Image-based precision medicine aims to personalize treatment decisions based
on an individual's unique imaging features so as to improve their clinical
outcome. Machine learning frameworks that integrate uncertainty estimation as
part of their treatment recommendations would be safer and more reliable.
However, little work has been done in adapting uncertainty estimation
techniques and validation metrics for precision medicine. In this paper, we use
Bayesian deep learning for estimating the posterior distribution over factual
and counterfactual outcomes on several treatments. This allows for estimating
the uncertainty for each treatment option and for the individual treatment
effects (ITE) between any two treatments. We train and evaluate this model to
predict future new and enlarging T2 lesion counts on a large, multi-center
dataset of MR brain images of patients with multiple sclerosis, exposed to
several treatments during randomized controlled trials. We evaluate the
correlation of the uncertainty estimate with the factual error, and, given the
lack of ground truth counterfactual outcomes, demonstrate how uncertainty for
the ITE prediction relates to bounds on the ITE error. Lastly, we demonstrate
how knowledge of uncertainty could modify clinical decision-making to improve
individual patient and clinical trial outcomes.

本研究使用基于贝叶斯的深度学习技术，通过对多发性硬化症患者的 MRI 图像进行数据训练，估计病人的不同治疗方案的后验分布，计算每种治疗方案和任意两种治疗方案之间的个体治疗效应（ITE）并对其不确定性进行评估，从而实现 “精准医学”，并对临床医生的决策提供指导。