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As Artificial Intelligence (AI) making advancements in medical decision-making, there is a growing need to ensure doctors develop appropriate reliance on AI to avoid adverse outcomes. However, existing methods in enabling appropriate AI reliance might encounter challenges while being applied in the medical domain. With this regard, this work employs and provides the validation of an alternative approach -- majority voting -- to facilitate appropriate reliance on AI in medical decision-making. This is achieved by a multi-institutional user study involving 32 medical professionals with various backgrounds, focusing on the pathology task of visually detecting a pattern, mitoses, in tumor images. Here, the majority voting process was conducted by synthesizing decisions under AI assistance from a group of pathology doctors (pathologists). Two metrics were used to evaluate the appropriateness of AI reliance: Relative AI Reliance (RAIR) and Relative Self-Reliance (RSR). Results showed that even with groups of three pathologists, majority-voted decisions significantly increased both RAIR and RSR -- by approximately 9% and 31%, respectively -- compared to decisions made by one pathologist collaborating with AI. This increased appropriateness resulted in better precision and recall in the detection of mitoses. While our study is centered on pathology, we believe these insights can be extended to general high-stakes decision-making processes involving similar visual tasks., Comment: 46 pages, 11 figures. Accepted International Journal of Human-Computer Studies

The expansion of artificial intelligence (AI) in pathology tasks has intensified the demand for doctors' annotations in AI development. However, collecting high-quality annotations from doctors is costly and time-consuming, creating a bottleneck in AI progress. This study investigates eye-tracking as a cost-effective technology to collect doctors' behavioral data for AI training with a focus on the pathology task of mitosis detection. One major challenge in using eye-gaze data is the low signal-to-noise ratio, which hinders the extraction of meaningful information. We tackled this by levering the properties of inter-observer eye-gaze consistencies and creating eye-gaze labels from consistent eye-fixations shared by a group of observers. Our study involved 14 non-medical participants, from whom we collected eye-gaze data and generated eye-gaze labels based on varying group sizes. We assessed the efficacy of such eye-gaze labels by training Convolutional Neural Networks (CNNs) and comparing their performance to those trained with ground truth annotations and a heuristic-based baseline. Results indicated that CNNs trained with our eye-gaze labels closely followed the performance of ground-truth-based CNNs, and significantly outperformed the baseline. Although primarily focused on mitosis, we envision that insights from this study can be generalized to other medical imaging tasks., Comment: Accepted by IEEE International Conference on Healthcare Informatics 2024

Recognition of mitotic figures in histologic tumor specimens is highly relevant to patient outcome assessment. This task is challenging for algorithms and human experts alike, with deterioration of algorithmic performance under shifts in image representations. Considerable covariate shifts occur when assessment is performed on different tumor types, images are acquired using different digitization devices, or specimens are produced in different laboratories. This observation motivated the inception of the 2022 challenge on MItosis Domain Generalization (MIDOG 2022). The challenge provided annotated histologic tumor images from six different domains and evaluated the algorithmic approaches for mitotic figure detection provided by nine challenge participants on ten independent domains. Ground truth for mitotic figure detection was established in two ways: a three-expert consensus and an independent, immunohistochemistry-assisted set of labels. This work represents an overview of the challenge tasks, the algorithmic strategies employed by the participants, and potential factors contributing to their success. With an $F_1$ score of 0.764 for the top-performing team, we summarize that domain generalization across various tumor domains is possible with today's deep learning-based recognition pipelines. However, we also found that domain characteristics not present in the training set (feline as new species, spindle cell shape as new morphology and a new scanner) led to small but significant decreases in performance. When assessed against the immunohistochemistry-assisted reference standard, all methods resulted in reduced recall scores, but with only minor changes in the order of participants in the ranking.

Artificial Intelligence (AI) brings advancements to support pathologists in navigating high-resolution tumor images to search for pathology patterns of interest. However, existing AI-assisted tools have not realized this promised potential due to a lack of insight into pathology and HCI considerations for pathologists' navigation workflows in practice. We first conducted a formative study with six medical professionals in pathology to capture their navigation strategies. By incorporating our observations along with the pathologists' domain knowledge, we designed NaviPath -- a human-AI collaborative navigation system. An evaluation study with 15 medical professionals in pathology indicated that: (i) compared to the manual navigation, participants saw more than twice the number of pathological patterns in unit time with NaviPath, and (ii) participants achieved higher precision and recall against the AI and the manual navigation on average. Further qualitative analysis revealed that navigation was more consistent with NaviPath, which can improve the overall examination quality., Comment: Accepted ACM CHI Conference on Human Factors in Computing Systems (CHI '23)

This work presents a mitosis detection method with only one vanilla Convolutional Neural Network (CNN). Our method consists of two steps: given an image, we first apply a CNN using a sliding window technique to extract patches that have mitoses; we then calculate each extracted patch's class activation map to obtain the mitosis's precise location. To increase the model performance on high-domain-variance pathology images, we train the CNN with a data augmentation pipeline, a noise-tolerant loss that copes with unlabeled images, and a multi-rounded active learning strategy. In the MIDOG 2022 challenge, our approach, with an EfficientNet-b3 CNN model, achieved an overall F1 score of 0.7323 in the preliminary test phase, and 0.6847 in the final test phase (task 1). Our approach sheds light on the broader applicability of class activation maps for object detections in pathology images., Comment: 3 pages, 2 figures

Recent developments in AI have provided assisting tools to support pathologists' diagnoses. However, it remains challenging to incorporate such tools into pathologists' practice; one main concern is AI's insufficient workflow integration with medical decisions. We observed pathologists' examination and discovered that the main hindering factor to integrate AI is its incompatibility with pathologists' workflow. To bridge the gap between pathologists and AI, we developed a human-AI collaborative diagnosis tool -- xPath -- that shares a similar examination process to that of pathologists, which can improve AI's integration into their routine examination. The viability of xPath is confirmed by a technical evaluation and work sessions with twelve medical professionals in pathology. This work identifies and addresses the challenge of incorporating AI models into pathology, which can offer first-hand knowledge about how HCI researchers can work with medical professionals side-by-side to bring technological advances to medical tasks towards practical applications., Comment: 31 pages, 13 figures. Accepted ACM Transactions on Computer-Human Interaction

Despite the promises of data-driven artificial intelligence (AI), little is known about how we can bridge the gulf between traditional physician-driven diagnosis and a plausible future of medicine automated by AI. Specifically, how can we involve AI usefully in physicians' diagnosis workflow given that most AI is still nascent and error-prone (e.g., in digital pathology)? To explore this question, we first propose a series of collaborative techniques to engage human pathologists with AI given AI's capabilities and limitations, based on which we prototype Impetus - a tool where an AI takes various degrees of initiatives to provide various forms of assistance to a pathologist in detecting tumors from histological slides. We summarize observations and lessons learned from a study with eight pathologists and discuss recommendations for future work on human-centered medical AI systems., Comment: 25 pages, 5 figures. To appear in the 24th ACM Conference on Computer-Supported Cooperative Work and Social Computing (CSCW 2021)