Mitigating Bias in Radiology Machine Learning: 1. Data Handling
Open accessAbstract
Minimizing bias is critical to adoption and implementation of machine learning (ML) in clinical practice. Systematic mathematical biases produce consistent and reproducible differences between the observed and expected performance of ML systems, resulting in suboptimal performance. Such biases can be traced back to various phases of ML development: data handling, model development, and performance evaluation. This report presents 12 suboptimal practices during data handling of an ML study, explains how those practices can lead to biases, and describes what may be done to mitigate them. Authors employ an arbitrary and simplified framework that splits ML data handling into four steps: data collection, data investigation, data splitting, and feature engineering. Examples from the available research literature are provided. A Google Colaboratory Jupyter notebook includes code examples to demonstrate the suboptimal practices and steps to prevent them. Keywords: Data Handling, Bias, Machine Learning, Deep Learning, Convolutional Neural Network (CNN), Computer-aided Diagnosis (CAD) © RSNA, 2022
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Written from the paper’s full text.
TL;DR
This report describes 12 suboptimal data-handling practices that can introduce systematic mathematical bias into radiology machine learning studies and offers mitigation strategies. It organizes data handling into four steps—data collection, data investigation, data splitting, and feature engineering—and provides a Google Colaboratory notebook with code examples.
Key findings
- The authors identify 12 major practices during data handling that predispose ML systems to mathematical bias, spanning data collection, data investigation, data splitting, and feature engineering.
- Systematic biases produce consistent and reproducible differences between observed and expected performance, limiting real-world application; the report notes more than 8000 radiology AI publications worldwide from 2000 to 2018.
- Specific risks include single-source data, inadequate exploratory data analysis, leakage between training and test sets, imbalanced datasets, overfitting to hyperparameters, improper feature removal or scaling, and mismanagement of missing data.
- In an illustrative hip radiograph example, a 2% complication incidence among 10 000 patients yields 9800 patients without complications versus 200 with complications; with a conventional 10%–20% test holdout, only 20–40 patients with complications would be in the test set.
Methods
- Narrative methodological report/review intended for radiologists interested in ML who are not expert data scientists, using computer vision examples but noting most principles apply to other ML applications.
- The authors employ an arbitrary and simplified framework that splits ML data handling into four steps: data collection, data investigation, data splitting, and feature engineering.
- Examples are drawn from available research literature, and a Google Colaboratory Jupyter notebook includes code examples to demonstrate suboptimal practices and prevention steps.
Limitations
- The paper states that its four-step data-handling framework is arbitrary and oversimplified, and that ML systems are not developed as a linear process.
- The report states it considers only mathematical forms of bias, not social and ethical forms, and is not an exhaustive list of problems or solutions; bias mitigation strategies are problem specific and may be unnecessary or inappropriate in some situations.
- The paper also states that not all bias-prone practices can be easily replaced or improved, and some biases may be tolerated or even helpful depending on data and task; as evident from the text, this is a conceptual review without an empirical sample or systematic review methodology.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
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- Premisecitation§ Introduction
Models may not generalize well if training data are collected from a single source.
“Models may not generalize well if training data are collected from a single source (15).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] 15. Doshi-Velez F , Kim B . Considerations for Evaluation and Generalization in Interpretable Machine Learning . In: Escalante HJ , Escalera S , Guyon I , et al. , eds. Explainable and Interpretable Models in Computer Vision and Machine Learning. The Springer Series on Challenges in Machine Learning . Cham, Switzerland: : Springer; , 2018. ; 3 – 17 . [Google Scholar] source
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- Interpretationnone given§ Abstract
Twelve major practices during data handling predispose machine learning systems to mathematical bias.
“This report describes 12 major practices during data handling that predispose machine learning systems to mathematical bias.”
Quote in the paperSubstantial claim - Premisecitation§ Introduction
Discussion of proper data handling in existing guidelines for machine learning system development is often insufficient.
“Although several guidelines exist for the proper development of ML systems, discussion of proper data handling is often insufficient (8,9).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] 8. Kumar A , Boehm M , Yang J . Data Management in Machine Learning: Challenges, Techniques, and Systems . In: Proceedings of the 2017 ACM International Conference on Management of Data . New York, NY: : Association for Computing Machinery; , 2017. ; 1717 – 1722 . [Google Scholar] source
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- Premisecitation§ Introduction
Training a model on multiple data types may improve the performance of machine learning systems.
