The morphology and distribution of microcalcifications are the most important descriptors for radiologists to diagnose breast cancer based on mammograms. However, it is very challenging and time-consuming for radiologists to characterize these descriptors manually, and there also lacks of effective and automatic solutions for this problem. We observed that the distribution and morphology descriptors are determined by the radiologists based on the spatial and visual relationships among calcifications. Thus, we hypothesize that this information can be effectively modelled by learning a relationship-aware representation using graph convolutional networks (GCNs). In this study, we propose a multi-task deep GCN method for automatic characterization of both the morphology and distribution of microcalcifications in mammograms. Our proposed method transforms morphology and distribution characterization into node and graph classification problem and learns the representations concurrently. We trained and validated the proposed method in an in-house dataset and public DDSM dataset with 195 and 583 cases,respectively. The proposed method reaches good and stable results with distribution AUC at 0.812 $\pm$ 0.043 and 0.873 $\pm$ 0.019, morphology AUC at 0.663 $\pm$ 0.016 and 0.700 $\pm$ 0.044 for both in-house and public datasets. In both datasets, our proposed method demonstrates statistically significant improvements compared to the baseline models. The performance improvements brought by our proposed multi-task mechanism can be attributed to the association between the distribution and morphology of calcifications in mammograms, which is interpretable using graphical visualizations and consistent with the definitions of descriptors in the standard BI-RADS guideline. In short, we explore, for the first time, the application of GCNs in microcalcification characterization that suggests the potential of using graph learning for more robust understanding of medical images.

Purpose: We aimed to develop a novel interpretable artificial intelligence (AI) model algorithm focusing on automatic detection and classification of various patterns of calcification distribution in mammographic images using a unique graph convolution approach. Materials and methods: Images from 292 patients, which showed calcifications according to the mammographic reports and diagnosed breast cancers, were collected. The calcification distributions were classified as diffuse, segmental, regional, grouped, or linear. Excluded were mammograms with (1) breast cancer with multiple lexicons such as mass, asymmetry, or architectural distortion without calcifications; (2) hidden calcifications that were difficult to mark; or (3) incomplete medical records. Results: A graph-convolutional-network-based model was developed. A total of 581 mammographic images from 292 cases of breast cancer were divided based on the calcification distribution pattern: diffuse (n = 67), regional (n = 115), group (n = 337), linear (n = 8), or segmental (n = 54). The classification performances were measured using metrics including precision, recall, F1 score, accuracy, and multi-class area under the receiver operating characteristic curve. The proposed model achieved a precision of 0.522 ± 0.028, sensitivity of 0.643 ± 0.017, specificity of 0.847 ± 0.009, F1 score of 0.559 ± 0.018, accuracy of 64.325 ± 1.694%, and area under the curve of 0.745 ± 0.030; thus, the method was found to be superior compared to all baseline models. The predicted linear and diffuse classifications were highly similar to the ground truth, and the predicted grouped and regional classifications were also superior compared to baseline models. The prediction results are interpretable using visualization methods to highlight the important calcification nodes in graphs. Conclusions: The proposed deep neural network framework is an AI solution that automatically detects and classifies calcification distribution patterns on mammographic images highly suspected of showing breast cancers. Further study of the AI model in an actual clinical setting and additional data collection will improve its performance.

Research objectives: Clostriodiodes difficile infection (CDI) is a major cause of healthcare-associated diarrhoea with high mortality. There is a lack of validated predictors for severe outcomes in CDI. The aim of this study is to derive and validate a clinical prediction tool for CDI in-hospital mortality using a large critical care database. Methodology: The demographics, clinical parameters, laboratory results and mortality of CDI were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. We subsequently trained three machine learning models: logistic regression (LR), random forest (RF) and gradient boosting machine (GBM) to predict in-hospital mortality. The individual performances of the models were compared against current severity scores (Clostridiodes difficile Associated Risk of Death Score (CARDS) and ATLAS (Age, Treatment with systemic antibiotics, leukocyte count, Albumin and Serum creatinine as a measure of renal function) by calculating area under receiver operating curve (AUROC). We identified factors associated with higher mortality risk in each model. Summary of results: From 61 532 intensive care unit stays in the MIMIC-III database, there were 1315 CDI cases. The mortality rate for CDI in the study cohort was 18.33%. AUROC was 0.69 (95% CI, 0.60 to 0.76) for LR, 0.71 (95% CI, 0.62 to 0.77) for RF and 0.72 (95% CI, 0.64 to 0.78) for GBM, while previously AUROC was 0.57 (95% CI, 0.51 to 0.65) for CARDS and 0.63 (95% CI, 0.54 to 0.70) for ATLAS. Albumin, lactate and bicarbonate were significant mortality factors for all the models. Free calcium, potassium, white blood cell, urea, platelet and mean blood pressure were present in at least two of the three models. Conclusion: Our machine learning derived CDI in-hospital mortality prediction model identified pertinent factors that can assist critical care clinicians in identifying patients at high risk of dying from CDI.

