Federated learning, ethics, and the double black box problem in medical AI

Federated learning (FL) is a machine learning approach that allows multiple devices or institutions to collaboratively train a model without sharing their local data with a third-party. FL is considered a promising way to address patient privacy concerns in medical artificial intelligence. The ethical risks of medical FL systems themselves, however, have thus far been underexamined. This paper aims to address this gap. We argue that medical FL presents a new variety of opacity -- federation opacity -- that, in turn, generates a distinctive double black box problem in healthcare AI. We highlight several instances in which the anticipated benefits of medical FL may be exaggerated, and conclude by highlighting key challenges that must be overcome to make FL ethically feasible in medicine.

An Explainable and Conformal AI Model to Detect Temporomandibular Joint Involvement in Children Suffering from Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease during childhood and adolescence. The temporomandibular joints (TMJ) are among the most frequently affected joints in patients with JIA, and mandibular growth is especially vulnerable to arthritic changes of the TMJ in children. A clinical examination is the most cost-effective method to diagnose TMJ involvement, but clinicians find it difficult to interpret and inaccurate when used only on clinical examinations. This study implemented an explainable artificial intelligence (AI) model that can help clinicians assess TMJ involvement. The classification model was trained using Random Forest on 6154 clinical examinations of 1035 pediatric patients (67% female, 33% male) and evaluated on its ability to correctly classify TMJ involvement or not on a separate test set. Most notably, the results show that the model can classify patients within two years of their first examination as having TMJ involvement with a precision of 0.86 and a sensitivity of 0.7. The results show promise for an AI model in the assessment of TMJ involvement in children and as a decision support tool.