A reinforcement learning model for AI-based decision support in skin cancer Journal Article
| Authors: | Barata, C.; Rotemberg, V.; Codella, N. C. F.; Tschandl, P.; Rinner, C.; Akay, B. N.; Apalla, Z.; Argenziano, G.; Halpern, A.; Lallas, A.; Longo, C.; Malvehy, J.; Puig, S.; Rosendahl, C.; Soyer, H. P.; Zalaudek, I.; Kittler, H. |
| Article Title: | A reinforcement learning model for AI-based decision support in skin cancer |
| Abstract: | We investigated whether human preferences hold the potential to improve diagnostic artificial intelligence (AI)-based decision support using skin cancer diagnosis as a use case. We utilized nonuniform rewards and penalties based on expert-generated tables, balancing the benefits and harms of various diagnostic errors, which were applied using reinforcement learning. Compared with supervised learning, the reinforcement learning model improved the sensitivity for melanoma from 61.4% to 79.5% (95% confidence interval (CI): 73.5–85.6%) and for basal cell carcinoma from 79.4% to 87.1% (95% CI: 80.3–93.9%). AI overconfidence was also reduced while simultaneously maintaining accuracy. Reinforcement learning increased the rate of correct diagnoses made by dermatologists by 12.0% (95% CI: 8.8–15.1%) and improved the rate of optimal management decisions from 57.4% to 65.3% (95% CI: 61.7–68.9%). We further demonstrated that the reward-adjusted reinforcement learning model and a threshold-based model outperformed naïve supervised learning in various clinical scenarios. Our findings suggest the potential for incorporating human preferences into image-based diagnostic algorithms. © 2023, The Author(s). |
| Keywords: | controlled study; diagnostic accuracy; melanoma; actinic keratosis; basal cell carcinoma; skin neoplasms; skin cancer; pathology; algorithms; skin tumor; algorithm; artificial intelligence; diagnostic error; dermatofibroma; carcinoma, basal cell; vascular lesion; decision support system; dermatologist; bowen disease; reward; pigmented nevus; humans; human; article; reinforcement (psychology) |
| Journal Title: | Nature Medicine |
| Volume: | 29 |
| Issue: | 8 |
| ISSN: | 1078-8956 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2023-08-01 |
| Start Page: | 1941 |
| End Page: | 1946 |
| Language: | English |
| DOI: | 10.1038/s41591-023-02475-5 |
| PUBMED: | 37501017 |
| PROVIDER: | scopus |
| PMCID: | PMC10427421 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF -- Source: Scopus |
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