Background . In critical care, intensivists are required to continuously monitor high-dimensional vital signs and lab measurements to detect and diagnose acute patient conditions, which has always been a challenging task. Recently, deep learning models such as recurrent neural networks (RNNs) have demonstrated their strong potential on predicting such events. However, in real deployment, the patient data are continuously coming and there is no effective adaptation mechanism for RNN to incorporate those new data and become more accurate. Methods . In this study, we propose a novel self-correcting mechanism for RNN to fill in this gap. Our mechanism feeds prediction errors from the predictions of previous timestamps into the prediction of the current timestamp, so that the model can “learn” from previous predictions. We also proposed a regularization method that takes into account not only the model’s prediction errors on the labels but also its estimation errors on the input data. Results . We compared the performance of our proposed method with the conventional deep learning models on two real-world clinical datasets for the task of acute kidney injury (AKI) prediction and demonstrated that the proposed model achieved an area under ROC curve at 0.893 on the MIMIC-III dataset and 0.871 on the Philips eICU dataset. Conclusions . The proposed self-correcting RNNs demonstrated effectiveness in AKI prediction and have the potential to be applied to clinical applications.

Background: Breast cancer remains the most common cancer among women globally. Mammography is a key diagnostic modality; however, interpretation is increasingly challenged by rising imaging volumes, a global shortage of breast radiologists, and variability in reader experience. Artificial intelligence (AI) has been proposed as a potential adjunct to address these issues, particularly in settings with high breast density, such as Asian populations. This study aimed to evaluate the impact of AI assistance on mammographic diagnostic performance among resident and consultant radiologists in Singapore. Objective: To assess whether AI assistance improves diagnostic accuracy in mammographic breast cancer detection across radiologists with varying levels of experience. Methods: A multi-reader, multi-case study was conducted at the National University Hospital, Singapore, from May to August 2023. De-identified digital mammograms from 500 women (250 with cancer and 250 normal or benign) were interpreted by 17 radiologists (4 consultants, 4 senior residents, and 9 junior residents). Each radiologist read all cases over 2 reading sessions: one without AI assistance and another with AI assistance, separated by a 1-month washout period. The AI system (FxMammo) provided heatmaps and malignancy risk scores to support decision-making. Area under the curve of the receiver operating characteristic (AUROC) was used to evaluate diagnostic performance. Results: Among the 500 cases, 250 were malignant and 250 were non-malignant. Of the malignant cases, 16%(80/500) were ductal carcinoma in situ and 84%(420/500) were invasive cancers. Among non-malignant cases, 69.2%(346/500) were normal, 17.6%(88) benign, and 3.6%(18/500) possibly benign but stable on follow-up. Masses (54.4%, 272) and calcifications (10.8%, 54/500) were the most common findings in cancer cases. A majority of both malignant (66.8%, 334/500) and non-malignant (68%, 340/500) cases had heterogeneously or extremely dense breasts (BIRADS [Breast Imaging Reporting and Data System] categories C and D). The AI model achieved an AUROC of 0.93 (95% CI 0.91‐0.95), slightly higher than consultant radiologists (AUROC 0.90, 95% CI 0.89‐0.92; P =.21). With AI assistance, AUROC improved among junior residents (from 0.84 to 0.86; P =.38) and senior residents (from 0.85 to 0.88; P =.13), with senior residents approaching consultant-level performance (AUROC difference 0.02; P =.051). Diagnostic gains with AI were greatest in women with dense breasts and among less experienced radiologists. AI also improved inter-reader agreement and time efficiency, particularly in benign or normal cases. Conclusions: This is the first study in Asia to evaluate AI assistance in mammography interpretation by radiologists of varying experience. AI significantly improved diagnostic performance and efficiency among residents, helping to narrow the experience-performance gap without compromising specificity. These findings suggest a role for AI in enhancing diagnostic consistency, improving workflow, and supporting training. Integration into clinical and educational settings may offer scalable benefits, though careful attention to threshold calibration, feedback loops, and real-world validation remains essential. Further studies in routine screening settings are needed to confirm generalizability and cost-effectiveness.