When imaging reveals an abnormality in a kidney — such as cancer or a stone — patients and their physicians face a critical decision for what to do next: Wait? Do an invasive procedure? Or run more tests?

A new 91�Թ��� research project combines artificial intelligence (AI), computer vision and clinical expertise to help physicians make that decision with greater confidence and efficiency.

The project, called Kidney-VLM, is supported by a one-year $974,681 grant from the Florida Department of Health’s Florida Cancer Innovation Fund and is led by Pegah Khosravi, a medical AI expert and College of Medicine associate professor with a joint appointment at 91�Թ���’s College of Engineering and Computer Science.

VLM stands for vision-language model, a trainable AI platform that examines both images and data. The 91�Թ��� system analyzes visual information such as CT scans, while the language component comes from radiology, bloodwork and pathology reports. Bringing together those sources allows the system to provide a more comprehensive look at a patient’s kidney health to support more informed treatment planning. A physician could also ask the system a question and receive a response tied specifically to the patient’s imaging data and pathology.

“Kidney-VLM is designed to connect pieces of a patient’s medical story that may often be reviewed separately,” Khosravi says. “Medical AI should not merely produce an answer. It should provide evidence that allows clinicians to understand, evaluate and appropriately question that answer.”

A Clearer Vision for Patient Care

Khosravi is leading the project through , a collaborative initiative that brings together more than two dozen AI-related faculty members, their students and industry partners across disciplines. AdventHealth, a 91�Թ��� Pegasus Partner, is also partnering on the research.

Trustee Chair of Computer Science , IAI’s director and founding director of 91�Թ���’s Center for Research in Computer Vision, brings decades of experience in computer vision, visual reasoning and machine learning to the project.

He says the new research addresses the challenges of integrating computer vision and medical AI into clinical settings.

“Kidney-VLM advances computer vision by moving beyond isolated detection or classification toward an integrated and clinically interpretable system,” Shah says. “This project offers an opportunity to translate advances in computer vision into a practical tool that may help clinicians characterize kidney tumors more confidently and reduce unnecessary procedures.”

The project exemplifies 91�Թ���’s willingness to foster interdisciplinary research and continue responsibly exploring the potential of AI, he says.

“By bringing AI researchers, physicians, and clinical partners together from the beginning, the project creates a pathway from foundational research to meaningful patient impact,” Shah says. “With 91�Թ���’s strength in computer vision, the College of Medicine’s clinical expertise, and our partnership with AdventHealth, Florida is well positioned to become a national leader in responsible and clinically impactful AI innovation. This is exactly the type of collaboration we seek to foster.”

91�Թ��� computer science researchers Yu Tian and Chen Chen are helping develop the AI architecture. Tian is an assistant professor with joint appointments in the College of Engineering and Computer Science and College of Medicine, while Chen is an associate professor of computer science.

“Success will not be measured only by whether the model achieves a higher accuracy score,” Khosravi says. “We also want to determine whether it performs reliably across various patient groups and clinical settings, whether its explanations are medically sound and whether clinicians can recognize when the system is uncertain. Of course, a clinically useful AI system must be accurate, but it must also be transparent, calibrated and safe.”

Making AI Work in the Clinic

Abdo Asmar, a professor of internal medicine at the College of Medicine and a nephrologist with 91�Թ��� Health Faculty Physician Practice, is guiding the project from the clinical side. He cares for patients who may undergo imaging because of kidney disease, hypertension, kidney stones or another medical issue and then discover they have a renal mass or complex cyst.

“This project is important because it focuses on a very real clinical problem with direct implications for patients: how to make better decisions when kidney tumors or suspicious renal findings are discovered,” Asmar says. “Ultimately, this could help patients avoid unnecessary surgery, reduce healthcare costs and ensure that those with more concerning cancers receive timely evaluation and treatment. To me, this project represents a practical and patient-centered application of AI.”

He stresses that physicians must approach AI as a support, not a replacement, for medical judgment.

“We’re not replacing clinical judgment but strengthening it at the point where decisions are most consequential.” — Abdo Asmar, professor

“We’re not replacing clinical judgment but strengthening it at the point where decisions are most consequential,” he says. “While I am excited about the potential uses of AI in medicine, I remain grounded in the belief that physicians and medical researchers have an obligation to use AI carefully, ethically and always in service of better patient care.”

AdventHealth Research Institute’s Michael McDonald, a urologic oncologist, surgeon and researcher is working with the team to ensure the research remains clinically relevant and scientifically accurate.

He envisions that Kidney-VLM can address existing diagnostic limitations.

