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- All Subjects: deep learning
- All Subjects: Health Care Management
- Creators: Wu, Teresa
Description
Overcrowding of Emergency Departments (EDs) put the safety of patients at risk. Decision makers implement Ambulance Diversion (AD) as a way to relieve congestion and ensure timely treatment delivery. However, ineffective design of AD policies reduces the accessibility to emergency care and adverse events may arise. The objective of this dissertation is to propose methods to design and analyze effective AD policies that consider performance measures that are related to patient safety. First, a simulation-based methodology is proposed to evaluate the mean performance and variability of single-factor AD policies in a single hospital environment considering the trade-off between average waiting time and percentage of time spent on diversion. Regression equations are proposed to obtain parameters of AD policies that yield desired performance level. The results suggest that policies based on the total number of patients waiting are more consistent and provide a high precision in predicting policy performance. Then, a Markov Decision Process model is proposed to obtain the optimal AD policy assuming that information to start treatment in a neighboring hospital is available. The model is designed to minimize the average tardiness per patient in the long run. Tardiness is defined as the time that patients have to wait beyond a safety time threshold to start receiving treatment. Theoretical and computational analyses show that there exists an optimal policy that is of threshold type, and diversion can be a good alternative to decrease tardiness when ambulance patients cause excessive congestion in the ED. Furthermore, implementation of AD policies in a simulation model that accounts for several relaxations of the assumptions suggests that the model provides consistent policies under multiple scenarios. Finally, a genetic algorithm is combined with simulation to design effective policies for multiple hospitals simultaneously. The model has the objective of minimizing the time that patients spend in non-value added activities, including transportation, waiting and boarding in the ED. Moreover, the AD policies are combined with simple ambulance destination policies to create ambulance flow control mechanisms. Results show that effective ambulance management can significantly reduce the time that patients have to wait to receive appropriate level of care.
ContributorsRamirez Nafarrate, Adrian (Author) / Fowler, John W. (Thesis advisor) / Wu, Teresa (Thesis advisor) / Gel, Esma S. (Committee member) / Limon, Jorge (Committee member) / Arizona State University (Publisher)
Created2011
Description
In healthcare facilities, health information systems (HISs) are used to serve different purposes. The radiology department adopts multiple HISs in managing their operations and patient care. In general, the HISs that touch radiology fall into two categories: tracking HISs and archive HISs. Electronic Health Records (EHR) is a typical tracking HIS, which tracks the care each patient receives at multiple encounters and facilities. Archive HISs are typically specialized databases to store large-size data collected as part of the patient care. A typical example of an archive HIS is the Picture Archive and Communication System (PACS), which provides economical storage and convenient access to diagnostic images from multiple modalities. How to integrate such HISs and best utilize their data remains a challenging problem due to the disparity of HISs as well as high-dimensionality and heterogeneity of the data. My PhD dissertation research includes three inter-connected and integrated topics and focuses on designing integrated HISs and further developing statistical models and machine learning algorithms for process and patient care improvement.
Topic 1: Design of super-HIS and tracking of quality of care (QoC). My research developed an information technology that integrates multiple HISs in radiology, and proposed QoC metrics defined upon the data that measure various dimensions of care. The DDD assisted the clinical practices and enabled an effective intervention for reducing lengthy radiologist turnaround times for patients.
Topic 2: Monitoring and change detection of QoC data streams for process improvement. With the super-HIS in place, high-dimensional data streams of QoC metrics are generated. I developed a statistical model for monitoring high- dimensional data streams that integrated Singular Vector Decomposition (SVD) and process control. The algorithm was applied to QoC metrics data, and additionally extended to another application of monitoring traffic data in communication networks.
Topic 3: Deep transfer learning of archive HIS data for computer-aided diagnosis (CAD). The novelty of the CAD system is the development of a deep transfer learning algorithm that combines the ideas of transfer learning and multi- modality image integration under the deep learning framework. Our system achieved high accuracy in breast cancer diagnosis compared with conventional machine learning algorithms.
