Trends in clinical validation and usage of US Food and Drug Administration-cleared artificial intelligence algorithms for medical imaging

Attitudes and perceptions of Thai medical students regarding artificial intelligence in radiology and medicine

INTRODUCTION

Artificial Intelligence (AI) has made a profound impact on the medical sector, particularly in radiology. The integration of AI knowledge into medical education is essential to equip future healthcare professionals with the skills needed to effectively leverage these advancements in their practices. Despite its significance, many medical schools have yet to incorporate AI into their curricula. This study aims to assess the attitudes of medical students in Thailand toward AI and its application in radiology, with the objective of better planning for its inclusion.

METHODS

Between February and June 2022, we conducted a survey in two Thai medical schools: Chiang Mai University in Northern Thailand and Prince of Songkla University in Southern Thailand. We employed 5-point Likert scale questions (ranging from strongly agree to strongly disagree) to evaluate students' opinions on three main aspects: (1) their understanding of AI, (2) the inclusion of AI in their medical education, and (3) the potential impact of AI on medicine and radiology.

RESULTS

Our findings revealed that merely 31% of medical students perceived to have a basic understanding of AI. Nevertheless, nearly all students (93.6%) recognized the value of AI training for their careers and strongly advocated for its inclusion in the medical school curriculum. Furthermore, those students who had a better understanding of AI were more likely to believe that AI would revolutionize the field of radiology (p = 0.02), making it more captivating and impactful (p = 0.04).

CONCLUSION

Our study highlights a noticeable gap in the understanding of AI among medical students in Thailand and its practical applications in healthcare. However, the overwhelming consensus among these students is their readiness to embrace the incorporation of AI training into their medical education. This enthusiasm holds the promise of enhancing AI adoption, ultimately leading to an improvement in the standard of healthcare services in Thailand, aligning with the country's healthcare vision.

A Responsible Framework for Applying Artificial Intelligence on Medical Images and Signals at the Point of Care: The PACS-AI Platform

The potential of artificial intelligence (AI) in medicine lies in its ability to enhance clinicians' capacity to analyse medical images, thereby improving diagnostic precision and accuracy and thus enhancing current tests. However, the integration of AI within health care is fraught with difficulties. Heterogeneity among health care system applications, reliance on proprietary closed-source software, and rising cybersecurity threats pose significant challenges. Moreover, before their deployment in clinical settings, AI models must demonstrate their effectiveness across a wide range of scenarios and must be validated by prospective studies, but doing so requires testing in an environment mirroring the clinical workflow, which is difficult to achieve without dedicated software. Finally, the use of AI techniques in health care raises significant legal and ethical issues, such as the protection of patient privacy, the prevention of bias, and the monitoring of the device's safety and effectiveness for regulatory compliance. This review describes challenges to AI integration in health care and provides guidelines on how to move forward. We describe an open-source solution that we developed that integrates AI models into the Picture Archives Communication System (PACS), called PACS-AI. This approach aims to increase the evaluation of AI models by facilitating their integration and validation with existing medical imaging databases. PACS-AI may overcome many current barriers to AI deployment and offer a pathway toward responsible, fair, and effective deployment of AI models in health care. In addition, we propose a list of criteria and guidelines that AI researchers should adopt when publishing a medical AI model to enhance standardisation and reproducibility.