“Our ultimate goal is to provide physicians with better information before treatment decisions are made,” McDonald says. “For example, in kidney cancer, one of the major challenges is that imaging can’t always reliably determine whether a renal mass is benign or malignant before surgery, and the final diagnosis may not be known until after the tumor is removed and examined by pathology.”

Kidney-VLM is a focused tool to pinpoint a specific set of medical conditions, but Khosravi and her team are hopeful that the model will provide a foundation for broader advances in medical AI.

“The importance of this project extends beyond a single algorithm or disease,” Khosravi says. “Kidney-VLM provides an opportunity to develop a reproducible framework for trustworthy medical AI that can eventually be adapted to other cancers and clinical challenges.”

Research reported in this article was funded by the State of Florida, Department of Health, Public Health Research, Biomedical Research Program, through the Casey DeSantis Florida Cancer Innovation Fund (grant number 26C36). This content is solely the responsibility of the authors and does not necessarily represent the official views of the State of Florida.

“As the need for physicians grows in … Florida, with an estimated 18,000 physician shortage projected over the next decade, we are helping to meet those needs.” — Stephen Cico, associate dean for graduate medical education

Doctors cannot practice medicine immediately after graduating from medical school — they must first complete residences, where they train with experienced physicians in their specialty of choice, such as pediatrics or surgery. Fellowships are optional programs that come after residency for doctors seeking even more specialized training. Residencies and fellowships are integral to solving the physician shortage because many physicians begin their practices near where they do their post-graduate training.

“As the need for physicians grows in the state of Florida, with an estimated 18,000 physician shortage projected over the next decade, we are helping to meet those needs,” says Stephen Cico, 91�Թ���’s associate dean for graduate medical education and the 91�Թ���-HCA consortium’s designated institutional officer. “We are focused on medical specialties that are or are going to be in the highest demand.”

Florida’s Fastest Growing Program

91�Թ��� began its first residency in 2014 in internal medicine with HCA Florida Osceola Hospital and the Orlando VA Medical Center. Today, the 91�Թ���-HCA Florida GME Consortium has 44 accredited programs across the state — in Greater Orlando, Gainesville, Tallahassee, Ocala, Pensacola, Fort Walton Beach and Sanford.

“This spring, the 91�Թ���-HCA Florida Healthcare GME Consortium celebrated a major milestone — our 1,000^th graduate. These new attending physicians will go on to make a positive difference in the community with the skills and experience gained working alongside experts in one of our teaching hospitals,” says Cheryll Albold, vice president of graduate medical education for HCA Healthcare’s North Florida Division. “We are excited to add six new graduate medical education programs starting July 1, further expanding learning opportunities, in vitally needed healthcare specialties, for our next generation of doctors.”

“These graduate medical education programs in our hospitals are instrumental to the success of our communities,” says Alan Keesee, chief executive officer at HCA Florida Ocala Hospital.

In the last three years, the consortium grew by 200 physicians, 13 programs and three hospitals. No other GME-sponsoring institution in Florida has had that level of growth. The latest programs beginning this summer include physical medicine and rehabilitation and transitional year residencies at HCA Florida Lake Monroe Hospital in Sanford, a cardiology fellowship at UCA Florida Osceola Hospital, transitional year and psychiatry residencies at HCA Florida West Hospital and a cardiology residency at HCA Florida Ocala Hospital. The transitional year program is a one-year training that provides newly graduated doctors with comprehensive clinical skills before they go on to more specialized training in areas such as dermatology and physical medicine and rehabilitation.

“These graduate medical education programs in our hospitals are instrumental to the success of our communities,” says Alan Keesee, chief executive officer at HCA Florida Ocala Hospital. “We are training up the next generation of physicians in local communities in an effort to retain their talent and meet the needs of our growing populations.”

Helping Address Physician Shortage

A Florida Physician Workforce Study shows that almost one-third of licensed physicians in Florida are 60 or older and as many as 8,000 plan to stop seeing patients in the next five years — most because of retirement. In the past eight years, the 91�Թ���-HCA consortium has graduated 1,043 new physicians and approximately 50% are practicing in Florida, a major contribution to addressing Florida’s physician shortage. The 91�Թ���-HCA Consortium is able to train more doctors to meet this need because unlike traditional academic programs, the partnership has multiples of specialty programs. For example, 91�Թ���-HCA has six programs in internal medicine across the state, two in family medicine, three in OB-GYN and four in psychiatry — a significant contribution to primary care services for Floridians. Emergency medicine is another high-need area. 91�Թ���-HCA has three ER training programs across Florida and just increased the number of residents it is training in Osceola County to help meet that area’s demands.

