Laleh Seyyed-Kalantari

Jacob-Junqi Tian, David Emerson, Sevil Zanjani Miyandoab et al.

Prompting large language models has gained immense popularity in recent years due to the advantage of producing good results even without the need for labelled data. However, this requires prompt tuning to get optimal prompts that lead to better model performances. In this paper, we explore the use of soft-prompt tuning on sentiment classification task to quantify the biases of large language models (LLMs) such as Open Pre-trained Transformers (OPT) and Galactica language model. Since these models are trained on real-world data that could be prone to bias toward certain groups of populations, it is important to identify these underlying issues. Using soft-prompts to evaluate bias gives us the extra advantage of avoiding the human-bias injection that can be caused by manually designed prompts. We check the model biases on different sensitive attributes using the group fairness (bias) and find interesting bias patterns. Since LLMs have been used in the industry in various applications, it is crucial to identify the biases before deploying these models in practice. We open-source our pipeline and encourage industry researchers to adapt our work to their use cases.

Carolina A. M. Heming, Mohamed Abdalla, Shahram Mohanna et al.

Clinical AI model reporting cards should be expanded to incorporate a broad bias reporting of both social and non-social factors. Non-social factors consider the role of other factors, such as disease dependent, anatomic, or instrument factors on AI model bias, which are essential to ensure safe deployment.

Chi-Yu Chen, Rawan Abulibdeh, Arash Asgari et al.

Artificial intelligence is revealing what medicine never intended to encode. Deep vision models, trained on chest X-rays, can now detect not only disease but also invisible traces of social inequality. In this study, we show that state-of-the-art architectures (DenseNet121, SwinV2-B, MedMamba) can predict a patient's health insurance type, a strong proxy for socioeconomic status, from normal chest X-rays with significant accuracy (AUC around 0.67 on MIMIC-CXR-JPG, 0.68 on CheXpert). The signal persists even when age, race, and sex are controlled for, and remains detectable when the model is trained exclusively on a single racial group. Patch-based occlusion reveals that the signal is diffuse rather than localized, embedded in the upper and mid-thoracic regions. This suggests that deep networks may be internalizing subtle traces of clinical environments, equipment differences, or care pathways; learning socioeconomic segregation itself. These findings challenge the assumption that medical images are neutral biological data. By uncovering how models perceive and exploit these hidden social signatures, this work reframes fairness in medical AI: the goal is no longer only to balance datasets or adjust thresholds, but to interrogate and disentangle the social fingerprints embedded in clinical data itself.

Laleh Seyyed-Kalantari, Guanxiong Liu, Matthew McDermott et al.

Machine learning systems have received much attention recently for their ability to achieve expert-level performance on clinical tasks, particularly in medical imaging. Here, we examine the extent to which state-of-the-art deep learning classifiers trained to yield diagnostic labels from X-ray images are biased with respect to protected attributes. We train convolution neural networks to predict 14 diagnostic labels in 3 prominent public chest X-ray datasets: MIMIC-CXR, Chest-Xray8, CheXpert, as well as a multi-site aggregation of all those datasets. We evaluate the TPR disparity -- the difference in true positive rates (TPR) -- among different protected attributes such as patient sex, age, race, and insurance type as a proxy for socioeconomic status. We demonstrate that TPR disparities exist in the state-of-the-art classifiers in all datasets, for all clinical tasks, and all subgroups. A multi-source dataset corresponds to the smallest disparities, suggesting one way to reduce bias. We find that TPR disparities are not significantly correlated with a subgroup's proportional disease burden. As clinical models move from papers to products, we encourage clinical decision makers to carefully audit for algorithmic disparities prior to deployment. Our code can be found at, https://github.com/LalehSeyyed/CheXclusion

Farnaz Kohankhaki, D. B. Emerson, Jacob-Junqi Tian et al.

