Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Columbia University Irving Medical Center, Departments of Dermatology.
Br J Dermatol. 2024 May 17;190(6):789-797. doi: 10.1093/bjd/ljae040.
The field of dermatology is experiencing the rapid deployment of artificial intelligence (AI), from mobile applications (apps) for skin cancer detection to large language models like ChatGPT that can answer generalist or specialist questions about skin diagnoses. With these new applications, ethical concerns have emerged. In this scoping review, we aimed to identify the applications of AI to the field of dermatology and to understand their ethical implications. We used a multifaceted search approach, searching PubMed, MEDLINE, Cochrane Library and Google Scholar for primary literature, following the PRISMA Extension for Scoping Reviews guidance. Our advanced query included terms related to dermatology, AI and ethical considerations. Our search yielded 202 papers. After initial screening, 68 studies were included. Thirty-two were related to clinical image analysis and raised ethical concerns for misdiagnosis, data security, privacy violations and replacement of dermatologist jobs. Seventeen discussed limited skin of colour representation in datasets leading to potential misdiagnosis in the general population. Nine articles about teledermatology raised ethical concerns, including the exacerbation of health disparities, lack of standardized regulations, informed consent for AI use and privacy challenges. Seven addressed inaccuracies in the responses of large language models. Seven examined attitudes toward and trust in AI, with most patients requesting supplemental assessment by a physician to ensure reliability and accountability. Benefits of AI integration into clinical practice include increased patient access, improved clinical decision-making, efficiency and many others. However, safeguards must be put in place to ensure the ethical application of AI.
皮肤病学领域正在迅速部署人工智能(AI),从用于皮肤癌检测的移动应用程序(apps)到可以回答有关皮肤诊断的一般或专业问题的大型语言模型(如 ChatGPT)。随着这些新应用的出现,出现了一些伦理问题。在本次范围综述中,我们旨在确定人工智能在皮肤病学领域的应用,并了解其伦理含义。我们采用了多方面的搜索方法,在 PubMed、MEDLINE、Cochrane 图书馆和 Google Scholar 中搜索初级文献,遵循 PRISMA 扩展范围综述指南。我们的高级查询包括与皮肤病学、人工智能和伦理考虑相关的术语。我们的搜索结果为 202 篇论文。经过初步筛选,纳入了 68 项研究。其中 32 项与临床图像分析有关,并提出了误诊、数据安全、隐私侵犯和替代皮肤科医生工作等方面的伦理问题。17 项讨论了数据集在肤色代表性方面的局限性,这可能导致一般人群中的潜在误诊。9 篇关于远程皮肤病学的文章提出了伦理问题,包括健康差距的加剧、缺乏标准化法规、AI 使用的知情同意和隐私挑战。7 项涉及大型语言模型响应的准确性问题。7 项研究了对 AI 的态度和信任,大多数患者要求由医生进行补充评估,以确保可靠性和问责制。将 AI 整合到临床实践中的好处包括增加患者就诊机会、改善临床决策、提高效率等。然而,必须采取保障措施,以确保 AI 的伦理应用。
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