Multimodal large language models have demonstrated comparable performance to that of radiology trainees on multiple-choice board-style exams. However, to develop clinically useful multimodal LLM tools, high-quality benchmarks curated by domain experts are essential. To curate released and holdout datasets of 100 chest radiographic studies each and propose an artificial intelligence (AI)-assisted expert labeling procedure to allow radiologists to label studies more efficiently. A total of 13,735 deidentified chest radiographs and their corresponding reports from the MIDRC were used. GPT-4o extracted abnormal findings from the reports, which were then mapped to 12 benchmark labels with a locally hosted LLM (Phi-4-Reasoning). From these studies, 1,000 were sampled on the basis of the AI-suggested benchmark labels for expert review; the sampling algorithm ensured that the selected studies were clinically relevant and captured a range of difficulty levels. Seventeen chest radiologists participated, and they marked "Agree all", "Agree mostly" or "Disagree" to indicate their assessment of the correctness of the LLM suggested labels. Each chest radiograph was evaluated by three experts. Of
When technical requirements are high, and patient outcomes are critical, opportunities for monitoring and improving surgical skills via objective motion analysis feedback may be particularly beneficial. This narrative review synthesises work on technical and non-technical surgical skills, collaborative task performance, and pose estimation to illustrate new opportunities to advance cardiothoracic surgical performance with innovations from computer vision and artificial intelligence. These technological innovations are critically evaluated in terms of the benefits they could offer the cardiothoracic surgical community, and any barriers to the uptake of the technology are elaborated upon. Like some other specialities, cardiothoracic surgery has relatively few opportunities to benefit from tools with data capture technology embedded within them (as with robotic-assisted laparoscopic surgery, for example). In such cases, pose estimation techniques that allow for movement tracking across a conventional operating field without using specialist equipment or markers offer considerable potential. With video data from either simulated or real surgical procedures, these tools can (1) provide
We propose an automated method based on deep learning to compute the cardiothoracic ratio and detect the presence of cardiomegaly from chest radiographs. We develop two separate models to demarcate the heart and chest regions in an X-ray image using bounding boxes and use their outputs to calculate the cardiothoracic ratio. We obtain a sensitivity of 0.96 at a specificity of 0.81 with a mean absolute error of 0.0209 on a held-out test dataset and a sensitivity of 0.84 at a specificity of 0.97 with a mean absolute error of 0.018 on an independent dataset from a different hospital. We also compare three different segmentation model architectures for the proposed method and observe that Attention U-Net yields better results than SE-Resnext U-Net and EfficientNet U-Net. By providing a numeric measurement of the cardiothoracic ratio, we hope to mitigate human subjectivity arising out of visual assessment in the detection of cardiomegaly.
The cardiothoracic ratio (CTR), a clinical metric of heart size in chest X-rays (CXRs), is a key indicator of cardiomegaly. Manual measurement of CTR is time-consuming and can be affected by human subjectivity, making it desirable to design computer-aided systems that assist clinicians in the diagnosis process. Automatic CTR estimation through chest organ segmentation, however, requires large amounts of pixel-level annotated data, which is often unavailable. To alleviate this problem, we propose an unsupervised domain adaptation framework based on adversarial networks. The framework learns domain invariant feature representations from openly available data sources to produce accurate chest organ segmentation for unlabeled datasets. Specifically, we propose a model that enforces our intuition that prediction masks should be domain independent. Hence, we introduce a discriminator that distinguishes segmentation predictions from ground truth masks. We evaluate our system's prediction based on the assessment of radiologists and demonstrate the clinical practicability for the diagnosis of cardiomegaly. We finally illustrate on the JSRT dataset that the semi-supervised performance of our
We propose an algorithm for calculating the cardiothoracic ratio (CTR) from chest X-ray films. Our approach applies a deep learning model based on U-Net with VGG16 encoder to extract lung and heart masks from chest X-ray images and calculate CTR from the extents of obtained masks. Human radiologists evaluated our CTR measurements, and $76.5\%$ were accepted to be included in medical reports without any need for adjustment. This result translates to a large amount of time and labor saved for radiologists using our automated tools.
