Publications by Costantino Grana

Overcrowding in Emergency Departments (EDs) is a pressing concern driven by high patient demand and limited resources. Prolonged Length of Stay (pLOS), a major contributor to this congestion, may lead to adverse outcomes, including patients leaving without being seen, suboptimal clinical care, increased mortality rates, provider burnout, and escalating healthcare costs. This study investigates the application of various Machine Learning (ML) algorithms to predict both LOS and pLOS. A retrospective analysis examined 32,967 accesses at a northern Italian hospital’s ED between 2022 and 2024. Twelve classification algorithms were evaluated in forecasting pLOS, using clinically relevant thresholds. Two data variants were employed for model comparison: one containing only structured data (e.g., demographics and clinical information), while a second one also including features extracted from free-text nursing notes. To enhance the accuracy of LOS prediction, novel queue-based variables capturing the real-time state of the ED were incorporated as additional dynamic predictors. Compared to single-algorithm models, ensemble models demonstrated superior robustness in forecasting both ED-LOS and ED-pLOS. These findings highlight the potential for integrating ML into EDs practices as auxiliary tools to provide valuable insights into patient flow. By identifying patients at high risk of pLOS, healthcare professionals can proactively implement strategies to expedite care, optimize resource allocation, and ultimately improve patient outcomes and ED efficiency, promoting a more effective and sustainable public healthcare delivery.

Barcodes are a critical technology in industrial automation, logistics, and retail, enabling fast and reliable data capture. While deep learning has significantly improved barcode localization accuracy, most modern architectures remain too computationally demanding for real-time deployment on embedded systems without dedicated hardware acceleration. In this work, we present BaFaLo (Barcode Fast Localizer), an ultra-lightweight segmentation-based neural network for barcode localization. Our model is specifically optimized for real-time performance on low-power CPUs while maintaining high localization accuracy for both 1D and 2D barcodes. It features a two-branch architecture—comprising a local feature extractor and a global context module—and is tailored for low-resolution inputs to improve inference speed further. We benchmark BaFaLo against several lightweight architectures for object detection or segmentation, including YOLO Nano, Fast-SCNN, BiSeNet V2, and ContextNet, using the BarBeR dataset. BaFaLo achieves the fastest inference time among all deep-learning models tested, operating at 57.62ms per frame on a single CPU core of a Raspberry Pi 3B+. Despite its compact design, it achieves a decoding rate nearly equivalent to YOLO Nano for 1D barcodes and only 3.5 percentage points lower for 2D barcodes while being approximately nine times faster.

Effective hospital resource management hinges on established metrics such as Length of Stay (LOS) and Prolonged Length of Stay (pLOS). Reducing pLOS is associated with improved patient outcomes and optimized resource utilization (e.g., bed allocation). This study investigates several Machine Learning (ML) models for both LOS and pLOS prediction. We conducted a retrospective study analyzing data from general inpatients discharged between 2022 and 2023 at a northern Italian hospital. Sixteen regression and twelve classification algorithms were compared in forecasting LOS as either a continuous or multi-class variable (1-3 days, 4-10 days, >10 days). Additionally, the same models were assessed for pLOS prediction (defined as LOS exceeding 8 days). All models were evaluated using two variants of the same dataset: one containing only structured data (e.g., demographics and clinical information), and a second one also containing features extracted from free-text diagnosis. Ensemble models, leveraging the combined strengths of multiple ML algorithms, demonstrated superior accuracy in predicting both LOS and pLOS compared to single-algorithm models, particularly when utilizing both structured and unstructured data extracted from diagnoses. Integration of ML, particularly ensemble models, has the potential to significantly improve LOS prediction and identify patients at high risk of pLOS. Such insights can empower healthcare professionals and bed managers to optimize patient care and resource allocation, promoting overall healthcare efficiency and sustainability.

Cone-beam computed tomography (CBCT) is a standard imaging modality in orofacial and dental practices, providing essential 3D volumetric imaging of anatomical structures, including jawbones, teeth, sinuses, and neurovascular canals. Accurately segmenting these structures is fundamental to numerous clinical applications, such as surgical planning and implant placement. However, manual segmentation of CBCT scans is time-intensive and requires expert input, creating a demand for automated solutions through deep learning. Effective development of such algorithms relies on access to large, well-annotated datasets, yet current datasets are often privately stored or limited in scope and considered structures, especially concerning 3D annotations. This paper proposes ToothFairy2, a comprehensive, publicly accessible CBCT dataset with voxel-level 3D annotations of 42 distinct classes corresponding to maxillofacial structures. We validate the dataset by benchmarking state-of-the-art neural network models, including convolutional, transformer-based, and hybrid Mamba-based architectures, to evaluate segmentation performance across complex anatomical regions. Our work also explores adaptations to the nnU-Net framework to optimize multi-class segmentation for maxillofacial anatomy. The proposed dataset provides a fundamental resource for advancing maxillofacial segmentation and supports future research in automated 3D image analysis in digital dentistry.

