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Prateek Prasanna

Prateek Prasanna contributes to research discovery and scholarly infrastructure.

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Published work

11 published item(s)

preprint2026arXiv

Semantic Context-aware mOdality fUsion Transformer (SCOUT): A Context-Aware Multimodal Transformer for Concept-Grounded Pathology Report Generation

Whole-slide images (WSIs) present a fundamental challenge for computational pathology due to their extreme resolution, multi-scale heterogeneity, and the requirement for clinically reliable interpretation. Although recent pathology foundation models have enabled fluent report generation, they often lack clinical grounding, failing to accurately represent key diagnostic concepts and relationships observed by pathologists. This limitation arises from the difficulty of integrating heterogeneous visual evidence spanning fine-grained cellular patterns, slide-level tissue architecture, and high-level diagnostic concepts, while maintaining interpretability and clinical coherence. Here we present SCOUT: Semantic Context-aware mOdality fUsion Transformer, a context-aware concept-grounded multimodal framework for pathology report generation that enables progressive conditioning of image representations by global slide information and explicit diagnostic concepts. The method integrates local histological patterns, whole-slide context, and expert-curated semantic descriptors within a unified learning paradigm, allowing visual features to be dynamically refined throughout the encoding process. By combining depth-aware contextual modulation with adaptive multimodal fusion during text generation, the framework produces clinically coherent reports while preserving complementarity across representational scales. Using CONCH1.5 features, we evaluate SCOUT against WSI-Caption, HistGen, and BiGen on TCGA-BRCA, MICCAI REG, and HistAI. SCOUT achieves the best BLEU-1 to BLEU-4 and METEOR scores on all datasets, plus the best ROUGE-L on TCGA-BRCA and MICCAI REG. On TCGA-BRCA, it reaches 0.436/0.303/0.202/0.156 BLEU-1/2/3/4 and 0.204 METEOR; on REG 2025, it achieves 0.865/0.834/0.805/0.780 and 0.568. These results support progressive contextual conditioning for grounded pathology report generation.

preprint2022arXiv

Brain Cancer Survival Prediction on Treatment-na ive MRI using Deep Anchor Attention Learning with Vision Transformer

Image-based brain cancer prediction models, based on radiomics, quantify the radiologic phenotype from magnetic resonance imaging (MRI). However, these features are difficult to reproduce because of variability in acquisition and preprocessing pipelines. Despite evidence of intra-tumor phenotypic heterogeneity, the spatial diversity between different slices within an MRI scan has been relatively unexplored using such methods. In this work, we propose a deep anchor attention aggregation strategy with a Vision Transformer to predict survival risk for brain cancer patients. A Deep Anchor Attention Learning (DAAL) algorithm is proposed to assign different weights to slice-level representations with trainable distance measurements. We evaluated our method on N = 326 MRIs. Our results outperformed attention multiple instance learning-based techniques. DAAL highlights the importance of critical slices and corroborates the clinical intuition that inter-slice spatial diversity can reflect disease severity and is implicated in outcome.

preprint2022arXiv

CD-Net: Histopathology Representation Learning using Pyramidal Context-Detail Network

Extracting rich phenotype information, such as cell density and arrangement, from whole slide histology images (WSIs), requires analysis of large field of view, i.e more contexual information. This can be achieved through analyzing the digital slides at lower resolution. A potential drawback is missing out on details present at a higher resolution. To jointly leverage complementary information from multiple resolutions, we present a novel transformer based Pyramidal Context-Detail Network (CD-Net). CD-Net exploits the WSI pyramidal structure through co-training of proposed Context and Detail Modules, which operate on inputs from multiple resolutions. The residual connections between the modules enable the joint training paradigm while learning self-supervised representation for WSIs. The efficacy of CD-Net is demonstrated in classifying Lung Adenocarcinoma from Squamous cell carcinoma.

preprint2022arXiv

Learning Topological Interactions for Multi-Class Medical Image Segmentation

Deep learning methods have achieved impressive performance for multi-class medical image segmentation. However, they are limited in their ability to encode topological interactions among different classes (e.g., containment and exclusion). These constraints naturally arise in biomedical images and can be crucial in improving segmentation quality. In this paper, we introduce a novel topological interaction module to encode the topological interactions into a deep neural network. The implementation is completely convolution-based and thus can be very efficient. This empowers us to incorporate the constraints into end-to-end training and enrich the feature representation of neural networks. The efficacy of the proposed method is validated on different types of interactions. We also demonstrate the generalizability of the method on both proprietary and public challenge datasets, in both 2D and 3D settings, as well as across different modalities such as CT and Ultrasound. Code is available at: https://github.com/TopoXLab/TopoInteraction

preprint2022arXiv

Lung Swapping Autoencoder: Learning a Disentangled Structure-texture Representation of Chest Radiographs

