Michal Rosen-Zvi - Academia.edu (original) (raw)

Papers by Michal Rosen-Zvi

PubMed, 2022

Breast cancer (BC) risk models based on electronic health records (EHR) can assist physicians in ... more Breast cancer (BC) risk models based on electronic health records (EHR) can assist physicians in estimating the probability of an individual with certain risk factors to develop BC in the future. In this retrospective study, we used clinical data combined with machine learning tools to assess the utility of a personalized BC risk model on 13,786 Israeli and 1,695 American women who underwent screening mammography in the years 2012-2018 and 2008-2018, respectively. Clinical features were extracted from EHR, personal questionnaires, and past radiologists' reports. Using a set of 1,547 features, the predictive ability for BC within 12 months was measured in both datasets and in sub-cohorts of interest. Our results highlight the improved performance of our model over previous established BC risk models, their ultimate potential for risk-based screening policies on first time patients and novel clinically relevant risk factors that can compensate for the absence of imaging history information.

Frontiers in Medicine, Apr 13, 2023

Editorial on the Research Topic Explainable multimodal AI in cancer patient care: how can we redu... more Editorial on the Research Topic Explainable multimodal AI in cancer patient care: how can we reduce the gap between technology and practice?

Radiology, Mar 1, 2023

Background: Computational models based on artificial intelligence (AI) are increasingly used to d... more Background: Computational models based on artificial intelligence (AI) are increasingly used to diagnose malignant breast lesions. However, assessment from radiologic images of the specific pathologic lesion subtypes, as detailed in the results of biopsy procedures, remains a challenge. Purpose: To develop an AI-based model to identify breast lesion subtypes with mammograms and linked electronic health records labeled with histopathologic information. Materials and Methods: In this retrospective study, 26 569 images were collected in 9234 women who underwent digital mammography to pretrain the algorithms. The training data included individuals who had at least 1 year of clinical and imaging history followed by biopsy-based histopathologic diagnosis from March 2013 to November 2018. A model that combined convolutional neural networks with supervised learning algorithms was independently trained to make breast lesion predictions with data from 2120 women in Israel and 1642 women in the United States. Results were reported using the area under the receiver operating characteristic curve (AUC) with the 95% DeLong approach to estimate CIs. Significance was tested with bootstrapping. Results: The Israeli model was validated in 456 women and tested in 441 women (mean age, 51 years 6 11 [SD]). The U.S. model was validated in 350 women and tested in 344 women (mean age, 60 years 6 12). For predicting malignancy in the test sets (consisting of 220 Israeli patient examinations and 126 U.S. patient examinations with ductal carcinoma in situ or invasive cancer), the algorithms obtained an AUC of 0.88 (95% CI: 0.85, 0.91) and 0.80 (95% CI: 0.74, 0.85) for Israeli and U.S. patients, respectively (P = .006). These results may not hold for other cohorts of patients, and generalizability across populations should be further investigated. Conclusion: The results offer supporting evidence that artificial intelligence applied to clinical and mammographic images can identify breast lesion subtypes when the data are sufficiently large, which may help assess diagnostic workflow and reduce biopsy sampling errors. Published under a CC BY 4.0 license.

Cancers, Aug 9, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Frontiers in Medicine

arXiv (Cornell University), Oct 17, 2018

Biases in observational data of treatments pose a major challenge to estimating expected treatmen... more Biases in observational data of treatments pose a major challenge to estimating expected treatment outcomes in different populations. An important technique that accounts for these biases is reweighting samples to minimize the discrepancy between treatment groups. We present a novel reweighting approach that uses bi-level optimization to alternately train a discriminator to minimize classification error, and a balancing weights generator that uses exponentiated gradient descent to maximize this error. This approach borrows principles from generative adversarial networks (GANs) to exploit the power of classifiers for measuring two-sample divergence. We provide theoretical results for conditions in which the estimation error is bounded by two factors: (i) the discrepancy measure induced by the discriminator; and (ii) the weights variability. Experimental results on several benchmarks comparing to previous state-of-the-art reweighting methods demonstrate the effectiveness of this approach in estimating causal effects.

BACKGROUND The outbreak of the COVID-19 pandemic had a major effect on the consumption of health ... more BACKGROUND The outbreak of the COVID-19 pandemic had a major effect on the consumption of health care services. Changes in the use of routine diagnostic exams, increased incidences of postacute COVID-19 syndrome (PCS), and other pandemic-related factors may have influenced detected clinical conditions. OBJECTIVE This study aimed to analyze the impact of COVID-19 on the use of outpatient medical imaging services and clinical findings therein, specifically focusing on the time period after the launch of the Israeli COVID-19 vaccination campaign. In addition, the study tested whether the observed gains in abnormal findings may be linked to PCS or COVID-19 vaccination. METHODS Our data set included 572,480 ambulatory medical imaging patients in a national health organization from January 1, 2019, to August 31, 2021. We compared different measures of medical imaging utilization and clinical findings therein before and after the surge of the pandemic to identify significant changes. We al...

