File size: 17,580 Bytes
d6f5fcf
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
469c3b7
 
d6f5fcf
 
 
 
 
 
 
 
 
 
 
469c3b7
66234d2
d6f5fcf
469c3b7
d6f5fcf
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
469c3b7
d6f5fcf
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
469c3b7
 
d6f5fcf
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
469c3b7
d6f5fcf
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
469c3b7
 
 
 
d6f5fcf
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
"""Reference bank (round 3, item 4): bench-only selection, runtime refusals, endpoint shape.

Synthetic fixtures only. Bench cases are evaluation-only and never served to learners, which is why their outlines
may be shown; these tests pin that no practice/assessment/holdout case can reach the reference endpoints."""

from __future__ import annotations

import json
from pathlib import Path

import pytest
import yaml

from backend.app.settings import REPO_ROOT
from backend.app.tests.conftest import FIXTURES
from pipeline import reference_bank as rb
from shared.contracts import Case

N_LABELS = 18  # 13 X-ray + 5 volumetric labels in config/taxonomy.yaml

LABEL_KEYS = {
    "label",
    "display",
    "kind",
    "one_liner",
    "key_signs",
    "mimics",
    "commonly_confused_with",
    "search_tip",
    "radiopaedia_url",
    "review_status",
    "modality",  # the label's modality (volumetric expansion)
    "signs",  # sign schematic ids for the label (GET /api/signs/{id})
    "examples",
    "volume_examples",  # CT/MR bench examples (volumetric expansion)
}
EXAMPLE_KEYS = {"case_id", "image_url", "width", "height", "finding"}
FINDING_KEYS = {"finding_id", "polygon", "bbox", "relative_location", "side"}
NORMAL_KEYS = {"case_id", "image_url", "width", "height"}
REAL_CARDS = REPO_ROOT / "content" / "teaching_cards"
REAL_CASES = REPO_ROOT / "data" / "processed" / "cases.jsonl"
COMMITTED_BANK = REPO_ROOT / "config" / "reference_bank.yaml"
NON_BENCH = {"practice", "assess_A", "assess_B", "holdout"}


def rewrite(root: Path, **changes: dict) -> None:
    """Edit fixture cases in place: rewrite(root, syn_001={"split": "bench", "qa_flags": []})."""
    p = root / "cases.jsonl"
    out = []
    for line in p.read_text().splitlines():
        c = json.loads(line)
        c.update(changes.get(c["case_id"], {}))
        out.append(json.dumps(c))
    p.write_text("\n".join(out) + "\n")


def fixture_cases(**changes: dict) -> list[Case]:
    cases = []
    for line in (FIXTURES / "cases.jsonl").read_text().splitlines():
        c = json.loads(line)
        c.update(changes.get(c["case_id"], {}))
        cases.append(Case.model_validate(c))
    return cases


BENCH = {"split": "bench", "qa_flags": []}
LABELS = [("nodule", "focal"), ("effusion", "focal"), ("mass", "focal"), ("cardiomegaly", "pattern")]


# ------------------------------------------------------------------ selection (pure)
def test_selection_uses_only_unflagged_bench_cases():
    cases = fixture_cases(
        syn_001=BENCH,  # nodule, single finding
        syn_005=BENCH,  # mass + nodule
        syn_003={"split": "bench"},  # effusion, bench but still qa-flagged ("synthetic") -> never chosen
        syn_006={"split": "assess_A", "qa_flags": []},  # effusion, not bench -> never chosen
        syn_007={"split": "holdout", "qa_flags": []},  # cardiomegaly, not bench -> never chosen
        syn_008=BENCH,
        syn_009={"split": "bench", "qa_flags": ["orientation_suspect"]},
    )
    bank = rb.select_bank(cases, LABELS)
    by_id = {c.case_id: c for c in cases}
    picked = [e["case_id"] for es in bank["labels"].values() for e in es] + [e["case_id"] for e in bank["normal"]]
    assert picked, "expected some picks"
    for cid in picked:
        assert by_id[cid].split == "bench" and by_id[cid].qa_flags == [], cid
    assert bank["labels"]["effusion"] == [] and bank["labels"]["cardiomegaly"] == []
    assert bank["labels"]["mass"] == [{"case_id": "syn_005", "finding_id": "syn_005#F1"}]
    # single-finding case preferred; syn_005 is already used for mass so it is only a fallback for nodule
    assert bank["labels"]["nodule"][0] == {"case_id": "syn_001", "finding_id": "syn_001#F1"}
    assert bank["normal"] == [{"case_id": "syn_008"}]
    assert list(bank["labels"]) == [lab for lab, _ in LABELS]  # taxonomy order kept


