Alessandro Bria’s research while affiliated with University of Cassino and Southern Lazio and other places

The automated processing of Electronic Health Records (EHRs) poses a significant challenge due to their unstructured nature, rich in valuable, yet disorganized information. Natural Language Processing (NLP), particularly Named Entity Recognition (NER), has been instrumental in extracting structured information from EHR data. However, existing literature primarly focuses on extracting handcrafted clinical features through NLP and NER methods without delving into their learned representations. In this work, we explore the untapped potential of these representations by considering their contextual richness and entity-specific information. Our proposed methodology extracts representations generated by a transformer-based NER model on EHRs data, combines them using a hierarchical attention mechanism, and employs the obtained enriched representation as input for a clinical prediction model. Specifically, this study addresses Overall Survival (OS) in Non-Small Cell Lung Cancer (NSCLC) using unstructured EHRs data collected from an Italian clinical centre encompassing 838 records from 231 lung cancer patients. Whilst our study is applied on EHRs written in Italian, it serves as use case to prove the effectiveness of extracting and employing high level textual representations that capture relevant information as named entities. Our methodology is interpretable because the hierarchical attention mechanism highlights the information in EHRs that the model considers the most crucial during the decision-making process. We validated this interpretability by measuring the agreement of domain experts on the importance assigned by the hierarchical attention mechanism to EHRs information through a questionnaire. Results demonstrate the effectiveness of our method, showcasing statistically significant improvements over traditional manually extracted clinical features.

This study presents Latent Diffusion Autoencoder (LDAE), a novel encoder-decoder diffusion-based framework for efficient and meaningful unsupervised learning in medical imaging, focusing on Alzheimer disease (AD) using brain MR from the ADNI database as a case study. Unlike conventional diffusion autoencoders operating in image space, LDAE applies the diffusion process in a compressed latent representation, improving computational efficiency and making 3D medical imaging representation learning tractable. To validate the proposed approach, we explore two key hypotheses: (i) LDAE effectively captures meaningful semantic representations on 3D brain MR associated with AD and ageing, and (ii) LDAE achieves high-quality image generation and reconstruction while being computationally efficient. Experimental results support both hypotheses: (i) linear-probe evaluations demonstrate promising diagnostic performance for AD (ROC-AUC: 90%, ACC: 84%) and age prediction (MAE: 4.1 years, RMSE: 5.2 years); (ii) the learned semantic representations enable attribute manipulation, yielding anatomically plausible modifications; (iii) semantic interpolation experiments show strong reconstruction of missing scans, with SSIM of 0.969 (MSE: 0.0019) for a 6-month gap. Even for longer gaps (24 months), the model maintains robust performance (SSIM > 0.93, MSE < 0.004), indicating an ability to capture temporal progression trends; (iv) compared to conventional diffusion autoencoders, LDAE significantly increases inference throughput (20x faster) while also enhancing reconstruction quality. These findings position LDAE as a promising framework for scalable medical imaging applications, with the potential to serve as a foundation model for medical image analysis. Code available at https://github.com/GabrieleLozupone/LDAE

Accurate prognosis of Non-Small Cell Lung Cancer (NSCLC) is crucial for enhancing patient care and treatment outcomes. Despite the advancements in deep learning, the task of overall survival prediction in NSCLC has not fully leveraged these techniques, yet. This study introduces a novel methodology for predicting 2-year overall survival (OS) in NSCLC patients using CT scans. Our approach integrates CT scan representations produced by EfficientNetB0 with a soft attention mechanism to identify the most relevant slices for survival risk prediction, which are then analyzed by a risk-assessment network. To validate our method and ensure reproducibility, we employed the public LUNG1 dataset and a smaller private dataset. Our approach was compared to a benchmark 3D network and two variants of our methodology: on the LUNG1 it outperformed the competitors achieving a mean Ctd-index of 0.584 over 10-fold cross-validation. On the LUNG1 we also demonstrated the adaptability of our method with 4 other 2D backbones replacing the EfficientNetB0, confirming that our mechanism of combining 2D slice representations to construct a 3D volume representation is more effective for OS prediction compared to a traditional 3D approach. Finally, we used transfer learning on the private dataset, showing that it can significantly enhance performance in limited data scenarios, increasing the Ctd-index by 0.076 compared to model without transfer learning.