Real-world healthcare data hold the potential to identify therapeutic solutions for progressive d... more Real-world healthcare data hold the potential to identify therapeutic solutions for progressive diseases by efficiently pinpointing safe and efficacious repurposing drug candidates. This approach circumvents key early clinical development challenges, particularly relevant for neurological diseases, concordant with the vision of the 21st Century Cures Act. However, to-date, these data have been utilized mainly for confirmatory purposes rather than as drug discovery engines. Here, we demonstrate the usefulness of real-world data in identifying drug repurposing candidates for disease- modifying effects, specifically candidate marketed drugs that exhibit beneficial effects on Parkinson’s disease (PD) progression. We performed an observational study in cohorts of ascertained PD patients extracted from two large medical databases, Explorys SuperMart (N=88,867) and IBM MarketScan Research Databases (N=106,395); and applied two conceptually different, well-established causal inference metho...

Radiology, 2022

Background: Digital breast tomosynthesis (DBT) has higher diagnostic accuracy than digital mammog... more Background: Digital breast tomosynthesis (DBT) has higher diagnostic accuracy than digital mammography, but interpretation time is substantially longer. Artificial intelligence (AI) could improve reading efficiency. Purpose: To evaluate the use of AI to reduce workload by filtering out normal DBT screens. Materials and Methods: The retrospective study included 13 306 DBT examinations from 9919 women performed between June 2013 and November 2018 from two health care networks. The cohort was split into training, validation, and test sets (3948, 1661, and 4310 women, respectively). A workflow was simulated in which the AI model classified cancer-free examinations that could be dismissed from the screening worklist and used the original radiologists' interpretations on the rest of the worklist examinations. The AI system was also evaluated with a reader study of five breast radiologists reading the DBT mammograms of 205 women. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and recall rate were evaluated in both studies. Statistics were computed across 10 000 bootstrap samples to assess 95% CIs, noninferiority, and superiority tests. Results: The model was tested on 4310 screened women (mean age, 60 years 6 11 [standard deviation]; 5182 DBT examinations). Compared with the radiologists' performance (417 of 459 detected cancers [90.8%], 477 recalls in 5182 examinations [9.2%]), the use of AI to automatically filter out cases would result in 39.6% less workload, noninferior sensitivity (413 of 459 detected cancers; 90.0%; P = .002), and 25% lower recall rate (358 recalls in 5182 examinations; 6.9%; P = .002). In the reader study, AUC was higher in the standalone AI compared with the mean reader (0.84 vs 0.81; P = .002). Conclusion: The artificial intelligence model was able to identify normal digital breast tomosynthesis screening examinations, which decreased the number of examinations that required radiologist interpretation in a simulated clinical workflow. Published under a CC BY 4.0 license.

Trends in Biotechnology, 2021

Tumors are unique and complex ecosystems, in which heterogeneous cell subpopulations with variabl... more Tumors are unique and complex ecosystems, in which heterogeneous cell subpopulations with variable molecular profiles, aggressiveness, and proliferation potential coexist and interact. Understanding how heterogeneity influences tumor progression has important clinical implications for improving diagnosis, prognosis, and treatment response prediction. Several recent innovations in data acquisition methods and computational metrics have enabled the quantification of spatiotemporal heterogeneity across different scales of tumor organization. Here, we summarize the most promising efforts from a common experimental and computational perspective, discussing their advantages, shortcomings, and challenges. With personalized medicine entering a new era of unprecedented opportunities, our vision is that of future workflows integrating across modalities, scales, and dimensions to capture intricate aspects of the tumor ecosystem and to open new avenues for improved patient care.

Medical Image Computing and Computer Assisted Intervention – MICCAI 2020, 2020

ArXiv, 2020

The Coronavirus disease 2019 (COVID-19) global pandemic has transformed almost every facet of hum... more The Coronavirus disease 2019 (COVID-19) global pandemic has transformed almost every facet of human society throughout the world. Against an emerging, highly transmissible disease with no definitive treatment or vaccine, governments worldwide have implemented non-pharmaceutical intervention (NPI) to slow the spread of the virus. Examples of such interventions include community actions (e.g. school closures, restrictions on mass gatherings), individual actions (e.g. mask wearing, self-quarantine), and environmental actions (e.g. public facility cleaning). We present the Worldwide Non-pharmaceutical Interventions Tracker for COVID-19 (WNTRAC), a comprehensive dataset consisting of over 6,000 NPIs implemented worldwide since the start of the pandemic. WNTRAC covers NPIs implemented across 261 countries and territories, and classifies NPI measures into a taxonomy of sixteen NPI types. NPI measures are automatically extracted daily from Wikipedia articles using natural language processin...

