A Systematic review of ‘Fair’ AI model development for image classification and prediction

Background Artificial Intelligence (AI) models have demonstrated expert-level performance in image-based recognition and diagnostic tasks, resulting in increased adoption and FDA approvals for clinical applications. The new challenge in AI is to understand the limitations of models to reduce potential harm. Particularly, unknown disparities based on demographic factors could encrypt currently existing inequalities worsening patient care for some groups. Method Following PRISMA guidelines, we present a systematic review of ‘fair’ deep learning modeling techniques for natural and medical image applications which were published between year 2011 to 2021. Our search used Covidence review management software and incorporates articles from PubMed, IEEE, and ACM search engines and three reviewers independently review the manuscripts. Results Inter-rater agreement was 0.89 and conflicts were resolved by obtaining consensus between three reviewers. Our search initially retrieved 692 studies but after careful screening, our review included 22 manuscripts that carried four prevailing themes; ‘fair’ training dataset generation (4/22), representation learning (10/22), model disparity across institutions (5/22) and model fairness with respect to patient demographics (3/22). However, we observe that often discussion regarding fairness are also limited to analyzing existing bias without further establishing methodologies to overcome model disparities. Particularly for medical imaging, most papers lack the use of a standardized set of metrics to measure fairness/bias in algorithms. Discussion We benchmark the current literature regarding fairness in AI-based image analysis and highlighted the existing challenges. Based on the current research trends, exploration of adversarial learning for demographic/camera/institution agnostic models is an important direction to minimize disparity gaps for imaging. Privacy preserving approaches also present encouraging performance for both natural and medical image domain.