“Our goal for our GME programs is, ultimately, increasing access to expert care for our patients throughout Florida.” — Cheryll Albold, vice president of graduate medical education for HCA Healthcare’s North Florida Division

These GME programs also bring needed physicians to rural and isolated areas where access to medical care is limited, such as Pensacola, Ocala, Sanford and Osceola County. For example, the consortium created the first community-based reproductive endocrinology and infertility fellowship in the country. This specialty helps infertile couples and most of those services are in large cities, requiring patients to travel long distances for care. The 91�Թ���-HCA program is based at HCA Florida Osceola Hospital in Kissimmee.

In addition to providing care at HCA Florida Healthcare hospitals, many of the residents and fellows also care for the state’s veterans. Physicians training in internal medicine, rheumatology, endocrinology, psychiatry, cardiology, surgery, vascular surgery and reproductive endocrinology and infertility provide care at the Orlando VA Medical Center.

“Our goal for our GME programs is, ultimately, increasing access to expert care for our patients throughout Florida,” Albold says. “HCA Florida Healthcare’s strategic partnership with 91�Թ���’s College of Medicine is providing a pipeline that will directly benefit patients by continually training the best and brightest new doctors, many of whom will ultimately build their own practices right here in the Sunshine State.”

The magazine’s yearly awards are compiled by Consumer’s Checkbook, a Washington, D.C.-based nonprofit research organization that surveys Orlando area physicians, and DataJoe Research, a software and research company specializing in data collection and verification.

91�Թ��� Health Faculty Physician Practice is the clinic of the 91�Թ��� College of Medicine, with locations in East Orlando and Lake Nona’s Medical City. The clinic specializes in primary and specialty care under one roof. In addition to caring for patients across the community, all 91�Թ��� Health doctors are faculty members at the College of Medicine, where they educate medical students, residents and fellows, and also conduct research.

Here are the physicians recognized by Orlando Magazine and their specialties:

• , Nephrology
• , Rheumatology
• Rheumatology
• , Geriatrics
• , Internal Medicine

To learn more information on the practice or to schedule an appointment, visit visit the .

Asmar received the award during the group’s annual scientific meeting this fall, where one of his residents received first place for research on improving patient access to heart rehabilitation services.

The American College of Physicians is the world’s largest medical specialty organization and is committed to advancing “the science and practice of internal medicine.” The Florida chapter’s Teacher of the Year is presented to a physician who has demonstrated outstanding leadership and dedication to medical education.

“Dr. Asmar has proven to be a most influential teacher. His passion for medicine and lifelong learning is tangible and unwavering, inspiring his residents to strive to be the best they can be,” his award nomination noted.

Board certified in internal medicine and nephrology, Asmar is program director of the . The residency, established in 2014 as 91�Թ���’s first graduate medical education (GME) program, trains internal medicine specialists at the Orlando VA Medical Center and HCF Florida Osceola Hospital.

Asmar serves as vice chairman of GME for the College of Medicine and also cares for patients at . He earned his doctor of medicine degree at Kaunas Medical University in Kaunas, Lithuania. He did his residency at Cook County Hospital in Chicago, where he was named chief resident. He received his fellowship training in clinical nephrology at the University of Florida.

“I am thankful, humbled and honored to receive this award,” Asmar says.

The ACP Florida Chapter’s annual meeting included research presentations. Inman Squires, a resident at the 91�Թ���-HCA Florida Healthcare Internal Medicine Residency Program of Greater Orlando/Osceola won the QI Poster Award for a quality improvement project: Unbreak My Heart: Increasing Cardiac Rehabilitation Referral Rate.

The magazine has two yearly recognition lists. Top Doctors honorees are determined by Consumers’ CHECKBOOK, a Washington, D.C.-based non-profit organization. The Premier Doctors List is a peer reviewed study done by an independent research company.

In addition to caring for patients at 91�Թ��� Health’s two locations — in East Orlando and Lake Nona — the College of Medicine faculty honorees also educate medical students, residents and fellows. To request an appointment at 91�Թ��� Health or to learn more about the practice, please visit .

Here are this year’s honorees and their specialty:

Top Doctors List Recognition

Mariana Dangiolo, family medicine, geriatrics

Premier Doctors List Recognition

Abdo Asmar, nephrology

Vladimir Neychev, endocrine and general surgery

Naveed Sami, dermatology

Top & Premier Doctors List Recognition

Shazia Beg, rheumatology

Neha Bhanusali, rheumatology

Joyce Paulson, internal medicine

Also honored was Diane Davey, who retired from the College of Medicine and continues to care for patients as a pathologist at the Orlando VA Medical Center.