“Training a model on multiple data types may improve the performance of ML systems (14).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] 14. Huang S-C , Pareek A , Seyyedi S , Banerjee I , Lungren MP . Fusion of medical imaging and electronic health records using deep learning: a systematic review and implementation guidelines . NPJ Digit Med 2020. ; 3 ( 1 ): 136 . [DOI] [PMC free article] [PubMed] [Google Scholar] source
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- Premisecitation§ Abstract
Systematic mathematical biases produce consistent and reproducible differences between the observed and expected performance of machine learning systems, resulting in suboptimal performance.
“Systematic mathematical biases produce consistent and reproducible differences between the observed and expected performance of ML systems, resulting in suboptimal performance.”
- Also stated in: § Introduction · plain
“systematic bias produces consistent and reproducible differences between observed and expected performance (4).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4] 4. Krishna R , Maithreyi R , Surapaneni KM . Research bias: a review for medical students . J Clin Diagn Res 2010. ; 4 ( 2 ): 2320 – 2324 . https://www.jcdr.net/article_abstract.aspx?issn=0973-709x&year=2010&volume=4&issue=2&page=2320%20-%202324&issn=0973-709x&id=677 . [Google Scholar]
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- Also stated in: § Introduction · plain
- Premisecitation§ Introduction
Suboptimal quality of clinical data often limits the performance of machine learning algorithms.
“Suboptimal quality of clinical data often limits the performance of ML algorithms (6,7).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [6] 6. Wang F , Casalino LP , Khullar D . Deep Learning in Medicine-Promise, Progress, and Challenges . JAMA Intern Med 2019. ; 179 ( 3 ): 293 – 294 . [DOI] [PubMed] [Google Scholar] source
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- Premisecitation§ Introduction
Overlap of specific patients and images in public datasets, the Frankenstein problem, means real-world performance is poorer than measured.
“It is also critical to make sure that there is no overlap of specific patients and images in public datasets, the so-called Frankenstein problem, where one public set is used to train a model and another is used to validate, but the presence of the same case in both sets means the real-world performance is poorer than measured (26).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [26] 26. Roberts M , Driggs D , Thorpe M , et al . Common pitfalls and recommendations for using machine learning to detect and prognosticate for COVID-19 using chest radiographs and CT scans . Nat Mach Intell 2021. ; 3 ( 3 ): 199 – 217 . [Google Scholar]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Introduction
Data from a single source may not sample the full data distribution in the real world.
“Data from a single source may not sample the full data distribution in the real world.”
Quote in the paperSubstantial claim - Premisecitation§ Introduction
Feeding redundant data may hinder training by adding unnecessary complexity.
“feeding redundant data may hinder training by adding unnecessary complexity (11).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] 11. Ohno-Machado L , Fraser HS , Ohrn A . Improving machine learning performance by removing redundant cases in medical data sets . Proc AMIA Symp 1998. ; 523 – 527 . [PMC free article] [PubMed] [Google Scholar]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationnone given§ Introduction
Failing to collect all available data predisposes trained models to additional biases.
“Conversely, failing to collect all available data predisposes trained models to additional biases.”
Quote in the paperNot a substantial claim - Interpretationcitation§ Introduction
Collection of data from a single point in time can introduce data drift because hardware and software scanner upgrades, disease incidence and appearance changes, and new treatments may alter image appearance.
“Another less recognized “single source” issue is collection of data from a single point in time. Hardware and software scanner upgrades may alter image appearance. Disease incidence and appearance change with time, and new treatments may affect the appearance. Although the input data to ML systems may remain homogeneous over time, potential data drift should be anticipated (17).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] 17. Guo X , Gichoya JW , Trivedi H , Purkayastha S , Banerjee I . MedShift: identifying shift data for medical dataset curation . arXiv 2112.13885 [preprint] http://arxiv.org/abs/2112.13885. Posted December 27, 2021. Accessed October 2021 . [DOI] [PMC free article] [PubMed] source
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- Interpretationreasoning§ Introduction
A random train-test split at the image level will result in biased training when data are clustered, such as multiple images per patient.
