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Study Finds AI Falls Short When Analyzing Medical Data

By MedImaging International staff writers
Posted on 20 Nov 2018

A study conducted at the Icahn School of Medicine at Mount Sinai (New York, NY, USA) has found that artificial intelligence (AI) tools trained to detect pneumonia on chest X-rays suffered significant decreases in performance when tested on data from outside health systems. These findings suggest that unless AI in the medical space is carefully tested for performance across a wide range of populations, the deep learning models may not perform as accurately as expected.

Amidst the growing interest in the use of computer system frameworks called convolutional neural networks (CNN) to analyze medical imaging and provide a computer-aided diagnosis, recent studies have found that AI image classification may not generalize to new data as well as commonly portrayed. The researchers at the Icahn School of Medicine at Mount Sinai assessed how AI models identified pneumonia in 158,000 chest X-rays across three medical institutions. They chose to study the diagnosis of pneumonia on chest X-rays due to its common occurrence, clinical significance, and prevalence in the research community.

The researchers found that in three out of five comparisons, the performance of CNNs in diagnosing diseases on X-rays from hospitals outside of its own network was significantly lower as compared to X-rays from the original health system. However, CNNs were able to detect the hospital system where an X-ray was acquired with a high-degree of accuracy, and cheated at their predictive task based on the prevalence of pneumonia at the training institution. The researchers found that the key problem in using deep learning models in medicine was their use of a massive number of parameters, making it challenging to identify specific variables driving predictions, such as the types of CT scanners used at a hospital and the resolution quality of imaging.

“Our findings should give pause to those considering rapid deployment of AI platforms without rigorously assessing their performance in real-world clinical settings reflective of where they are being deployed,” said senior author Eric Oermann, MD, Instructor in Neurosurgery at the Icahn School of Medicine at Mount Sinai. “Deep learning models trained to perform medical diagnosis can generalize well, but this cannot be taken for granted since patient populations and imaging techniques differ significantly across institutions.”

“If CNN systems are to be used for medical diagnosis, they must be tailored to carefully consider clinical questions, tested for a variety of real-world scenarios, and carefully assessed to determine how they impact accurate diagnosis,” said first author John Zech, a medical student at the Icahn School of Medicine at Mount Sinai.

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Icahn School of Medicine at Mount Sinai

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70 (353.09791564941): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (240.08750915527): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (54.836273193359): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (45.7763671875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (64.849853515625): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

105 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

106 (56.982040405273): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294775768 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294775768 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

109 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

110 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294775768 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (531.91184997559): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294775768 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (629.18663024902): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (557.89947509766): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (157.11784362793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

115 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

116 (136.8522644043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

117 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

118 (174.04556274414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

119 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

120 (391.00646972656): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 35213.947296143): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (154.01840209961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

123 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

124 (591.99333190918): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294775768 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294775768 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 609623.90899658): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (107.0499420166): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (70.095062255859): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (67.949295043945): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (48.160552978516): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (629.90188598633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (433.92181396484): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=217

136 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=217

137 (521.89826965332): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))217((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (483.98971557617): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))217((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

140 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

141 (!!!!! 9580.135345459): TRUNCATE TABLE jos_trademed_module

142 (128.98445129395): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294775768 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (75.101852416992): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294775768 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (615.11993408203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

147 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

148 (!!!!! 1521.110534668): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

150 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

151 (72.002410888672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294775768 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294775768 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (52.928924560547): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=217 or channel_id is null)

153 (44.107437133789): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=217 or channel_id is null)

154 (77.962875366211): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (159.02519226074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

156 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294775768 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294775768 AND published='1' LIMIT 1

157 (56.982040405273): select jos_twitters.link from jos_twitters where cat=10

158 (44.822692871094): select jos_facebook.link from jos_facebook where cat=10

159 (43.153762817383): select jos_google_plus.link from jos_google_plus where cat=10

160 (54.121017456055): select jos_linkedin.link from jos_linkedin where cat=10

161 (497.81799316406): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1658.9164733887): insert into jos_banners_delta values (14615,'2025-06-17 19:01:44','216.73.216.120','view'),(14202,'2025-06-17 19:01:44','216.73.216.120','view'),(14203,'2025-06-17 19:01:44','216.73.216.120','view')

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