M. Brooke Bernhardt

Melanie Bernhardt, Fabio De Sousa Ribeiro, Ben Glocker

Failure detection in automated image classification is a critical safeguard for clinical deployment. Detected failure cases can be referred to human assessment, ensuring patient safety in computer-aided clinical decision making. Despite its paramount importance, there is insufficient evidence about the ability of state-of-the-art confidence scoring methods to detect test-time failures of classification models in the context of medical imaging. This paper provides a reality check, establishing the performance of in-domain misclassification detection methods, benchmarking 9 widely used confidence scores on 6 medical imaging datasets with different imaging modalities, in multiclass and binary classification settings. Our experiments show that the problem of failure detection is far from being solved. We found that none of the benchmarked advanced methods proposed in the computer vision and machine learning literature can consistently outperform a simple softmax baseline, demonstrating that improved out-of-distribution detection or model calibration do not necessarily translate to improved in-domain misclassification detection. Our developed testbed facilitates future work in this important area

Mélanie Bernhardt, Charles Jones, Ben Glocker

An increasing number of reports raise concerns about the risk that machine learning algorithms could amplify health disparities due to biases embedded in the training data. Seyyed-Kalantari et al. find that models trained on three chest X-ray datasets yield disparities in false-positive rates (FPR) across subgroups on the 'no-finding' label (indicating the absence of disease). The models consistently yield higher FPR on subgroups known to be historically underserved, and the study concludes that the models exhibit and potentially even amplify systematic underdiagnosis. We argue that the experimental setup in the study is insufficient to study algorithmic underdiagnosis. In the absence of specific knowledge (or assumptions) about the extent and nature of the dataset bias, it is difficult to investigate model bias. Importantly, their use of test data exhibiting the same bias as the training data (due to random splitting) severely complicates the interpretation of the reported disparities.

Ben Glocker, Charles Jones, Melanie Bernhardt et al.

It has been rightfully emphasized that the use of AI for clinical decision making could amplify health disparities. An algorithm may encode protected characteristics, and then use this information for making predictions due to undesirable correlations in the (historical) training data. It remains unclear how we can establish whether such information is actually used. Besides the scarcity of data from underserved populations, very little is known about how dataset biases manifest in predictive models and how this may result in disparate performance. This article aims to shed some light on these issues by exploring new methodology for subgroup analysis in image-based disease detection models. We utilize two publicly available chest X-ray datasets, CheXpert and MIMIC-CXR, to study performance disparities across race and biological sex in deep learning models. We explore test set resampling, transfer learning, multitask learning, and model inspection to assess the relationship between the encoding of protected characteristics and disease detection performance across subgroups. We confirm subgroup disparities in terms of shifted true and false positive rates which are partially removed after correcting for population and prevalence shifts in the test sets. We further find a previously used transfer learning method to be insufficient for establishing whether specific patient information is used for making predictions. The proposed combination of test-set resampling, multitask learning, and model inspection reveals valuable new insights about the way protected characteristics are encoded in the feature representations of deep neural networks.