“In such a scenario, a random train-test split at the image level will result in biased training.”
Quote in the paperSubstantial claim - Premisecitation§ Introduction
There is a risk that developers may gradually find hyperparameters that work best on their test set but are not necessarily generalizable to other unseen data.
“Therefore, there is a risk that developers may gradually find the hyperparameters that work best on their test set but are not necessarily generalizable to other unseen data (44).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [44] 44. Cawley GC , Talbot NLC . On Over-Fitting in Model Selection and Subsequent Selection Bias in Performance Evaluation . J Mach Learn Res 2010. ; 11 ( 70 ): 2079 – 2107 . https://jmlr.org/papers/v11/cawley10a.html . [Google Scholar]
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- Interpretationreasoning§ Introduction
Systematic biases can reduce the fairness of machine learning systems.
“Systematic biases can reduce the fairness of ML systems”
Quote in the paperNot a substantial claim - Interpretationreasoning§ Introduction
Each step of data handling, model development, and performance evaluation may introduce systematic or random bias.
“Each of these steps may introduce systematic or random bias.”
Quote in the paperNot a substantial claim - Interpretationreasoning§ Introduction
Splitting medical data at the patient level is the standard way to prevent data leakage.
“The standard way to prevent data leakage is to split medical data at the patient level.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Introduction
When training and test sets consist of data from different patients, developers can be more assured that their models will not have a chance to find similar noise between the sets.
“When training and test sets consist of data from different patients, developers can be more assured that their models will not have a chance to find similar noise between the sets.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Introduction
Using k-fold cross-validation is typically better than using conventional train-test data splitting, specifically when dealing with small and imbalanced datasets.
“Using k-fold cross-validation is typically better than using the conventional train-test data splitting, specifically when dealing with small and imbalanced datasets.”
Quote in the paperNot a substantial claim- Rests on an assumption: Medical datasets are substantially smaller than most nonmedical datasets.
- Rests on an assumption: Available medical data may have imbalanced distribution based on several variables.
- Premisecitation§ Introduction
Underrepresented groups may receive more or fewer diagnostic and treatment options than necessary.
“They may even receive more or fewer diagnostic and treatment options than necessary (52).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [52] 52. Pierson E , Cutler DM , Leskovec J , Mullainathan S , Obermeyer Z . An algorithmic approach to reducing unexplained pain disparities in underserved populations . Nat Med 2021. ; 27 ( 1 ): 136 – 140 . [DOI] [PubMed] [Google Scholar]
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- Interpretationcitation§ Introduction
How missing data are handled affects bias and fairness in ML.
“While discussing why missing data exists in ML is outside the scope of this report, how missing data are handled does affect bias and fairness.”
Quote in the paperSubstantial claim- Rests on an assumption: All real-world data are likely to have missing data.
- Interpretationreasoning§ Introduction
Suboptimal practices during feature engineering can make ML models prone to underfitting and bias.
“Because of the complicated nature of feature engineering, suboptimal practices can occur during feature engineering and make the ML models prone to underfitting and bias.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Introduction
Even splitting based on series or study levels is not sufficient to prevent data leakage.
“Even splitting based on series or study levels is not sufficient to prevent data leakage.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Introduction
Data may leak even if developers ensure that no data are repeated in both training and test sets because medical data are usually clustered at different levels.
“Data may “leak,” even if developers ensure that no data are repeated in both training and test sets because medical data are usually clustered at different levels.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Introduction
Whether the assumption that removing noise from data enables easier fitting is valid depends on the input data, the algorithm, and the task.
“Whether this assumption is valid depends on the input data, the algorithm, and the task at hand.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 21
- May combine two claims. 17
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Premisenone given§ AbstractBiases in machine learning systems can be traced back to various phases of machine learning development: data handling, model development, and performance evaluation.
“Such biases can be traced back to various phases of ML development: data handling, model development, and performance evaluation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
Premisecitation§ IntroductionHuman-labeled annotations require a clear protocol and measurement of intra- and interannotator reliability to reduce recall, observer, or measurement biases.
