RAIS-DR系统提升糖尿病视网膜病变筛查准确率与公平性,适合临床落地。
Design and Validation of a Responsible Artificial Intelligence-based System for the Referral of Diabetic Retinopathy Patients
- 融合预处理、质量评估与三类分类模型,全流程责任化AI设计
- 在1046例患者上较EyeArt系统提升6%-19%准确率,特异性提高10%-20%
- 跨人群公平性优异,助力减少医疗资源不平等
糖尿病视网膜病变(DR)是工作人群失明的主要原因。早期发现可降低95%的失明风险,但眼科医生短缺和及时检查困难限制了检测。基于眼底照相(RFPs)的AI模型提供潜在解决方案,但低质量数据与偏差可能导致系统学习非预期特征,阻碍临床应用。为此,我们开发了负责任AI系统RAIS-DR,贯穿AI生命周期融入伦理原则。该系统整合高效卷积模型,用于预处理、质量评估及三类专用DR分类。我们在本地1,046名患者数据集上评估其性能,该数据集对两系统均未见过。相较于FDA批准的EyeArt系统,RAIS-DR在F1分数上提升5%-12%,准确率提升6%-19%,特异性提升10%-20%。公平性指标如差异影响与平等机会差值显示,其在不同人口子群体中表现均衡,凸显其降低医疗不平等的潜力。结果表明,RAIS-DR是临床场景下鲁棒且符合伦理的DR筛查方案。代码与模型权重已公开于https://gitlab.com/inteligencia-gubernamental-jalisco/jalisco-retinopathy,附带RAIL工具。
原文摘要 · Abstract (English)
Diabetic Retinopathy (DR) is a leading cause of vision loss in working-age individuals. Early detection of DR can reduce the risk of vision loss by up to 95%, but a shortage of retinologists and challenges in timely examination complicate detection. Artificial Intelligence (AI) models using retinal fundus photographs (RFPs) offer a promising solution. However, adoption in clinical settings is hindered by low-quality data and biases that may lead AI systems to learn unintended features. To address these challenges, we developed RAIS-DR, a Responsible AI System for DR screening that incorporates ethical principles across the AI lifecycle. RAIS-DR integrates efficient convolutional models for preprocessing, quality assessment, and three specialized DR classification models. We evaluated RAIS-DR against the FDA-approved EyeArt system on a local dataset of 1,046 patients, unseen by both systems. RAIS-DR demonstrated significant improvements, with F1 scores increasing by 5-12%, accuracy by 6-19%, and specificity by 10-20%. Additionally, fairness metrics such as Disparate Impact and Equal Opportunity Difference indicated equitable performance across demographic subgroups, underscoring RAIS-DR's potential to reduce healthcare disparities. These results highlight RAIS-DR as a robust and ethically aligned solution for DR screening in clinical settings. The code, weights of RAIS-DR are available at https://gitlab.com/inteligencia-gubernamental-jalisco/jalisco-retinopathy with RAIL.
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