Beauty Is in the AI of the Beholder: Are We Ready for the Clinical Integration of Artificial Intelligence in Radiography? An Exploratory Analysis of Perceived AI Knowledge, Skills, Confidence, and Education Perspectives of UK Radiographers

Introduction: The use of artificial intelligence (AI) in medical imaging and radiotherapy has been met with both scepticism and excitement. However, clinical integration of AI is already well-underway. Many authors have recently reported on the AI knowledge and perceptions of radiologists/medical staff and students however there is a paucity of information regarding radiographers. Published literature agrees that AI is likely to have significant impact on radiology practice. As radiographers are at the forefront of radiology service delivery, an awareness of the current level of their perceived knowledge, skills, and confidence in AI is essential to identify any educational needs necessary for successful adoption into practice. Aim: The aim of this survey was to determine the perceived knowledge, skills, and confidence in AI amongst UK radiographers and highlight priorities for educational provisions to support a digital healthcare ecosystem. Methods: A survey was created on Qualtrics® and promoted via social media (Twitter®/LinkedIn®). This survey was open to all UK radiographers, including students and retired radiographers. Participants were recruited by convenience, snowball sampling. Demographic information was gathered as well as data on the perceived, self-reported, knowledge, skills, and confidence in AI of respondents. Insight into what the participants understand by the term “AI” was gained by means of a free text response. Quantitative analysis was performed using SPSS® and qualitative thematic analysis was performed on NVivo®. Results: Four hundred and eleven responses were collected (80% from diagnostic radiography and 20% from a radiotherapy background), broadly representative of the workforce distribution in the UK. Although many respondents stated that they understood the concept of AI in general (78.7% for diagnostic and 52.1% for therapeutic radiography respondents, respectively) there was a notable lack of sufficient knowledge of AI principles, understanding of AI terminology, skills, and confidence in the use of AI technology. Many participants, 57% of diagnostic and 49% radiotherapy respondents, do not feel adequately trained to implement AI in the clinical setting. Furthermore 52% and 64%, respectively, said they have not developed any skill in AI whilst 62% and 55%, respectively, stated that there is not enough AI training for radiographers. The majority of the respondents indicate that there is an urgent need for further education (77.4% of diagnostic and 73.9% of therapeutic radiographers feeling they have not had adequate training in AI), with many respondents stating that they had to educate themselves to gain some basic AI skills. Notable correlations between confidence in working with AI and gender, age, and highest qualification were reported. Conclusion: Knowledge of AI terminology, principles, and applications by healthcare practitioners is necessary for adoption and integration of AI applications. The results of this survey highlight the perceived lack of knowledge, skills, and confidence for radiographers in applying AI solutions but also underline the need for formalised education on AI to prepare the current and prospective workforce for the upcoming clinical integration of AI in healthcare, to safely and efficiently navigate a digital future. Focus should be given on different needs of learners depending on age, gender, and highest qualification to ensure optimal integration.

[1]  Marshall Godwin,et al.  Health measurement scales , 1991 .

[2]  C. Langlotz,et al.  A Roadmap for Foundational Research on Artificial Intelligence in Medical Imaging: From the 2018 NIH/RSNA/ACR/The Academy Workshop. , 2019, Radiology.

[3]  M. Mamzer,et al.  Perceptions of artificial intelligence in healthcare: findings from a qualitative survey study among actors in France , 2020, Journal of Translational Medicine.

[4]  E. Emanuel,et al.  The End of Radiology? Three Threats to the Future Practice of Radiology. , 2016, Journal of the American College of Radiology : JACR.

[5]  P. Stone,et al.  What is a systemic review? , 2002, Applied nursing research : ANR.

[6]  T. Leiner,et al.  An international survey on AI in radiology in 1,041 radiologists and radiology residents part 1: fear of replacement, knowledge, and attitude , 2021, European Radiology.

[7]  T. Akudjedu,et al.  Radiographers’ perspectives on the emerging integration of artificial intelligence into diagnostic imaging: The Ghana study , 2021, Journal of medical radiation sciences.

[8]  Jessica M. Sin,et al.  AI-RADS: An Artificial Intelligence Curriculum for Residents , 2020, Academic Radiology.

[9]  P. Mahadevan,et al.  An overview , 2007, Journal of Biosciences.

[10]  William P. Wagner,et al.  Gender, Performance, and Self-Efficacy: A Quasi-Experimental Field Study , 2020, J. Comput. Inf. Syst..

[11]  M. Fazal,et al.  The past, present and future role of artificial intelligence in imaging. , 2018, European journal of radiology.

[12]  Gunther Eysenbach,et al.  Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) , 2004, Journal of medical Internet research.

[13]  J. Kim,et al.  Physician Confidence in Artificial Intelligence: An Online Mobile Survey , 2018, Journal of medical Internet research.

[14]  M. Tavakol,et al.  Making sense of Cronbach's alpha , 2011, International journal of medical education.

[15]  Radiological Technologists Artificial Intelligence and the Radiographer/Radiological Technologist Profession: A joint statement of the International Society of Radiographers and Radiological Technologists and the European Federation of Radiographer Societies , 2020 .

[16]  E. Siegel,et al.  Medical Student Perspectives on the Impact of Artificial Intelligence on the Practice of Medicine. , 2020, Current problems in diagnostic radiology.

[17]  Maryann Hardy,et al.  Artificial intelligence in diagnostic imaging: Impact on the radiography profession. , 2019, The British journal of radiology.

[18]  Andy P. Field,et al.  Discovering Statistics Using Ibm Spss Statistics , 2017 .

