Systematic Review of Radiologist and Medical Student Attitudes on the Role and Impact of AI in Radiology

Attitudes towards artificial intelligence in emergency medicine

OBJECTIVE

To assess Australian and New Zealand emergency clinicians' attitudes towards the use of artificial intelligence (AI) in emergency medicine.

METHODS

We undertook a qualitative interview-based study based on grounded theory. Participants were recruited through ED internal mailing lists, the Australasian College for Emergency Medicine Bulletin, and the research teams' personal networks. Interviews were transcribed, coded and themes presented.

RESULTS

Twenty-five interviews were conducted between July 2021 and May 2022. Thematic saturation was achieved after 22 interviews. Most participants were from either Western Australia (52%) or Victoria (16%) and were consultants (96%). More participants reported feeling optimistic (10/25) than neutral (6/25), pessimistic (2/25) or mixed (7/25) towards the use of AI in the ED. A minority expressed scepticism regarding the feasibility or value of implementing AI into the ED. Multiple potential risks and ethical issues were discussed by participants including skill loss from overreliance on AI, algorithmic bias, patient privacy and concerns over liability. Participants also discussed perceived inadequacies in existing information technology systems. Participants felt that AI technologies would be used as decision support tools and not replace the roles of emergency clinicians. Participants were not concerned about the impact of AI on their job security. Most (17/25) participants thought that AI would impact emergency medicine within the next 10 years.

CONCLUSIONS

Emergency clinicians interviewed were generally optimistic about the use of AI in emergency medicine, so long as it is used as a decision support tool and they maintain the ability to override its recommendations.

Systematic review of artificial intelligence development and evaluation for MRI diagnosis of knee ligament or meniscus tears

OBJECTIVE

The purpose of this systematic review was to summarize the results of original research studies evaluating the characteristics and performance of deep learning models for detection of knee ligament and meniscus tears on MRI.

MATERIALS AND METHODS

We searched PubMed for studies published as of February 2, 2022 for original studies evaluating development and evaluation of deep learning models for MRI diagnosis of knee ligament or meniscus tears. We summarized study details according to multiple criteria including baseline article details, model creation, deep learning details, and model evaluation.

RESULTS

19 studies were included with radiology departments leading the publications in deep learning development and implementation for detecting knee injuries via MRI. Among the studies, there was a lack of standard reporting and inconsistently described development details. However, all included studies reported consistently high model performance that significantly supplemented human reader performance.

CONCLUSION

From our review, we found radiology departments have been leading deep learning development for injury detection on knee MRIs. Although studies inconsistently described DL model development details, all reported high model performance, indicating great promise for DL in knee MRI analysis.

Diagnostic performance of deep learning models versus radiologists in COVID-19 pneumonia: A systematic review and meta-analysis

PURPOSE

Although several studies have compared the performance of deep learning (DL) models and radiologists for the diagnosis of COVID-19 pneumonia on CT of the chest, these results have not been collectively evaluated. We performed a meta-analysis of original articles comparing the performance of DL models versus radiologists in detecting COVID-19 pneumonia.

METHODS

A systematic search was conducted on the three main medical literature databases, Scopus, Web of Science, and PubMed, for articles published as of February 1st, 2023. We included original scientific articles that compared DL models trained to detect COVID-19 pneumonia on CT to radiologists. Meta-analysis was performed to determine DL versus radiologist performance in terms of model sensitivity and specificity, taking into account inter and intra-study heterogeneity.

RESULTS

Twenty-two articles met the inclusion criteria. Based on the meta-analytic calculations, DL models had significantly higher pooled sensitivity (0.933 vs. 0.829, p < 0.001) compared to radiologists with similar pooled specificity (0.905 vs. 0.897, p = 0.746). In the differentiation of COVID-19 versus community-acquired pneumonia, the DL models had significantly higher sensitivity compared to radiologists (0.915 vs. 0.836, p = 0.001).

CONCLUSIONS

DL models have high performance for screening of COVID-19 pneumonia on chest CT, offering the possibility of these models for augmenting radiologists in clinical practice.

