Despite the superior diagnostic capability of Magnetic Resonance Imaging (MRI), its use as a Point-of-Care (PoC) device remains limited by high cost and complexity. To enable such a future by reducing the magnetic field strength, one key approach will be to improve sampling strategies. Previous work has shown that it is possible to make diagnostic decisions directly from k-space with fewer samples. Such work shows that single diagnostic decisions can be made, but if we aspire to see MRI as a true PoC, multiple and sequential decisions are necessary while minimizing the number of samples acquired. We present a novel multi-objective reinforcement learning framework enabling comprehensive, sequential, diagnostic evaluation from undersampled k-space data. Our approach during inference actively adapts to sequential decisions to optimally sample. To achieve this, we introduce a training methodology that identifies the samples that contribute the best to each diagnostic objective using a step-wise weighting reward function. We evaluate our approach in two sequential knee pathology assessment tasks: ACL sprain detection and cartilage thickness loss assessment. Our framework achieves diagnostic performance competitive with various policy-based benchmarks on disease detection, severity quantification, and overall sequential diagnosis, while substantially saving k-space samples. Our approach paves the way for the future of MRI as a comprehensive and affordable PoC device. Our code is publicly available at https://github.com/vios-s/MRI_Sequential_Active_Sampling
This study introduces a pioneering Dynamic Hypergraph Networks (DHCE) model designed to predict future medical diagnoses from electronic health records with enhanced accuracy. The DHCE model innovates by identifying and differentiating acute and chronic diseases within a patient's visit history, constructing dynamic hypergraphs that capture the complex, high-order interactions between diseases. It surpasses traditional recurrent neural networks and graph neural networks by effectively integrating clinical event data, reflected through medical language model-assisted encoding, into a robust patient representation. Through extensive experiments on two benchmark datasets, MIMIC-III and MIMIC-IV, the DHCE model exhibits superior performance, significantly outpacing established baseline models in the precision of sequential diagnosis prediction.
In this paper, we present NECHO v2, a novel framework designed to enhance the predictive accuracy of multimodal sequential patient diagnoses under uncertain missing visit sequences, a common challenge in real clinical settings. Firstly, we modify NECHO, designed in a diagnosis code-centric fashion, to handle uncertain modality representation dominance under the imperfect data. Secondly, we develop a systematic knowledge distillation by employing the modified NECHO as both teacher and student. It encompasses a modality-wise contrastive and hierarchical distillation, transformer representation random distillation, along with other distillations to align representations between teacher and student tightly and effectively. We also propose curriculum learning guided random data erasing within sequences during both training and distillation of the teacher to lightly simulate scenario with missing visit information, thereby fostering effective knowledge transfer. As a result, NECHO v2 verifies itself by showing robust superiority in multimodal sequential diagnosis prediction under both balanced and imbalanced incomplete settings on multimodal healthcare data.
Treatment planning for chronic diseases is a critical task in medical artificial intelligence, particularly in traditional Chinese medicine (TCM). However, generating optimized sequential treatment strategies for patients with chronic diseases in different clinical encounters remains a challenging issue that requires further exploration. In this study, we proposed a TCM herbal prescription planning framework based on deep reinforcement learning for chronic disease treatment (PrescDRL). PrescDRL is a sequential herbal prescription optimization model that focuses on long-term effectiveness rather than achieving maximum reward at every step, thereby ensuring better patient outcomes. We constructed a high-quality benchmark dataset for sequential diagnosis and treatment of diabetes and evaluated PrescDRL against this benchmark. Our results showed that PrescDRL achieved a higher curative effect, with the single-step reward improving by 117% and 153% compared to doctors. Furthermore, PrescDRL outperformed the benchmark in prescription prediction, with precision improving by 40.5% and recall improving by 63%. Overall, our study demonstrates the potential of using artificial intelligence to improve clinical intelligent diagnosis and treatment in TCM.
Sequential diagnosis prediction on the Electronic Health Record (EHR) has been proven crucial for predictive analytics in the medical domain. EHR data, sequential records of a patient's interactions with healthcare systems, has numerous inherent characteristics of temporality, irregularity and data insufficiency. Some recent works train healthcare predictive models by making use of sequential information in EHR data, but they are vulnerable to irregular, temporal EHR data with the states of admission/discharge from hospital, and insufficient data. To mitigate this, we propose an end-to-end robust transformer-based model called SETOR, which exploits neural ordinary differential equation to handle both irregular intervals between a patient's visits with admitted timestamps and length of stay in each visit, to alleviate the limitation of insufficient data by integrating medical ontology, and to capture the dependencies between the patient's visits by employing multi-layer transformer blocks. Experiments conducted on two real-world healthcare datasets show that, our sequential diagnoses prediction model SETOR not only achieves better predictive results than previous state-of-the-art approaches, irrespective of sufficient or insufficient training data, but also derives more interpretable embeddings of medical codes. The experimental codes are available at the GitHub repository (https://github.com/Xueping/SETOR).
