arXiv subjects

Pranav Rajpurkar

Publications and source records attributed to Pranav Rajpurkar.

At least 55 records · Page 3Linked to original sources

arXiv2024

ReXamine-Global: A Framework for Uncovering Inconsistencies in Radiology Report Generation Metrics

Given the rapidly expanding capabilities of generative AI models for radiology, there is a need for robust metrics that can accurately measure the quality of AI-generated radiology reports across diverse hospitals. We develop ReXamine-Global, a LLM-powered, multi-site framework that tests metrics across different writing styles and patient populations, exposing gaps in their generalization. First, our method tests whether a metric is undesirably sensitive to reporting style, providing different scores depending on whether AI-generated reports are stylistically similar to ground-truth reports or not. Second, our method measures whether a metric reliably agrees with experts, or whether metric and expert scores of AI-generated report quality diverge for some sites. Using 240 reports from 6 hospitals around the world, we apply ReXamine-Global to 7 established report evaluation metrics and uncover serious gaps in their generalizability. Developers can apply ReXamine-Global when designing new report evaluation metrics, ensuring their robustness across sites. Additionally, our analysis of existing metrics can guide users of those metrics towards evaluation procedures that work reliably at their sites of interest.

cs.LG↗

arXiv2024

Uncovering Knowledge Gaps in Radiology Report Generation Models through Knowledge Graphs

Recent advancements in artificial intelligence have significantly improved the automatic generation of radiology reports. However, existing evaluation methods fail to reveal the models' understanding of radiological images and their capacity to achieve human-level granularity in descriptions. To bridge this gap, we introduce a system, named ReXKG, which extracts structured information from processed reports to construct a comprehensive radiology knowledge graph. We then propose three metrics to evaluate the similarity of nodes (ReXKG-NSC), distribution of edges (ReXKG-AMS), and coverage of subgraphs (ReXKG-SCS) across various knowledge graphs. We conduct an in-depth comparative analysis of AI-generated and human-written radiology reports, assessing the performance of both specialist and generalist models. Our study provides a deeper understanding of the capabilities and limitations of current AI models in radiology report generation, offering valuable insights for improving model performance and clinical applicability.

cs.AI↗

arXiv2024

FineRadScore: A Radiology Report Line-by-Line Evaluation Technique Generating Corrections with Severity Scores

The current gold standard for evaluating generated chest x-ray (CXR) reports is through radiologist annotations. However, this process can be extremely time-consuming and costly, especially when evaluating large numbers of reports. In this work, we present FineRadScore, a Large Language Model (LLM)-based automated evaluation metric for generated CXR reports. Given a candidate report and a ground-truth report, FineRadScore gives the minimum number of line-by-line corrections required to go from the candidate to the ground-truth report. Additionally, FineRadScore provides an error severity rating with each correction and generates comments explaining why the correction was needed. We demonstrate that FineRadScore's corrections and error severity scores align with radiologist opinions. We also show that, when used to judge the quality of the report as a whole, FineRadScore aligns with radiologists as well as current state-of-the-art automated CXR evaluation metrics. Finally, we analyze FineRadScore's shortcomings to provide suggestions for future improvements.

cs.CL↗

arXiv2024

Direct Preference Optimization for Suppressing Hallucinated Prior Exams in Radiology Report Generation

Recent advances in generative vision-language models (VLMs) have exciting potential implications for AI in radiology, yet VLMs are also known to produce hallucinations, nonsensical text, and other unwanted behaviors that can waste clinicians' time and cause patient harm. Drawing on recent work on direct preference optimization (DPO), we propose a simple method for modifying the behavior of pretrained VLMs performing radiology report generation by suppressing unwanted types of generations. We apply our method to the prevention of hallucinations of prior exams, addressing a long-established problem behavior in models performing chest X-ray report generation. Across our experiments, we find that DPO fine-tuning achieves a 3.2-4.8x reduction in lines hallucinating prior exams while maintaining model performance on clinical accuracy metrics. Our work is, to the best of our knowledge, the first work to apply DPO to medical VLMs, providing a data- and compute- efficient way to suppress problem behaviors while maintaining overall clinical accuracy.

cs.LG↗

arXiv2024

Learning Generalized Medical Image Representations through Image-Graph Contrastive Pretraining

Medical image interpretation using deep learning has shown promise but often requires extensive expert-annotated datasets. To reduce this annotation burden, we develop an Image-Graph Contrastive Learning framework that pairs chest X-rays with structured report knowledge graphs automatically extracted from radiology notes. Our approach uniquely encodes the disconnected graph components via a relational graph convolution network and transformer attention. In experiments on the CheXpert dataset, this novel graph encoding strategy enabled the framework to outperform existing methods that use image-text contrastive learning in 1% linear evaluation and few-shot settings, while achieving comparable performance to radiologists. By exploiting unlabeled paired images and text, our framework demonstrates the potential of structured clinical insights to enhance contrastive learning for medical images. This work points toward reducing demands on medical experts for annotations, improving diagnostic precision, and advancing patient care through robust medical image understanding.