Well-labeled datasets of chest radiographs (CXRs) are difficult to acquire due to the high cost of annotation. Thus, it is desirable to learn a robust and transferable representation in an unsupervised manner to benefit tasks that lack labeled data. Unlike natural images, medical images have their own domain prior; e.g., we observe that many pulmonary diseases, such as the COVID-19, manifest as changes in the lung tissue texture rather than the anatomical structure. Therefore, we hypothesize that studying only the texture without the influence of structure variations would be advantageous for downstream prognostic and predictive modeling tasks. In this paper, we propose a generative framework, the Lung Swapping Autoencoder (LSAE), that learns factorized representations of a CXR to disentangle the texture factor from the structure factor. Specifically, by adversarial training, the LSAE is optimized to generate a hybrid image that preserves the lung shape in one image but inherits the lung texture of another. To demonstrate the effectiveness of the disentangled texture representation, we evaluate the texture encoder $Enc^t$ in LSAE on ChestX-ray14 (N=112,120), and our own multi-institutional COVID-19 outcome prediction dataset, COVOC (N=340 (Subset-1) + 53 (Subset-2)). On both datasets, we reach or surpass the state-of-the-art by finetuning $Enc^t$ in LSAE that is 77% smaller than a baseline Inception v3. Additionally, in semi-and-self supervised settings with a similar model budget, $Enc^t$ in LSAE is also competitive with the state-of-the-art MoCo. By "re-mixing" the texture and shape factors, we generate meaningful hybrid images that can augment the training set. This data augmentation method can further improve COVOC prediction performance. The improvement is consistent even when we directly evaluate the Subset-1 trained model on Subset-2 without any fine-tuning.

preprint2022arXiv

RadioTransformer: A Cascaded Global-Focal Transformer for Visual Attention-guided Disease Classification

In this work, we present RadioTransformer, a novel visual attention-driven transformer framework, that leverages radiologists' gaze patterns and models their visuo-cognitive behavior for disease diagnosis on chest radiographs. Domain experts, such as radiologists, rely on visual information for medical image interpretation. On the other hand, deep neural networks have demonstrated significant promise in similar tasks even where visual interpretation is challenging. Eye-gaze tracking has been used to capture the viewing behavior of domain experts, lending insights into the complexity of visual search. However, deep learning frameworks, even those that rely on attention mechanisms, do not leverage this rich domain information. RadioTransformer fills this critical gap by learning from radiologists' visual search patterns, encoded as 'human visual attention regions' in a cascaded global-focal transformer framework. The overall 'global' image characteristics and the more detailed 'local' features are captured by the proposed global and focal modules, respectively. We experimentally validate the efficacy of our student-teacher approach for 8 datasets involving different disease classification tasks where eye-gaze data is not available during the inference phase. Code: https://github.com/bmi-imaginelab/radiotransformer.

preprint2022arXiv

Surgical Phase Recognition in Laparoscopic Cholecystectomy

Automatic recognition of surgical phases in surgical videos is a fundamental task in surgical workflow analysis. In this report, we propose a Transformer-based method that utilizes calibrated confidence scores for a 2-stage inference pipeline, which dynamically switches between a baseline model and a separately trained transition model depending on the calibrated confidence level. Our method outperforms the baseline model on the Cholec80 dataset, and can be applied to a variety of action segmentation methods.

preprint2022arXiv

Temporal Context Matters: Enhancing Single Image Prediction with Disease Progression Representations

Clinical outcome or severity prediction from medical images has largely focused on learning representations from single-timepoint or snapshot scans. It has been shown that disease progression can be better characterized by temporal imaging. We therefore hypothesized that outcome predictions can be improved by utilizing the disease progression information from sequential images. We present a deep learning approach that leverages temporal progression information to improve clinical outcome predictions from single-timepoint images. In our method, a self-attention based Temporal Convolutional Network (TCN) is used to learn a representation that is most reflective of the disease trajectory. Meanwhile, a Vision Transformer is pretrained in a self-supervised fashion to extract features from single-timepoint images. The key contribution is to design a recalibration module that employs maximum mean discrepancy loss (MMD) to align distributions of the above two contextual representations. We train our system to predict clinical outcomes and severity grades from single-timepoint images. Experiments on chest and osteoarthritis radiography datasets demonstrate that our approach outperforms other state-of-the-art techniques.