Given a system that does not work as expected, Sequential Diagnosis (SD) aims at suggesting a series of system measurements to isolate the true explanation for the system's misbehavior from a potentially exponential set of possible explanations. To reason about the best next measurement, SD methods usually require a sample of possible fault explanations at each step of the iterative diagnostic process. The computation of this sample can be accomplished by various diagnostic search algorithms. Among those, Reiter's HS-Tree is one of the most popular due its desirable properties and general applicability. Usually, HS-Tree is used in a stateless fashion throughout the SD process to (re)compute a sample of possible fault explanations in each iteration, each time given the latest (updated) system knowledge including all so-far collected measurements. At this, the built search tree is discarded between two iterations, although often large parts of the tree have to be rebuilt in the next iteration, involving redundant operations and calls to costly reasoning services. As a remedy to this, we propose DynamicHS, a variant of HS-Tree that maintains state throughout the diagnostic session and additionally embraces special strategies to minimize the number of expensive reasoner invocations. In this vein, DynamicHS provides an answer to a longstanding question posed by Raymond Reiter in his seminal paper from 1987. Extensive evaluations on real-world diagnosis problems prove the reasonability of the DynamicHS and testify its clear superiority to HS-Tree wrt. computation time. More specifically, DynamicHS outperformed HS-Tree in 96% of the executed sequential diagnosis sessions and, per run, the latter required up to 800% the time of the former. Remarkably, DynamicHS achieves these performance improvements while preserving all desirable properties as well as the general applicability of HS-Tree.
Reiter's HS-Tree is one of the most popular diagnostic search algorithms due to its desirable properties and general applicability. In sequential diagnosis, where the addressed diagnosis problem is subject to successive change through the acquisition of additional knowledge about the diagnosed system, HS-Tree is used in a stateless fashion. That is, the existing search tree is discarded when new knowledge is obtained, albeit often large parts of the tree are still relevant and have to be rebuilt in the next iteration, involving redundant operations and costly reasoner calls. As a remedy to this, we propose DynamicHS, a variant of HS-Tree that avoids these redundancy issues by maintaining state throughout sequential diagnosis while preserving all desirable properties of HS-Tree. Preliminary results of ongoing evaluations in a problem domain where HS-Tree is the state-of-the-art diagnostic method suggest significant time savings achieved by DynamicHS by reducing expensive reasoner calls.
Given a malfunctioning system, sequential diagnosis aims at identifying the root cause of the failure in terms of abnormally behaving system components. As initial system observations usually do not suffice to deterministically pin down just one explanation of the system's misbehavior, additional system measurements can help to differentiate between possible explanations. The goal is to restrict the space of explanations until there is only one (highly probable) explanation left. To achieve this with a minimal-cost set of measurements, various (active learning) heuristics for selecting the best next measurement have been proposed. We report preliminary results of extensive ongoing experiments with a set of selection heuristics on real-world diagnosis cases. In particular, we try to answer questions such as "Is some heuristic always superior to all others?", "On which factors does the (relative) performance of the particular heuristics depend?" or "Under which circumstances should I use which heuristic?"
There has long been debate about the relative merits of decision theoretic methods and heuristic rule-based approaches for reasoning under uncertainty. We report an experimental comparison of the performance of the two approaches to troubleshooting, specifically to test selection for fault diagnosis. We use as experimental testbed the problem of diagnosing motorcycle engines. The first approach employs heuristic test selection rules obtained from expert mechanics. We compare it with the optimal decision analytic algorithm for test selection which employs estimated component failure probabilities and test costs. The decision analytic algorithm was found to reduce the expected cost (i.e. time) to arrive at a diagnosis by an average of 14% relative to the expert rules. Sensitivity analysis shows the results are quite robust to inaccuracy in the probability and cost estimates. This difference suggests some interesting implications for knowledge acquisition.