eess.IV↗

arXiv2023

LymphoML: An interpretable artificial intelligence-based method identifies morphologic features that correlate with lymphoma subtype

The accurate classification of lymphoma subtypes using hematoxylin and eosin (H&E)-stained tissue is complicated by the wide range of morphological features these cancers can exhibit. We present LymphoML - an interpretable machine learning method that identifies morphologic features that correlate with lymphoma subtypes. Our method applies steps to process H&E-stained tissue microarray cores, segment nuclei and cells, compute features encompassing morphology, texture, and architecture, and train gradient-boosted models to make diagnostic predictions. LymphoML's interpretable models, developed on a limited volume of H&E-stained tissue, achieve non-inferior diagnostic accuracy to pathologists using whole-slide images and outperform black box deep-learning on a dataset of 670 cases from Guatemala spanning 8 lymphoma subtypes. Using SHapley Additive exPlanation (SHAP) analysis, we assess the impact of each feature on model prediction and find that nuclear shape features are most discriminative for DLBCL (F1-score: 78.7%) and classical Hodgkin lymphoma (F1-score: 74.5%). Finally, we provide the first demonstration that a model combining features from H&E-stained tissue with features from a standardized panel of 6 immunostains results in a similar diagnostic accuracy (85.3%) to a 46-stain panel (86.1%).

cs.LG↗

arXiv2023

Multimodal Clinical Benchmark for Emergency Care (MC-BEC): A Comprehensive Benchmark for Evaluating Foundation Models in Emergency Medicine

We propose the Multimodal Clinical Benchmark for Emergency Care (MC-BEC), a comprehensive benchmark for evaluating foundation models in Emergency Medicine using a dataset of 100K+ continuously monitored Emergency Department visits from 2020-2022. MC-BEC focuses on clinically relevant prediction tasks at timescales from minutes to days, including predicting patient decompensation, disposition, and emergency department (ED) revisit, and includes a standardized evaluation framework with train-test splits and evaluation metrics. The multimodal dataset includes a wide range of detailed clinical data, including triage information, prior diagnoses and medications, continuously measured vital signs, electrocardiogram and photoplethysmograph waveforms, orders placed and medications administered throughout the visit, free-text reports of imaging studies, and information on ED diagnosis, disposition, and subsequent revisits. We provide performance baselines for each prediction task to enable the evaluation of multimodal, multitask models. We believe that MC-BEC will encourage researchers to develop more effective, generalizable, and accessible foundation models for multimodal clinical data.

cs.LG↗

arXiv2023

Style-Aware Radiology Report Generation with RadGraph and Few-Shot Prompting

Automatically generated reports from medical images promise to improve the workflow of radiologists. Existing methods consider an image-to-report modeling task by directly generating a fully-fledged report from an image. However, this conflates the content of the report (e.g., findings and their attributes) with its style (e.g., format and choice of words), which can lead to clinically inaccurate reports. To address this, we propose a two-step approach for radiology report generation. First, we extract the content from an image; then, we verbalize the extracted content into a report that matches the style of a specific radiologist. For this, we leverage RadGraph -- a graph representation of reports -- together with large language models (LLMs). In our quantitative evaluations, we find that our approach leads to beneficial performance. Our human evaluation with clinical raters highlights that the AI-generated reports are indistinguishably tailored to the style of individual radiologist despite leveraging only a few examples as context.

cs.AI↗

arXiv2023

Exploring the Boundaries of GPT-4 in Radiology

The recent success of general-domain large language models (LLMs) has significantly changed the natural language processing paradigm towards a unified foundation model across domains and applications. In this paper, we focus on assessing the performance of GPT-4, the most capable LLM so far, on the text-based applications for radiology reports, comparing against state-of-the-art (SOTA) radiology-specific models. Exploring various prompting strategies, we evaluated GPT-4 on a diverse range of common radiology tasks and we found GPT-4 either outperforms or is on par with current SOTA radiology models. With zero-shot prompting, GPT-4 already obtains substantial gains ($\approx$ 10% absolute improvement) over radiology models in temporal sentence similarity classification (accuracy) and natural language inference ($F_1$). For tasks that require learning dataset-specific style or schema (e.g. findings summarisation), GPT-4 improves with example-based prompting and matches supervised SOTA. Our extensive error analysis with a board-certified radiologist shows GPT-4 has a sufficient level of radiology knowledge with only occasional errors in complex context that require nuanced domain knowledge. For findings summarisation, GPT-4 outputs are found to be overall comparable with existing manually-written impressions.