def test_selection_ranks_single_finding_then_area_then_contrast():
    base = fixture_cases(syn_001=BENCH, syn_005=BENCH)
    one = next(c for c in base if c.case_id == "syn_001")
    two = next(c for c in base if c.case_id == "syn_005")

    def clone(case: Case, cid: str, area: float, contrast: float | None) -> Case:
        fs = [
            f.model_copy(
                update={"finding_id": f.finding_id.replace(case.case_id, cid), "area_frac": area, "contrast": contrast}
            )
            for f in case.findings
        ]
        return case.model_copy(update={"case_id": cid, "findings": fs})

    cases = [
        clone(two, "multi_big", 0.5, 0.9),  # largest, but shares the film with another finding
        clone(one, "single_small", 0.001, 0.9),
        clone(one, "single_big_low", 0.01, 0.1),
        clone(one, "single_big_high", 0.01, 0.8),
    ]
    order = [c.case_id for c, _ in rb.candidates(cases, "nodule", "focal")]
    assert order == ["single_big_high", "single_big_low", "single_small", "multi_big"]
    assert rb.select_bank(cases, [("nodule", "focal")], per_label=3)["labels"]["nodule"] == [
        {"case_id": "single_big_high", "finding_id": "single_big_high#F1"},
        {"case_id": "single_big_low", "finding_id": "single_big_low#F1"},
        {"case_id": "single_small", "finding_id": "single_small#F1"},
    ]


def test_normals_need_a_known_ctr_below_half():
    cases = fixture_cases(
        syn_008=BENCH,
        syn_009={**BENCH, "cardiothoracic_ratio": 0.55},
        syn_010={**BENCH, "cardiothoracic_ratio": None},
    )
    assert [c.case_id for c in rb.normal_candidates(cases)] == ["syn_008"]


def test_cli_writes_reviewable_yaml(processed_copy, tmp_path):
    rewrite(processed_copy, syn_001=BENCH, syn_007=BENCH, syn_008=BENCH)
    out = tmp_path / "bank.yaml"
    assert rb.main(["--processed", str(processed_copy), "--out", str(out)]) == 0
    text = out.read_text()
    assert text.startswith("#") and "BENCH" in text and "GENERATED" in text
    doc = yaml.safe_load(text)
    assert doc["version"] == 1 and doc["split"] == "bench"
    assert len(doc["labels"]) == N_LABELS  # every taxonomy label (X-ray and volumetric)
    assert doc["labels"]["nodule"] == [{"case_id": "syn_001", "finding_id": "syn_001#F1"}]
    assert doc["labels"]["cardiomegaly"] == [{"case_id": "syn_007", "finding_id": "syn_007#F1"}]
    assert doc["normal"] == [{"case_id": "syn_008"}]


# ------------------------------------------------------------------ endpoints
@pytest.fixture
def ref_env(api_env, processed_copy, tmp_path, monkeypatch):
    """Client on a fixture copy where syn_001 (nodule), syn_007 (cardiomegaly) and syn_008 (normal) are bench cases;
    everything else stays in practice (syn_005 is moved to assess_A)."""