Early mobilization is a structured protocol designed to facilitate motor recovery in intensive care unit (ICU) patients with ICU-acquired weakness. This process is typically implemented by an interdisciplinary team of nurses, physical therapists, and other healthcare professionals. However, its application is often constrained by the patients' critical conditions, limited mobility, and the challenges of coordinating care within resource-intensive ICU environments. In this study, we developed a patient-centered virtual reality (VR) exergame through an interdisciplinary design process involving clinicians and therapists, tailored to the constraints of critical care. The exergame incorporates progressive mobility levels that mirror early mobilization practices, and includes an embodied avatar to provide guidance and motivation. Using Meta Quest 3 body tracking, the system captures and visualizes patients' movements, thereby providing motivational engagement and quantifiable mobility metrics. We evaluated the exergame in two stages: a dual-user study involving healthy participants and healthcare professionals or students (N = 13), and a subsequent study with cardiothoracic ICU patients
We introduce CRIMSON, a clinically grounded evaluation framework for chest X-ray report generation that assesses reports based on diagnostic correctness, contextual relevance, and patient safety. Unlike prior metrics, CRIMSON incorporates full clinical context, including patient age, indication, and guideline-based decision rules, and prevents normal or clinically insignificant findings from exerting disproportionate influence on the overall score. The framework categorizes errors into a comprehensive taxonomy covering false findings, missing findings, and eight attribute-level errors (e.g., location, severity, measurement, and diagnostic overinterpretation). Each finding is assigned a clinical significance level (urgent, actionable non-urgent, non-actionable, or expected/benign), based on a guideline developed in collaboration with attending cardiothoracic radiologists, enabling severity-aware weighting that prioritizes clinically consequential mistakes over benign discrepancies. CRIMSON is validated through strong alignment with clinically significant error counts annotated by six board-certified radiologists in ReXVal (Kendalls tau = 0.61-0.71; Pearsons r = 0.71-0.84), and throu
Robust anatomical segmentation of chest X-rays (CXRs) remains challenging due to the scarcity of comprehensive annotations and the substantial variability of real-world acquisition conditions. We propose AnyCXR, a unified framework that enables generalizable multi-organ segmentation across arbitrary CXR projection angles using only synthetic supervision. The method combines a Multi-stage Domain Randomization (MSDR) engine, which generates over 100,000 anatomically faithful and highly diverse synthetic radiographs from 3D CT volumes, with a Conditional Joint Annotation Regularization (CAR) learning strategy that leverages partial and imperfect labels by enforcing anatomical consistency in a latent space. Trained entirely on synthetic data, AnyCXR achieves strong zero-shot generalization on multiple real-world datasets, providing accurate delineation of 54 anatomical structures in PA, lateral, and oblique views. The resulting segmentation maps support downstream clinical tasks, including automated cardiothoracic ratio estimation, spine curvature assessment, and disease classification, where the incorporation of anatomical priors improves diagnostic performance. These results demonstr
Deep learning models have revolutionized medical imaging and diagnostics, yet their opaque nature poses challenges for clinical adoption and trust. Amongst approaches to improve model interpretability, concept-based explanations aim to provide concise and human-understandable explanations of any arbitrary classifier. However, such methods usually require a large amount of manually collected data with concept annotation, which is often scarce in the medical domain. In this paper, we propose Conceptual Counterfactual Explanations for Chest X-ray (CoCoX), which leverages the joint embedding space of an existing vision-language model (VLM) to explain black-box classifier outcomes without the need for annotated datasets. Specifically, we utilize textual concepts derived from chest radiography reports and a pre-trained chest radiography-based VLM to explain three common cardiothoracic pathologies. We demonstrate that the explanations generated by our method are semantically meaningful and faithful to underlying pathologies.
Collaborative planning for congenital heart diseases typically involves creating physical heart models through 3D printing, which are then examined by both surgeons and cardiologists. Recent developments in mobile augmented reality (AR) technologies have presented a viable alternative, known for their ease of use and portability. However, there is still a lack of research examining the utilization of multi-user mobile AR environments to support collaborative planning for cardiovascular surgeries. We created ARCollab, an iOS AR app designed for enabling multiple surgeons and cardiologists to interact with a patient's 3D heart model in a shared environment. ARCollab enables surgeons and cardiologists to import heart models, manipulate them through gestures and collaborate with other users, eliminating the need for fabricating physical heart models. Our evaluation of ARCollab's usability and usefulness in enhancing collaboration, conducted with three cardiothoracic surgeons and two cardiologists, marks the first human evaluation of a multi-user mobile AR tool for surgical planning. ARCollab is open-source, available at https://github.com/poloclub/arcollab.
