Behind the mask: a critical perspective on the ethical, moral, and legal implications of AI in ophthalmology.

PURPOSE: This narrative review aims to provide an overview of the dangers, controversial aspects, and implications of artificial intelligence (AI) use in ophthalmology and other medical-related fields. METHODS: We conducted a decade-long comprehensive search (January 2013-May 2023) of both academic and grey literature, focusing on the application of AI in ophthalmology and healthcare. This search included key web-based academic databases, non-traditional sources, and targeted searches of specific organizations and institutions. We reviewed and selected documents for relevance to AI, healthcare, ethics, and guidelines, aiming for a critical analysis of ethical, moral, and legal implications of AI in healthcare. RESULTS: Six main issues were identified, analyzed, and discussed. These include bias and clinical safety, cybersecurity, health data and AI algorithm ownership, the "black-box" problem, medical liability, and the risk of widening inequality in healthcare. CONCLUSION: Solutions to address these issues include collecting high-quality data of the target population, incorporating stronger security measures, using explainable AI algorithms and ensemble methods, and making AI-based solutions accessible to everyone. With careful oversight and regulation, AI-based systems can be used to supplement physician decision-making and improve patient care and outcomes.

Combining Deep Phenotyping of Serum Proteomics and Clinical Data via Machine Learning for COVID-19 Biomarker Discovery.

The persistence of long-term coronavirus-induced disease 2019 (COVID-19) sequelae demands better insights into its natural history. Therefore, it is crucial to discover the biomarkers of disease outcome to improve clinical practice. In this study, 160 COVID-19 patients were enrolled, of whom 80 had a "non-severe" and 80 had a "severe" outcome. Sera were analyzed by proximity extension assay (PEA) to assess 274 unique proteins associated with inflammation, cardiometabolic, and neurologic diseases. The main clinical and hematochemical data associated with disease outcome were grouped with serological data to form a dataset for the supervised machine learning techniques. We identified nine proteins (i.e., CD200R1, MCP1, MCP3, IL6, LTBP2, MATN3, TRANCE, α2-MRAP, and KIT) that contributed to the correct classification of COVID-19 disease severity when combined with relative neutrophil and lymphocyte counts. By analyzing PEA, clinical and hematochemical data with statistical methods that were able to handle many variables in the presence of a relatively small sample size, we identified nine potential serum biomarkers of a "severe" outcome. Most of these were confirmed by literature data. Importantly, we found three biomarkers associated with central nervous system pathologies and protective factors, which were downregulated in the most severe cases.

Few-Shot Pixel-Precise Document Layout Segmentation via Dynamic Instance Generation and Local Thresholding.

Over the years, the humanities community has increasingly requested the creation of artificial intelligence frameworks to help the study of cultural heritage. Document Layout segmentation, which aims at identifying the different structural components of a document page, is a particularly interesting task connected to this trend, specifically when it comes to handwritten texts. While there are many effective approaches to this problem, they all rely on large amounts of data for the training of the underlying models, which is rarely possible in a real-world scenario, as the process of producing the ground truth segmentation task with the required precision to the pixel level is a very time-consuming task and often requires a certain degree of domain knowledge regarding the documents at hand. For this reason, in this paper, we propose an effective few-shot learning framework for document layout segmentation relying on two novel components, namely a dynamic instance generation and a segmentation refinement module. This approach is able of achieving performances comparable to the current state of the art on the popular Diva-HisDB dataset, while relying on just a fraction of the available data.

Explainable artificial intelligence model for the detection of geographic atrophy using colour retinal photographs.

OBJECTIVE: To develop and validate an explainable artificial intelligence (AI) model for detecting geographic atrophy (GA) via colour retinal photographs. METHODS AND ANALYSIS: We conducted a prospective study where colour fundus images were collected from healthy individuals and patients with retinal diseases using an automated imaging system. All images were categorised into three classes: healthy, GA and other retinal diseases, by two experienced retinologists. Simultaneously, an explainable learning model using class activation mapping techniques categorised each image into one of the three classes. The AI system's performance was then compared with manual evaluations. RESULTS: A total of 540 colour retinal photographs were collected. Data was divided such that 300 images from each class trained the AI model, 120 for validation and 120 for performance testing. In distinguishing between GA and healthy eyes, the model demonstrated a sensitivity of 100%, specificity of 97.5% and an overall diagnostic accuracy of 98.4%. Performance metrics like area under the receiver operating characteristic (AUC-ROC, 0.988) and the precision-recall (AUC-PR, 0.952) curves reinforced the model's robust achievement. When differentiating GA from other retinal conditions, the model preserved a diagnostic accuracy of 96.8%, a precision of 90.9% and a recall of 100%, leading to an F1-score of 0.952. The AUC-ROC and AUC-PR scores were 0.975 and 0.909, respectively. CONCLUSIONS: Our explainable AI model exhibits excellent performance in detecting GA using colour retinal images. With its high sensitivity, specificity and overall diagnostic accuracy, the AI model stands as a powerful tool for the automated diagnosis of GA.

Masked Transformer for Image Anomaly Localization.

Image anomaly detection consists in detecting images or image portions that are visually different from the majority of the samples in a dataset. The task is of practical importance for various real-life applications like biomedical image analysis, visual inspection in industrial production, banking, traffic management, etc. Most of the current deep learning approaches rely on image reconstruction: the input image is projected in some latent space and then reconstructed, assuming that the network (mostly trained on normal data) will not be able to reconstruct the anomalous portions. However, this assumption does not always hold. We thus propose a new model based on the Vision Transformer architecture with patch masking: the input image is split in several patches, and each patch is reconstructed only from the surrounding data, thus ignoring the potentially anomalous information contained in the patch itself. We then show that multi-resolution patches and their collective embeddings provide a large improvement in the model's performance compared to the exclusive use of the traditional square patches. The proposed model has been tested on popular anomaly detection datasets such as MVTec and head CT and achieved good results when compared to other state-of-the-art approaches.