Topic 1: Design of super-HIS and tracking of quality of care (QoC). My research developed an information technology that integrates multiple HISs in radiology, and proposed QoC metrics defined upon the data that measure various dimensions of care. The DDD assisted the clinical practices and enabled an effective intervention for reducing lengthy radiologist turnaround times for patients.
Topic 2: Monitoring and change detection of QoC data streams for process improvement. With the super-HIS in place, high-dimensional data streams of QoC metrics are generated. I developed a statistical model for monitoring high- dimensional data streams that integrated Singular Vector Decomposition (SVD) and process control. The algorithm was applied to QoC metrics data, and additionally extended to another application of monitoring traffic data in communication networks.
Topic 3: Deep transfer learning of archive HIS data for computer-aided diagnosis (CAD). The novelty of the CAD system is the development of a deep transfer learning algorithm that combines the ideas of transfer learning and multi- modality image integration under the deep learning framework. Our system achieved high accuracy in breast cancer diagnosis compared with conventional machine learning algorithms.
ContributorsWang, Kun (Author) / Li, Jing (Thesis advisor) / Wu, Teresa (Committee member) / Pan, Rong (Committee member) / Zwart, Christine M. (Committee member) / Arizona State University (Publisher)
Created2018
Description
The current Enterprise Requirements and Acquisition Model (ERAM), a discrete event simulation of the major tasks and decisions within the DoD acquisition system, identifies several what-if intervention strategies to improve program completion time. However, processes that contribute to the program acquisition completion time were not explicitly identified in the simulation study. This research seeks to determine the acquisition processes that contribute significantly to total simulated program time in the acquisition system for all programs reaching Milestone C. Specifically, this research examines the effect of increased scope management, technology maturity, and decreased variation and mean process times in post-Design Readiness Review contractor activities by performing additional simulation analyses. Potential policies are formulated from the results to further improve program acquisition completion time.
ContributorsWorger, Danielle Marie (Author) / Wu, Teresa (Thesis director) / Shunk, Dan (Committee member) / Wirthlin, J. Robert (Committee member) / Industrial, Systems (Contributor) / Barrett, The Honors College (Contributor)
Created2013-05
Description
Optimization of surgical operations is a challenging managerial problem for surgical suite directors. This dissertation presents modeling and solution techniques for operating room (OR) planning and scheduling problems. First, several sequencing and patient appointment time setting heuristics are proposed for scheduling an Outpatient Procedure Center. A discrete event simulation model is used to evaluate how scheduling heuristics perform with respect to the competing criteria of expected patient waiting time and expected surgical suite overtime for a single day compared to current practice. Next, a bi-criteria Genetic Algorithm is used to determine if better solutions can be obtained for this single day scheduling problem. The efficacy of the bi-criteria Genetic Algorithm, when surgeries are allowed to be moved to other days, is investigated. Numerical experiments based on real data from a large health care provider are presented. The analysis provides insight into the best scheduling heuristics, and the tradeoff between patient and health care provider based criteria. Second, a multi-stage stochastic mixed integer programming formulation for the allocation of surgeries to ORs over a finite planning horizon is studied. The demand for surgery and surgical duration are random variables. The objective is to minimize two competing criteria: expected surgery cancellations and OR overtime. A decomposition method, Progressive Hedging, is implemented to find near optimal surgery plans. Finally, properties of the model are discussed and methods are proposed to improve the performance of the algorithm based on the special structure of the model. It is found simple rules can improve schedules used in practice. Sequencing surgeries from the longest to shortest mean duration causes high expected overtime, and should be avoided, while sequencing from the shortest to longest mean duration performed quite well in our experiments. Expending greater computational effort with more sophisticated optimization methods does not lead to substantial improvements. However, controlling daily procedure mix may achieve substantial improvements in performance. A novel stochastic programming model for a dynamic surgery planning problem is proposed in the dissertation. The efficacy of the progressive hedging algorithm is investigated. It is found there is a significant correlation between the performance of the algorithm and type and number of scenario bundles in a problem instance. The computational time spent to solve scenario subproblems is among the most significant factors that impact the performance of the algorithm. The quality of the solutions can be improved by detecting and preventing cyclical behaviors.