Radiology as a Specialty in the Era of Artificial Intelligence: A Systematic Review and Meta-analysis on Medical Students, Radiology Trainees, and Radiologists

RATIONALE AND OBJECTIVES

Artificial intelligence (AI) is changing radiology by automating tasks and assisting in abnormality detection and understanding perceptions of medical students, radiology trainees, and radiologists is vital for preparing them for AI integration in radiology.

MATERIALS AND METHODS

A systematic review and meta-analysis were conducted following established guidelines. PubMed, Scopus, and Web of Science were searched up to March 5, 2023. Eligible studies reporting outcomes of interest were included, and relevant data were extracted and analyzed using STATA software version 17.0.

RESULTS

A meta-analysis of 21 studies revealed that 22.36% of individuals were less likely to choose radiology as a career due to concerns about advances in AI. Medical students showed higher rates of concern (31.94%) compared to radiology trainees and radiologists (9.16%) (P < .01). Radiology trainees and radiologists also demonstrated higher basic AI knowledge (71.84% vs 35.38%). Medical students had higher rates of belief that AI poses a threat to the radiology job market (42.66% vs 6.25%, P < .02). The pooled rate of respondents who believed that "AI will revolutionize radiology in the future" was 79.48%, with no significant differences based on participants' positions. The pooled rate of responders who believed in the integration of AI in medical curricula was 81.75% among radiology trainees and radiologists and 70.23% among medical students.

CONCLUSION

The study revealed growing concerns regarding the impact of AI in radiology, particularly among medical students, which can be addressed by revamping education, providing direct AI experience, addressing limitations, and emphasizing medico-legal issues to prepare for AI integration in radiology.

Artificial intelligence as diagnostic aiding tool in cases of Prostate Imaging Reporting and Data System category 3: the results of retrospective multi-center cohort study

PURPOSE

To study the effect of artificial intelligence (AI) on the diagnostic performance of radiologists in interpreting prostate mpMRI images of the PI-RADS 3 category.

METHODS

In this multicenter study, 16 radiologists were invited to interpret prostate mpMRI cases with and without AI. The study included a total of 87 cases initially diagnosed as PI-RADS 3 by radiologists without AI, with 28 cases being clinically significant cancers (csPCa) and 59 cases being non-csPCa. The study compared the diagnostic efficacy between readings without and with AI, the reading time, and confidence levels.

RESULTS

AI changed the diagnosis in 65 out of 87 cases. Among the 59 non-csPCa cases, 41 were correctly downgraded to PI-RADS 1-2, and 9 were incorrectly upgraded to PI-RADS 4-5. For the 28 csPCa cases, 20 were correctly upgraded to PI-RADS 4-5, and 5 were incorrectly downgraded to PI-RADS 1-2. Radiologists assisted by AI achieved higher diagnostic specificity and accuracy than those without AI [0.695 vs 0.000 and 0.736 vs 0.322, both P < 0.001]. Sensitivity with AI was not significantly different from that without AI [0.821 vs 1.000, P = 1.000]. AI reduced reading time significantly compared to without AI (mean: 351 seconds, P < 0.001). The diagnostic confidence score with AI was significantly higher than that without AI (Cohen Kappa: -0.016).

CONCLUSION

With the help of AI, there was an improvement in the diagnostic accuracy of PI-RADS category 3 cases by radiologists. There is also an increase in diagnostic efficiency and diagnostic confidence.

An evidence-based approach to artificial intelligence education for medical students: A systematic review