Bias in large language models (LLMs) has many forms, from overt discrimination to implicit stereotypes. Counterfactual bias evaluation is a widely used approach to quantifying bias and often relies on template-based probes that explicitly state group membership. It measures whether the outcome of a task performed by an LLM is invariant to a change in group membership. In this work, we find that template-based probes can lead to unrealistic bias measurements. For example, LLMs appear to mistakenly cast text associated with White race as negative at higher rates than other groups. We hypothesize that this arises artificially via a mismatch between commonly unstated norms, in the form of markedness, in the pretraining text of LLMs (e.g., Black president vs. president) and templates used for bias measurement (e.g., Black president vs. White president). The findings highlight the potential misleading impact of varying group membership through explicit mention in counterfactual bias quantification.

Nikta Gohari Sadr, Sahar Heidariasl, Karine Megerdoomian et al.

Large language models (LLMs) struggle to navigate culturally specific communication norms, limiting their effectiveness in global contexts. We focus on Persian taarof, a social norm in Iranian interactions, which is a sophisticated system of ritual politeness that emphasizes deference, modesty, and indirectness, yet remains absent from existing cultural benchmarks. We introduce TaarofBench, the first benchmark for evaluating LLM understanding of taarof, comprising 450 role-play scenarios covering 12 common social interaction topics, validated by native speakers. Our evaluation of five frontier LLMs reveals substantial gaps in cultural competence, with accuracy rates 40-48% below native speakers when taarof is culturally appropriate. Performance varies between interaction topics, improves with Persian-language prompts, and exhibits gender-based asymmetries. We also show that responses rated "polite" by standard metrics often violate taarof norms, indicating the limitations of Western politeness frameworks. Through supervised fine-tuning and Direct Preference Optimization, we achieve 21.8% and 42.3% improvement in model alignment with cultural expectations. Our human study with 33 participants (11 native Persian, 11 heritage, and 11 non-Iranian speakers) forms baselines in varying degrees of familiarity with Persian norms. This work lays the foundation for developing diverse and culturally aware LLMs, enabling applications that better navigate complex social interactions.

Linglin Zhang, Beatrice Brown-Mulry, Vineela Nalla et al.

Although deep learning models for abnormality classification can perform well in screening mammography, the demographic, imaging, and clinical characteristics associated with increased risk of model failure remain unclear. This retrospective study uses the Emory BrEast Imaging Dataset(EMBED) containing mammograms from 115931 patients imaged at Emory Healthcare between 2013-2020, with BI-RADS assessment, region of interest coordinates for abnormalities, imaging features, pathologic outcomes, and patient demographics. Multiple deep learning models were trained to distinguish between abnormal tissue patches and randomly selected normal tissue patches from screening mammograms. We assessed model performance by subgroups defined by age, race, pathologic outcome, tissue density, and imaging characteristics and investigated their associations with false negatives (FN) and false positives (FP). We also performed multivariate logistic regression to control for confounding between subgroups. The top-performing model, ResNet152V2, achieved accuracy of 92.6%(95%CI=92.0-93.2%), and AUC 0.975(95%CI=0.972-0.978). Before controlling for confounding, nearly all subgroups showed statistically significant differences in model performance. However, after controlling for confounding, we found lower FN risk associates with Other race(RR=0.828;p=.050), biopsy-proven benign lesions(RR=0.927;p=.011), and mass(RR=0.921;p=.010) or asymmetry(RR=0.854;p=.040); higher FN risk associates with architectural distortion (RR=1.037;p<.001). Higher FP risk associates to BI-RADS density C(RR=1.891;p<.001) and D(RR=2.486;p<.001). Our results demonstrate subgroup analysis is important in mammogram classifier performance evaluation, and controlling for confounding between subgroups elucidates the true associations between variables and model failure. These results can help guide developing future breast cancer detection models.

Faiza Khan Khattak, Vallijah Subasri, Amrit Krishnan et al.