cs.CL↗

arXiv2023

Augmenting medical image classifiers with synthetic data from latent diffusion models

While hundreds of artificial intelligence (AI) algorithms are now approved or cleared by the US Food and Drugs Administration (FDA), many studies have shown inconsistent generalization or latent bias, particularly for underrepresented populations. Some have proposed that generative AI could reduce the need for real data, but its utility in model development remains unclear. Skin disease serves as a useful case study in synthetic image generation due to the diversity of disease appearance, particularly across the protected attribute of skin tone. Here we show that latent diffusion models can scalably generate images of skin disease and that augmenting model training with these data improves performance in data-limited settings. These performance gains saturate at synthetic-to-real image ratios above 10:1 and are substantially smaller than the gains obtained from adding real images. As part of our analysis, we generate and analyze a new dataset of 458,920 synthetic images produced using several generation strategies. Our results suggest that synthetic data could serve as a force-multiplier for model development, but the collection of diverse real-world data remains the most important step to improve medical AI algorithms.

cs.CV↗

arXiv2023

RadGraph2: Modeling Disease Progression in Radiology Reports via Hierarchical Information Extraction

We present RadGraph2, a novel dataset for extracting information from radiology reports that focuses on capturing changes in disease state and device placement over time. We introduce a hierarchical schema that organizes entities based on their relationships and show that using this hierarchy during training improves the performance of an information extraction model. Specifically, we propose a modification to the DyGIE++ framework, resulting in our model HGIE, which outperforms previous models in entity and relation extraction tasks. We demonstrate that RadGraph2 enables models to capture a wider variety of findings and perform better at relation extraction compared to those trained on the original RadGraph dataset. Our work provides the foundation for developing automated systems that can track disease progression over time and develop information extraction models that leverage the natural hierarchy of labels in the medical domain.

cs.CL↗

arXiv2023

Med-Flamingo: a Multimodal Medical Few-shot Learner

Medicine, by its nature, is a multifaceted domain that requires the synthesis of information across various modalities. Medical generative vision-language models (VLMs) make a first step in this direction and promise many exciting clinical applications. However, existing models typically have to be fine-tuned on sizeable down-stream datasets, which poses a significant limitation as in many medical applications data is scarce, necessitating models that are capable of learning from few examples in real-time. Here we propose Med-Flamingo, a multimodal few-shot learner adapted to the medical domain. Based on OpenFlamingo-9B, we continue pre-training on paired and interleaved medical image-text data from publications and textbooks. Med-Flamingo unlocks few-shot generative medical visual question answering (VQA) abilities, which we evaluate on several datasets including a novel challenging open-ended VQA dataset of visual USMLE-style problems. Furthermore, we conduct the first human evaluation for generative medical VQA where physicians review the problems and blinded generations in an interactive app. Med-Flamingo improves performance in generative medical VQA by up to 20\% in clinician's rating and firstly enables multimodal medical few-shot adaptations, such as rationale generation. We release our model, code, and evaluation app under https://github.com/snap-stanford/med-flamingo.

cs.CV↗

arXiv2023

BenchMD: A Benchmark for Unified Learning on Medical Images and Sensors

Medical data poses a daunting challenge for AI algorithms: it exists in many different modalities, experiences frequent distribution shifts, and suffers from a scarcity of examples and labels. Recent advances, including transformers and self-supervised learning, promise a more universal approach that can be applied flexibly across these diverse conditions. To measure and drive progress in this direction, we present BenchMD: a benchmark that tests how well unified, modality-agnostic methods, including architectures and training techniques (e.g. self-supervised learning, ImageNet pretraining),perform on a diverse array of clinically-relevant medical tasks. BenchMD combines 19 publicly available datasets for 7 medical modalities, including 1D sensor data, 2D images, and 3D volumetric scans. Our benchmark reflects real-world data constraints by evaluating methods across a range of dataset sizes, including challenging few-shot settings that incentivize the use of pretraining. Finally, we evaluate performance on out-of-distribution data collected at different hospitals than the training data, representing naturally-occurring distribution shifts that frequently degrade the performance of medical AI models. Our baseline results demonstrate that no unified learning technique achieves strong performance across all modalities, leaving ample room for improvement on the benchmark. Code is released at https://github.com/rajpurkarlab/BenchMD.

cs.CV↗

arXiv2023

Improving Zero-Shot Detection of Low Prevalence Chest Pathologies using Domain Pre-trained Language Models

