creatinine value within the following thirty days. Framed as a pilot study, this work provides an initial demonstration that simple temporal representations can capture useful patterns in routine paediatric data and lays the groundwork for future multimodal extensions using additional clinical signals and more detailed renal outcomes.

cs.LG↗

arXiv2024

Considerations and Recommendations from the ISMRM Diffusion Study Group for preclinical diffusion MRI: Part 1 -- In vivo small-animal imaging

Small-animal diffusion MRI (dMRI) has been used for methodological development and validation, characterizing the biological basis of diffusion phenomena, and comparative anatomy. The steps from animal setup and monitoring, to acquisition, analysis, and interpretation are complex, with many decisions that may ultimately affect what questions can be answered using the resultant data. This work aims to present selected recommendations and guidelines from the diffusion community, on best practices for preclinical dMRI of in vivo animals. We describe the general considerations and foundational knowledge that must be considered when designing experiments. We briefly describe differences in animal species and disease models and discuss why some may be more or less appropriate for different studies. We then give guidelines for in vivo acquisition protocols, including decisions on hardware, animal preparation, and imaging sequences, followed by advice for data processing including pre-processing, model-fitting, and tractography. Finally, we provide an online resource which lists publicly available preclinical dMRI datasets and software packages, to promote responsible and reproducible research. In each section, we attempt to provide guides and recommendations, but also highlight areas for which no guidelines exist (and why), and where future work should focus. While we mainly cover the central nervous system (on which most preclinical dMRI studies are focused), we also provide, where possible and applicable, recommendations for other organs of interest. An overarching goal herein is to enhance the rigor and reproducibility of small animal dMRI acquisitions and analyses, and thereby advance biomedical knowledge.

physics.med-ph↗

arXiv2024

Considerations and recommendations from the ISMRM Diffusion Study Group for preclinical diffusion MRI: Part 2 -- Ex vivo imaging: added value and acquisition

The value of preclinical diffusion MRI (dMRI) is substantial. While dMRI enables in vivo non-invasive characterization of tissue, ex vivo dMRI is increasingly used to probe tissue microstructure and brain connectivity. Ex vivo dMRI has several experimental advantages including higher signal-to-noise ratio and spatial resolution compared to in vivo studies, and enabling more advanced diffusion contrasts. Another major advantage of ex vivo dMRI is the direct comparison with histological data as a methodological validation. However, there are a number of considerations that must be made when performing ex vivo experiments. The steps from tissue preparation, image acquisition and processing, and interpretation of results are complex, with decisions that not only differ dramatically from in vivo imaging of small animals, but ultimately affect what questions can be answered using the data. This work represents "Part 2" of a 3-part series of recommendations and considerations for preclinical dMRI. We describe best practices for dMRI of ex vivo tissue, with a focus on the value that ex vivo imaging adds to the field of dMRI and considerations in ex vivo image acquisition. We give general considerations and foundational knowledge that must be considered when designing experiments. We describe differences in specimens and models and discuss why some may be more or less appropriate for different studies. We then give guidelines for ex vivo protocols, including tissue fixation, sample preparation, and MR scanning. In each section, we attempt to provide guidelines and recommendations, but also highlight areas for which no guidelines exist (and why), and where future work should lie. An overarching goal herein is to enhance the rigor and reproducibility of ex vivo dMRI acquisitions and analyses, and thereby advance biomedical knowledge.

physics.med-ph↗

arXiv2024

Considerations and recommendations from the ISMRM Diffusion Study Group for preclinical diffusion MRI: Part 3 -- Ex vivo imaging: data processing, comparisons with microscopy, and tractography

Preclinical diffusion MRI (dMRI) has proven value in methods development and validation, characterizing the biological basis of diffusion phenomena, and comparative anatomy. While dMRI enables in vivo non-invasive characterization of tissue, ex vivo dMRI is increasingly being used to probe tissue microstructure and brain connectivity. Ex vivo dMRI has several experimental advantages that facilitate high spatial resolution and high signal-to-noise ratio (SNR) images, cutting-edge diffusion contrasts, and direct comparison with histological data as a methodological validation. However, there are a number of considerations that must be made when performing ex vivo experiments. The steps from tissue preparation, image acquisition and processing, and interpretation of results are complex, with many decisions that not only differ dramatically from in vivo imaging of small animals, but ultimately affect what questions can be answered using the data. This work concludes a 3-part series of recommendations and considerations for preclinical dMRI. Herein, we describe best practices for dMRI of ex vivo tissue, with a focus on image pre-processing, data processing and model fitting, and tractography. In each section, we attempt to provide guidelines and recommendations, but also highlight areas for which no guidelines exist (and why), and where future work should lie. We end by providing guidelines on code sharing and data sharing, and point towards open-source software and databases specific to small animal and ex vivo imaging.

physics.med-ph↗

arXiv2021

Acquisition-invariant brain MRI segmentation with informative uncertainties

Combining multi-site data can strengthen and uncover trends, but is a task that is marred by the influence of site-specific covariates that can bias the data and therefore any downstream analyses. Post-hoc multi-site correction methods exist but have strong assumptions that often do not hold in real-world scenarios. Algorithms should be designed in a way that can account for site-specific effects, such as those that arise from sequence parameter choices, and in instances where generalisation fails, should be able to identify such a failure by means of explicit uncertainty modelling. This body of work showcases such an algorithm, that can become robust to the physics of acquisition in the context of segmentation tasks, while simultaneously modelling uncertainty. We demonstrate that our method not only generalises to complete holdout datasets, preserving segmentation quality, but does so while also accounting for site-specific sequence choices, which also allows it to perform as a harmonisation tool.

