Challenges for Responsible AI Design and Workflow Integration in Healthcare: A Case Study of Automatic Feeding Tube Qualification in Radiology

• URL: http://arxiv.org/abs/2405.05299v1
• Date: Wed, 8 May 2024 14:16:22 GMT
• Title: Challenges for Responsible AI Design and Workflow Integration in Healthcare: A Case Study of Automatic Feeding Tube Qualification in Radiology
• Authors: Anja Thieme, Abhijith Rajamohan, Benjamin Cooper, Heather Groombridge, Robert Simister, Barney Wong, Nicholas Woznitza, Mark Ames Pinnock, Maria Teodora Wetscherek, Cecily Morrison, Hannah Richardson, Fernando Pérez-García, Stephanie L. Hyland, Shruthi Bannur, Daniel C. Castro, Kenza Bouzid, Anton Schwaighofer, Mercy Ranjit, Harshita Sharma, Matthew P. Lungren, Ozan Oktay, Javier Alvarez-Valle, Aditya Nori, Stephen Harris, Joseph Jacob,
• Abstract summary: Nasogastric tubes (NGTs) are feeding tubes that are inserted through the nose into the stomach to deliver nutrition or medication. Recent AI developments demonstrate the feasibility of robustly detecting NGT placement from Chest X-ray images. We present a human-centered approach to the problem and describe insights derived following contextual inquiry and in-depth interviews with 15 clinical stakeholders.
• Score: 35.284458448940796
• License: http://arxiv.org/licenses/nonexclusive-distrib/1.0/
• Abstract: Nasogastric tubes (NGTs) are feeding tubes that are inserted through the nose into the stomach to deliver nutrition or medication. If not placed correctly, they can cause serious harm, even death to patients. Recent AI developments demonstrate the feasibility of robustly detecting NGT placement from Chest X-ray images to reduce risks of sub-optimally or critically placed NGTs being missed or delayed in their detection, but gaps remain in clinical practice integration. In this study, we present a human-centered approach to the problem and describe insights derived following contextual inquiry and in-depth interviews with 15 clinical stakeholders. The interviews helped understand challenges in existing workflows, and how best to align technical capabilities with user needs and expectations. We discovered the trade-offs and complexities that need consideration when choosing suitable workflow stages, target users, and design configurations for different AI proposals. We explored how to balance AI benefits and risks for healthcare staff and patients within broader organizational and medical-legal constraints. We also identified data issues related to edge cases and data biases that affect model training and evaluation; how data documentation practices influence data preparation and labelling; and how to measure relevant AI outcomes reliably in future evaluations. We discuss how our work informs design and development of AI applications that are clinically useful, ethical, and acceptable in real-world healthcare services.

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