Abstract
The rapid increase in telemedicine coupled with recent advances in diagnostic artificial intelligence (AI) create the imperative to consider the opportunities and risks of inserting AI-based support into new paradigms of care. Here we build on recent achievements in the accuracy of image-based AI for skin cancer diagnosis to address the effects of varied representations of AI-based support across different levels of clinical expertise and multiple clinical workflows. We find that good quality AI-based support of clinical decision-making improves diagnostic accuracy over that of either AI or physicians alone, and that the least experienced clinicians gain the most from AI-based support. We further find that AI-based multiclass probabilities outperformed content-based image retrieval (CBIR) representations of AI in the mobile technology environment, and AI-based support had utility in simulations of second opinions and of telemedicine triage. In addition to demonstrating the potential benefits associated with good quality AI in the hands of non-expert clinicians, we find that faulty AI can mislead the entire spectrum of clinicians, including experts. Lastly, we show that insights derived from AI class-activation maps can inform improvements in human diagnosis. Together, our approach and findings offer a framework for future studies across the spectrum of image-based diagnostics to improve human-computer collaboration in clinical practice.
References
-
- Webster, P. Virtual health care in the era of COVID-19. Lancet 395, 1180β1181 (2020). - DOI
-
- He, J. et al. The practical implementation of artificial intelligence technologies in medicine. Nat. Med. 25, 30β36 (2019). - DOI
-
- McKinney, S. M. et al. International evaluation of an AI system for breast cancer screening. Nature 577, 89β94 (2020). - DOI
-
- Gulshan, V. et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. JAMA 316, 2402β2410 (2016). - DOI
-
- Esteva, A. et al. Dermatologist-level classification of skin cancer with deep neural networks. Nature 542, 115β118 (2017). - DOI
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