4.6 Review

A scoping review of artificial intelligence applications in thoracic surgery

Journal

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Volume 61, Issue 2, Pages 239-248

Publisher

OXFORD UNIV PRESS INC
DOI: 10.1093/ejcts/ezab422

Keywords

Artificial intelligence; Machine learning; Prediction; Survival; Complications; Algorithm

Funding

  1. National Institute of Health through NIBIB [R01 EB017205]

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Machine learning has great potential in thoracic surgery, but also faces challenges. The transparency of data and algorithm design, as well as the systemic bias on which models are dependent, remain issues to be addressed. Although not widely used yet in thoracic surgery, it is essential for thoracic surgeons to be at the forefront in the safe introduction of machine learning to the clinic and operating room.
OBJECTIVES Machine learning (ML) has great potential, but there are few examples of its implementation improving outcomes. The thoracic surgeon must be aware of pertinent ML literature and how to evaluate this field for the safe translation to patient care. This scoping review provides an introduction to ML applications specific to the thoracic surgeon. We review current applications, limitations and future directions. METHODS A search of the PubMed database was conducted with inclusion requirements being the use of an ML algorithm to analyse patient information relevant to a thoracic surgeon and contain sufficient details on the data used, ML methods and results. Twenty-two papers met the criteria and were reviewed using a methodological quality rubric. RESULTS ML demonstrated enhanced preoperative test accuracy, earlier pathological diagnosis, therapies to maximize survival and predictions of adverse events and survival after surgery. However, only 4 performed external validation. One demonstrated improved patient outcomes, nearly all failed to perform model calibration and one addressed fairness and bias with most not generalizable to different populations. There was a considerable variation to allow for reproducibility. CONCLUSIONS There is promise but also challenges for ML in thoracic surgery. The transparency of data and algorithm design and the systemic bias on which models are dependent remain issues to be addressed. Although there has yet to be widespread use in thoracic surgery, it is essential thoracic surgeons be at the forefront of the eventual safe introduction of ML to the clinic and operating room.

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