Using AI to Identify Unremarkable Chest Radiographs for Automatic Reporting

Background Radiology practices have a high volume of unremarkable chest radiographs and artificial intelligence (AI) could possibly improve workflow by providing an automatic report. Purpose To estimate the proportion of unremarkable chest radiographs, where AI can correctly exclude pathology (ie, specificity) without increasing diagnostic errors. Materials and Methods In this retrospective study, consecutive chest radiographs in unique adult patients (≥18 years of age) were obtained January 1-12, 2020, at four Danish hospitals. Exclusion criteria included insufficient radiology reports or AI output error. Two thoracic radiologists, who were blinded to AI output, labeled chest radiographs as "remarkable" or "unremarkable" based on predefined unremarkable findings (reference standard). Radiology reports were classified similarly. A commercial AI tool was adapted to output a chest radiograph "remarkableness" probability, which was used to calculate specificity at different AI sensitivities. Chest radiographs with missed findings by AI and/or the radiology report were graded by one thoracic radiologist as critical, clinically significant, or clinically insignificant. Paired proportions were compared using the McNemar test. Results A total of 1961 patients were included (median age, 72 years [IQR, 58-81 years]; 993 female), with one chest radiograph per patient. The reference standard labeled 1231 of 1961 chest radiographs (62.8%) as remarkable and 730 of 1961 (37.2%) as unremarkable. At 99.9%, 99.0%, and 98.0% sensitivity, the AI had a specificity of 24.5% (179 of 730 radiographs [95% CI: 21, 28]), 47.1% (344 of 730 radiographs [95% CI: 43, 51]), and 52.7% (385 of 730 radiographs [95% CI: 49, 56]), respectively. With the AI fixed to have a similar sensitivity as radiology reports (87.2%), the missed findings of AI and reports had 2.2% (27 of 1231 radiographs) and 1.1% (14 of 1231 radiographs) classified as critical (P = .01), 4.1% (51 of 1231 radiographs) and 3.6% (44 of 1231 radiographs) classified as clinically significant (P = .46), and 6.5% (80 of 1231) and 8.1% (100 of 1231) classified as clinically insignificant (P = .11), respectively. At sensitivities greater than or equal to 95.4%, the AI tool exhibited less than or equal to 1.1% critical misses. Conclusion A commercial AI tool used off-label could correctly exclude pathology in 24.5%-52.7% of all unremarkable chest radiographs at greater than or equal to 98% sensitivity. The AI had equal or lower rates of critical misses than radiology reports at sensitivities greater than or equal to 95.4%. These results should be confirmed in a prospective study. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Yoon and Hwang in this issue.

Clinical, Cultural, Computational, and Regulatory Considerations to Deploy AI in Radiology: Perspectives of RSNA and MICCAI Experts

The Radiological Society of North of America (RSNA) and the Medical Image Computing and Computer Assisted Intervention (MICCAI) Society have led a series of joint panels and seminars focused on the present impact and future directions of artificial intelligence (AI) in radiology. These conversations have collected viewpoints from multidisciplinary experts in radiology, medical imaging, and machine learning on the current clinical penetration of AI technology in radiology and how it is impacted by trust, reproducibility, explainability, and accountability. The collective points-both practical and philosophical-define the cultural changes for radiologists and AI scientists working together and describe the challenges ahead for AI technologies to meet broad approval. This article presents the perspectives of experts from MICCAI and RSNA on the clinical, cultural, computational, and regulatory considerations-coupled with recommended reading materials-essential to adopt AI technology successfully in radiology and, more generally, in clinical practice. The report emphasizes the importance of collaboration to improve clinical deployment, highlights the need to integrate clinical and medical imaging data, and introduces strategies to ensure smooth and incentivized integration. Keywords: Adults and Pediatrics, Computer Applications-General (Informatics), Diagnosis, Prognosis © RSNA, 2024.

Enhancing patient outcomes: the role of clinical utility in guiding healthcare providers in curating radiology AI applications

With advancements in artificial intelligence (AI) dominating the headlines, diagnostic imaging radiology is no exception to the accelerating role that AI is playing in today's technology landscape. The number of AI-driven radiology diagnostic imaging applications (digital diagnostics) that are both commercially available and in-development is rapidly expanding as are the potential benefits these tools can deliver for patients and providers alike. Healthcare providers seeking to harness the potential benefits of digital diagnostics may consider evaluating these tools and their corresponding use cases in a systematic and structured manner to ensure optimal capital deployment, resource utilization, and, ultimately, patient outcomes-or clinical utility. We propose several guiding themes when using clinical utility to curate digital diagnostics.

Comparison of Commercial AI Software Performance for Radiograph Lung Nodule Detection and Bone Age Prediction

Background Multiple commercial artificial intelligence (AI) products exist for assessing radiographs; however, comparable performance data for these algorithms are limited. Purpose To perform an independent, stand-alone validation of commercially available AI products for bone age prediction based on hand radiographs and lung nodule detection on chest radiographs. Materials and Methods This retrospective study was carried out as part of Project AIR. Nine of 17 eligible AI products were validated on data from seven Dutch hospitals. For bone age prediction, the root mean square error (RMSE) and Pearson correlation coefficient were computed. The reference standard was set by three to five expert readers. For lung nodule detection, the area under the receiver operating characteristic curve (AUC) was computed. The reference standard was set by a chest radiologist based on CT. Randomized subsets of hand (n = 95) and chest (n = 140) radiographs were read by 14 and 17 human readers, respectively, with varying experience. Results Two bone age prediction algorithms were tested on hand radiographs (from January 2017 to January 2022) in 326 patients (mean age, 10 years ± 4 [SD]; 173 female patients) and correlated strongly with the reference standard (r = 0.99; P < .001 for both). No difference in RMSE was observed between algorithms (0.63 years [95% CI: 0.58, 0.69] and 0.57 years [95% CI: 0.52, 0.61]) and readers (0.68 years [95% CI: 0.64, 0.73]). Seven lung nodule detection algorithms were validated on chest radiographs (from January 2012 to May 2022) in 386 patients (mean age, 64 years ± 11; 223 male patients). Compared with readers (mean AUC, 0.81 [95% CI: 0.77, 0.85]), four algorithms performed better (AUC range, 0.86-0.93; P value range, <.001 to .04). Conclusions Compared with human readers, four AI algorithms for detecting lung nodules on chest radiographs showed improved performance, whereas the remaining algorithms tested showed no evidence of a difference in performance. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Omoumi and Richiardi in this issue.

