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  1. Automated curation of noisy external data in the medical domain has long been in high demand, as AI technologies need to be validated using various sources with clean, annotated data. Identifying the variance between internal and external sources is a fundamental step in curating a high-quality dataset, as the data distributions from different sources can vary significantly and subsequently affect the performance of AI models. The primary challenges for detecting data shifts are - (1) accessing private data across healthcare institutions for manual detection and (2) the lack of automated approaches to learn efficient shift-data representation without training samples. To overcome these problems, we propose an automated pipeline called MedShift to detect top-level shift samples and evaluate the significance of shift data without sharing data between internal and external organizations. MedShift employs unsupervised anomaly detectors to learn the internal distribution and identify samples showing significant shiftness for external datasets, and then compares their performance. To quantify the effects of detected shift data, we train a multi-class classifier that learns internal domain knowledge and evaluates the classification performance for each class in external domains after dropping the shift data. We also propose a data quality metric to quantify the dissimilarity between internal and external datasets. We verify the efficacy of MedShift using musculoskeletal radiographs (MURA) and chest X-ray datasets from multiple external sources. Our experiments show that our proposed shift data detection pipeline can be beneficial for medical centers to curate high-quality datasets more efficiently. 
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    Free, publicly-accessible full text available August 1, 2024
  2. 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.

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    Free, publicly-accessible full text available October 1, 2024
  3. Purpose Prior studies show convolutional neural networks predicting self-reported race using x-rays of chest, hand and spine, chest computed tomography, and mammogram. We seek an understanding of the mechanism that reveals race within x-ray images, investigating the possibility that race is not predicted using the physical structure in x-ray images but is embedded in the grayscale pixel intensities. Approach Retrospective full year 2021, 298,827 AP/PA chest x-ray images from 3 academic health centers across the United States and MIMIC-CXR, labeled by self-reported race, were used in this study. The image structure is removed by summing the number of each grayscale value and scaling to percent per image (PPI). The resulting data are tested using multivariate analysis of variance (MANOVA) with Bonferroni multiple-comparison adjustment and class-balanced MANOVA. Machine learning (ML) feed-forward networks (FFN) and decision trees were built to predict race (binary Black or White and binary Black or other) using only grayscale value counts. Stratified analysis by body mass index, age, sex, gender, patient type, make/model of scanner, exposure, and kilovoltage peak setting was run to study the impact of these factors on race prediction following the same methodology. Results MANOVA rejects the null hypothesis that classes are the same with 95% confidence (F 7.38, P < 0.0001) and balanced MANOVA (F 2.02, P < 0.0001). The best FFN performance is limited [area under the receiver operating characteristic (AUROC) of 69.18%]. Gradient boosted trees predict self-reported race using grayscale PPI (AUROC 77.24%). Conclusions Within chest x-rays, pixel intensity value counts alone are statistically significant indicators and enough for ML classification tasks of patient self-reported race. 
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    Free, publicly-accessible full text available November 1, 2024
  4. Free, publicly-accessible full text available September 1, 2024
  5. With each passing year, the state-of-the-art deep learning neural networks grow larger in size, requiring larger computing and power resources. The high compute resources required by these large networks are alienating the majority of the world population that lives in low-resource settings and lacks the infrastructure to benefit from these advancements in medical AI. Current state-of-the-art medical AI, even with cloud resources, is a bit difficult to deploy in remote areas where we don’t have good internet connectivity. We demonstrate a cost-effective approach to deploying medical AI that could be used in limited resource settings using Edge Tensor Processing Unit (TPU). We trained and optimized a classification model on the Chest X-ray 14 dataset and a segmentation model on the Nerve ultrasound dataset using INT8 Quantization Aware Training. Thereafter, we compiled the optimized models for Edge TPU execution. We find that the inference performance on edge TPUs is 10x faster compared to other embedded devices. The optimized model is 3x and 12x smaller for the classification and segmentation respectively, compared to the full precision model. In summary, we show the potential of Edge TPUs for two medical AI tasks with faster inference times, which could potentially be used in low-resource settings for medical AI-based diagnostics. We finally discuss some potential challenges and limitations of our approach for real-world deployments. 
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    Abstract Real-time execution of machine learning (ML) pipelines on radiology images is difficult due to limited computing resources in clinical environments, whereas running them in research clusters requires efficient data transfer capabilities. We developed Niffler, an open-source Digital Imaging and Communications in Medicine (DICOM) framework that enables ML and processing pipelines in research clusters by efficiently retrieving images from the hospitals’ PACS and extracting the metadata from the images. We deployed Niffler at our institution (Emory Healthcare, the largest healthcare network in the state of Georgia) and retrieved data from 715 scanners spanning 12 sites, up to 350 GB/day continuously in real-time as a DICOM data stream over the past 2 years. We also used Niffler to retrieve images bulk on-demand based on user-provided filters to facilitate several research projects. This paper presents the architecture and three such use cases of Niffler. First, we executed an IVC filter detection and segmentation pipeline on abdominal radiographs in real-time, which was able to classify 989 test images with an accuracy of 96.0%. Second, we applied the Niffler Metadata Extractor to understand the operational efficiency of individual MRI systems based on calculated metrics. We benchmarked the accuracy of the calculated exam time windows by comparing Niffler against the Clinical Data Warehouse (CDW). Niffler accurately identified the scanners’ examination timeframes and idling times, whereas CDW falsely depicted several exam overlaps due to human errors. Third, with metadata extracted from the images by Niffler, we identified scanners with misconfigured time and reconfigured five scanners. Our evaluations highlight how Niffler enables real-time ML and processing pipelines in a research cluster. 
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