Recent advances in zero-shot learning have enabled the use of paired image-text data to replace structured labels, replacing the need for expert annotated datasets. Models such as CLIP-based CheXzero utilize these advancements in the domain of chest X-ray interpretation. We hypothesize that domain pre-trained models such as CXR-BERT, BlueBERT, and ClinicalBERT offer the potential to improve the performance of CLIP-like models with specific domain knowledge by replacing BERT weights at the cost of breaking the original model's alignment. We evaluate the performance of zero-shot classification models with domain-specific pre-training for detecting low-prevalence pathologies. Even though replacing the weights of the original CLIP-BERT degrades model performance on commonly found pathologies, we show that pre-trained text towers perform exceptionally better on low-prevalence diseases. This motivates future ensemble models with a combination of differently trained language models for maximal performance.

physics.med-ph↗

arXiv2023

Multimodal Image-Text Matching Improves Retrieval-based Chest X-Ray Report Generation

Automated generation of clinically accurate radiology reports can improve patient care. Previous report generation methods that rely on image captioning models often generate incoherent and incorrect text due to their lack of relevant domain knowledge, while retrieval-based attempts frequently retrieve reports that are irrelevant to the input image. In this work, we propose Contrastive X-Ray REport Match (X-REM), a novel retrieval-based radiology report generation module that uses an image-text matching score to measure the similarity of a chest X-ray image and radiology report for report retrieval. We observe that computing the image-text matching score with a language-image model can effectively capture the fine-grained interaction between image and text that is often lost when using cosine similarity. X-REM outperforms multiple prior radiology report generation modules in terms of both natural language and clinical metrics. Human evaluation of the generated reports suggests that X-REM increased the number of zero-error reports and decreased the average error severity compared to the baseline retrieval approach. Our code is available at: https://github.com/rajpurkarlab/X-REM

cs.CL↗

arXiv2023

Video Pretraining Advances 3D Deep Learning on Chest CT Tasks

Pretraining on large natural image classification datasets such as ImageNet has aided model development on data-scarce 2D medical tasks. 3D medical tasks often have much less data than 2D medical tasks, prompting practitioners to rely on pretrained 2D models to featurize slices. However, these 2D models have been surpassed by 3D models on 3D computer vision benchmarks since they do not natively leverage cross-sectional or temporal information. In this study, we explore whether natural video pretraining for 3D models can enable higher performance on smaller datasets for 3D medical tasks. We demonstrate video pretraining improves the average performance of seven 3D models on two chest CT datasets, regardless of finetuning dataset size, and that video pretraining allows 3D models to outperform 2D baselines. Lastly, we observe that pretraining on the large-scale out-of-domain Kinetics dataset improves performance more than pretraining on a typically-sized in-domain CT dataset. Our results show consistent benefits of video pretraining across a wide array of architectures, tasks, and training dataset sizes, supporting a shift from small-scale in-domain pretraining to large-scale out-of-domain pretraining for 3D medical tasks. Our code is available at: https://github.com/rajpurkarlab/chest-ct-pretraining

eess.IV↗

arXiv2022

Improving dermatology classifiers across populations using images generated by large diffusion models

Dermatological classification algorithms developed without sufficiently diverse training data may generalize poorly across populations. While intentional data collection and annotation offer the best means for improving representation, new computational approaches for generating training data may also aid in mitigating the effects of sampling bias. In this paper, we show that DALL$\cdot$E 2, a large-scale text-to-image diffusion model, can produce photorealistic images of skin disease across skin types. Using the Fitzpatrick 17k dataset as a benchmark, we demonstrate that augmenting training data with DALL$\cdot$E 2-generated synthetic images improves classification of skin disease overall and especially for underrepresented groups.

eess.IV↗

arXiv2022

Improving Radiology Report Generation Systems by Removing Hallucinated References to Non-existent Priors

Current deep learning models trained to generate radiology reports from chest radiographs are capable of producing clinically accurate, clear, and actionable text that can advance patient care. However, such systems all succumb to the same problem: making hallucinated references to non-existent prior reports. Such hallucinations occur because these models are trained on datasets of real-world patient reports that inherently refer to priors. To this end, we propose two methods to remove references to priors in radiology reports: (1) a GPT-3-based few-shot approach to rewrite medical reports without references to priors; and (2) a BioBERT-based token classification approach to directly remove words referring to priors. We use the aforementioned approaches to modify MIMIC-CXR, a publicly available dataset of chest X-rays and their associated free-text radiology reports; we then retrain CXR-RePaiR, a radiology report generation system, on the adapted MIMIC-CXR dataset. We find that our re-trained model--which we call CXR-ReDonE--outperforms previous report generation methods on clinical metrics, achieving an average BERTScore of 0.2351 (2.57% absolute improvement). We expect our approach to be broadly valuable in enabling current radiology report generation systems to be more directly integrated into clinical pipelines.

cs.CL↗