将临床经验融入前列腺癌预测模型,提升模型可解释性。
On Aligning Prediction Models with Clinical Experiential Learning: A Prostate Cancer Case Study
- 用临床调研约束模型,纠正非单调预测问题
- 模型性能未下降,且在不同简化程度下均有效
- 适合临床医生参与的医疗AI开发场景
过去十年,机器学习在医疗应用中迅速增长。尽管性能优异,现代模型常未能捕捉临床所需模式。例如,癌症分期与生存率之间可能出现非单调关系。本文提出可复现框架,研究模型行为与临床经验之间的偏差,聚焦现代机器学习流程的欠规范问题。以前列腺癌预后预测为例,通过调查收集临床知识并引入约束,纠正模型不一致之处,并分析不同欠规范程度下模型性能与行为的影响。结果表明,模型可对齐临床经验而无需牺牲性能。受生成式AI启发,我们通过随机对照实验检验反馈驱动对齐在非生成型临床风险预测中的可行性。结果显示,当约束模型与非约束模型对患者预测差异越大时,其临床解释差异越明显。
原文摘要 · Abstract (English)
Over the past decade, the use of machine learning (ML) models in healthcare applications has rapidly increased. Despite high performance, modern ML models do not always capture patterns the end user requires. For example, a model may predict a non-monotonically decreasing relationship between cancer stage and survival, keeping all other features fixed. In this paper, we present a reproducible framework for investigating this misalignment between model behavior and clinical experiential learning, focusing on the effects of underspecification of modern ML pipelines. In a prostate cancer outcome prediction case study, we first identify and address these inconsistencies by incorporating clinical knowledge, collected by a survey, via constraints into the ML model, and subsequently analyze the impact on model performance and behavior across degrees of underspecification. The approach shows that aligning the ML model with clinical experiential learning is possible without compromising performance. Motivated by recent literature in generative AI, we further examine the feasibility of a feedback-driven alignment approach in non-generative AI clinical risk prediction models through a randomized experiment with clinicians. Our findings illustrate that, by eliciting clinicians' model preferences using our proposed methodology, the larger the difference in how the constrained and unconstrained models make predictions for a patient, the more apparent the difference is in clinical interpretation.
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