ContributorsGul, Serhat (Author) / Fowler, John W. (Thesis advisor) / Denton, Brian T. (Thesis advisor) / Wu, Teresa (Committee member) / Zhang, Muhong (Committee member) / Arizona State University (Publisher)
Created2010
Description
Surgery is one of the most important functions in a hospital with respect to operational cost, patient flow, and resource utilization. Planning and scheduling the Operating Room (OR) is important for hospitals to improve efficiency and achieve high quality of service. At the same time, it is a complex task due to the conflicting objectives and the uncertain nature of surgeries. In this dissertation, three different methodologies are developed to address OR planning and scheduling problem. First, a simulation-based framework is constructed to analyze the factors that affect the utilization of a catheterization lab and provide decision support for improving the efficiency of operations in a hospital with different priorities of patients. Both operational costs and patient satisfaction metrics are considered. Detailed parametric analysis is performed to provide generic recommendations. Overall it is found the 75th percentile of process duration is always on the efficient frontier and is a good compromise of both objectives. Next, the general OR planning and scheduling problem is formulated with a mixed integer program. The objectives include reducing staff overtime, OR idle time and patient waiting time, as well as satisfying surgeon preferences and regulating patient flow from OR to the Post Anesthesia Care Unit (PACU). Exact solutions are obtained using real data. Heuristics and a random keys genetic algorithm (RKGA) are used in the scheduling phase and compared with the optimal solutions. Interacting effects between planning and scheduling are also investigated. Lastly, a multi-objective simulation optimization approach is developed, which relaxes the deterministic assumption in the second study by integrating an optimization module of a RKGA implementation of the Non-dominated Sorting Genetic Algorithm II (NSGA-II) to search for Pareto optimal solutions, and a simulation module to evaluate the performance of a given schedule. It is experimentally shown to be an effective technique for finding Pareto optimal solutions.
ContributorsLi, Qing (Author) / Fowler, John W (Thesis advisor) / Mohan, Srimathy (Thesis advisor) / Gopalakrishnan, Mohan (Committee member) / Askin, Ronald G. (Committee member) / Wu, Teresa (Committee member) / Arizona State University (Publisher)
Created2010
Description
In this thesis, the applications of deep learning in the analysis, detection and classification of medical imaging datasets were studied, with a focus on datasets having a limited sample size. A combined machine learning-deep learning model was designed to classify one small dataset, prostate cancer provided by Mayo Clinic, Arizona. Deep learning model was implemented to extract imaging features followed by machine learning classifier for prostate cancer diagnosis. The results were compared against models trained on texture-based features, namely gray level co-occurrence matrix (GLCM) and Gabor. Some of the challenges of performing diagnosis on medical imaging datasets with limited sample sizes, have been identified. Lastly, a set of future works have been proposed. Keywords: Deep learning, radiology, transfer learning, convolutional neural network.
