Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table

A CNN-LSTM for predicting mortality in the ICU

An accurate predicted mortality is crucial to healthcare as it provides an empirical risk estimate for prognostic decision making, patient stratification and hospital benchmarking. Current prediction methods in practice are severity of disease scoring systems that usually involve a fixed set of admission attributes and summarized physiological data. These systems are prone to bias and require substantial manual effort which necessitates an updated approach which can account for most shortcomings. Clinical observation notes allow for recording highly subjective data on the patient that can possibly facilitate higher discrimination. Moreover, deep learning models can automatically extract and select features without human input.This thesis investigates the potential of a combination of a deep learning model and notes for predicting mortality with a higher accuracy. A custom architecture, called CNN-LSTM, is conceptualized for mapping multiple notes compiled in a hospital stay to a mortality outcome. It employs both convolutional and recurrent layers with the former capturing semantic relationships in individual notes independently and the latter capturing temporal relationships between concurrent notes in a hospital stay. This approach is compared to three severity of disease scoring systems with a case study on the MIMIC-III dataset. Experiments are set up to assess the CNN-LSTM for predicting mortality using only the notes from the first 24, 12 and 48 hours of a patient stay. The model is trained using K-fold cross-validation with k=5 and the mortality probability calculated by the three severity scores on the held-out set is used as the baseline. It is found that the CNN-LSTM outperforms the baseline on all experiments which serves as a proof-of-concept of how notes and deep learning can better outcome prediction

Learning Better Clinical Risk Models.

Risk models are used to estimate a patient’s risk of suffering particular outcomes throughout clinical practice. These models are important for matching patients to the appropriate level of treatment, for effective allocation of resources, and for fairly evaluating the performance of healthcare providers. The application and development of methods from the field of machine learning has the potential to improve patient outcomes and reduce healthcare spending with more accurate estimates of patient risk. This dissertation addresses several limitations of currently used clinical risk models, through the identification of novel risk factors and through the training of more effective models. As wearable monitors become more effective and less costly, the previously untapped predictive information in a patient’s physiology over time has the potential to greatly improve clinical practice. However translating these technological advances into real-world clinical impacts will require computational methods to identify high-risk structure in the data. This dissertation presents several approaches to learning risk factors from physiological recordings, through the discovery of latent states using topic models, and through the identification of predictive features using convolutional neural networks. We evaluate these approaches on patients from a large clinical trial and find that these methods not only outperform prior approaches to leveraging heart rate for cardiac risk stratification, but that they improve overall prediction of cardiac death when considered alongside standard clinical risk factors. We also demonstrate the utility of this work for learning a richer description of sleep recordings. Additionally, we consider the development of risk models in the presence of missing data, which is ubiquitous in real-world medical settings. We present a novel method for jointly learning risk and imputation models in the presence of missing data, and find significant improvements relative to standard approaches when evaluated on a large national registry of trauma patients.PhDComputer Science and EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/113326/1/alexve_1.pd

Representation learning for uncertainty-aware clinical decision support

Over the last decade, there has been an increasing trend towards digitalization in healthcare, where a growing amount of patient data is collected and stored electronically. These recorded data are known as electronic health records. They are the basis for state-of-the-art research on clinical decision support so that better patient care can be delivered with the help of advanced analytical techniques like machine learning. Among various technical fields in machine learning, representation learning is about learning good representations from raw data to extract useful information for downstream prediction tasks. Deep learning, a crucial class of methods in representation learning, has achieved great success in many fields such as computer vision and natural language processing. These technical breakthroughs would presumably further advance the research and development of data analytics in healthcare. This thesis addresses clinically relevant research questions by developing algorithms based on state-of-the-art representation learning techniques. When a patient visits the hospital, a physician will suggest a treatment in a deterministic manner. Meanwhile, uncertainty comes into play when the past statistics of treatment decisions from various physicians are analyzed, as they would possibly suggest different treatments, depending on their training and experiences. The uncertainty in clinical decision-making processes is the focus of this thesis. The models developed for supporting these processes will therefore have a probabilistic nature. More specifically, the predictions are predictive distributions in regression tasks and probability distributions over, e.g., different treatment decisions, in classification tasks. The first part of the thesis is concerned with prescriptive analytics to provide treatment recommendations. Apart from patient information and treatment decisions, the outcome after the respective treatment is included in learning treatment suggestions. The problem setting is known as learning individualized treatment rules and is formulated as a contextual bandit problem. A general framework for learning individualized treatment rules using data from observational studies is presented based on state-of-the-art representation learning techniques. From various offline evaluation methods, it is shown that the treatment policy in our proposed framework can demonstrate better performance than both physicians and competitive baselines. Subsequently, the uncertainty-aware regression models in diagnostic and predictive analytics are studied. Uncertainty-aware deep kernel learning models are proposed, which allow the estimation of the predictive uncertainty by a pipeline of neural networks and a sparse Gaussian process. By considering the input data structure, respective models are developed for diagnostic medical image data and sequential electronic health records. Various pre-training methods from representation learning are adapted to investigate their impacts on the proposed models. Through extensive experiments, it is shown that the proposed models delivered better performance than common architectures in most cases. More importantly, uncertainty-awareness of the proposed models is illustrated by systematically expressing higher confidence in more accurate predictions and less confidence in less accurate ones. The last part of the thesis is about missing data imputation in descriptive analytics, which provides essential evidence for subsequent decision-making processes. Rather than traditional mean and median imputation, a more advanced solution based on generative adversarial networks is proposed. The presented method takes the categorical nature of patient features into consideration, which enables the stabilization of the adversarial training. It is shown that the proposed method can better improve the predictive accuracy compared to traditional imputation baselines

Deep Learning Applications for Biomedical Data and Natural Language Processing

The human brain can be seen as an ensemble of interconnected neurons, more or less specialized to solve different cognitive and motor tasks. In computer science, the term deep learning is often applied to signify sets of interconnected nodes, where deep means that they have several computational layers. Development of deep learning is essentially a quest to mimic how the human brain, at least partially, operates.In this thesis, I will use machine learning techniques to tackle two different domain of problems. The first is a problem in natural language processing. We improved classification of relations within images, using text associated with the pictures. The second domain is regarding heart transplant. We created models for pre- and post-transplant survival and simulated a whole transplantation queue, to be able to asses the impact of different allocation policies. We used deep learning models to solve these problems.As introduction to these problems, I will present the basic concepts of machine learning, how to represent data, how to evaluate prediction results, and how to create different models to predict values from data. Following that, I will also introduce the field of heart transplant and some information about simulation