We introduce Bits2Bites, the first publicly available dataset for occlusal classification from intra-oral scans, comprising 200 paired upper and lower dental arches annotated across multiple clinically relevant dimensions (sagittal, vertical, transverse, and midline relationships). Leveraging this resource, we propose a multi-task learning benchmark that jointly predicts five occlusal traits from raw 3D point clouds using state-of-the-art point-based neural architectures. Our approach includes extensive ablation studies assessing the benefits of multi-task learning against single-task baselines, as well as the impact of automatically-predicted anatomical landmarks as input features. Results demonstrate the feasibility of directly inferring comprehensive occlusion information from unstructured 3D data, achieving promising performance across all tasks. Our entire dataset, code, and pretrained models are publicly released to foster further research in automated orthodontic diagnosis.

CNNs and Transformer-based architectures are recently dominating the field of 3D medical segmentation. While CNNs face limitations in the local receptive field, Transformers require significant memory and data, making them less suitable for analyzing large 3D medical volumes. Consequently, fully convolutional network models like U-Net are still leading the 3D segmentation scenario. Although efforts have been made to reduce the Transformers computational complexity, such optimized models still struggle with content-based reasoning. This paper examines Mamba, a Recurrent Neural Network (RNN) based on State Space Models (SSMs), which achieves linear complexity and has outperformed Transformers in long-sequence tasks. Specifically, we assess Mamba’s performance in 3D medical segmentation using three widely recognized and commonly employed datasets and propose architectural enhancements to improve its segmentation effectiveness by mitigating the primary shortcomings of existing Mamba-based solutions.

This paper tackles the domain of multimodal prompting for visual recognition, specifically when dealing with missing modalities through multimodal Transformers. It presents two main contributions: (i) we introduce a novel prompt learning module which is designed to produce sample-specific prompts and (ii) we show that modality-agnostic prompts can effectively adjust to diverse missing modality scenarios. Our model, termed SCP, exploits the semantic representation of available modalities to query a learnable memory bank, which allows the generation of prompts based on the semantics of the input. Notably, SCP distinguishes itself from existing methodologies for its capacity of self-adjusting to both the missing modality scenario and the semantic context of the input, without prior knowledge about the specific missing modality and the number of modalities. Through extensive experiments, we show the effectiveness of the proposed prompt learning framework and demonstrate enhanced performance and robustness across a spectrum of missing modality cases.

Barcodes, despite their long history, remain an essential technology in supply chain management. In addition, barcodes have found extensive use in industrial engineering, particularly in warehouse automation, component tracking, and robot guidance. To detect a barcode in an image, multiple algorithms have been proposed in the literature, with a significant increase of interest in the topic since the rise of deep learning. However, research in the field suffers from many limitations, including the scarcity of public datasets and code implementations which hinders the reproducibility and reliability of published results. For this reason, we developed ``BarBeR'' (Barcode Benchmark Repository), a benchmark designed for testing and comparing barcode detection algorithms. This benchmark includes the code implementation of various detection algorithms for barcodes, along with a suite of useful metrics. Among the supported localization methods, there are multiple deep-learning detection models, that will be used to assess the recent contributions of Artificial Intelligence to this field. In addition, we provide a large, annotated dataset of 8748 barcode images, combining multiple public barcode datasets with standardized annotation formats for both detection and segmentation tasks. Finally, we provide a thorough summary of the history and literature on barcode localization and share the results obtained from running the benchmark on our dataset, offering valuable insights into the performance of different algorithms when applied to real-world problems.

Testicular ultrasound imaging is vital for assessing male infertility, with testicular inhomogeneity serving as a key biomarker. However, subjective interpretation and the scarcity of publicly available datasets pose challenges to automated classification. In this study, we explore supervised and unsupervised pretraining strategies using a ResNet-based architecture, supplemented by diffusion-based generative models to synthesize realistic ultrasound images. Our results demonstrate that pretraining significantly enhances classification performance compared to training from scratch, and synthetic data can effectively substitute real images in the pretraining process, alleviating data-sharing constraints. These methods offer promising advancements toward robust, clinically valuable automated analysis of male infertility. The source code is publicly available at https://github.com/AImageLab-zip/TesticulUS/.

QR and Datamatrix codes are widely used in warehouse logistics and high-speed production pipelines. Still, distant or small barcodes often yield low-pixel-density images that are hard to read. Conventional solutions rely on costly hardware or enhanced lighting, raising expenses and potentially reducing depth of field. We propose Mosaic-SR, a multi-step, adaptive super-resolution (SR) method that devotes more computation to barcode regions than uniform backgrounds. For each patch, it predicts an uncertainty value to decide how many refinement steps are required. Our experiments show that Mosaic-SR surpasses state-of-the-art SR models on 2D barcode images, achieving higher PSNR and decoding rates in less time. All code and trained models are publicly available at https://github.com/Henvezz95/mosaic-sr.