    def _make(bank: dict | str | None, cards: bool = True):
        rewrite(processed_copy, syn_001={"split": "bench"}, syn_007={"split": "bench"}, syn_008={"split": "bench"})
        rewrite(processed_copy, syn_005={"split": "assess_A"})
        c = api_env(processed_copy)
        if cards:
            monkeypatch.setenv("BLINDSPOT_CARDS_DIR", str(REAL_CARDS))
        p = tmp_path / "reference_bank.yaml"
        if bank is not None:
            p.write_text(bank if isinstance(bank, str) else yaml.safe_dump(bank))
        monkeypatch.setenv("BLINDSPOT_REFERENCE_BANK", str(p))
        return c

    return _make


GOOD_BANK = {
    "version": 1,
    "split": "bench",
    "labels": {
        "nodule": [{"case_id": "syn_001", "finding_id": "syn_001#F1"}],
        "cardiomegaly": [{"case_id": "syn_007", "finding_id": "syn_007#F1"}],
    },
    "normal": [{"case_id": "syn_008"}],
}


def test_reference_shape_matches_contract(ref_env):
    c = ref_env(GOOD_BANK)
    r = c.get("/api/reference")
    assert r.status_code == 200, r.text
    body = r.json()
    assert set(body) == {"labels", "normal_examples"}
    from backend.app import config

    assert [e["label"] for e in body["labels"]] == list(config.labels())  # every label, taxonomy order
    assert len(body["labels"]) == N_LABELS
    for e in body["labels"]:
        assert set(e) == LABEL_KEYS, e["label"]
        assert e["display"] == config.display(e["label"]) and e["kind"] in ("focal", "pattern")
        assert e["one_liner"] and e["key_signs"] and e["search_tip"], e["label"]  # real card text
        assert e["review_status"] in ("ai_draft", "student_reviewed", "radiologist_reviewed")
        assert all(lab in config.labels() for lab in e["commonly_confused_with"])
        assert len(e["examples"]) <= 3
        for ex in e["examples"]:
            assert set(ex) == EXAMPLE_KEYS and set(ex["finding"]) == FINDING_KEYS
    by = {e["label"]: e for e in body["labels"]}
    (ex,) = by["nodule"]["examples"]
    assert ex["case_id"] == "syn_001" and ex["image_url"] == "/api/cases/syn_001/image"
    assert (ex["width"], ex["height"]) == (256, 256)
    assert ex["finding"]["finding_id"] == "F1" and "#" not in json.dumps(body)  # short ids only
    assert len(ex["finding"]["bbox"]) == 4
    assert ex["finding"]["polygon"] is None or all(len(p) == 2 for p in ex["finding"]["polygon"])
    assert ex["finding"]["side"] in ("right", "left", "bilateral", "midline", None)
    assert by["cardiomegaly"]["kind"] == "pattern" and by["cardiomegaly"]["examples"][0]["case_id"] == "syn_007"
    assert by["effusion"]["examples"] == []
    assert body["normal_examples"] == [
        {"case_id": "syn_008", "image_url": "/api/cases/syn_008/image", "width": 256, "height": 256}
    ]
    assert set(body["normal_examples"][0]) == NORMAL_KEYS
    assert c.get(ex["image_url"]).status_code == 200  # the example film is actually servable


def test_reference_label_endpoint(ref_env):
    c = ref_env(GOOD_BANK)
    one = c.get("/api/reference/nodule")
    assert one.status_code == 200, one.text
    assert one.json() == next(e for e in c.get("/api/reference").json()["labels"] if e["label"] == "nodule")
    assert set(one.json()) == LABEL_KEYS
    for bad in ("not_a_label", "normal", "not_sure"):
        assert c.get(f"/api/reference/{bad}").status_code == 404, bad


