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AURORA-DWM/Deep dive/In design

AURORA-DWM is an open, federated software stack for the multidisciplinary team caring for a patient with dandy-walker.

Dandy-Walker malformation is a spectrum of posterior-fossa anomalies with extreme phenotypic variability. AURORA-DWM places origin biology and lifelong CSF flow on the same axis.

What it is
A software substrate. 2 subsystems on one federated runtime, installed inside the hospital — not a cloud service, not a black box.
What it does
AURORA-DWM places the posterior-fossa spectrum on one axis. Two subsystems — origin architecture and lifetime CSF flow — connect prenatal counselling to lifelong trajectory modelling.
Who uses it
The fetal medicine · paediatric neuro · genetics MDT at pilot partner institutions today. Open to any hospital under MIT at public alpha (Q4 2026).
Why it exists
So a dandy-walker case at any hospital benefits from the substrate the top centres already have. Same code, same model cards, same audit story everywhere.
Subsystems
2
all spec-frozen
Pilot sites
Rare-disease registry partner in early conversation
scoping → live
Working papers
2
drafts in flight
Latency
target <120ms
median per case
License
MIT
@ public alpha
Stage
Soon
public alpha Q4 2026
I · The clinical surface

What clinicians actually see.

A non-functional preview of the AURORA-DWM surface. Composable panels, logged overrides, explainable end-to-end. Pilot sites tune this to their own workflow.

FidelityPixel-accurate mock — no live data.
SubstrateReact 18 · CSS custom properties · no framework lock-in.
ScopeVocabulary for all AURORA-* surfaces.

Fetal · 26+0w · suspected DWM variant

plannedRare-disease registry partner in early conversation override · 2
Stage
Planned — origin atlas outlined, build not started
Subsystems
2/2 ready
Latency
target <120ms
Audit log
on
Primary modality · overlayupdated 2s ago
10 mm
σ = 1.4 mm·ROI 24.7 cm³
overlay field
plan draft
Subsystem signalsupdated 2s ago
DWM-ORIGIN   Origin Architecture76%
DWM-LIFEFLOW   Lifetime Flow64%
Subtype AUC
0.83
10y cognition band
broad
II · The clinical case

Why an open module for dandy-walker.

AURORA-DWM places the posterior-fossa spectrum on one axis. Two subsystems — origin architecture and lifetime CSF flow — connect prenatal counselling to lifelong trajectory modelling.

Dandy-Walker malformation is a posterior-fossa spectrum: from incidental imaging finding to severe disability. Variance is enormous; the literature is fragmented; counselling families is hard. AURORA-DWM tries to put that whole spectrum on one explicit axis.

The two subsystems are deliberately scoped. Origin architecture captures the biology that pre-determines a large share of variance. Lifetime flow models the long-horizon CSF-and-development trajectory that the family will live with.

Most of the module's value at the bedside is communicative: confidence-banded subtype calls and trajectory projections that a family can actually understand. Patient-advocate council seats have veto rights over the patient-facing surfaces.

We are not building a product around Dandy-Walker. We are seeding an infrastructure — so that any hospital with the will to use it can.
DWM · POSTERIOR-FOSSA SPECTRUM

Not four diseases. One axis.

AURORA-DWM places the posterior-fossa spectrum on one continuous axis. The current case is a point on that axis with explicit uncertainty bounds — never a discrete label drawn from a four-bin menu.

Fetal · 26+0w · current case · 0.83 AUC
Mega cisterna magna
incidental
Blake's pouch cyst
transient
DWM-variant
spectrum
Classical DWM
syndromic risk
DWM-ORIGIN · the rhombic-lip developmental priors fix the left end of the axis.
DWM-LIFEFLOW · the long-horizon trajectory, with broad bands when the imaging is sparse.
Counselling-aware · the family conversation gets a band, not a bin.
III · The stack

2 subsystems. Each one independently useful.

Every AURORA-DWM subsystem can be adopted alone or as part of the bundle. Each ships with its own model cards, eval results and a one-command install.

DWM · 01 planned

Origin Architecture

DWM-ORIGIN

Cerebellar vermis dysgenesis and 4th-ventricle cystic biology.

Cerebellar-vermis dysgenesis and 4th-ventricle cystic biology. Subtype-aware priors for the rest of the module.

DWM · 02 planned

Lifetime Flow

DWM-LIFEFLOW

Long-horizon flow, behavior and cognitive trajectory simulator.

Long-horizon CSF flow, behavior and cognitive trajectory simulator with explicit uncertainty bands.

IV · The product, in detail

What AURORA-DWM produces, end-to-end.

Inputs the module reads from your existing systems, outputs it returns to them, the protocols it speaks, and the lifecycle of one case as it moves through AURORA-DWM.