“Human-labeled annotations (eg, segmentation masks or bounding boxes) require a clear protocol and measurement of intra- and interannotator reliability to reduce recall, observer, or measurement biases (24).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] 24. Mongan J , Moy L , Kahn CE Jr . Checklist for Artificial Intelligence in Medical Imaging (CLAIM): A Guide for Authors and Reviewers . Radiol Artif Intell 2020. ; 2 ( 2 ): e200029 . [DOI] [PMC free article] [PubMed] [Google Scholar] source
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Premisecitation§ IntroductionIncorporation of domain expertise can enrich exploratory data analysis.
“Incorporation of domain expertise can enrich EDA (34).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34] 34. Langer T , Meisen T . Towards Utilizing Domain Expertise for Exploratory Data Analysis . In: Proceedings of the 12th International Symposium on Visual Information Communication and Interaction . New York, NY: : Association for Computing Machinery; ; 2019. ; 1 – 5 . [Google Scholar]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ IntroductionPublic datasets may be prone to biases and may not represent or report the age, race, or sex of the original population.
“Public datasets may be prone to biases and may not represent or report the age, race, or sex of the original population (25).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25] 25. Garcia Santa Cruz B , Bossa MN , Sölter J , Husch AD . Public Covid-19 X-ray datasets and their impact on model bias - A systematic review of a significant problem . Med Image Anal 2021. ; 74 : 102225 . [DOI] [PMC free article] [PubMed] [Google Scholar] source
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Premisecitation§ IntroductionChest radiograph classifiers trained on publicly available datasets may have multiple racial, sex, and socioeconomic biases that reflect the patient distribution in their training data, resulting in poor generalizability.
“For example, chest radiograph classifiers trained on publicly available datasets may have multiple racial, sex, and socioeconomic biases that reflect the patient distribution in their training data (16), resulting in poor generalizability.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [16] 16. Seyyed-Kalantari L , Liu G , McDermott M , Chen IY , Ghassemi M . CheXclusion: Fairness gaps in deep chest X-ray classifiers . Pac Symp Biocomput 2021. ; 26 : 232 – 243 . [PubMed] [Google Scholar] source
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Interpretationreasoning§ IntroductionMedical data for underrepresented groups may be less available and ignored or misinterpreted by ML systems that have not addressed missing values properly during training, resulting in prejudice and selection biases.
“Therefore, the medical data for such underrepresented groups may be less available and ignored (or interpreted mistakenly) by ML systems that have not addressed missing values properly during training, resulting in prejudice and selection biases.”
Quote in the paperSubstantial claim- Rests on an assumption: All real-world data are likely to have missing data.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationreasoning§ IntroductionData split at levels higher than the patient level, such as institution level, may be beneficial if there are consistent differences in how a hospital handles patient scans.
“Finally, there are instances where data split at levels higher than the patient level may be beneficial. For example, if there are consistent differences in how a hospital handles patient scans, it may be valuable to separate data at the institution level.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ IntroductionUnrecognized bias may contribute to suboptimal results.
“Unrecognized bias may contribute to suboptimal results.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ IntroductionNormalization may amplify noise in features with almost constant values, and standardization can significantly distort data values in the presence of outliers.
“As with other examples, normalization may amplify the noise in features with almost constant values, and standardization can significantly distort data values in the presence of outliers (48).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [48] 48. Cendrero SM . Warning About Normalizing Data . business.blogthinkbig.com. https://business.blogthinkbig.com/warning-about-normalizing-data/. Published 2018. Accessed October 2021 .
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Premisecitation§ IntroductionRemoving all patients with missing data can result in bias and fairness issues, including exacerbating small or imbalanced datasets and worse model performance on underrepresented populations.
“This approach can result in bias and fairness issues, as (a) removal of cases may exacerbate the problem of small or imbalanced datasets, and (b) the missing data are not random and more commonly affects a specific population of patients; thus, the final model’s performance may be significantly worse on underrepresented populations (53,54).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [53] 53. Schafer JL , Graham JW . Missing data: our view of the state of the art . Psychol Methods 2002. ; 7 ( 2 ): 147 – 177 . [PubMed] [Google Scholar]
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- cites [54] 54. Johnson DR , Young R . Toward best practices in analyzing datasets with missing data: Comparisons and recommendations . J Marriage Fam 2011. ; 73 ( 5 ): 926 – 945 . [Google Scholar]
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Premisecitation§ IntroductionSome ML repositories may have more than 40% of data missing.
