Peri-Diagnostic Decision Support Through Cost-Efficient Feature Acquisition at Test-Time

摘要

Computer-aided diagnosis (CADx) algorithms in medicine provide patient-specific decision support for physicians. These algorithms are usually applied after full acquisition of high-dimensional multimodal examination data, and often assume feature-completeness. This, however, is rarely the case due to examination costs, invasiveness, or a lack of indication. A sub-problem in CADx, which to our knowledge has not been addressed by the M1CCAI community so far, is to guide the physician during the entire peri-diagnostic workflow, including the acquisition stage. We model the following question, asked from a physician's perspective: "Given the evidence collected so far, which examination should I perform next, in order to achieve the most accurate and efficient diagnostic prediction?". In this work, we propose a novel approach which is enticingly simple: use dropout at the input layer, and integrated gradients of the trained network at test-time to attribute feature importance dynamically. We validate and explain the effectiveness of our proposed approach using two public medical and two synthetic datasets: Results show that our proposed approach is more cost- and feature-efficient than prior approaches and achieves a higher overall accuracy. This directly translates to less unnecessary examinations for patients, and a quicker, less costly and more accurate decision support for the physician.