Covid-19 infection influenced the screening test rate of breast cancer worldwide due to the quarantine measures, routine procedures reduction, and delay of early diagnosis, causing high mortality risk and severity of the disease. X-ray mammography is the gold standard for diagnosing early signs of breast cancer, and Artificial Intelligence enables the detection of suspicious lesions and classifying them in terms of malignancy. This paper aimed to investigate mass detection and classification in a large-scale OPTIMAM dataset with 6000 cases and extracted 3524 images with masses in the mammograms of the Hologic manufacturer. The methodology of the detection step is to train the RetinaNet architecture of ResNet50, ResNet101, and ResNet152 backbones with three types of initializations by ImageNet and COCO weights and from scratch. The dataset was pre-processed to generate two types of input with entire mammograms and patches, which are stated as the first and the second approaches. The results show that in the first approach, RetinaNet of ResNet50 backbone with ImageNet and COCO weights and ResNet152 with the same weights performed 0.91 True Positive Rate at 0.78 False Positive Per Image, respectively. In contrast, in the second approach, ResNet152 with ImageNet weights reached 0.88 TPR at 0.78 FPPI. In the classification step, the Transfer Learning approach was applied with fine-tuning by adding L2-regularization and class weights to balance class distribution in the datasets.

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This study presents an innovative method for Alzheimer's disease diagnosis using 3D MRI designed to enhance the explainability of model decisions. Our approach adopts a soft attention mechanism, enabling 2D CNNs to extract volumetric representations. At the same time, the importance of each slice in decision-making is learned, allowing the generation of a voxel-level attention map to produces an explainable MRI. To test our method and ensure the reproducibility of our results, we chose a standardized collection of MRI data from the Alzheimer's Disease Neuroimaging Initiative (ADNI). On this dataset, our method significantly outperforms state-of-the-art methods in (i) distinguishing AD from cognitive normal (CN) with an accuracy of 0.856 and Matthew's correlation coefficient (MCC) of 0.712, representing improvements of 2.4\% and 5.3\% respectively over the second-best, and (ii) in the prognostic task of discerning stable from progressive mild cognitive impairment (MCI) with an accuracy of 0.725 and MCC of 0.443, showing improvements of 10.2\% and 20.5\% respectively over the second-best. We achieved this prognostic result by adopting a double transfer learning strategy, which enhanced sensitivity to morphological changes and facilitated early-stage AD detection. With voxel-level precision, our method identified which specific areas are being paid attention to, identifying these predominant brain regions: the \emph{hippocampus}, the \emph{amygdala}, the \emph{parahippocampal}, and the \emph{inferior lateral ventricles}. All these areas are clinically associated with AD development. Furthermore, our approach consistently found the same AD-related areas across different cross-validation folds, proving its robustness and precision in highlighting areas that align closely with known pathological markers of the disease.

In the last few years Artificial Intelligence (AI) is emerging as a game changer in many areas of society and, in particular, its integration in medicine heralds a transformative approach towards personalized healthcare and well-being, promising significant improvements in diagnostic precision, therapeutic outcomes, and patient care. Our research explores the cutting-edge realms of multimodal AI, resilient AI, and healthcare robotics, aiming to harness the synergy of diverse data modalities and advanced computational models to redefine healthcare paradigms. This multidisciplinary effort seeks to bridge technology and clinical practice, advancing AI-driven next generation personalized healthcare and well-being.

This paper explores the potential of leveraging electronic health records (EHRs) for personalized health research through the application of artificial intelligence (AI) techniques, specifically Named Entity Recognition (NER). By extracting crucial patient information from clinical texts, including diagnoses, medications, symptoms, and lab tests, AI facilitates the rapid identification of relevant data, paving the way for future care paradigms. The study focuses on Non-small cell lung cancer (NSCLC) in Italian clinical notes, introducing a novel set of 29 clinical entities that include both presence or absence (negation) of relevant information associated with NSCLC. Using a state-of-the-art model pretrained on Italian biomedical texts, we achieve promising results (average F1-score of 80.8%), demonstrating the feasibility of employing AI for extracting biomedical information in the Italian language.