01Inputs4 types
Imaging
Modality set defined by the module's RFC.
DICOM 3.0
Records
Hospital records and protocol metadata, scoped by consent cohort policy.
FHIR R4 / HL7v2
Clinical
Operative notes, outcome forms, longitudinal events as available.
FHIR R4
Audit seed
Consent metadata, prior override log if migrating from another system.
AURORA audit (NDJSON)
02Outputs4 artefacts
Integrated assessment
Module-specific structured report combining 2 subsystem signals.
Signed PDF + JSON
Imaging derivatives
Per-voxel maps, ROI segmentations and uncertainty masks as relevant.
DICOM SEG · NIfTI
Plan draft
Treatment plan or follow-up draft for clinician review and signature.
Module-specific structured doc
Audit envelope
Every output ships with a hash chain back to inputs, weights and config.
AURORA audit (NDJSON)
03Case lifecycle6 steps · median target <120ms
  1. 01
    Bind
    Imaging or record arrives at PACS/EHR. AURORA binds the case by SOP/MRN, checks consent policy.
  2. 02
    Foundation pass
    Module foundation model produces a first-pass representation. Median target <120ms on partner-site hardware.
  3. 03
    Subsystem fan-out
    2 subsystems run in parallel; each writes its signal + uncertainty to the case.
  4. 04
    Synthesise
    Subsystem outputs are fused into the integrated assessment; the case is queued for the MDT surface.
  5. 05
    Clinician review
    MDT reviews on the AURORA surface. Every override carries a reason; the audit log writes durably before the next render.
  6. 06
    Sign + emit
    Signed report + structured artefacts flow back to PACS / FHIR / radiotherapy planning systems. Hash chain closes.
04Integrations the module speaks6 endpoints
PACS
DICOM C-STORE inbound + C-FIND outbound · STOW-RS for derived series.
EHR
FHIR R4 — DiagnosticReport, Condition, Observation, ServiceRequest. OAuth2 client credentials.
Lab feeds
HL7v2 (ORU^R01) for legacy molecular and laboratory results.
Auth
OIDC — Microsoft AD FS, Okta, Keycloak. Per-clinician identity in every override log entry.
Provenance
Sigstore-signed weights + container digests. Per-site federation key in Vault or KMS.
Telemetry
Off by default. When enabled, opt-in per-site; payload schema is in the module RFC.
05Per-subsystem, in detail2 units · independently installable
DWM-ORIGIN
Origin Architecture
planned

Cerebellar-vermis dysgenesis and 4th-ventricle cystic biology. Subtype-aware priors for the rest of the module.

DWM-LIFEFLOW
Lifetime Flow
planned

Long-horizon CSF flow, behavior and cognitive trajectory simulator with explicit uncertainty bands.

Reversibility
Nothing the module installs is destructive. Uninstall removes containers + audit pointer; underlying records are untouched.
Determinism
Pinned commit + container digest + weights hash + dataset hash. Every AURORA-DWM run is re-runnable and re-attributable.
Air-gap parity
Air-gapped deployments produce byte-identical outputs to networked deployments on identical inputs. No silent telemetry, ever.
Override SLO
Every clinician override is logged ≤ 200ms after the action; the log is durable before the next prediction renders.
V · Working papers

Our own writing on AURORA-DWM.

2 drafts by the module team and pilot collaborators. Each documents one slice of the substrate — methods, evaluation protocol, lessons. Slot PDFs in as they're ready; the entries point to placeholders until then.

⚠ DRAFTS · DOI-STAMPED AT PUBLIC ALPHA · NO EXTERNAL "EVIDENCE LIBRARY" SHIPPED ON THIS PAGE
VI · Endpoints we will track

The metrics that matter over a lifetime.

These are the endpoints AURORA-DWM is built to measure across pilot deployments. The targets below are pilot goals, not retrospective results.

+19%
target
Counselling-clarity score

Family-rated comprehension of diagnosis and outlook.

−24%
target
Inappropriate CSF diversion

Diversions later judged unneeded.

0.83AUC
target
Subtype discrimination

On multicentre fetal MRI.

+11%
target
Trial-eligible identification

Families offered relevant studies earlier.

100%
target
Auditable override rate

Every override logged with reason.

−35%
target
Time-to-genetic-referral

Faster onward routing for syndromic cases.

⚠ PILOT TARGETS · NOT RETROSPECTIVE RESULTS · TO BE VALIDATED AT PUBLIC ALPHA
VII · Install AURORA-DWM

From pip install to a hospital deploy in one afternoon.

Available to pilot partners today on private registries. At public alpha (Q4 2026) the same images, weights and signatures ship under MIT on public registries. For the full per-product download grid, see the unified download page.

step 1 of 3
pip install aurora-dwm
step 2 of 3
aurora doctor dwm
# → AURORA-DWM  ✓ python  ✓ models  ✓ atlas
# → two subsystems loaded
step 3 of 3
from aurora.dwm import subtype
out = subtype(case_id="bench/dwm/case-0003")
print(out.label, out.band)    # → "DWV", "moderate"
Hardware
CPU · NVIDIA · AMD · Apple silicon
OS
Linux · macOS · Windows · WSL
Deploys
Cloud · On-prem · Air-gapped · Edge
Telemetry
Opt-in · Off by default

Hardware footprint, in practice

AURORA-DWM is designed to run on hardware that already exists inside hospital networks. CPU-only inference is supported for the lighter subsystems; the heavier ones benefit from a recent GPU but do not require one. A single modern workstation handles routine cases under the latency target.

Networking and consent

Federated deploys do not require open inbound ports. The runtime opens an outbound mTLS connection to the federation control plane; model updates are signed, audited and pulled. Patient data never traverses the federation. Consent metadata is a first-class object — subsystems with an explicit consent dependency refuse to run on records that lack the appropriate cohort policy.

Migration paths

Most pilot sites land on AURORA-DWM with an existing system in place. The recommended path is: install alongside, compare outputs on a held-out cohort for one quarter, then move read-only surfaces to AURORA, and decide on the rest. Reversibility is a design goal — nothing in the install creates lock-in.

Download grid

For the full per-product, per-platform download buttons (macOS / Windows / Linux installers + pip / docker / helm / rust commands), see the unified download page. Each subsystem of AURORA-DWM is independently downloadable there.

VIII · Questions

The honest questions on AURORA-DWM.

Eight diseases is the beginning.

AURORA is in private pilot today and opens to the world at public alpha in Q4 2026 under MIT. If you carry the weight of these diseases — as a clinician, scientist, builder, patient or advocate — there is a seat at the table.

Changelogv0.6.0