“In fact, some ML repositories may have more than 40% of data missing (49).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] 49. Dua D , Graff C . UCI Machine Learning Repository . http://archive.ics.uci.edu/ml. Published 2017. Accessed October 2021.
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Interpretationnone given§ ConclusionML systems may be biased in different ways.
“Limitations do exist in ML studies, and ML systems may be biased in different ways.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning§ IntroductionObserving the data itself, rather than only its statistical properties, often provides new insights.
“While we already described several statistical measures to evaluate input data, observing the data itself (and not its statistical properties) often provides new insights.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationreasoning§ IntroductionFeature scaling techniques can result in poorer fit and even bias if misapplied.
“Although these techniques are applied to improve model fit and generalizability, they can result in poorer fit, and even bias, if misapplied.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationnone given§ ConclusionBias mitigation strategies are problem specific, and certain strategies may be unnecessary or inappropriate in specific situations.
“Additionally, bias mitigation strategies are problem specific, and certain strategies described above may be unnecessary or even inappropriate in specific situations.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
Premisecitation§ ConclusionDepending on the data and task, biases in ML systems could be tolerated or even considered helpful.
“Depending on the data and task at hand, such biases could be tolerated or even considered helpful (58).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [58] 58. Pot M , Kieusseyan N , Prainsack B . Not all biases are bad: equitable and inequitable biases in machine learning and radiology . Insights Imaging 2021. ; 12 ( 1 ): 13 . [DOI] [PMC free article] [PubMed] [Google Scholar] Articles from Radiology: Artificial Intelligence are provided here courtesy of Radiological Society of North America
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Premisecitation§ IntroductionMissing data may not be evenly distributed, leading to unwanted effects on the fairness of the data and the resulting models.
“Previous research has shown that missing data may not be evenly distributed, leading to unwanted effects on the fairness of the data and the resulting models (50).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [50] 50. Martínez-Plumed F , Ferri C , Nieves D , Hernández-Orallo J . Missing the missing values: The ugly duckling of fairness in machine learning . Int J Intell Syst 2021. ; 36 ( 7 ): 3217 – 3258 . [Google Scholar]
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Premisecitation§ IntroductionBoth k-fold cross-validation and nested cross-validation are prone to methodologic biases and may not always be feasible.
“It should be noted that both the k-fold cross-validation and nested cross-validation approaches are prone to methodologic biases and may not be always feasible; therefore, specific guidelines must be followed to obtain their most reliable performance (46).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [46] 46. Zheng A , Casari A . Feature Engineering for Machine Learning: Principles and Techniques for Data Scientists . Sebastopol, Calif: : O’Reilly Media; , 2018. . [Google Scholar]
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Premisecitation§ IntroductionUnderrepresented groups may be reluctant to provide sensitive information on medical or demographic questionnaires and are more likely to miss follow-up medical visits.
“For example, underrepresented groups may be reluctant to provide sensitive information on medical or demographic questionnaires and are more likely to miss follow-up medical visits (51).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [51] 51. Gilbert DT , Fiske ST , Lindzey G . The Handbook of Social Psychology . Boston, Mass: : McGraw-Hill; , 1998. . [Google Scholar]
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Interpretationnone given§ IntroductionTree-based ML algorithms do not consider the scale of the data and often do not need feature scaling.
“For example, ML algorithms such as tree-based models do not consider the scale of the data and often do not need feature scaling.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ IntroductionUsing k-fold cross-validation ensures that data from each patient with complications have been used once to evaluate the model's performance.
“Using k-fold cross-validation in our example, developers can ensure that the data from each of the 200 patients with complications have been used once to evaluate the model’s performance.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationreasoning§ IntroductionIn a conventional train-test split with 10%-20% held out, a highly imbalanced dataset can yield a test set with too few patients with the outcome to be representative, so reported model performance may not generalize to real-world data.