In response to the outbreak of the coronavirus disease 2019 (Covid-19), governments worldwide hav... more In response to the outbreak of the coronavirus disease 2019 (Covid-19), governments worldwide have introduced multiple restriction policies, known as non-pharmaceutical interventions (NPIs). However, the relative impact of control measures and the long-term causal contribution of each NPI are still a topic of debate. We present a method to rigorously study the effectiveness of interventions on the rate of the time-varying reproduction number Rtand on human mobility, considered here as a proxy measure of policy adherence and social distancing. We frame our model using a causal inference approach to quantify the impact of five governmental interventions introduced until June 2020 to control the outbreak in 113 countries: confinement, school closure, mask wearing, cultural closure, and work restrictions. Our results indicate that mobility changes are more accurately predicted when compared to reproduction number. All NPIs, except for mask wearing, significantly affected human mobility ...

IBM Journal of Research and Development, 2011

Rising costs, decreasing quality of care, diminishing productivity, and increasing complexity hav... more Rising costs, decreasing quality of care, diminishing productivity, and increasing complexity have all contributed to the present state of the healthcare industry. The interactions between payers (e.g., insurance companies and health plans) and providers (e.g., hospitals and laboratories) are growing and are becoming more complicated. The constant upsurge in and enhanced complexity of diagnostic and treatment information has made the clinical decision-making process more difficult. Medical transaction charges are greater than ever. Population-specific financial requirements are increasing the economic burden on the entire system. Medical insurance and identity theft frauds are on the rise. The current lack of comparative cost analytics hampers systematic efficiency. Redundant and unnecessary interventions add to medical expenditures that add no value. Contemporary payment models are antithetic to outcome-driven medicine. The rate of medical errors and mistakes is high. Slow inefficient processes and the lack of best practice support for care delivery do not create productive settings. Information technology has an important role to play in approaching these problems. This paper describes IBM Research's approach to helping address these issues, i.e., the evidence-based healthcare platform.

HIV Medicine, 2010

The EuResist expert system is a novel data-driven online system for computing the probability of ... more The EuResist expert system is a novel data-driven online system for computing the probability of 8-week success for any given pair of HIV-1 genotype and combination antiretroviral therapy regimen plus optional patient information. The objective of this study was to compare the EuResist system vs. human experts (EVE) for the ability to predict response to treatment. Methods The EuResist system was compared with 10 HIV-1 drug resistance experts for the ability to predict 8-week response to 25 treatment cases derived from the EuResist database validation data set. All current and past patient data were made available to simulate clinical practice. The experts were asked to provide a qualitative and quantitative estimate of the probability of treatment success. Results There were 15 treatment successes and 10 treatment failures. In the classification task, the number of mislabelled cases was six for EuResist and 6-13 for the human experts [mean AE standard deviation (SD) 9.1 AE 1.9]. The accuracy of EuResist was higher than the average for the experts (0.76 vs. 0.64, respectively). The quantitative estimates computed by EuResist were significantly correlated (Pearson r 5 0.695, Po0.0001) with the mean quantitative estimates provided by the experts. However, the agreement among experts was only moderate (for the classification task, inter-rater k 5 0.355; for the quantitative estimation, mean AE SD coefficient of variation 5 55.9 AE 22.4%). Conclusions With this limited data set, the EuResist engine performed comparably to or better than human experts. The system warrants further investigation as a treatment-decision support tool in clinical practice.

Bioinformatics, 2008

Motivation: Optimizing HIV therapies is crucial since the virus rapidly develops mutations to eva... more Motivation: Optimizing HIV therapies is crucial since the virus rapidly develops mutations to evade drug pressure. Recent studies have shown that genotypic information might not be sufficient for the design of therapies and that other clinical and demographical factors may play a role in therapy failure. This study is designed to assess the improvement in prediction achieved when such information is taken into account. We use these factors to generate a prediction engine using a variety of machine learning methods and to determine which clinical conditions are most misleading in terms of predicting the outcome of a therapy. Results: Three different machine learning techniques were used: generative–discriminative method, regression with derived evolutionary features, and regression with a mixture of effects. All three methods had similar performances with an area under the receiver operating characteristic curve (AUC) of 0.77. A set of three similar engines limited to genotypic infor...

In response to the outbreak of the Covid-19 pandemic, governments worldwide have introduced multi... more In response to the outbreak of the Covid-19 pandemic, governments worldwide have introduced multiple restriction policies, known as non-pharmaceutical interventions (NPIs). However, there still remains uncertainty about the relative impact of such policies. In this work, we quantitatively assess the eectiveness of NPIs using a causal inference approach. We gather geospatial data to study the eect size of dierent NPIs as measured by change of the reproduction number and mobility trends. Our analysis includes the most frequent NPIs that were applied by 121 countries throughout 2020 until February 2021 as well as country-level information such as mobility and economic, demographic, environmental, social and health indicators. We present findings about the causal impact of five restriction policies - mask wearing, entertainment closure, freedom of movement (border closures), domestic flight restrictions and school closure - and discuss challenges in drawing causal inferences when aggreg...

Different types of mental health services provided to individuals after release from jail. (DOCX ... more Different types of mental health services provided to individuals after release from jail. (DOCX 35 kb)