This year’s honorees are:

• , Nephrology
• , Rheumatology
• , Rheumatology
• , Family Medicine and Geriatrics
• , Cardiology
• , General and Endocrine Surgery
• , Ophthalmology
• , Internal Medicine
• , Internal and Lifestyle Medicine

91�Թ��� Health is the College of Medicine’s clinical practice and offers primary and specialty care to patients across the community. It has two locations — in East Orlando, just blocks from the main 91�Թ��� campus, and also in Lake Nona. For more information, please visit .

Mustafa Kinaan has shown his dedication to the Central Florida community throughout his graduate medical education (GME) journey.

In 2014, he was one of 91�Թ���’s first 17 residents when the medical school began its first internal residency program in partnership with HCA Healthcare and the Orlando VA Medical Center. After graduating from the program, he became chief resident, overseeing residents at the VA. A year later, he entered 91�Թ���-HCA’s endocrinology fellowship, caring for patients at the VA and HCA Florida Osceola Hospital. In 2020, he joined Premier Endocrinology in Kissimmee and St. Cloud, saying he was staying in greater Orlando to “care for the new family I love.”

Now, he is leading the endocrinology program that trained him — creating more physicians who treat conditions including diabetes, thyroid and pituitary gland disease.

“Dr. Kinaan is the first GME trainee to go from resident in one of our programs, to fellow, to core faculty member and now to become a program director leading our endocrinology fellowship,” says Stephen Cico, the medical school’s assistant dean for graduate medical education. “Recruiting the best, training the best and retaining our residents and fellows has been a goal of the 91�Թ���-HCA GME Consortium since its inception in 2016.  Dr. Kinaan is a skilled educator, compassionate physician and engaged faculty member — he is exactly the kind of physician we want representing our consortium in leadership positions.”

Kinaan graduated from Weill Cornell Medical College in Qatar and did clerkship rotations and conducted research on the impact of diabetes on heart disease at Cornell University in New York. He says his experience helping to build new residency and fellowship programs at 91�Թ��� has given him an unprecedented experience.

“You’re not just learning, you’re building the program. It was a rich environment for me. At 91�Թ���, I was given all the tools I need to help shape the future.” — Mustafa Kinaan, endocrinologist

The fellowship program currently trains four physicians per year, with fellows caring for patients in out-patient and hospital settings. While he leads the program, Kinaan continues to care for patients at Premier Endocrinology and also serves as an attending physician and faculty member at HCA Florida Osceola Hospital.

Abdo Asmar has led the Greater Orlando Internal Medicine Residency program since it began, and says he saw the young physician’s promise early in his training.

“I cannot tell you how honored and proud I am that Mustafa is our program director,” he says. “This is what we want to do with our GME programs — grow the next generation of outstanding physicians who are also extraordinary teachers. This is how we improve healthcare.”

Throughout his 91�Թ��� career, Kinaan has received awards for teaching, and this year received the College of Medicine’s faculty award for outstanding GME clinical teaching and mentorship. He also helped create a new research infrastructure to better support scholarship by residents and fellows. Asmar says his mentee was an innovative and engaging teacher even as a resident – known for his compelling case review reports. “He is a learner-focused educator,” he says. “He knows how to share information based on a learner’s needs.”

As he moves forward training tomorrow’s endocrinologists, Kinaan says he is committed to building a fellowship that is recognized locally, regionally and nationally.

“Our goal is to create extraordinary physicians who have the expertise and the compassion to create long-term relationships with their patients,” he says. “Our patients have chronic illnesses, and many have suffered for years because of their conditions. We want our physicians to be passionate about endocrinology and the opportunity to be part of the patient’s support system for years to come.”

Doctors cannot care for patients independently immediately after they graduate from medical school. They must first go through residency training — three to seven years depending on the specialty. After residency, many go into fellowships for even more specialized training.

The 91�Թ���-HCA Healthcare GME consortium is one of the fastest growing in Florida, now training nearly 560 physicians in Tallahassee, Gainesville, Ocala, Pensacola and the greater Orlando area — with more planned. Residency programs are a key to solving the state’s physician shortage as the majority of physicians begin practicing where they do their residency training. 91�Թ���-HCA has 36 accredited programs in specialties including surgery, psychiatry, internal, family and emergency medicine, geriatrics, and neurology.

The physicians are all 91�Թ��� College of Medicine faculty and provide care at 91�Թ��� Health, the medical school’s academic practice. The practice offers primary and specialty care to patients across the community at two locations — in East Orlando just blocks from the main 91�Թ��� campus and in Lake Nona.