preprint2021arXiv

EventScore: An Automated Real-time Early Warning Score for Clinical Events

Early prediction of patients at risk of clinical deterioration can help physicians intervene and alter their clinical course towards better outcomes. In addition to the accuracy requirement, early warning systems must make the predictions early enough to give physicians enough time to intervene. Interpretability is also one of the challenges when building such systems since being able to justify the reasoning behind model decisions is desirable in clinical practice. In this work, we built an interpretable model for the early prediction of various adverse clinical events indicative of clinical deterioration. The model is evaluated on two datasets and four clinical events. The first dataset is collected in a predominantly COVID-19 positive population at Stony Brook Hospital. The second dataset is the MIMIC III dataset. The model was trained to provide early warning scores for ventilation, ICU transfer, and mortality prediction tasks on the Stony Brook Hospital dataset and to predict mortality and the need for vasopressors on the MIMIC III dataset. Our model first separates each feature into multiple ranges and then uses logistic regression with lasso penalization to select the subset of ranges for each feature. The model training is completely automated and doesn't require expert knowledge like other early warning scores. We compare our model to the Modified Early Warning Score (MEWS) and quick SOFA (qSOFA), commonly used in hospitals. We show that our model outperforms these models in the area under the receiver operating characteristic curve (AUROC) while having a similar or better median detection time on all clinical events, even when using fewer features. Unlike MEWS and qSOFA, our model can be entirely automated without requiring any manually recorded features. We also show that discretization improves model performance by comparing our model to a baseline logistic regression model.

preprint2020arXiv

Can tumor location on pre-treatment MRI predict likelihood of pseudo-progression versus tumor recurrence in Glioblastoma? A feasibility study

A significant challenge in Glioblastoma (GBM) management is identifying pseudo-progression (PsP), a benign radiation-induced effect, from tumor recurrence, on routine imaging following conventional treatment. Previous studies have linked tumor lobar presence and laterality to GBM outcomes, suggesting that disease etiology and progression in GBM may be impacted by tumor location. Hence, in this feasibility study, we seek to investigate the following question: Can tumor location on treatment-naïve MRI provide early cues regarding likelihood of a patient developing pseudo-progression versus tumor recurrence? In this study, 74 pre-treatment Glioblastoma MRI scans with PsP (33) and tumor recurrence (41) were analyzed. First, enhancing lesion on Gd-T1w MRI and peri-lesional hyperintensities on T2w/FLAIR were segmented by experts and then registered to a brain atlas. Using patients from the two phenotypes, we construct two atlases by quantifying frequency of occurrence of enhancing lesion and peri-lesion hyperintensities, by averaging voxel intensities across the population. Analysis of differential involvement was then performed to compute voxel-wise significant differences (p-value<0.05) across the atlases. Statistically significant clusters were finally mapped to a structural atlas to provide anatomic localization of their location. Our results demonstrate that patients with tumor recurrence showed prominence of their initial tumor in the parietal lobe, while patients with PsP showed a multi-focal distribution of the initial tumor in the frontal and temporal lobes, insula, and putamen. These preliminary results suggest that lateralization of pre-treatment lesions towards certain anatomical areas of the brain may allow to provide early cues regarding assessing likelihood of occurrence of pseudo-progression from tumor recurrence on MRI scans.

preprint2020arXiv

Spatial-And-Context aware (SpACe) &#34;virtual biopsy&#34; radiogenomic maps to target tumor mutational status on structural MRI

With growing emphasis on personalized cancer-therapies,radiogenomics has shown promise in identifying target tumor mutational status on routine imaging (i.e. MRI) scans. These approaches fall into 2 categories: (1) deep-learning/radiomics (context-based), using image features from the entire tumor to identify the gene mutation status, or (2) atlas (spatial)-based to obtain likelihood of gene mutation status based on population statistics. While many genes (i.e. EGFR, MGMT) are spatially variant, a significant challenge in reliable assessment of gene mutation status on imaging has been the lack of available co-localized ground truth for training the models. We present Spatial-And-Context aware (SpACe) &#34;virtual biopsy&#34; maps that incorporate context-features from co-localized biopsy site along with spatial-priors from population atlases, within a Least Absolute Shrinkage and Selection Operator (LASSO) regression model, to obtain a per-voxel probability of the presence of a mutation status (M+ vs M-). We then use probabilistic pair-wise Markov model to improve the voxel-wise prediction probability. We evaluate the efficacy of SpACe maps on MRI scans with co-localized ground truth obtained from corresponding biopsy, to predict the mutation status of 2 driver genes in Glioblastoma: (1) EGFR (n=91), and (2) MGMT (n=81). When compared against deep-learning (DL) and radiomic models, SpACe maps obtained training and testing accuracies of 90% (n=71) and 90.48% (n=21) in identifying EGFR amplification status,compared to 80% and 71.4% via radiomics, and 74.28% and 65.5% via DL. For MGMT status, training and testing accuracies using SpACe were 88.3% (n=61) and 71.5% (n=20), compared to 52.4% and 66.7% using radiomics,and 79.3% and 68.4% using DL. Following validation,SpACe maps could provide surgical navigation to improve localization of sampling sites for targeting of specific driver genes in cancer.