def test_non_bench_cases_are_refused_even_if_listed(ref_env):
    """Defence in depth: a hand-edited YAML pointing at a practice or assessment case must not expose its outline."""
    bank = {
        "labels": {
            "nodule": [
                {"case_id": "syn_005", "finding_id": "syn_005#F2"},  # assess_A
                {"case_id": "syn_001", "finding_id": "syn_001#F1"},  # bench: kept
            ],
            "pneumothorax": [{"case_id": "syn_002", "finding_id": "syn_002#F1"}],  # practice
            "effusion": [{"case_id": "syn_003", "finding_id": "syn_003#F1"}],  # practice
        },
        "normal": [{"case_id": "syn_009"}, {"case_id": "syn_008"}],  # syn_009 is practice
    }
    c = ref_env(bank)
    body = c.get("/api/reference").json()
    by = {e["label"]: e for e in body["labels"]}
    assert [ex["case_id"] for ex in by["nodule"]["examples"]] == ["syn_001"]
    assert by["pneumothorax"]["examples"] == [] and by["effusion"]["examples"] == []
    assert [n["case_id"] for n in body["normal_examples"]] == ["syn_008"]
    text = json.dumps(body)
    for cid in ("syn_002", "syn_003", "syn_005", "syn_009"):
        assert cid not in text, cid
    assert c.get("/api/reference/pneumothorax").json()["examples"] == []


def test_missing_cases_wrong_findings_and_missing_images_are_skipped(ref_env, processed_copy):
    bank = {
        "labels": {
            "nodule": [
                {"case_id": "cxd_not_in_bundle", "finding_id": "cxd_not_in_bundle#F1"},  # hosted bundle lacks it
                {"case_id": "syn_001", "finding_id": "syn_001#F9"},  # no such finding
                {"case_id": "syn_007", "finding_id": "syn_007#F1"},  # bench, but that finding is cardiomegaly
                {"finding_id": "syn_001#F1"},  # malformed entry
                "syn_001",  # malformed entry
                {"case_id": "syn_001", "finding_id": "syn_001#F1"},
                {"case_id": "syn_001", "finding_id": "syn_001#F1"},  # duplicate case
            ],
            "cardiomegaly": [{"case_id": "syn_007", "finding_id": "syn_007#F1"}],
            "mass": "not a list",
        },
        "normal": [{"case_id": "syn_001"}, {"case_id": "nope"}, {"case_id": "syn_008"}],  # syn_001 is not normal
    }
    c = ref_env(bank)
    (processed_copy / "images" / "syn_007.png").unlink()  # image missing from the bundle
    r = c.get("/api/reference")
    assert r.status_code == 200, r.text
    by = {e["label"]: e for e in r.json()["labels"]}
    assert [ex["case_id"] for ex in by["nodule"]["examples"]] == ["syn_001"]
    assert by["cardiomegaly"]["examples"] == [] and by["mass"]["examples"] == []
    assert [n["case_id"] for n in r.json()["normal_examples"]] == ["syn_008"]


@pytest.mark.parametrize("bank", [None, "", "labels: [1, 2", "- just\n- a list\n", "labels: 3\nnormal: {a: 1}\n"])
def test_missing_or_broken_yaml_gives_empty_examples_not_an_error(ref_env, bank):
    c = ref_env(bank)
    r = c.get("/api/reference")
    assert r.status_code == 200, r.text
    assert len(r.json()["labels"]) == N_LABELS and all(e["examples"] == [] for e in r.json()["labels"])
    assert r.json()["normal_examples"] == []
    assert c.get("/api/reference/effusion").json()["examples"] == []


def test_missing_cards_do_not_500(ref_env):
    c = ref_env(GOOD_BANK, cards=False)  # BLINDSPOT_CARDS_DIR points at an empty tmp dir
    r = c.get("/api/reference")
    assert r.status_code == 200, r.text
    e = next(x for x in r.json()["labels"] if x["label"] == "nodule")
    assert set(e) == LABEL_KEYS
    assert (e["one_liner"], e["key_signs"], e["mimics"], e["search_tip"], e["radiopaedia_url"]) == (
        "",
        [],
        [],
        "",
        None,
    )
    assert e["display"] == "Nodule" and len(e["examples"]) == 1  # taxonomy text and examples still served


