Quest 7.29 - Case-level exploratory study
Multimodal treatment recommendation with auditable clinical reasoning.
The complete 83-case cohort combines preoperative clinical text with AP and lateral DSA views. Every case has an out-of-fold Top-1 and Top-2 recommendation, a model-generated rationale, and an explicit uncertainty statement.
What has been completed
From data audit to a complete case-level review set
The technical pipeline covers all 83 cases. Blinded physician review remains the next validation step.
Data audit
83 de-identified cases were linked to 166 PNG images. Each case has one AP and one lateral view.
Leakage-controlled evaluation
Each case appeared in a held-out test fold exactly once across five folds.
Multi-reference scoring
Top-1 and Top-2 predictions were compared with all supplied expert references, preserving disagreement.
Reasoning generation
Qwen3.6-27B generated 83 case rationales from model outputs without receiving the reference labels.
Interpretation
Strong candidate coverage, limited exact agreement
Top-2 coverage is high when any expert reference is accepted. Exact agreement with the technique actually used remains modest, reflecting both model error and real treatment-choice variability.
Important limits
Not yet a clinical validation result
- No patient-to-case mapping was supplied; evaluation is case-level.
- No independent locked external cohort has been tested.
- Class scores have not been calibrated as probabilities of clinical correctness.
- Generated rationales still require blinded physician review.
Cohort organization
One primary grouping, three complementary views
Cases are grouped by the model's Top-1 technique and can be filtered by performance, score separation, and expert-reference agreement.
Primary groupingTop-1 technique
Coil embolization alone55
Stent-assisted coil embolization14
Flow diversion alone7
Balloon-assisted coil embolization3
Flow diversion with coil embolization3
Flow disruption (intra-saccular)1
PerformanceAny expert reference
61Top-1 matches any expert reference
15Top-2 adds a matching option
7Neither Top-1 nor Top-2 matches
UncertaintyTop-1 minus Top-2 score
44Clearer preference (margin >= 0.20)
20Intermediate (margin 0.10-0.20)
19High uncertainty (margin < 0.10)
Reference agreementFour expert labels
12Unanimous expert reference (4/4)
42Expert majority (3/4)
29Substantial expert disagreement
Complete cohort
All 83 de-identified cases
Use the filters to inspect recommendations, failure modes, uncertainty, and expert disagreement without changing the underlying case set.
83cases shown
Case 1Top-2 rescue
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 5Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 6Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 7Top-2 rescue
Coil embolization aloneAlternative: Flow diversion with coil embolizationView case detailsCase 8Top-1 hit
Flow diversion aloneAlternative: Flow diversion with coil embolizationView case detailsCase 9Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 10Top-2 rescue
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 11Top-2 rescue
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 12Top-1 hit
Balloon-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 13Top-1 hit
Flow diversion with coil embolizationAlternative: Stent-assisted coil embolizationView case detailsCase 14Top-1 hit
Stent-assisted coil embolizationAlternative: Flow disruption (intra-saccular)View case detailsCase 15Top-1 hit
Flow diversion aloneAlternative: Coil embolization aloneView case detailsCase 16Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 17Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 18Top-1 hit
Flow diversion aloneAlternative: Coil embolization aloneView case detailsCase 19Top-1 hit
Balloon-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 20Top-2 rescue
Flow disruption (intra-saccular)Alternative: Flow diversion aloneView case detailsCase 22Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 23Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 24Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 25Top-2 miss
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 26Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 27Top-1 hit
Flow diversion with coil embolizationAlternative: Flow diversion aloneView case detailsCase 28Top-1 hit
Stent-assisted coil embolizationAlternative: Flow disruption (intra-saccular)View case detailsCase 29Top-2 miss
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 30Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 31Top-2 miss
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 32Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 33Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 37Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 38Top-1 hit
Coil embolization aloneAlternative: Flow diversion aloneView case detailsCase 39Top-2 rescue
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 41Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 42Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 44Top-1 hit
Coil embolization aloneAlternative: Flow diversion aloneView case detailsCase 45Top-1 hit
Coil embolization aloneAlternative: Flow diversion with coil embolizationView case detailsCase 46Top-1 hit
Coil embolization aloneAlternative: Flow diversion aloneView case detailsCase 47Top-2 rescue
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 48Top-1 hit