“there is a substantial risk that the few patients with complications from the test set are not representative of the population. Therefore, developers cannot rely on the reported model performance applied to their test set, as it may not generalize to the real-world data.”
Quote in the paperSubstantial claim- Rests on an assumption: Medical datasets are substantially smaller than most nonmedical datasets.
- Rests on an assumption: Available medical data may have imbalanced distribution based on several variables.
- Rests on an assumption: The causes of imbalance in medical datasets go beyond machine learning and may pertain to population-level frequencies or patient recruitment protocols.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone given§ ConclusionAddressing social and ethical biases often needs political decisions and time-consuming changes in stakeholders' behaviors.
“Addressing such biases often needs political decisions and time-consuming changes in stakeholders’ behaviors.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationreasoning§ IntroductionAs k models have been trained on different data, it is more likely that their mean performance is generalizable to real-world data, particularly if the variance is low.
“Also, as the k models have been trained on different data, it is more likely that their mean performance is generalizable to real-world data, particularly if the variance is low.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ IntroductionNested cross-validation is a variant of k-fold cross-validation that aims to address overfitting to hyperparameters.
“Nested cross-validation is a variant of the k-fold cross-validation technique that tries to address the issue of overfitting to the hyperparameters (45).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [45] 45. Varma S , Simon R . Bias in error estimation when using cross-validation for model selection . BMC Bioinformatics 2006. ; 7 ( 1 ): 91 . [DOI] [PMC free article] [PubMed] [Google Scholar]
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Interpretationnone given§ ConclusionNot all bias-prone practices in ML can be easily replaced or improved.
“Finally, not all bias-prone practices in ML can be easily replaced or improved.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone given§ ConclusionSocial and ethical forms of bias can harm underrepresented groups or benefit those with more resources.
“Social and ethical forms of bias can harm underrepresented groups or benefit those with more resources.”
Quote in the paperNot a substantial claimMay combine two claims.
Premisecitation§ IntroductionSome imputation techniques, especially those using predictive ML, may amplify algorithmic bias, but imputation generally improves model performance while maintaining fairness.
“While some imputation techniques (especially those that use predictive ML) may amplify algorithmic bias in the data, they generally improve the model’s performance while maintaining its fairness (50).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] 50. Martínez-Plumed F , Ferri C , Nieves D , Hernández-Orallo J . Missing the missing values: The ugly duckling of fairness in machine learning . Int J Intell Syst 2021. ; 36 ( 7 ): 3217 – 3258 . [Google Scholar]
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Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone given§ IntroductionStandardization is more effective when feature values have an almost Gaussian distribution and the ML algorithm assumes normal distribution, whereas normalization does not have this limitation.
“For example, standardization is more effective if the feature values have an almost Gaussian distribution, and the ML algorithm assumes the distribution of data to be normal. Normalization, on the other hand, does not have this limitation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Interpretationreasoning§ IntroductionNormalization is more appropriate for algorithms like k-nearest neighbors and artificial neural networks, while standardization works better for regression algorithms.
“Therefore, while normalization is more appropriate for algorithms like k-nearest neighbors and artificial neural networks, standardization works better for regression algorithms.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
Premisecitation§ IntroductionThe quality of an exploratory data analysis depends on the ability of developers to ask the right questions and detect patterns based on cognitive ability, domain expertise, and experience in data interpretation.
“In fact, the quality of an EDA depends on the ability of the developers to ask the right questions and detect patterns within the data based on their cognitive ability, domain expertise, and experience in data interpretation (35).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [35] 35. Grolemund G , Wickham H . A Cognitive Interpretation of Data Analysis . Int Stat Rev 2014. ; 82 ( 2 ): 184 – 204 . [Google Scholar]
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Interpretationnone given§ IntroductionMost principles of data handling for computer vision machine learning are applicable to other machine learning applications such as natural language processing or tabular data analysis.
“however, most of the principles are applicable to other ML applications such as natural language processing or tabular data analysis.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Medical datasets are substantially smaller than most nonmedical datasets.
“the size of medical datasets is substantially smaller than most nonmedical datasets (eg, ImageNet)”
The paper relies on this without support.
Available medical data may have imbalanced distribution based on several variables.
