Cited by 403Artificial Intelligence in Healthcare and EducationCutaneous Melanoma Detection and ManagementEthics and Social Impacts of AI

Lack of Transparency and Potential Bias in Artificial Intelligence Data Sets and Algorithms: A Scoping Review

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Daneshjou, Roxana, Smith, Mary P., Sun, Mary D., Rotemberg, Veronica, Zou, James·2021·JAMA Dermatology

Abstract

IMPORTANCE: Clinical artificial intelligence (AI) algorithms have the potential to improve clinical care, but fair, generalizable algorithms depend on the clinical data on which they are trained and tested. OBJECTIVE: To assess whether data sets used for training diagnostic AI algorithms addressing skin disease are adequately described and to identify potential sources of bias in these data sets. DATA SOURCES: In this scoping review, PubMed was used to search for peer-reviewed research articles published between January 1, 2015, and November 1, 2020, with the following paired search terms: deep learning and dermatology, artificial intelligence and dermatology, deep learning and dermatologist, and artificial intelligence and dermatologist. STUDY SELECTION: Studies that developed or tested an existing deep learning algorithm for triage, diagnosis, or monitoring using clinical or dermoscopic images of skin disease were selected, and the articles were independently reviewed by 2 investigators to verify that they met selection criteria. CONSENSUS PROCESS: Data set audit criteria were determined by consensus of all authors after reviewing existing literature to highlight data set transparency and sources of bias. RESULTS: A total of 70 unique studies were included. Among these studies, 1 065 291 images were used to develop or test AI algorithms, of which only 257 372 (24.2%) were publicly available. Only 14 studies (20.0%) included descriptions of patient ethnicity or race in at least 1 data set used. Only 7 studies (10.0%) included any information about skin tone in at least 1 data set used. Thirty-six of the 56 studies developing new AI algorithms for cutaneous malignant neoplasms (64.3%) met the gold standard criteria for disease labeling. Public data sets were cited more often than private data sets, suggesting that public data sets contribute more to new development and benchmarks. CONCLUSIONS AND RELEVANCE: This scoping review identified 3 issues in data sets that are used to develop and test clinical AI algorithms for skin disease that should be addressed before clinical translation: (1) sparsity of data set characterization and lack of transparency, (2) nonstandard and unverified disease labels, and (3) inability to fully assess patient diversity used for algorithm development and testing.

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  • Fewer studies have concentrated specifically on the implications and consequences of biased AI in healthcare.

    “Fewer studies have concentrated specifically on the implications and consequences of biased AI in healthcare [19–22].”
  • Existing reviews differ in scope, depth, and focus, leaving a gap in understanding how bias permeates the development of AI for clinical decisions.

    “While these reviews have made valuable contributions to our understanding of bias in medical AI, they differ in scope, depth, and focus, leaving a gap in understanding how bias permeates the development of AI for clinical decisions.”
  • Bias in AI algorithms can manifest as selection or information bias, potentially leading to unfair and inaccurate outcomes.

    “This bias in AI algorithms can manifest in various ways such as selection or information bias, potentially leading to unfair and inaccurate outcomes [10].”

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Research works printed but not linked: 4

  1. [3]Holland S, Hosny A, Newman S, Joseph J, Chmielinski K. The dataset nutrition label: a framework to drive higher data quality standards. arXiv. Preprint posted online May 9, 2018. 1805.03677.
  2. [4]Gebru T, Morgenstern J, Vecchione B, Datasheets for datasets. arXiv. Preprint posted online March 19, 2020. 1803.09010.
  3. [5]Deng J, Dong W, Socher R, Li L-J, Li K, Fei-Fei L. ImageNet: a large-scale hierarchical image database. In: 2009 IEEE Conference on Computer Vision and Pattern Recognition. IEEE; 2009: 248– 255.
  4. [85]Kinyanjui NM, Odonga T, Cintas C, Estimating skin tone and effects on classification performance in dermatology datasets. Paper presented at: NeurIPS 2019 Workshop on Fair ML for Health; Vancouver, Canada; 2019.

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Authors
Daneshjou, R., Smith, M. P., Sun, M. D., Rotemberg, V., & Zou, J.
Affiliations
  • Stanford Medicine (US)
  • Memorial Sloan Kettering Cancer Center (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • Chan Zuckerberg Biohub San Francisco (US)
Venue
JAMA Dermatology
Published
2021-11-01
Volume
157
Issue
11
Pages
1362
ISSN
2168-6068 (ISSN-L)
OpenAlex
W3199500316
Cited by
403
References
94
Citations by year
2026: 97 · 2025: 132 · 2024: 89 · 2023: 61 · 2022: 20 · 2021: 4
FWCI
3.59
Type
journal article
Language
en
Open access
Locations
  • JAMA Dermatology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (U01MH098953)
  • National Cancer Institute (P30CA008748)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32AR007422)
Topics
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
  • Social Sciences › Safety Research › Ethics and Social Impacts of AI
Keywords
clinical AI, skin diseases, dermoscopic images, deep learning, training data transparency, algorithmic bias, skin cancer diagnosis, patient diversity, skin tone, algorithmic fairness
MeSH terms
Algorithms, Artificial Intelligence, Humans, Neoplasms, Triage

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