The exponential growth of artificial intelligence (AI) in the last two decades has been recognized by many as an opportunity to improve the quality of patient care. However, medical education systems have been slow to adapt to the age of AI, resulting in a paucity of AI-specific education in medical schools. The purpose of this systematic review is to evaluate the current evidence-based recommendations for the inclusion of an AI education curriculum in undergraduate medicine. Six databases were searched from inception to April 23, 2022 for cross sectional and cohort studies of fair quality or higher on the Newcastle-Ottawa scale, systematic, scoping, and integrative reviews, randomized controlled trials, and Delphi studies about AI education in undergraduate medical programs. The search yielded 991 results, of which 27 met all the criteria and seven more were included using reference mining. Despite the limitations of a high degree of heterogeneity among the study types and a lack of follow-up studies evaluating the impacts of current AI strategies, a thematic analysis of the key AI principles identified six themes needed for a successful implementation of AI in medical school curricula. These themes include ethics, theory and application, communication, collaboration, quality improvement, and perception and attitude. The themes of ethics, theory and application, and communication were further divided into subthemes, including patient-centric and data-centric ethics; knowledge for practice and knowledge for communication; and communication for clinical decision-making, communication for implementation, and communication for knowledge dissemination. Based on the survey studies, medical professionals and students, who generally have a low baseline knowledge of AI, have been strong supporters of adding formal AI education into medical curricula, suggesting more research needs to be done to push this agenda forward.

Radiology Residents' Perceptions of Artificial Intelligence: Nationwide Cross-Sectional Survey Study

BACKGROUND

Artificial intelligence (AI) is transforming various fields, with health care, especially diagnostic specialties such as radiology, being a key but controversial battleground. However, there is limited research systematically examining the response of "human intelligence" to AI.

OBJECTIVE

This study aims to comprehend radiologists' perceptions regarding AI, including their views on its potential to replace them, its usefulness, and their willingness to accept it. We examine the influence of various factors, encompassing demographic characteristics, working status, psychosocial aspects, personal experience, and contextual factors.

METHODS

Between December 1, 2020, and April 30, 2021, a cross-sectional survey was completed by 3666 radiology residents in China. We used multivariable logistic regression models to examine factors and associations, reporting odds ratios (ORs) and 95% CIs.

RESULTS

In summary, radiology residents generally hold a positive attitude toward AI, with 29.90% (1096/3666) agreeing that AI may reduce the demand for radiologists, 72.80% (2669/3666) believing AI improves disease diagnosis, and 78.18% (2866/3666) feeling that radiologists should embrace AI. Several associated factors, including age, gender, education, region, eye strain, working hours, time spent on medical images, resilience, burnout, AI experience, and perceptions of residency support and stress, significantly influence AI attitudes. For instance, burnout symptoms were associated with greater concerns about AI replacement (OR 1.89; P<.001), less favorable views on AI usefulness (OR 0.77; P=.005), and reduced willingness to use AI (OR 0.71; P<.001). Moreover, after adjusting for all other factors, perceived AI replacement (OR 0.81; P<.001) and AI usefulness (OR 5.97; P<.001) were shown to significantly impact the intention to use AI.

CONCLUSIONS

This study profiles radiology residents who are accepting of AI. Our comprehensive findings provide insights for a multidimensional approach to help physicians adapt to AI. Targeted policies, such as digital health care initiatives and medical education, can be developed accordingly.

Norwegian radiologists' expectations of artificial intelligence in mammographic screening - A cross-sectional survey

PURPOSE

To explore Norwegian breast radiologists' expectations of adding artificial intelligence (AI) in the interpretation procedure of screening mammograms.

METHODS

All breast radiologists involved in interpretation of screening mammograms in BreastScreen Norway during 2021 and 2022 (n = 98) were invited to take part in this anonymous cross-sectional survey about use of AI in mammographic screening. The questionnaire included background information of the respondents, their expectations, considerations of biases, and ethical and social implications of implementing AI in screen reading. Data was collected digitally and analyzed using descriptive statistics.

RESULTS

The response rate was 61% (60/98), and 67% (40/60) of the respondents were women. Sixty percent (36/60) reported ≥10 years' experience in screen reading, while 82% (49/60) reported no or limited experience with AI in health care. Eighty-two percent of the respondents were positive to explore AI in the interpretation procedure in mammographic screening. When used as decision support, 68% (41/60) expected AI to increase the radiologists' sensitivity for cancer detection. As potential challenges, 55% (33/60) reported lack of trust in the AI system and 45% (27/60) reported discrepancy between radiologists and AI systems as possible challenges. The risk of automation bias was considered high among 47% (28/60). Reduced time spent reading mammograms was rated as a potential benefit by 70% (42/60).