“even the available data may have imbalanced distribution based on several variables”
The paper relies on this without support.
The causes of imbalance in medical datasets go beyond machine learning and may pertain to population-level frequencies or patient recruitment protocols.
“The causes of this imbalance go beyond ML and may pertain to population-level frequencies or patient recruitment protocols.”
The paper relies on this without support.
All real-world data are likely to have missing data.
“All real-world data are likely to have missing data.”
The paper relies on this without support.
ML models do not necessarily learn as humans do.
“Another problem with that assumption is that ML models do not necessarily learn as humans do.”
The paper relies on this without support.
What is considered noise to developers may be a source of valuable signal data for models.
“What is considered noise to developers may be a source of valuable signal data for models.”
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“31 35 To correct for any identified biases, mitigation measures should be tested, such as data resampling, bias free representations, and equalised odds postprocessing, 36-40 to verify their impact on both the tool’s fairness and the model’s accuracy.”
AI pitfalls and what not to do: mitigating bias in AI
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“There are different techniques to internally test an ML model, for example, simple train-validation-test split, cross-validation, and nested cross-validation (15).”
MethodSelf-citationAI in Pathology: What could possibly go wrong?
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“75 If available data sets are found to be imbalanced in the distribution of key variables, rebalancing may be needed.”
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Hanneman, K., Playford, D., Dey, D., van Assen, M., Mastrodicasa, D., Cook, T. S., Gichoya, J. W., Williamson, E. E., Rubin, G. D., & on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention; and Council on Lifelong Congenital Heart Disease and Heart Health in the Young (2024) · Circulation · doi:10.1161/cir.0000000000001202 · Cited by 72 · see citing works
“69 Systematic data-handling biases include spectrum bias, in which the population in the data set does not resemble the population to which the model is applied, and recall bias, in which similar data are not consistently labeled.”
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“These approaches cover biases in fields such as healthcare data from clinician interactions, hiring and promotion, 37 imaging, 38 text classification, 39 and transportation, 40 among others.”
A Current Review of Generative AI in Medicine: Core Concepts, Applications, and Current Limitations
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“• Bias introduction: If not carefully implemented, data minimization could inadvertently introduce bias by selectively removing certain types of data [37].”
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“For each fold, we trained three models with different random weight initializations and used majority voting as the model ensemble strategy for final predictions [38].”
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Self-citationPitfalls and Best Practices in Evaluation of AI Algorithmic Biases in Radiology
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“85 Training a model on imbalanced data sets, leads to unfair or false decisions about under-represented populations.”
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“Given that bias at one stage can propagate to subsequent stages, it is crucial for researchers to continually generate and use diverse and representative datasets (17).”
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Implications of Bias in Artificial Intelligence: Considerations for Cardiovascular Imaging
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“[52] Addressing biases in datasets and ensuring model fairness is essential for equitable healthcare.”
Generating Diagnostic and Actionable Explanations for Fair Graph Neural Networks
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Self-citationDetecting Common Sources of AI Bias: Questions to Ask When Procuring an AI Solution
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Best Practices for the Safe Use of Large Language Models and Other Generative AI in Radiology
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“Moreover, through the establishment of robust and representative pixel frequency tables, this preprocessing method could potentially mitigate systematic biases related to demographics, disease representation, and data management [33, 34].”
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“Generative AI models, which create new synthetic data based on patterns learned from real data sets, offer a novel approach to understanding disparities in medical imaging data sets [9].”
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Machine Learning in Cardiovascular Imaging: A Scoping Review of Published Literature
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The Evolving Role of Artificial Intelligence in Gastrointestinal Histopathology: An Update
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Self-citationApplication of Natural Language Processing in Total Joint Arthroplasty: Opportunities and Challenges
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Self-citationArtificial Intelligence in Radiology: Overview of Application Types, Design, and Challenges
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A survey of Paediatric Radiology Artificial IntelligencePreprint
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“Quality labels are instrumental for training and evaluating deep learning models [38].”