ContributorsSarkar, Suryadipto (Author) / Wu, Teresa (Thesis advisor) / Papandreou-Suppappola, Antonia (Committee member) / Silva, Alvin (Committee member) / Arizona State University (Publisher)
Created2021
Description
Over the past few decades, medical imaging is becoming important in medicine for disease diagnosis, prognosis, treatment assessment and health monitoring. As medical imaging has progressed, imaging biomarkers are being rapidly developed for early diagnosis and staging of disease. Detecting and segmenting objects from images are often the first steps in quantitative measurement of these biomarkers. While large objects can often be automatically or semi-automatically delineated, segmenting small objects (blobs) is challenging. The small object of particular interest in this dissertation are glomeruli from kidney magnetic resonance (MR) images. This problem has its unique challenges. First of all, the size of glomeruli is extremely small and very similar with noises from images. Second, there are massive of glomeruli in kidney, e.g. over 1 million glomeruli in human kidney, and the intensity distribution is heterogenous. A third recognized issue is that a large portion of glomeruli are overlapping and touched in images. The goal of this dissertation is to develop computational algorithms to identify and discover glomeruli related imaging biomarkers. The first phase is to develop a U-net joint with Hessian based Difference of Gaussians (UH-DoG) blob detector. Joining effort from deep learning alleviates the over-detection issue from Hessian analysis. Next, as extension of UH-DoG, a small blob detector using Bi-Threshold Constrained Adaptive Scales (BTCAS) is proposed. Deep learning is treated as prior of Difference of Gaussian (DoG) to improve its efficiency. By adopting BTCAS, under-segmentation issue of deep learning is addressed. The second phase is to develop a denoising convexity-consistent Blob Generative Adversarial Network (BlobGAN). BlobGAN could achieve high denoising performance and selectively denoise the image without affecting the blobs. These detectors are validated on datasets of 2D fluorescent images, 3D synthetic images, 3D MR (18 mice, 3 humans) images and proved to be outperforming the competing detectors. In the last phase, a Fréchet Descriptors Distance based Coreset approach (FDD-Coreset) is proposed for accelerating BlobGAN’s training. Experiments have shown that BlobGAN trained on FDD-Coreset not only significantly reduces the training time, but also achieves higher denoising performance and maintains approximate performance of blob identification compared with training on entire dataset.
ContributorsXu, Yanzhe (Author) / Wu, Teresa (Thesis advisor) / Iquebal, Ashif (Committee member) / Yan, Hao (Committee member) / Beeman, Scott (Committee member) / Arizona State University (Publisher)
Created2022
Description
Deep learning is a sub-field of machine learning in which models are developed to imitate the workings of the human brain in processing data and creating patterns for decision making. This dissertation is focused on developing deep learning models for medical imaging analysis of different modalities for different tasks including detection, segmentation and classification. Imaging modalities including digital mammography (DM), magnetic resonance imaging (MRI), positron emission tomography (PET) and computed tomography (CT) are studied in the dissertation for various medical applications. The first phase of the research is to develop a novel shallow-deep convolutional neural network (SD-CNN) model for improved breast cancer diagnosis. This model takes one type of medical image as input and synthesizes different modalities for additional feature sources; both original image and synthetic image are used for feature generation. This proposed architecture is validated in the application of breast cancer diagnosis and proved to be outperforming the competing models. Motivated by the success from the first phase, the second phase focuses on improving medical imaging synthesis performance with advanced deep learning architecture. A new architecture named deep residual inception encoder-decoder network (RIED-Net) is proposed. RIED-Net has the advantages of preserving pixel-level information and cross-modality feature transferring. The applicability of RIED-Net is validated in breast cancer diagnosis and Alzheimer’s disease (AD) staging. Recognizing medical imaging research often has multiples inter-related tasks, namely, detection, segmentation and classification, my third phase of the research is to develop a multi-task deep learning model. Specifically, a feature transfer enabled multi-task deep learning model (FT-MTL-Net) is proposed to transfer high-resolution features from segmentation task to low-resolution feature-based classification task. The application of FT-MTL-Net on breast cancer detection, segmentation and classification using DM images is studied. As a continuing effort on exploring the transfer learning in deep models for medical application, the last phase is to develop a deep learning model for both feature transfer and knowledge from pre-training age prediction task to new domain of Mild cognitive impairment (MCI) to AD conversion prediction task. It is validated in the application of predicting MCI patients’ conversion to AD with 3D MRI images.
ContributorsGao, Fei (Author) / Wu, Teresa (Thesis advisor) / Li, Jing (Committee member) / Yan, Hao (Committee member) / Patel, Bhavika (Committee member) / Arizona State University (Publisher)
Created2019
Description
The use of Red Blood Cells (RBCs) is a pillar of modern health care. Annually, the lives of hundreds of thousands of patients are saved through ready access to safe, fresh, blood-type compatible RBCs. Worldwide, hospitals have the common goal to better utilize available blood units by maximizing patients served and reducing blood wastage. Managing blood is challenging because blood is perishable, its supply is stochastic and its demand pattern is highly uncertain. Additionally, RBCs are typed and patient compatibility is required.