CONCLUSION

The radiologists reported positive expectations of AI in the interpretation procedure of screening mammograms. Efforts to minimize the risk of automation bias and increase trust in the AI systems are important before and during future implementation of the tool.

Investigation and benchmarking of U-Nets on prostate segmentation tasks

In healthcare, a growing number of physicians and support staff are striving to facilitate personalized radiotherapy regimens for patients with prostate cancer. This is because individual patient biology is unique, and employing a single approach for all is inefficient. A crucial step for customizing radiotherapy planning and gaining fundamental information about the disease, is the identification and delineation of targeted structures. However, accurate biomedical image segmentation is time-consuming, requires considerable experience and is prone to observer variability. In the past decade, the use of deep learning models has significantly increased in the field of medical image segmentation. At present, a vast number of anatomical structures can be demarcated on a clinician's level with deep learning models. These models would not only unload work, but they can offer unbiased characterization of the disease. The main architectures used in segmentation are the U-Net and its variants, that exhibit outstanding performances. However, reproducing results or directly comparing methods is often limited by closed source of data and the large heterogeneity among medical images. With this in mind, our intention is to provide a reliable source for assessing deep learning models. As an example, we chose the challenging task of delineating the prostate gland in multi-modal images. First, this paper provides a comprehensive review of current state-of-the-art convolutional neural networks for 3D prostate segmentation. Second, utilizing public and in-house CT and MR datasets of varying properties, we created a framework for an objective comparison of automatic prostate segmentation algorithms. The framework was used for rigorous evaluations of the models, highlighting their strengths and weaknesses.

Artificial intelligence in radiology: trainees want more

AIM

To understand the attitudes of UK radiology trainees towards artificial intelligence (AI) in Radiology, in particular, assessing the demand for AI education.

MATERIALS AND METHODS

A survey, which ran over a period of 2 months, was created using the Google Forms platform and distributed via email to all UK training programmes.

RESULTS

The survey was completed by 149 trainee radiologists with at least one response from all UK training programmes. Of the responses, 83.7% were interested in AI use in radiology but 71.4% had no experience of working with AI and 79.9% would like to be involved in AI-based projects. Almost all (98.7%) felt that AI should be taught during their training, yet only one respondent stated that their training programme had implemented AI teaching. Respondents indicated that basic understanding, implementation, and critical appraisal of AI software should be prioritized in teaching. Of the trainees, 74.2% agreed that AI would enhance the job of diagnostic radiologists over the next 20 years. The main concerns raised were information technology/implementation and ethical/regulatory issues.

CONCLUSION

Despite the current limited availability of AI-based activities and teaching within UK training programmes, UK trainees' attitudes towards AI are mostly positive with many showing interest in being involved with AI-based projects, activities, and teaching.

Changes in Radiology Due to Artificial Intelligence That Can Attract Medical Students to the Specialty

The role of artificial intelligence (AI) in radiology has grown exponentially in the recent years. One of the primary worries by medical students is that AI will cause the roles of a radiologist to become automated and thus obsolete. Therefore, there is a greater hesitancy by medical students to choose radiology as a specialty. However, it is in this time of change that the specialty needs new thinkers and leaders. In this succinct viewpoint, 2 medical students involved in AI and 2 radiologists specializing in AI or clinical informatics posit that not only are these fears false, but the field of radiology will be transformed in such a way due to AI that there will be novel reasons to choose radiology. These new factors include greater impact on patient care, new space for innovation, interdisciplinary collaboration, increased patient contact, becoming master diagnosticians, and greater opportunity for global health initiatives, among others. Finally, since medical students view mentorship as a critical resource when deciding their career path, medical educators must also be cognizant of these changes and not give much credence to the prevalent fearmongering. As the field and practice of radiology continue to undergo significant change due to AI, it is urgent and necessary for the conversation to expand from expert to expert to expert to student. Medical students should be encouraged to choose radiology specifically because of the changes brought on by AI rather than being deterred by it.