def test_bank_edits_are_picked_up_without_restart(ref_env, tmp_path):
    c = ref_env(GOOD_BANK)
    assert len(c.get("/api/reference/nodule").json()["examples"]) == 1
    import os

    p = tmp_path / "reference_bank.yaml"
    p.write_text(yaml.safe_dump({"labels": {}, "normal": []}))
    os.utime(p, ns=(p.stat().st_atime_ns, p.stat().st_mtime_ns + 5_000_000_000))  # clinician edit
    assert c.get("/api/reference/nodule").json()["examples"] == []


def test_reference_is_behind_the_access_gate(ref_env, monkeypatch):
    from backend.app.settings import get_settings

    c = ref_env(GOOD_BANK)
    monkeypatch.setenv("BLINDSPOT_ACCESS_CODE", "sesame")
    get_settings.cache_clear()
    for path in ("/api/reference", "/api/reference/nodule"):
        assert c.get(path).status_code == 401, path
        ok = c.get(path, headers={"X-Blindspot-Access": "sesame"})
        assert ok.status_code == 200 and ok.headers["cache-control"] == "no-store"


def test_reference_image_urls_carry_the_base_path(ref_env, monkeypatch):
    from backend.app.settings import get_settings

    c = ref_env(GOOD_BANK)
    monkeypatch.setenv("BLINDSPOT_BASE_PATH", "/blindspot")
    get_settings.cache_clear()
    body = c.get("/blindspot/api/reference").json()
    ex = next(e for e in body["labels"] if e["label"] == "nodule")["examples"][0]
    assert ex["image_url"] == "/blindspot/api/cases/syn_001/image"
    assert body["normal_examples"][0]["image_url"] == "/blindspot/api/cases/syn_008/image"


# ------------------------------------------------------------------ the committed bank against the real data
def test_committed_bank_is_well_formed():
    doc = yaml.safe_load(COMMITTED_BANK.read_text())
    from backend.app import config

    # the committed YAML lists the X-ray labels; volumetric picks live in data/processed/reference_bank_volumetric.json
    assert doc["split"] == "bench" and set(doc["labels"]) == set(config.core_labels_for("cxr")) | {
        lab for lab in config.labels() if config.label_modality(lab) == "cxr"
    }
    for lab, entries in doc["labels"].items():
        assert len(entries) <= 3, lab
        for e in entries:
            assert set(e) == {"case_id", "finding_id"} and e["finding_id"].startswith(e["case_id"] + "#F"), e
    assert len(doc["normal"]) <= 3 and all(set(e) == {"case_id"} for e in doc["normal"])


@pytest.mark.skipif(not REAL_CASES.exists(), reason="real data/processed not present (CI / fresh clone)")
def test_committed_bank_lists_only_bench_cases_never_practice_or_assessment():
    """Non-negotiable #2: a reference outline must never belong to a case a learner can be served."""
    cases = {}
    for line in REAL_CASES.read_text().splitlines():
        if line.strip():
            c = json.loads(line)
            cases[c["case_id"]] = c
    doc = yaml.safe_load(COMMITTED_BANK.read_text())
    listed = [(lab, e) for lab, es in doc["labels"].items() for e in es] + [(None, e) for e in doc["normal"]]
    assert listed
    servable = {cid for cid, c in cases.items() if c["split"] in NON_BENCH}
    for lab, e in listed:
        c = cases.get(e["case_id"])
        assert c is not None, e
        assert c["split"] == "bench", (e, c["split"])
        assert e["case_id"] not in servable
        assert c["qa_flags"] == [], (e, c["qa_flags"])
        if lab is None:
            assert c["is_normal"] and not c["findings"], e
            assert c["cardiothoracic_ratio"] is not None and c["cardiothoracic_ratio"] < 0.5, e
        else:
            f = next((f for f in c["findings"] if f["finding_id"] == e["finding_id"]), None)
            assert f is not None and f["label"] == lab, (lab, e)
    # one film per example within a label
    for lab, es in doc["labels"].items():
        assert len({e["case_id"] for e in es}) == len(es), lab