Current Challenges in the Application of Algorithms in Multi-institutional Clinical Settings

The Coronavirus disease pandemic has highlighted the importance of artificial intelligence in multi-institutional clinical settings. Particularly in situations where the healthcare system is overloaded, and a lot of data is generated, artificial intelligence has great potential to provide automated solutions and to unlock the untapped potential of acquired data. This includes the areas of care, logistics, and diagnosis. For example, automated decision support applications could tremendously help physicians in their daily clinical routine. Especially in radiology and oncology, the exponential growth of imaging data, triggered by a rising number of patients, leads to a permanent overload of the healthcare system, making the use of artificial intelligence inevitable. However, the efficient and advantageous application of artificial intelligence in multi-institutional clinical settings faces several challenges, such as accountability and regulation hurdles, implementation challenges, and fairness considerations. This work focuses on the implementation challenges, which include the following questions: How to ensure well-curated and standardized data, how do algorithms from other domains perform on multi-institutional medical datasets, and how to train more robust and generalizable models? Also, questions of how to interpret results and whether there exist correlations between the performance of the models and the characteristics of the underlying data are part of the work. Therefore, besides presenting a technical solution for manual data annotation and tagging for medical images, a real-world federated learning implementation for image segmentation is introduced. Experiments on a multi-institutional prostate magnetic resonance imaging dataset showcase that models trained by federated learning can achieve similar performance to training on pooled data. Furthermore, Natural Language Processing algorithms with the tasks of semantic textual similarity, text classification, and text summarization are applied to multi-institutional, structured and free-text, oncology reports. The results show that performance gains are achieved by customizing state-of-the-art algorithms to the peculiarities of the medical datasets, such as the occurrence of medications, numbers, or dates. In addition, performance influences are observed depending on the characteristics of the data, such as lexical complexity. The generated results, human baselines, and retrospective human evaluations demonstrate that artificial intelligence algorithms have great potential for use in clinical settings. However, due to the difficulty of processing domain-specific data, there still exists a performance gap between the algorithms and the medical experts. In the future, it is therefore essential to improve the interoperability and standardization of data, as well as to continue working on algorithms to perform well on medical, possibly, domain-shifted data from multiple clinical centers

Deep-learning based detection of vessel occlusions on CT-angiography in patients with suspected acute ischemic stroke

Abstract Swift diagnosis and treatment play a decisive role in the clinical outcome of patients with acute ischemic stroke (AIS), and computer-aided diagnosis (CAD) systems can accelerate the underlying diagnostic processes. Here, we developed an artificial neural network (ANN) which allows automated detection of abnormal vessel findings without any a-priori restrictions and in <2 minutes. Pseudo-prospective external validation was performed in consecutive patients with suspected AIS from 4 different hospitals during a 6-month timeframe and demonstrated high sensitivity (≥87%) and negative predictive value (≥93%). Benchmarking against two CE- and FDA-approved software solutions showed significantly higher performance for our ANN with improvements of 25–45% for sensitivity and 4–11% for NPV (p ≤ 0.003 each). We provide an imaging platform ( https://stroke.neuroAI-HD.org ) for online processing of medical imaging data with the developed ANN, including provisions for data crowdsourcing, which will allow continuous refinements and serve as a blueprint to build robust and generalizable AI algorithms