Thread by @CincyKidsRad

Can equitable #ArtificialIntelligence be achieved without legislations? Why is @towbinaj talking about this. Find out the answer to both questions in this #SIIM23🧵

@towbinaj .@towbinaj typically has very clear objectives. This @RadiologyACR @SIIM_Tweets #DSI Summit talk is no exception #SIIM23 💪

@towbinaj @RadiologyACR @SIIM_Tweets This book was first published in 1972. Dr. @towbinaj notes that we are no closer to achieving #healthequity #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets Now, @towbinaj declares that he is going to use the Socratic method, asking and answering 11 questions to help the audience understand the ultimate answer to the question posed by his title #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets Question 1: What is equity? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets Equity has been defined as custom tools designed to address inequality #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets Question 2: What is #healthequity? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets The @CDCgov has defined #healthequity as the state in which everyone has a fair and just opportunity to attain their highest level of health. @towbinaj notes that even in this graphic, equity has not been achieved #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 3: How do we achieve #healthequity? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Per @CDCgov We achieve #healthequity by
* Addressing historical and contemporary injustices;
* Overcoming economic, social, and other obstacles to health and health care; and
* Eliminating preventable health disparities

#SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 4: Can #artificialintelligence enable equitable care? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Here, @towbinaj asks the audience to envision a no-show predictor algorithm #SIIM

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov If an insititution uses this algorithm to double-book appointments, equity is NOT achieved #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov However, if that same institution uses the no-show algorithm to call patients, offer taxi services or meals, or provide child-care, equitable care may be achieved #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 5: Can #artificialintelligence decrease #equity? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov To answer this question, @towbinaj asks the audience to envision an algorithm that triages imaging studies on a worklist. If that algorithm does not work for pediatric patients, a child with the same condition may receive less equitable care than if no algorithm were used #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 6: What are the barriers to creating equitable #artificialintelligence? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov For the most part, vendors have prioritized high return on investment algorithms. This excludes small patient populations, such as children #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 7: Does this problem exist in other industries? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov In the pharmaceutical industry, drugs were not being tested for pediatric indications. In 1997, more than 80% of approved drugs had no pediatric-specific labeling information #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 8: How have barriers to equitable care been removed? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Congress has passed a series of legislation to improve pediatric access to medications #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov This legislation has served both as a carrot and as a stick #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov The Best Pharmaceuticals for Children Act of 2002 provided a carrot. It was voluntary but extended the patent for a medication by 6 months #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov The Pediatric Research Equity Act of 2003 served as the stick. It required pediatric studies for new drugs (if a pediatric indication exists) and had a penalty for non-compliance #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov THis legislation (and others) has been successful, leading to more than 1000 changes to drug indications, improving access for children #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 9: Has legislation be enacted to prote equity for other groups? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov The #HealthyPeople2023 initiative is not legislation. However, it aims to eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all by 2030 #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov The #HealthEquity ad Accountability Act has been proposed in congress. This legislation has multiple provisions to eliminate health disparities and address social determinants of health #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 10: Are there other options besides legislation? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Per @towbinaj, #advocacy is crucial. We MUST
1. Talk to vendors.
2. Ask how their product could cause unintentional harm.
3. Test algorithms with your own data looking for unintended harm

#SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Importantly, we must keep asking questions #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov Question 11: What is the @RadiologyACR #DataScienceInstitute #DSI doing to address #healthequity in #artificialintelligence? #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov The @RadiologyACR has created the #ImageIntelliGently campaign to inform radiologists of potential inequity, encourage vendors to create pediatric #artificalintelligence, and advocate Congress and @US_FDA for guidance #SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov @US_FDA You can learn more about the #ImageIntelliGently campaign at buff.ly/3N3PbdU

#SIIM23

@towbinaj @RadiologyACR @SIIM_Tweets @CDCgov @US_FDA If you haven't watched the @RadiologyACR #imageIntelliGently video, you're missing out. Make it your #SIIM23 mission to watch AND share this content

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