Student perspectives on the integration of artificial intelligence into healthcare services

Background

Healthcare workers are often overworked, underfunded, and face many challenges. Integration of artificial intelligence into healthcare service provision can tackle these challenges by relieving burdens on healthcare workers. Since healthcare students are our future healthcare workers, we assessed the knowledge, attitudes, and perspectives of current healthcare students at Qatar University on the implementation of artificial intelligence into healthcare services.

Methods

This was a cross-sectional study of QU-Health Cluster students via an online survey over a three-week period in November 2021. Chi-squared tests and gamma coefficients were used to compare differences between categorical variables.

Results

One hundred and ninety-three QU-Health students responded. Most participants had a positive attitude towards artificial intelligence, finding it useful and reliable. The most popular perceived advantage of artificial intelligence was its ability to speed up work processes. Around 40% expressed concern about a threat to job security from artificial intelligence, and a majority believed that artificial intelligence cannot provide sympathetic care (57.9%). Participants who felt that artificial intelligence can better make diagnoses than humans also agreed that artificial intelligence could replace their job (p  =  0.005). Male students had more knowledge (p  =  0.005) and received more training (p  =  0.005) about healthcare artificial intelligence. Participants cited a lack of expert mentorship as a barrier to obtaining knowledge about artificial intelligence, followed by lack of dedicated courses and funding.

Conclusions

More resources are required for students to develop a good understanding about artificial intelligence. Education needs to be supported by expert mentorship. Further work is needed on how best to integrate artificial intelligence teaching into university curricula.

Artificial Intelligence and Radiology Education

Implementation of artificial intelligence (AI) applications into clinical practice requires AI-savvy radiologists to ensure the safe, ethical, and effective use of these systems for patient care. Increasing demand for AI education reflects recognition of the translation of AI applications from research to clinical practice, with positive trainee attitudes regarding the influence of AI on radiology. However, barriers to AI education, such as limited access to resources, predispose to insufficient preparation for the effective use of AI in practice. In response, national organizations have sponsored formal and self-directed learning courses to provide introductory content on imaging informatics and AI. Foundational courses, such as the National Imaging Informatics Course - Radiology and the Radiological Society of North America Imaging AI Certificate, lay a framework for trainees to explore the creation, deployment, and critical evaluation of AI applications. This report includes additional resources for formal programming courses, video series from leading organizations, and blogs from AI and informatics communities. Furthermore, the scope of "AI and radiology education" includes AI-augmented radiology education, with emphasis on the potential for "precision education" that creates personalized experiences for trainees by accounting for varying learning styles and inconsistent, possibly deficient, clinical case volume. © RSNA, 2022 Keywords: Use of AI in Education, Impact of AI on Education, Artificial Intelligence, Medical Education, Imaging Informatics, Natural Language Processing, Precision Education.

Machine Learning and Deep Learning in Cardiothoracic Imaging: A Scoping Review

Machine-learning (ML) and deep-learning (DL) algorithms are part of a group of modeling algorithms that grasp the hidden patterns in data based on a training process, enabling them to extract complex information from the input data. In the past decade, these algorithms have been increasingly used for image processing, specifically in the medical domain. Cardiothoracic imaging is one of the early adopters of ML/DL research, and the COVID-19 pandemic resulted in more research focus on the feasibility and applications of ML/DL in cardiothoracic imaging. In this scoping review, we systematically searched available peer-reviewed medical literature on cardiothoracic imaging and quantitatively extracted key data elements in order to get a big picture of how ML/DL have been used in the rapidly evolving cardiothoracic imaging field. During this report, we provide insights on different applications of ML/DL and some nuances pertaining to this specific field of research. Finally, we provide general suggestions on how researchers can make their research more than just a proof-of-concept and move toward clinical adoption.

The Cases for and against Artificial Intelligence in the Medical School Curriculum

Although artificial intelligence (AI) has immense potential to shape the future of medicine, its place in undergraduate medical education currently is unclear. Numerous arguments exist both for and against including AI in the medical school curriculum. AI likely will affect all medical specialties, perhaps radiology more so than any other. The purpose of this article is to present a balanced perspective on whether AI should be included officially in the medical school curriculum. After presenting the balanced point-counterpoint arguments, the authors provide a compromise. Keywords: Artificial Intelligence, Medical Education, Medical School Curriculum, Medical Students, Radiology, Use of AI in Education © RSNA, 2022.

