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Purpose Prior studies show convolutional neural networks predicting self-reported race using x-rays of chest, hand and spine, chest computed tomography, and mammogram. We seek an understanding of the mechanism that reveals race within x-ray images, investigating the possibility that race is not predicted using the physical structure in x-ray images but is embedded in the grayscale pixel intensities. Approach Retrospective full year 2021, 298,827 AP/PA chest x-ray images from 3 academic health centers across the United States and MIMIC-CXR, labeled by self-reported race, were used in this study. The image structure is removed by summing the number of each grayscale value and scaling to percent per image (PPI). The resulting data are tested using multivariate analysis of variance (MANOVA) with Bonferroni multiple-comparison adjustment and class-balanced MANOVA. Machine learning (ML) feed-forward networks (FFN) and decision trees were built to predict race (binary Black or White and binary Black or other) using only grayscale value counts. Stratified analysis by body mass index, age, sex, gender, patient type, make/model of scanner, exposure, and kilovoltage peak setting was run to study the impact of these factors on race prediction following the same methodology. Results MANOVA rejects the null hypothesis that classes are the same with 95% confidence (F 7.38, P < 0.0001) and balanced MANOVA (F 2.02, P < 0.0001). The best FFN performance is limited [area under the receiver operating characteristic (AUROC) of 69.18%]. Gradient boosted trees predict self-reported race using grayscale PPI (AUROC 77.24%). Conclusions Within chest x-rays, pixel intensity value counts alone are statistically significant indicators and enough for ML classification tasks of patient self-reported race. 

Understanding causality is a longstanding goal across many different domains. Different articles, such as those published in medical journals, publish newly discovered knowledge, often causal. In this paper, we use this intuition to build a model that leverages causal relations to unearth factors related to Sjögren’s syndrome. Sjögren’s syndrome is an autoimmune disease affecting up to 3.1 million Americans. The uncommon nature of the disease, coupled with common symptoms of other autoimmune conditions such as rheumatoid arthritis, it is difficult for clinicians to timely diagnose the disease. This is further worsened by suboptimal communication between dentists, and physicians, including rheumatologists and ophthalmologists, because clinical manifestations of this disease require the patients to visit physicians with different specialties. A centralized information system with easy access to common and uncommon factors related to Sjögren’s syndrome may alleviate the problem. We use automatically extracted causal relationships from text related to Sjögren’s syndrome collected from the medical literature to identify a set of factors, such as “signs and symptoms” and “associated conditions”, related to this disease. We show that our approach is capable of retrieving such factors with high precision and recall values. Comparative experiments show that this approach leads to 25% improvement in retrieval F1-score compared to several state-of-the-art biomedical models, including BioBERT and Gram-CNN. 

Research articles published in medical journals often present findings from causal experiments. In this paper, we use this intuition to build a model that leverages causal relations expressed in text to unearth factors related to Sjögren’s syndrome. Sjögren’s syndrome is an auto-immune disease affecting up to 3.1 million Americans. The uncommon nature of the disease, coupled with common symptoms with other autoimmune conditions make the timely diagnosis of this disease very hard. A centralized information system with easy access to common and uncommon factors related to Sjögren’s syndrome may alleviate the problem. We use automatically extracted causal relationships from text related to Sjögren’s syndrome collected from the medical literature to identify a set of factors, such as “signs and symptoms” and “associated conditions”, related to this disease. We show that our approach is capable of retrieving such factors with a high precision and recall values. Comparative experiments show that this approach leads to 25% improvement in retrieval F1-score compared to several state-of-the-art biomedical models, including BioBERT and Gram-CNN.