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Interpretable rheumatoid arthritis scoring via anatomy-aware multiple instance learning

Abstract:
The Sharp/van der Heijde (SvdH) score has been widely used in clinical trials to quantify radiographic damage in Rheumatoid Arthritis (RA), but its complexity has limited its adoption in routine clinical practice. To address the inefficiency of manual scoring, this work proposes a two-stage pipeline for interpretable image-level SvdH score prediction using dual-hand radiographs. Our approach extracts disease-relevant image regions and integrates them using attention-based multiple instance learning to generate image-level features for prediction. We propose two region extraction schemes: 1) sampling image tiles most likely to contain abnormalities, and 2) cropping patches containing disease-relevant joints. With Scheme 2, our best individual score prediction model achieved a Pearson’s correlation coefficient (PCC) of 0.943 and a root mean squared error (RMSE) of 15.73. Ensemble learning further boosted prediction accuracy, yielding a PCC of 0.945 and RMSE of 15.57, achieving state-of-the-art performance that is comparable to that of experienced radiologists (PCC = 0.97, RMSE = 18.75). Finally, our pipeline effectively identified and made decisions based on anatomical structures which clinicians consider relevant to RA progression.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1007/978-3-032-09569-5_6

Authors

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Institution:
University of Oxford
Division:
MSD
Department:
NDM
Sub department:
Big Data Institute
Role:
Author
ORCID:
0009-0002-6458-3156
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
NDORMS
Oxford college:
St Hilda's College
Role:
Author
ORCID:
0000-0002-4756-663X
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
NDM
Sub department:
Big Data Institute
Role:
Author
ORCID:
0000-0002-8432-2511


More from this funder
Funder identifier:
https://ror.org/0439y7842
Grant:
EP/S02428X/1


Publisher:
Springer
Host title:
Applications of Medical Artificial Intelligence: 4th International Workshop, AMAI 2025, Held in Conjunction with MICCAI 2025, Daejeon, South Korea, September 23, 2025, Proceedings
Pages:
52-62
Series:
Lecture Notes in Computer Science
Series number:
16206
Place of publication:
Cham, Switzerland
Publication date:
2026-01-02
Acceptance date:
2025-07-22
Event title:
4th International Workshop, AMAI 2025, held in conjunction with MICCAI 2025
Event location:
Daejeon, South Korea
Event website:
https://sites.google.com/view/amai2025/home
Event start date:
2025-09-23
Event end date:
2025-09-23
DOI:
EISSN:
1611-3349
ISSN:
0302-9743
EISBN:
9783032095695
ISBN:
9783032095688


Language:
English
Keywords:
Pubs id:
2355879
Local pid:
pubs:2355879
Deposit date:
2026-02-11
ARK identifier:

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