Acceptance of clinical artificial intelligence among physicians and medical students: A systematic review with cross-sectional survey

Background

Artificial intelligence (AI) needs to be accepted and understood by physicians and medical students, but few have systematically assessed their attitudes. We investigated clinical AI acceptance among physicians and medical students around the world to provide implementation guidance.

Materials and methods

We conducted a two-stage study, involving a foundational systematic review of physician and medical student acceptance of clinical AI. This enabled us to design a suitable web-based questionnaire which was then distributed among practitioners and trainees around the world.

Results

Sixty studies were included in this systematic review, and 758 respondents from 39 countries completed the online questionnaire. Five (62.50%) of eight studies reported 65% or higher awareness regarding the application of clinical AI. Although, only 10–30% had actually used AI and 26 (74.28%) of 35 studies suggested there was a lack of AI knowledge. Our questionnaire uncovered 38% awareness rate and 20% utility rate of clinical AI, although 53% lacked basic knowledge of clinical AI. Forty-five studies mentioned attitudes toward clinical AI, and over 60% from 38 (84.44%) studies were positive about AI, although they were also concerned about the potential for unpredictable, incorrect results. Seventy-seven percent were optimistic about the prospect of clinical AI. The support rate for the statement that AI could replace physicians ranged from 6 to 78% across 40 studies which mentioned this topic. Five studies recommended that efforts should be made to increase collaboration. Our questionnaire showed 68% disagreed that AI would become a surrogate physician, but believed it should assist in clinical decision-making. Participants with different identities, experience and from different countries hold similar but subtly different attitudes.

Conclusion

Most physicians and medical students appear aware of the increasing application of clinical AI, but lack practical experience and related knowledge. Overall, participants have positive but reserved attitudes about AI. In spite of the mixed opinions around clinical AI becoming a surrogate physician, there was a consensus that collaborations between the two should be strengthened. Further education should be conducted to alleviate anxieties associated with change and adopting new technologies.

Academic Radiology Departments Should Lead Artificial Intelligence Initiatives

RATIONALE AND OBJECTIVES

With a track record of innovation and unique access to digital data, radiologists are distinctly positioned to usher in a new medical era of artificial intelligence (AI).

MATERIALS AND METHODS

In this Perspective piece, we summarize AI initiatives that academic radiology departments should consider related to the traditional pillars of education, research, and clinical excellence, while also introducing a new opportunity for engagement with industry.

RESULTS

We provide early successful examples of each as well as suggestions to guide departments towards future success.

CONCLUSION

Our goal is to assist academic radiology leaders in bringing their departments into the AI era and realizing its full potential in our field.

Decision effect of a deep-learning model to assist a head computed tomography order for pediatric traumatic brain injury

The study aims to measure the effectiveness of an AI-based traumatic intracranial hemorrhage prediction model in the decisions of emergency physicians regarding ordering head computed tomography (CT) scans. We developed a deep-learning model for predicting traumatic intracranial hemorrhages (DEEPTICH) using a national trauma registry with 1.8 million cases. For simulation, 24 cases were selected from previous emergency department cases. For each case, physicians made decisions on ordering a head CT twice: initially without the DEEPTICH assistance, and subsequently with the DEEPTICH assistance. Of the 528 responses from 22 participants, 201 initial decisions were different from the DEEPTICH recommendations. Of these 201 initial decisions, 94 were changed after DEEPTICH assistance (46.8%). For the cases in which CT was initially not ordered, 71.4% of the decisions were changed (p < 0.001), and for the cases in which CT was initially ordered, 37.2% (p < 0.001) of the decisions were changed after DEEPTICH assistance. When using DEEPTICH, 46 (11.6%) unnecessary CTs were avoided (p < 0.001) and 10 (11.4%) traumatic intracranial hemorrhages (ICHs) that would have been otherwise missed were found (p = 0.039). We found that emergency physicians were likely to accept AI based on how they perceived its safety.