Self-supervised foundation models have recently been successfully extended to encode three-dimensional (3D) computed tomography (CT) images, with excellent performance across several downstream tasks, such as intracranial hemorrhage detection and lung cancer risk forecasting. However, as self-supervised models learn from complex data distributions, questions arise concerning whether these embeddings capture demographic information, such as age, sex, or race. Using the National Lung Screening Trial (NLST) dataset, which contains 3D CT images and demographic data, we evaluated a range of classifiers: softmax regression, linear regression, linear support vector machine, random forest, and decision tree, to predict sex, race, and age of the patients in the images. Our results indicate that the embeddings effectively encoded age and sex information, with a linear regression model achieving a root mean square error (RMSE) of 3.8 years for age prediction and a softmax regression model attaining an AUC of 0.998 for sex classification. Race prediction was less effective, with an AUC of 0.878. These findings suggest a detailed exploration into the information encoded in self-supervised learn
Generative AI systems such as ChatGPT and Claude are built upon language models that are typically evaluated for accuracy on curated benchmark datasets. Such evaluation paradigms measure predictive and reasoning capabilities of language models but do not assess if they can provide information that is useful to people. In this paper, we take some initial steps in developing an evaluation paradigm that centers human understanding and decision-making. We study the utility of generative AI systems in supporting people in a concrete task - making sense of clinical reports and imagery in order to make a clinical decision. We conducted a formative need-finding study in which participants discussed chest computed tomography (CT) scans and associated radiology reports of a fictitious close relative with a cardiothoracic radiologist. Using thematic analysis of the conversation between participants and medical experts, we identified commonly occurring themes across interactions, including clarifying medical terminology, locating the problems mentioned in the report in the scanned image, understanding disease prognosis, discussing the next diagnostic steps, and comparing treatment options. Bas
Advanced surgical procedures for congenital heart diseases (CHDs) require precise planning before the surgeries. The conventional approach utilizes 3D-printing and cutting physical heart models, which is a time and resource intensive process. While rapid advances in augmented reality (AR) technologies have the potential to streamline surgical planning, there is limited research that evaluates such AR approaches with medical experts. This paper presents an evaluation with 6 experts, 4 cardiothoracic surgeons, and 2 cardiologists, from Children's Healthcare of Atlanta (CHOA) Heart Center to validate the usability and technical innovations of CardiacAR, a prototype mobile AR surgical planning application. Potential future improvements based on user feedback are also proposed to further improve the design of CardiacAR and broaden its access.
Artificial intelligence (AI) and Machine Learning (ML) have shown great potential in improving the medical imaging workflow, from image acquisition and reconstruction to disease diagnosis and treatment. Particularly, in recent years, there has been a significant growth in the use of AI and ML algorithms, especially Deep Learning (DL) based methods, for medical image reconstruction. DL techniques have shown to be competitive and often superior over conventional reconstruction methods in terms of both reconstruction quality and computational efficiency. The use of DL-based image reconstruction also provides promising opportunities to transform the way cardiac images are acquired and reconstructed. In this chapter, we will review recent advances in DL-based reconstruction techniques for cardiac imaging, with emphasis on cardiac magnetic resonance (CMR) image reconstruction. We mainly focus on supervised DL methods for the application, including image post-processing techniques, model-driven approaches and k-space based methods. Current limitations, challenges and future opportunities of DL for cardiac image reconstruction are also discussed.
There is growing interest in applying machine learning methods to Electronic Medical Records (EMR). Across different institutions, however, EMR quality can vary widely. This work investigated the impact of this disparity on the performance of three advanced machine learning algorithms: logistic regression, multilayer perceptron, and recurrent neural network. The EMR disparity was emulated using different permutations of the EMR collected at Children's Hospital Los Angeles (CHLA) Pediatric Intensive Care Unit (PICU) and Cardiothoracic Intensive Care Unit (CTICU). The algorithms were trained using patients from the PICU to predict in-ICU mortality for patients in a held out set of PICU and CTICU patients. The disparate patient populations between the PICU and CTICU provide an estimate of generalization errors across different ICUs. We quantified and evaluated the generalization of these algorithms on varying EMR size, input types, and fidelity of data.
Understanding the causes and patient impacts of surgical adverse events will help improve systems and operational practices to avoid incidents in the future. We analyzed the adverse events data related to robotic systems and instruments used in minimally invasive surgery, reported to the U.S. FDA MAUDE database from January 2000 to December 2013. We determined the number of events reported per procedure and per surgical specialty, the most common types of device malfunctions and their impact on patients, and the causes for catastrophic events such as major complications, patient injuries, and deaths. During the study period, 144 deaths (1.4% of the 10,624 reports), 1,391 patient injuries (13.1%), and 8,061 device malfunctions (75.9%) were reported. The numbers of injury and death events per procedure have stayed relatively constant since 2007 (mean = 83.4, 95% CI, 74.2-92.7). Surgical specialties, for which robots are extensively used, such as gynecology and urology, had lower number of injuries, deaths, and conversions per procedure than more complex surgeries, such as cardiothoracic and head and neck (106.3 vs. 232.9, Risk Ratio = 2.2, 95% CI, 1.9-2.6). Device and instrument malf
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Scientists have created twisted laser beams that interact differently with right-handed and left-handed molecules, revealing their identity through the fragments they produce。 The approach could provide a faster, simpler, and more sensitive way to analyze important molecules used in chemistry and pharmaceuticals
A new 3D printing technique can produce exceptionally hard tungsten carbide cobalt while using less of its expensive raw materials。 By softening rather than fully melting the material, researchers created defect-free samples with industrial-grade hardness and opened the door to more efficient manufacturing