This research focuses on improving blood inventory management at the hospital level. It explores the importance of hospital characteristics, such as demand rate and blood-type distribution in supply and demand, for improving RBC inventory management. Available inventory models make simplifying assumptions; they tend to be general and do not utilize available data that could improve blood delivery. This dissertation develops useful and realistic models that incorporate data characterizing the hospital inventory position, distribution of blood types of donors and the population being served.
The dissertation contributions can be grouped into three areas. First, simulations are used to characterize the benefits of demand forecasting. In addition to forecast accuracy, it shows that characteristics such as forecast horizon, the age of replenishment units, and the percentage of demand that is forecastable influence the benefits resulting from demand variability reduction.
Second, it develops Markov decision models for improved allocation policies under emergency conditions, where only the units on the shelf are available for dispensing. In this situation the RBC perishability has no impact due to the short timeline for decision making. Improved location-specific policies are demonstrated via simulation models for two emergency event types: mass casualty events and pandemic influenza.
Third, improved allocation policies under normal conditions are found using Markov decision models that incorporate temporal dynamics. In this case, hospitals receive replenishment and units age and outdate. The models are solved using Approximate Dynamic Programming with model-free approximate policy iteration, using machine learning algorithms to approximate value or policy functions. These are the first stock- and age-dependent allocation policies that engage substitution between blood type groups to improve inventory performance.
This research focuses on improving blood inventory management at the hospital level. It explores the importance of hospital characteristics, such as demand rate and blood-type distribution in supply and demand, for improving RBC inventory management. Available inventory models make simplifying assumptions; they tend to be general and do not utilize available data that could improve blood delivery. This dissertation develops useful and realistic models that incorporate data characterizing the hospital inventory position, distribution of blood types of donors and the population being served.
The dissertation contributions can be grouped into three areas. First, simulations are used to characterize the benefits of demand forecasting. In addition to forecast accuracy, it shows that characteristics such as forecast horizon, the age of replenishment units, and the percentage of demand that is forecastable influence the benefits resulting from demand variability reduction.
Second, it develops Markov decision models for improved allocation policies under emergency conditions, where only the units on the shelf are available for dispensing. In this situation the RBC perishability has no impact due to the short timeline for decision making. Improved location-specific policies are demonstrated via simulation models for two emergency event types: mass casualty events and pandemic influenza.
Third, improved allocation policies under normal conditions are found using Markov decision models that incorporate temporal dynamics. In this case, hospitals receive replenishment and units age and outdate. The models are solved using Approximate Dynamic Programming with model-free approximate policy iteration, using machine learning algorithms to approximate value or policy functions. These are the first stock- and age-dependent allocation policies that engage substitution between blood type groups to improve inventory performance.
ContributorsDumkrieger, Gina (Author) / Mirchandani, Pitu B. (Thesis advisor) / Fowler, John (Committee member) / Wu, Teresa (Committee member) / Ju, Feng (Committee member) / Arizona State University (Publisher)
Created2020
Description
High-dimensional data is omnipresent in modern industrial systems. An imaging sensor in a manufacturing plant a can take images of millions of pixels or a sensor may collect months of data at very granular time steps. Dimensionality reduction techniques are commonly used for dealing with such data. In addition, outliers typically exist in such data, which may be of direct or indirect interest given the nature of the problem that is being solved. Current research does not address the interdependent nature of dimensionality reduction and outliers. Some works ignore the existence of outliers altogether—which discredits the robustness of these methods in real life—while others provide suboptimal, often band-aid solutions. In this dissertation, I propose novel methods to achieve outlier-awareness in various dimensionality reduction methods. The problem is considered from many different angles depend- ing on the dimensionality reduction technique used (e.g., deep autoencoder, tensors), the nature of the application (e.g., manufacturing, transportation) and the outlier structure (e.g., sparse point anomalies, novelties).
ContributorsSergin, Nurettin Dorukhan (Author) / Yan, Hao (Thesis advisor) / Li, Jing (Committee member) / Wu, Teresa (Committee member) / Tsung, Fugee (Committee member) / Arizona State University (Publisher)
Created2021