Artificial Intelligence in Healthcare: Lost In Translation?

Artificial intelligence (AI) in healthcare is a potentially revolutionary tool to achieve improved healthcare outcomes while reducing overall health costs. While many exploratory results hit the headlines in recent years there are only few certified and even fewer clinically validated products available in the clinical setting. This is a clear indication of failing translation due to shortcomings of the current approach to AI in healthcare. In this work, we highlight the major areas, where we observe current challenges for translation in AI in healthcare, namely precision medicine, reproducible science, data issues and algorithms, causality, and product development. For each field, we outline possible solutions for these challenges. Our work will lead to improved translation of AI in healthcare products into the clinical setting

The social dilemma in AI development and why we have to solve it

While the demand for ethical artificial intelligence (AI) systems increases, the number of unethical uses of AI accelerates, even though there is no shortage of ethical guidelines. We argue that a main underlying cause for this is that AI developers face a social dilemma in AI development ethics, preventing the widespread adaptation of ethical best practices. We define the social dilemma for AI development and describe why the current crisis in AI development ethics cannot be solved without relieving AI developers of their social dilemma. We argue that AI development must be professionalised to overcome the social dilemma, and discuss how medicine can be used as a template in this process.

Anonymization of labeled TOF-MRA images for brain vessel segmentation using generative adversarial networks

Anonymization and data sharing are crucial for privacy protection and acquisition of large datasets for medical image analysis. This is a big challenge, especially for neuroimaging. Here, the brain's unique structure allows for re-identification and thus requires non-conventional anonymization. Generative adversarial networks (GANs) have the potential to provide anonymous images while preserving predictive properties. Analyzing brain vessel segmentation as a use case, we trained 3 GANs on time-of-flight (TOF) magnetic resonance angiography (MRA) patches for image-label generation: 1) Deep convolutional GAN, 2) Wasserstein-GAN with gradient penalty (WGAN-GP) and 3) WGAN-GP with spectral normalization (WGAN-GP-SN). The generated image-labels from each GAN were used to train a U-net for segmentation and tested on real data. Moreover, we applied our synthetic patches using transfer learning on a second dataset. For an increasing number of up to 15 patients we evaluated the model performance on real data with and without pre-training. The performance for all models was assessed by the Dice Similarity Coefficient (DSC) and the 95th percentile of the Hausdorff Distance (95HD). Comparing the 3 GANs, the U-net trained on synthetic data generated by the WGAN-GP-SN showed the highest performance to predict vessels (DSC/95HD 0.82/28.97) benchmarked by the U-net trained on real data (0.89/26.61). The transfer learning approach showed superior performance for the same GAN compared to no pre-training, especially for one patient only (0.91/25.68 vs. 0.85/27.36). In this work, synthetic image-label pairs retained generalizable information and showed good performance for vessel segmentation. Besides, we showed that synthetic patches can be used in a transfer learning approach with independent data. This paves the way to overcome the challenges of scarce data and anonymization in medical imaging.

From Bit To Bedside: A Practical Framework For Artificial Intelligence Product Development In Healthcare

Artificial Intelligence (AI) in healthcare holds great potential to expand access to high-quality medical care, whilst reducing overall systemic costs. Despite hitting the headlines regularly and many publications of proofs-of-concept, certified products are failing to breakthrough to the clinic. AI in healthcare is a multi-party process with deep knowledge required in multiple individual domains. The lack of understanding of the specific challenges in the domain is, therefore, the major contributor to the failure to deliver on the big promises. Thus, we present a decision perspective framework, for the development of AI-driven biomedical products, from conception to market launch. Our framework highlights the risks, objectives and key results which are typically required to proceed through a three-phase process to the market launch of a validated medical AI product. We focus on issues related to Clinical validation, Regulatory affairs, Data strategy and Algorithmic development. The development process we propose for AI in healthcare software strongly diverges from modern consumer software development processes. We highlight the key time points to guide founders, investors and key stakeholders throughout their relevant part of the process. Our framework should be seen as a template for innovation frameworks, which can be used to coordinate team communications and responsibilities towards a reasonable product development roadmap, thus unlocking the potential of AI in medicine.