Coil embolization aloneAlternative: Flow diversion aloneView case detailsCase 49Top-2 rescue
Coil embolization aloneAlternative: Flow diversion with coil embolizationView case detailsCase 50Top-1 hit
Coil embolization aloneAlternative: Flow diversion aloneView case detailsCase 51Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 52Top-2 rescue
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 53Top-1 hit
Coil embolization aloneAlternative: Flow diversion with coil embolizationView case detailsCase 54Top-2 rescue
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 55Top-1 hit
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 56Top-2 miss
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 57Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 58Top-2 rescue
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 59Top-2 rescue
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 60Top-1 hit
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 61Top-1 hit
Coil embolization aloneAlternative: Flow diversion with coil embolizationView case detailsCase 62Top-2 rescue
Coil embolization aloneAlternative: Flow disruption (intra-saccular)View case detailsCase 64Top-2 rescue
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 66Top-1 hit
Coil embolization aloneAlternative: Flow diversion with coil embolizationView case detailsCase 71Top-1 hit
Stent-assisted coil embolizationAlternative: Flow diversion aloneView case detailsCase 72Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 73Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 74Top-1 hit
Balloon-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 75Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 76Top-1 hit
Stent-assisted coil embolizationAlternative: Balloon-assisted coil embolizationView case detailsCase 77Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 78Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 79Top-2 miss
Flow diversion aloneAlternative: Coil embolization aloneView case detailsCase 80Top-1 hit
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 81Top-2 miss
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 82Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 83Top-1 hit
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 84Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 85Top-1 hit
Coil embolization aloneAlternative: Flow diversion aloneView case detailsCase 86Top-1 hit
Flow diversion aloneAlternative: Coil embolization aloneView case detailsCase 87Top-1 hit
Flow diversion aloneAlternative: Coil embolization aloneView case detailsCase 88Top-1 hit
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 89Top-1 hit
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 90Top-1 hit
Stent-assisted coil embolizationAlternative: Coil embolization aloneView case detailsCase 91Top-1 hit
Flow diversion aloneAlternative: Coil embolization aloneView case detailsCase 93Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 94Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsCase 95Top-1 hit
Flow diversion with coil embolizationAlternative: Flow diversion aloneView case detailsCase 96Top-1 hit
Coil embolization aloneAlternative: Flow diversion with coil embolizationView case detailsCase 97Top-2 rescue
Coil embolization aloneAlternative: Stent-assisted coil embolizationView case detailsCase 98Top-2 miss
Stent-assisted coil embolizationAlternative: Flow diversion aloneView case detailsCase 100Top-1 hit
Coil embolization aloneAlternative: Balloon-assisted coil embolizationView case detailsBlinded qualitative physician review
16 selected de-identified cases
Selected to cover confident, ambiguous, adjunctive-device, and retreatment scenarios. Outcome groups and expert-reference agreement are intentionally hidden in this section.
Review progress0 / 16
Ratings are stored only in this browser until exported.
Review case 1 of 16
Case 61
Awaiting review
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Flow diversion with coil embolization
Top-1 class score73.9%
Top-2 class score10.4%
View A - APOpen full size
View B - LateralOpen full size
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 75-year-old male presents with an unruptured right ACA A1 aneurysm measuring 5.3 mm x 4 mm x 5.4 mm with a 3.1 mm neck and a daughter sac.
Image observation
On the supplied views, a saccular outpouching appears on the proximal anterior cerebral artery with a visible neck connecting to the parent vessel.
Model-generated clinical rationale
The documented dimensions and neck width suggest a morphology that may be amenable to endovascular coiling. However, the presence of a daughter sac and the specific neck-to-dome ratio are critical factors that are not fully quantified in the narrative, potentially complicating coil stability.
Model uncertainty
The OOF classifier showed a relatively clear preference for Coil embolization alone over Flow diversion with coil embolization, but its scores are not probabilities of clinical correctness.
Clinical uncertainty / missing factor
The precise neck-to-dome ratio and the exact relationship of the daughter sac to the aneurysm neck are missing, which are essential for determining the feasibility of coil-only treatment versus adjunctive techniques.
Explicit evidence used
Unruptured right ACA A1 aneurysm | Dimensions 5.3 mm x 4 mm x 5.4 mm with 3.1 mm neck | Presence of a daughter sac