eess.IV↗

arXiv2021

The role of MRI physics in brain segmentation CNNs: achieving acquisition invariance and instructive uncertainties

Being able to adequately process and combine data arising from different sites is crucial in neuroimaging, but is difficult, owing to site, sequence and acquisition-parameter dependent biases. It is important therefore to design algorithms that are not only robust to images of differing contrasts, but also be able to generalise well to unseen ones, with a quantifiable measure of uncertainty. In this paper we demonstrate the efficacy of a physics-informed, uncertainty-aware, segmentation network that employs augmentation-time MR simulations and homogeneous batch feature stratification to achieve acquisition invariance. We show that the proposed approach also accurately extrapolates to out-of-distribution sequence samples, providing well calibrated volumetric bounds on these. We demonstrate a significant improvement in terms of coefficients of variation, backed by uncertainty based volumetric validation.

eess.IV↗

arXiv2020

Physics-informed brain MRI segmentation

Magnetic Resonance Imaging (MRI) is one of the most flexible and powerful medical imaging modalities. This flexibility does however come at a cost; MRI images acquired at different sites and with different parameters exhibit significant differences in contrast and tissue appearance, resulting in downstream issues when quantifying brain anatomy or the presence of pathology. In this work, we propose to combine multiparametric MRI-based static-equation sequence simulations with segmentation convolutional neural networks (CNN), to make these networks robust to variations in acquisition parameters. Results demonstrate that, when given both the image and their associated physics acquisition parameters, CNNs can produce segmentations that exhibit robustness to acquisition variations. We also show that the proposed physics-informed methods can be used to bridge multi-centre and longitudinal imaging studies where imaging acquisition varies across a site or in time.

physics.med-ph↗

arXiv2019

Machine learning based white matter models with permeability: An experimental study in cuprizone treated in-vivo mouse model of axonal demyelination

The intra-axonal water exchange time τi, a parameter associated with axonal permeability, could be an important biomarker for understanding demyelinating pathologies such as Multiple Sclerosis. Diffusion-Weighted MRI is sensitive to changes in permeability, however, the parameter has remained elusive due to the intractability of the mathematical models that incorporate it. Machine learning based computational models can potentially be used to estimate such parameters, and recently, a theoretical framework using a random forest (RF) suggests this is a promising approach. In this study, we adopt such an RF approach and experimentally investigate its suitability as a biomarker for demyelinating pathologies through direct comparison with histology. For this, we use an in-vivo cuprizone (CPZ) mouse model of demyelination with available ex-vivo electron microscopy (EM) data. We test our model on noise-free simulations and find very strong correlations between the predicted and ground truth parameters. For realistic noise levels as in our in-vivo data, the performance is affected, however, the parameters are still well estimated. We apply our RF model on in-vivo data from 8 CPZ and 8 wild-type (WT) mice and validate the RF estimates using histology. We find a strong correlation between the in-vivo RF estimates of τi and the EM measurements of myelin thickness ({ρ_τ}i = 0.82), and between RF estimates and EM measurements of intra-axonal volume fraction ({ρ_f} = 0.98). When comparing τi in CPZ and WT mice we find a statistically significant decrease in the corpus callosum of the CPZ compared to the WT mice, in line with our expectations that τi is lower in regions where the myelin sheath is damaged. Overall, these results demonstrate the suitability of machine learning compartment models with permeability as a potential biomarker for demyelinating pathologies.

physics.med-ph↗

arXiv2019

Accurate estimation of microscopic diffusion anisotropy and its time dependence in the mouse brain

Microscopic diffusion anisotropy (μA) has been recently gaining increasing attention for its ability to decouple the average compartment anisotropy from orientation dispersion. Advanced diffusion MRI sequences, such as double diffusion encoding (DDE) and double oscillating diffusion encoding (DODE) have been used for mapping μA. However, the time-dependence of μA has not been investigated insofar, and furthermore, the accuracy of μA estimation vis-à-vis different b-values was not assessed. Here, we investigate both these concepts using theory, simulation, and experiments in the mouse brain. In the first part, simulations and experimental results show that the conventional estimation of microscopic anisotropy from the difference of D(O)DE sequences with parallel and orthogonal gradient directions yields values that highly depend on the choice of b-value. To mitigate this undesirable bias, we propose a multi-shell approach that harnesses a polynomial fit of the signal difference up to third order terms in b-value. In simulations, this approach yields more accurate μA metrics, which are similar to the ground truth values. The second part of this work uses the proposed multi-shell method to estimate the time/frequency dependence of μA. The data shows either an increase or no change in μA with frequency depending on the region of interest, both in white and gray matter. When comparing the experimental results with simulations, it emerges that simple geometric models such as infinite cylinders with either negligible or finite radii cannot replicate the measured trend, and more complex models, which, for example, incorporate structure along the fibre direction are required. Thus, measuring the time dependence of microscopic anisotropy can provide valuable information for characterizing tissue microstructure.

physics.med-ph↗

arXiv2004

Oscillations in a maturation model of blood cell production

In this paper we use a continuous model to describe the development of a single cell lineage following the committal of stem cells. Three separate controls are implemented in the model, namely the proliferative control of stem cells, the proliferative control of developing blast cells, and the peripheral control of stem cell committal by circulating blood cell density. We show that variation of parameters in all three control systems can cause oscillations, and that the characters of these oscillations are very different. This allows us some potential insight into the mechanisms that may be operative in some of the dynamic blood diseases like cyclical neutropenia and periodic chronic myelogenous leukemia.

q-bio.TO↗