Machine Learning Health Operations (MLHOps) is the combination of processes for reliable, efficient, usable, and ethical deployment and maintenance of machine learning models in healthcare settings. This paper provides both a survey of work in this area and guidelines for developers and clinicians to deploy and maintain their own models in clinical practice. We cover the foundational concepts of general machine learning operations, describe the initial setup of MLHOps pipelines (including data sources, preparation, engineering, and tools). We then describe long-term monitoring and updating (including data distribution shifts and model updating) and ethical considerations (including bias, fairness, interpretability, and privacy). This work therefore provides guidance across the full pipeline of MLHOps from conception to initial and ongoing deployment.

Imon Banerjee, Ananth Reddy Bhimireddy, John L. Burns et al.

Background: In medical imaging, prior studies have demonstrated disparate AI performance by race, yet there is no known correlation for race on medical imaging that would be obvious to the human expert interpreting the images. Methods: Using private and public datasets we evaluate: A) performance quantification of deep learning models to detect race from medical images, including the ability of these models to generalize to external environments and across multiple imaging modalities, B) assessment of possible confounding anatomic and phenotype population features, such as disease distribution and body habitus as predictors of race, and C) investigation into the underlying mechanism by which AI models can recognize race. Findings: Standard deep learning models can be trained to predict race from medical images with high performance across multiple imaging modalities. Our findings hold under external validation conditions, as well as when models are optimized to perform clinically motivated tasks. We demonstrate this detection is not due to trivial proxies or imaging-related surrogate covariates for race, such as underlying disease distribution. Finally, we show that performance persists over all anatomical regions and frequency spectrum of the images suggesting that mitigation efforts will be challenging and demand further study. Interpretation: We emphasize that model ability to predict self-reported race is itself not the issue of importance. However, our findings that AI can trivially predict self-reported race -- even from corrupted, cropped, and noised medical images -- in a setting where clinical experts cannot, creates an enormous risk for all model deployments in medical imaging: if an AI model secretly used its knowledge of self-reported race to misclassify all Black patients, radiologists would not be able to tell using the same data the model has access to.

Haoran Zhang, Natalie Dullerud, Laleh Seyyed-Kalantari et al.

Clinical machine learning models experience significantly degraded performance in datasets not seen during training, e.g., new hospitals or populations. Recent developments in domain generalization offer a promising solution to this problem by creating models that learn invariances across environments. In this work, we benchmark the performance of eight domain generalization methods on multi-site clinical time series and medical imaging data. We introduce a framework to induce synthetic but realistic domain shifts and sampling bias to stress-test these methods over existing non-healthcare benchmarks. We find that current domain generalization methods do not consistently achieve significant gains in out-of-distribution performance over empirical risk minimization on real-world medical imaging data, in line with prior work on general imaging datasets. However, a subset of realistic induced-shift scenarios in clinical time series data do exhibit limited performance gains. We characterize these scenarios in detail, and recommend best practices for domain generalization in the clinical setting.

Sina Akbarian, Laleh Seyyed-Kalantari, Farzad Khalvati et al.

Deep learning and knowledge transfer techniques have permeated the field of medical imaging and are considered as key approaches for revolutionizing diagnostic imaging practices. However, there are still challenges for the successful integration of deep learning into medical imaging tasks due to a lack of large annotated imaging data. To address this issue, we propose a teacher-student learning framework to transfer knowledge from a carefully pre-trained convolutional neural network (CNN) teacher to a student CNN. In this study, we explore the performance of knowledge transfer in the medical imaging setting. We investigate the proposed network's performance when the student network is trained on a small dataset (target dataset) as well as when teacher's and student's domains are distinct. The performances of the CNN models are evaluated on three medical imaging datasets including Diabetic Retinopathy, CheXpert, and ChestX-ray8. Our results indicate that the teacher-student learning framework outperforms transfer learning for small imaging datasets. Particularly, the teacher-student learning framework improves the area under the ROC Curve (AUC) of the CNN model on a small sample of CheXpert (n=5k) by 4% and on ChestX-ray8 (n=5.6k) by 9%. In addition to small training data size, we also demonstrate a clear advantage of the teacher-student learning framework in the medical imaging setting compared to transfer learning. We observe that the teacher-student network holds a great promise not only to improve the performance of diagnosis but also to reduce overfitting when the dataset is small.