When a system behaves abnormally, sequential diagnosis takes a sequence of measurements of the system until the faults causing the abnormality are identified, and the goal is to reduce the diagnostic cost, defined here as the number of measurements. To propose measurement points, previous work employs a heuristic based on reducing the entropy over a computed set of diagnoses. This approach generally has good performance in terms of diagnostic cost, but can fail to diagnose large systems when the set of diagnoses is too large. Focusing on a smaller set of probable diagnoses scales the approach but generally leads to increased average diagnostic costs. In this paper, we propose a new diagnostic framework employing four new techniques, which scales to much larger systems with good performance in terms of diagnostic cost. First, we propose a new heuristic for measurement point selection that can be computed efficiently, without requiring the set of diagnoses, once the system is modeled as a Bayesian network and compiled into a logical form known as d-DNNF. Second, we extend hierarchical diagnosis, a technique based on system abstraction from our previous work, to handle probabilities so that it can be applied to sequential diagnosis to allow larger systems to be diagnosed. Third, for the largest systems where even hierarchical diagnosis fails, we propose a novel method that converts the system into one that has a smaller abstraction and whose diagnoses form a superset of those of the original system; the new system can then be diagnosed and the result mapped back to the original system. Finally, we propose a novel cost estimation function which can be used to choose an abstraction of the system that is more likely to provide optimal average cost. Experiments with ISCAS-85 benchmark circuits indicate that our approach scales to all circuits in the suite except one that has a flat structure not susceptible to useful abstraction.
Model-based diagnostic reasoning often leads to a large number of diagnostic hypotheses. The set of diagnoses can be reduced by taking into account extra observations (passive monitoring), measuring additional variables (probing) or executing additional tests (sequential diagnosis/test sequencing). In this paper we combine the above approaches with techniques from Automated Test Pattern Generation (ATPG) and Model-Based Diagnosis (MBD) into a framework called FRACTAL (FRamework for ACtive Testing ALgorithms). Apart from the inputs and outputs that connect a system to its environment, in active testing we consider additional input variables to which a sequence of test vectors can be supplied. We address the computationally hard problem of computing optimal control assignments (as defined in FRACTAL) in terms of a greedy approximation algorithm called FRACTAL-G. We compare the decrease in the number of remaining minimal cardinality diagnoses of FRACTAL-G to that of two more FRACTAL algorithms: FRACTAL-ATPG and FRACTAL-P. FRACTAL-ATPG is based on ATPG and sequential diagnosis while FRACTAL-P is based on probing and, although not an active testing algorithm, provides a baseline for comparing the lower bound on the number of reachable diagnoses for the FRACTAL algorithms. We empirically evaluate the trade-offs of the three FRACTAL algorithms by performing extensive experimentation on the ISCAS85/74XXX benchmark of combinational circuits.
In many model-based diagnosis applications it is impossible to provide such a set of observations and/or measurements that allow to identify the real cause of a fault. Therefore, diagnosis systems often return many possible candidates, leaving the burden of selecting the correct diagnosis to a user. Sequential diagnosis techniques solve this problem by automatically generating a sequence of queries to some oracle. The answers to these queries provide additional information necessary to gradually restrict the search space by removing diagnosis candidates inconsistent with the answers. During query computation, existing sequential diagnosis methods often require the generation of many unnecessary query candidates and strongly rely on expensive logical reasoners. We tackle this issue by devising efficient heuristic query search methods. The proposed methods enable for the first time a completely reasoner-free query generation while at the same time guaranteeing optimality conditions, e.g. minimal cardinality or best understandability, of the returned query that existing methods cannot realize. Hence, the performance of this approach is independent of the (complexity of the) diagnosed system. Experiments conducted using real-world problems show that the new approach is highly scalable and outperforms existing methods by orders of magnitude.
In this work we present strategies for (optimal) measurement selection in model-based sequential diagnosis. In particular, assuming a set of leading diagnoses being given, we show how queries (sets of measurements) can be computed and optimized along two dimensions: expected number of queries and cost per query. By means of a suitable decoupling of two optimizations and a clever search space reduction the computations are done without any inference engine calls. For the full search space, we give a method requiring only a polynomial number of inferences and guaranteeing query properties existing methods cannot provide. Evaluation results using real-world problems indicate that the new method computes (virtually) optimal queries instantly independently of the size and complexity of the considered diagnosis problems.
Model-Based Diagnosis deals with the identification of the real cause of a system's malfunction based on a formal system model and observations of the system behavior. When a malfunction is detected, there is usually not enough information available to pinpoint the real cause and one needs to discriminate between multiple fault hypotheses (called diagnoses). To this end, Sequential Diagnosis approaches ask an oracle for additional system measurements. This work presents strategies for (optimal) measurement selection in model-based sequential diagnosis. In particular, assuming a set of leading diagnoses being given, we show how queries (sets of measurements) can be computed and optimized along two dimensions: expected number of queries and cost per query. By means of a suitable decoupling of two optimizations and a clever search space reduction the computations are done without any inference engine calls. For the full search space, we give a method requiring only a polynomial number of inferences and show how query properties can be guaranteed which existing methods do not provide. Evaluation results using real-world problems indicate that the new method computes (virtually) optimal queries instantly independently of the size and complexity of the considered diagnosis problems and outperforms equally general methods not exploiting the proposed theory by orders of magnitude.