Strategies for Implementing Machine Learning Algorithms in the Clinical Practice of Radiology

Despite recent advancements in machine learning (ML) applications in health care, there have been few benefits and improvements to clinical medicine in the hospital setting. To facilitate clinical adaptation of methods in ML, this review proposes a standardized framework for the step-by-step implementation of artificial intelligence into the clinical practice of radiology that focuses on three key components: problem identification, stakeholder alignment, and pipeline integration. A review of the recent literature and empirical evidence in radiologic imaging applications justifies this approach and offers a discussion on structuring implementation efforts to help other hospital practices leverage ML to improve patient care. Clinical trial registration no. 04242667 © RSNA, 2024 Supplemental material is available for this article.

AI pitfalls and what not to do: mitigating bias in AI

Various forms of artificial intelligence (AI) applications are being deployed and used in many healthcare systems. As the use of these applications increases, we are learning the failures of these models and how they can perpetuate bias. With these new lessons, we need to prioritize bias evaluation and mitigation for radiology applications; all the while not ignoring the impact of changes in the larger enterprise AI deployment which may have downstream impact on performance of AI models. In this paper, we provide an updated review of known pitfalls causing AI bias and discuss strategies for mitigating these biases within the context of AI deployment in the larger healthcare enterprise. We describe these pitfalls by framing them in the larger AI lifecycle from problem definition, data set selection and curation, model training and deployment emphasizing that bias exists across a spectrum and is a sequela of a combination of both human and machine factors.

Challenges of implementing computer-aided diagnostic models for neuroimages in a clinical setting

Advances in artificial intelligence have cultivated a strong interest in developing and validating the clinical utilities of computer-aided diagnostic models. Machine learning for diagnostic neuroimaging has often been applied to detect psychological and neurological disorders, typically on small-scale datasets or data collected in a research setting. With the collection and collation of an ever-growing number of public datasets that researchers can freely access, much work has been done in adapting machine learning models to classify these neuroimages by diseases such as Alzheimer's, ADHD, autism, bipolar disorder, and so on. These studies often come with the promise of being implemented clinically, but despite intense interest in this topic in the laboratory, limited progress has been made in clinical implementation. In this review, we analyze challenges specific to the clinical implementation of diagnostic AI models for neuroimaging data, looking at the differences between laboratory and clinical settings, the inherent limitations of diagnostic AI, and the different incentives and skill sets between research institutions, technology companies, and hospitals. These complexities need to be recognized in the translation of diagnostic AI for neuroimaging from the laboratory to the clinic.

Applications of artificial intelligence in clinical management, research and health administration: imaging perspectives with a focus on hemophilia

INTRODUCTION

Joints of persons with hemophilia are frequently affected by repetitive hemarthrosis. In this paper concepts, perks and quirks of the use of artificial intelligence (AI), machine learning (ML) and deep learning are reviewed within clinical and research contexts of hemophilia and other blood-induced disorders' patient care, targeted to the imaging diagnosis of hemophilic joints, under the perspective of different stakeholders (radiologists, hematologists, nurses, physiotherapists, technologists, researchers, managers and patients/caregivers).

AREAS COVERED

Rubrics that determine the suitability of the utilization of AI in blood-induced disorders' patient care, including diagnosis and follow-up of patients are discussed, focusing on features in which AI can replace or augment the role of radiology in the clinical management and in research of patients. Insights on features in the design and conduct of AI projects in which the human intervention remains critical are provided.

EXPERT OPINION

The author discusses research concepts in radiogenomics, and challenges of the utilization of AI in different healthcare fields such as patient safety, data sharing and privacy regulations, workforce education and future jobs' shortage. Finally, the author proposes alternatives and potential solutions to mitigate challenges in successfully deploying ML algorithms into clinical practice.