The monthly magazine has a circulation of more than 100,000, is distributed to 1,000 local professional offices, and is available at Publix and CVS Pharmacies. It’s 2022 Top Physicians list includes 249 of Central Florida’s leading doctors.

Deborah German, vice president for health affairs and dean of 91�Թ���’s College of Medicine, says the medical school and its practice are honored by the recognition. “Thank you to our community for recognizing these outstanding faculty physicians who exemplify excellent, patient-centered care,” she says.

91�Թ��� Honorees

 is board certified in internal medicine and nephrology.

is board-certified in Internal Medicine and Rheumatology.

 is a board-certified family physician with subspecialty certification in geriatric medicine.

 is a board-certified cardiologist with an emphasis in echocardiography.

 is a board-certified general surgeon and an expert in endocrine and endocrine cancer surgery.

 is a board-certified ophthalmologist and refractive cataract surgeon who evaluates and manages eye diseases both medically and surgically.

 is board certified in internal medicine and lifestyle medicine.

�վ��������� for more information or to make an appointment.

Through a partnership with HCA, 91�Թ��� now has 11 accredited residency programs in Central and North Central Florida with more on the way. Through the HCA consortium, the medical school hopes to add approximately 600 residency spots in Florida by 2020 to help relieve the state and nation’s physician shortage.

“We’re very pleased to have so many 91�Թ��� students in our consortium programs,” said Dr. Diane Davey, associate dean for graduate medical education. “Today means we are going to be adding 100 physicians who will be training and serving patients in the Central Florida area.”

The bulk of the 91�Թ��� graduates are entering a transitional year residency based at Osceola Regional Medical Center. A transitional year – also called an internship – is required for many specialties such as dermatology and ophthalmology before residents go on to more specialized training.

91�Թ��� medical student Jae Kim will do his ophthalmology residency at Wayne State University and was thrilled to match at 91�Թ���, his first choice, for his transitional year. “My heart is here,” he said. “I’ve established connections here and am excited to continue the work to help build 91�Թ���’s program.”

Kim came to 91�Թ��� after getting his graduate engineering degree at UCLA and working to build faster, cheaper cell phones. He decided he wanted to use his scientific training to help people and came to the College of Medicine because it requires all medical students to do research. While in medical school, he developed a machine that can test uric acid levels in the blood of gout patients and a computerized imaging process that could help doctors diagnose diseases of the eye earlier and more accurately. The inventions have earned state and national honors.

Joseph Caravaglio will do his dermatology residency at Brown University after completing his transitional year at the 91�Թ���-HCA residency program. “I’m absolutely excited,” he said. “It’s a great opportunity to train in Orlando for another year because I love Orlando and I love 91�Թ���.”

Dr. Abdo Asmar is program director for the College of Medicine’s first residency program, internal medicine, in partnership with Osceola Regional Medical Center and the Orlando VA Medical Center. Transitional year residents will spend a great deal of time working in Dr. Asmar’s program.

“These are pioneers who have taken a chance on a new program and want to work with us to create a legacy,” he said. “We’re very excited to have so many of our outstanding students join us in providing excellent care to our patients and expanding our educational programs.”

After completing medical school, physicians must enter a graduate medical education program of between three and seven years depending on their specialty. Physicians, particularly in internal medicine, often go on to fellowship training in a subspecialty such as cardiology.

These 91�Թ��� residents will begin their fellowship training in July 2017:

The residents were in the first cohort of a partnership residency program that began in 2014 between the medical school, Osceola Regional Medical Center and the Orlando VA Medical Center. Since then, the College of Medicine has joined Hospital Corporation of America, owner of Osceola Regional, in creating other residency programs across Central and North Central Florida. By 2020, the 91�Թ���-HCA consortium is expected to add 580-plus residency slots to the state to help ease the physician shortage.

In addition to the 100 percent match rate for residents seeking fellowships, both of 91�Թ���’s chief residents who were seeking fellowship training matched. They are:

Dr. Abdo Asmar, program director of the 91�Թ���-HCA Consortium Internal Medicine Residency Program in Orlando, applauded the new fellows as pioneers. The three matched residents took a chance on a new program and helped build it from scratch, he said, while the chiefs – who did their residency training elsewhere – developed as leaders and educators through their work with 91�Թ��� and its partners. He noted that all five matched into highly competitive programs in locations and specialties that were their top choices. “I am so proud of them,” he said. “These are skilled, compassionate physicians who are tomorrow’s health leaders. Through their hard work and that of their faculty members and mentors, they have taken the next step in achieving their dreams. They have been important partners in our journey to improve the health of all.”