Self-citationA Stepwise Approach to Analyzing Musculoskeletal Imaging Data With Artificial Intelligence
Mickley, J. P., Grove, A. F., Rouzrokh, P., Yang, L., Larson, A. N., Sánchez‐Sotelo, J., Kremers, H. M., & Wyles, C. C. (2023) · Arthritis Care & Research · doi:10.1002/acr.25260 · Cited by 6 · see citing works
“48 If one patient has 10 different x-rays, ensure that all 10 of the x-rays are in either the training, validation, or testing sets and not spread between all of them.”
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“A bias in the training data would translate into a biased model, leading to performance disparities across diverse populations [66].”
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“15,16 This can occur with changes in the patient population, scanners, imaging protocols, or a variety of other scenarios.”
AI for Radiology: A Primer Part I. From Idea to Algorithm
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Machine Learning and Deep Learning in Cardiothoracic Imaging: A Scoping Review
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Educational Overview of the Concept and Application of Computer Vision in Arthroplasty
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Self-citationUnderstanding Bias in Artificial Intelligence: A Practice Perspective
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Self-citationBias in Artificial Intelligence: Impact on Breast Imaging
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Add-Remove-or-Relabel: Practitioner-Friendly Bias Mitigation via Influential Fairness
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“Concerns have arisen with respect to image recognition and object detection [20, 112], health assessment [40, 80, 90], advertisement systems [21, 42, 69, 109], and others [5, 19, 78].”
BackgroundIdentifying Patients with CSF-Venous Fistula Using Brain MRI: A Deep Learning Approach
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“Cross-validation of the fi nal model was performed on all seven groups to determine robustness of the results [16].”
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A pipeline to further enhance quality, integrity and reusability of the NCCID clinical data
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Self-citationData Foundations for Trustworthy AI in Dentistry
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De-Biased Disentanglement Learning for Pulmonary Embolism Survival Prediction on Multimodal Data
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“The recent uptick in AI applications to healthcare has raised attention to the issue of potential bias, revealing gaps in understanding regarding model implementation and effectiveness [5], [6].”
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“9,10 Computed tomography images were resampled to achieve 1 (cid”
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The Era of Artificial Intelligence in Radiology: How to Prepare for a Different Future
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“39 Given our initial pretraining phase involving 450 cases, it was our supposition that including an additional 35 cases featuring different imaging protocols would suf fi ciently help the model learn the distinct features of each data set.”
Self-citationMIDRC mRALE Mastermind Grand Challenge: AI to predict COVID severity on chest radiographs
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“The method has another advantage in that it addresses the problem of under-sampling in relevant data areas [5-10].”
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Clinical Validation in AI for Healthcare: An Experiential Learning
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Can AI developers avoid bias in public health applications?
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“Monitoring is another key theme, with emphasis on the need for developers to regularly evaluate algorithm performance during the design and implementation stages (20, 24).”
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Clinical Applications of Artificial Intelligence in Cardiovascular Imaging: Where Do We Stand?
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Ethics, Bias Mitigation, and Model Risk Management
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“Many note that developers should regularly monitor algo - rithms to assess performance throughout the design and implementation stages, including comparing performance across different demographic groups [ 26 , 48 , 55 ].”
- Authors
- Rouzrokh, P., Khosravi, B., Faghani, S., Moassefi, M., Vera Garcia, D. V., Singh, Y., Zhang, K., Conte, G. M., & Erickson, B. J.
- Affiliations
- Mayo Clinic (US)
- From the Radiology Informatics Laboratory, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905.
- ORCID
- Venue
- Radiology: Artificial Intelligence
- Published
- 2022-09-01
- Volume
- 4
- Issue
- 5
- Pages
- e210290-e210290
- ISSN
- 2638-6100 (ISSN-L)
- PMC
- PMC9533091
- OpenAlex
- W4292958735
- Semantic Scholar
- caaf3277faea39df66b92d950b3a5b406f1d2310
- Cited by
- 145
- References
- 40
- Citations by year
- 2026: 33 · 2025: 35 · 2024: 43 · 2023: 27 · 2022: 7
- FWCI
- 8.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Radiology Artificial Intelligence (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Social Sciences › Safety Research › Ethics and Social Impacts of AI
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Keywords
- algorithmic bias, bias mitigation, data handling, data collection, data partitioning, feature engineering, computer-aided diagnosis, convolutional neural networks, deep learning, performance evaluation
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