arXiv subjects

Justin W. Ady

Publications and source records attributed to Justin W. Ady.

3 recordsLinked to original sources

arXiv2026

Medi-Gemma: A Hybrid Clinical Decision Support System Integrating Deterministic EMR Analytics and Retrieval-Augmented Generation

Deploying Large Language Models (LLMs) in high-stakes clinical settings remains limited by structural hallucinations, weak deterministic reasoning over tabular patient data, and omissions in vector retrieval. This paper presents the architecture and validation of Medi-Gemma, a Clinical Decision Support System (CDSS) for wound pathology triage and workflow automation. The platform introduces a decoupled framework that separates clinical perception from data orchestration while preserving traceable reasoning. Medi-Gemma uses a multi-stage pipeline coordinated by a centralized ClinicalOrchestrator. Data requests are handled without generative inference by a DataManager that cleans unstructured Electronic Medical Record (EMR) files through type coercion. Natural language queries are processed by a hierarchical IntentRouter, which routes requests to deterministic analytics paths executed by a PandasQueryEngine or to patient-specific reasoning managed by a ClinicalRAGEngine using a CPU-optimized vector store. A key contribution is the Ground Truth Injection Module, which intercepts patient-specific queries, extracts numeric identification tokens, queries the structured dataframe via Pandas, retrieves the latest validated clinical state, and embeds this snapshot as an overriding context block in the LLM prompt before generation. Safety compliance is enforced by a deterministic ProtocolManager that maps clinical terminology to fixed evidence-based risk pathways, while a SafetyVerifier phrase filter prevents output rule violations. Validation shows that this architecture eliminates semantic context drift, prevents database compilation crashes, and improves factual adherence to backend clinical repositories. These results support Medi-Gemma as a safer pattern for LLM-based clinical decision support where structured data fidelity, retrieval grounding, and deterministic safeguards are essential.

cs.AI↗

arXiv2026

Evaluation of Medical Vision Language Models HuluMed and MedGemma, and general purpose chatbots Gemma 3, ChatGPT Plus, and Claude Pro on real previously unseen wound images

Chronic wound assessment remains a clinically challenging task that requires accurate interpretation of wound morphology, tissue composition, vascular characteristics, and infection risk. Recent advances in Vision-Language Models (VLMs) have introduced the possibility of automated multimodal wound analysis through image understanding combined with clinical reasoning. This study evaluates the performance of several general-purpose and medically specialized open-source and proprietary VLMs for clinical wound assessment using an expanded, curated dataset of 20 clinically diverse wounds spanning vascular, surgical, ischemic, venous, lymphedema, and amputation-related etiologies. Six VLMs were evaluated using a structured twelve-question clinical framework covering wound classification, infection risk, vascular intervention recommendations, debridement urgency, wound therapy selection, and advanced management planning. Across 20 wound cases and 240 clinician-graded wound-analysis decisions, ChatGPT achieved the highest overall performance with 174/240 correct responses (72.50%), followed by Claude with 149/240 (62.08%). Among the open-source and medically specialized models, HuluMed achieved the strongest performance with 96/240 correct responses (40.00%), followed by Gemma 3 (81/240, 33.75%), MedGemma 4B (62/240, 25.83%), and MedGemma 27B (42/240, 17.50%). The findings suggest that frontier general-purpose multimodal systems currently demonstrate substantially stronger wound-analysis performance than medically specialized alternatives, highlighting the continued importance of broad multimodal reasoning capabilities alongside domain-specific medical knowledge. Although current VLMs demonstrate promising potential for clinical decision support, substantial limitations remain in advanced wound-management reasoning, procedural planning, and autonomous clinical reliability.

cs.CV↗

arXiv2023

A Cascaded Neural Network System For Rating Student Performance In Surgical Knot Tying Simulation

As part of their training all medical students and residents have to pass basic surgical tasks such as knot tying, needle-passing, and suturing. Their assessment is typically performed in the operating room by surgical faculty where mistakes and failure by the student increases the operation time and cost. This evaluation is quantitative and has a low margin of error. Simulation has emerged as a cost effective option but it lacks assessment or requires additional expensive hardware for evaluation. Apps that provide training videos on surgical knot trying are available to students but none have evaluation. We propose a cascaded neural network architecture that evaluates a student's performance just from a video of themselves simulating a surgical knot tying task. Our model converts video frame images into feature vectors with a pre-trained deep convolutional network and then models the sequence of frames with a temporal network. We obtained videos of medical students and residents from the Robert Wood Johnson Hospital performing knot tying on a standardized simulation kit. We manually annotated each video and proceeded to do a five-fold cross-validation study on them. Our model achieves a median precision, recall, and F1-score of 0.71, 0.66, and 0.65 respectively in determining the level of knot related tasks of tying and pushing the knot. Our mean precision score averaged across different probability thresholds is 0.8. Both our F1-score and mean precision score are 8% and 30% higher than that of a recently published study for the same problem. We expect the accuracy of our model to further increase as we add more training videos to the model thus making it a practical solution that students can use to evaluate themselves.

cs.CV↗