[19]  Ralf Dresner,et al.  Health Measurement Scales A Practical Guide To Their Development And Use , 2016 .

[20]  F. Kitamura,et al.  Trustworthiness of Artificial Intelligence Models in Radiology and the Role of Explainability. , 2021, Journal of the American College of Radiology : JACR.

[21]  David Dunning,et al.  How chronic self-views influence (and potentially mislead) estimates of performance. , 2003, Journal of personality and social psychology.

[22]  Joel R. Evans,et al.  The value of online surveys: a look back and a look ahead , 2018, Internet Res..

[23]  Sarah Myers,et al.  Gender , Race , and Power in AI , 2019 .

[24]  D. Maintz,et al.  Medical students' attitude towards artificial intelligence: a multicentre survey , 2018, European Radiology.

[25]  P. Squara,et al.  Intelligence-Based Medicine , 2009 .

[26]  Yogesh Kumar Dwivedi,et al.  Artificial intelligence for decision making in the era of Big Data - evolution, challenges and research agenda , 2019, Int. J. Inf. Manag..

[27]  E. Meijering A bird’s-eye view of deep learning in bioimage analysis , 2020, Computational and structural biotechnology journal.

[28]  Bahjat Fakieh,et al.  Health Care Employees’ Perceptions of the Use of Artificial Intelligence Applications: Survey Study , 2020, Journal of medical Internet research.

[29]  Detmar W. Straub,et al.  Validation Guidelines for IS Positivist Research , 2004, Commun. Assoc. Inf. Syst..

[30]  T. Stephens,et al.  Can Computer-aided Detection Be Detrimental to Mammographic Interpretation? , 2011 .

[31]  A. Amlani,et al.  Attitudes and perceptions of UK medical students towards artificial intelligence and radiology: a multicentre survey , 2020, Insights into Imaging.

[32]  Phedias Diamandis,et al.  Physician perspectives on integration of artificial intelligence into diagnostic pathology , 2019, npj Digital Medicine.

[33]  Charlene Liew The future of radiology augmented with Artificial Intelligence: A strategy for success. , 2018, European journal of radiology.

[34]  L. Philpotts,et al.  Can computer-aided detection be detrimental to mammographic interpretation? , 2009, Radiology.

[35]  Heung-Il Suk,et al.  Deep Learning in Medical Image Analysis. , 2017, Annual review of biomedical engineering.

[36]  H. Yau,et al.  Gender Difference of Confidence in Using Technology for Learning , 2012 .

[37]  P. Cardon,et al.  A qualitative study. , 2001 .

[38]  Fabiola Baltar,et al.  Social research 2.0: virtual snowball sampling method using Facebook , 2012, Internet Res..

[39]  E. Ranschaert,et al.  Training opportunities of artificial intelligence (AI) in radiology: a systematic review , 2021, European Radiology.

[40]  C. Malamateniou,et al.  Artificial Intelligence: Guidance for clinical imaging and therapeutic radiography professionals, a summary by the Society of Radiographers AI working group. , 2021, Radiography.

[41]  Ronald D. Fricker,et al.  Sampling Methods for Online Surveys , 2015 .

[42]  C. Caplan A strategy for success. , 1988, Dental economics - oral hygiene.

[43]  J. Ioannidis,et al.  Artificial intelligence versus clinicians: systematic review of design, reporting standards, and claims of deep learning studies , 2020, BMJ.

[44]  A. Cotten,et al.  Impact of the rise of artificial intelligence in radiology: What do radiologists think? , 2019, Diagnostic and interventional imaging.

[45]  D. Dunning The Dunning–Kruger Effect: On Being Ignorant of One’s Own Ignorance , 2011 .

[46]  R. Castellino,et al.  Computer aided detection (CAD): an overview , 2005, Cancer imaging : the official publication of the International Cancer Imaging Society.

[47]  M. Knowles Andragogy in action , 1984 .

[48]  R. Dahlstrom,et al.  Challenges and opportunities , 2021, Foundations of a Sustainable Economy.

[49]  J. Oluwatayo Validity and Reliability Issues in Educational Research , 2012 .

[50]  S. Aarts,et al.  The opinions of radiographers, nuclear medicine technologists and radiation therapists regarding technology in health care: a qualitative study , 2017, Journal of medical radiation sciences.

[51]  N. Woznitza,et al.  Artificial Intelligence and the Radiographer/Radiological Technologist Profession: A joint statement of the International Society of Radiographers and Radiological Technologists and the European Federation of Radiographer Societies. , 2020, Radiography.

[52]  M. Nortvedt,et al.  Evidence-based radiography , 2008 .

[53]  Yi Wu Survey Study , 2018, Achieving Supply Chain Agility.

[54]  Alexander Wong,et al.  Explaining the Unexplained: A CLass-Enhanced Attentive Response (CLEAR) Approach to Understanding Deep Neural Networks , 2017, 2017 IEEE Conference on Computer Vision and Pattern Recognition Workshops (CVPRW).

[55]  H. Scarbrough,et al.  Professionals’ responses to the introduction of AI innovations in radiology and their implications for future adoption: a qualitative study , 2021, BMC Health Services Research.

[56]  H. Tekin,et al.  Assessment of the Willingness of Radiologists and Radiographers to Accept the Integration of Artificial Intelligence Into Radiology Practice. , 2020, Academic radiology.

[57]  Carlos A. Silva,et al.  On the Interpretability of Artificial Intelligence in Radiology: Challenges and Opportunities. , 2020, Radiology. Artificial intelligence.

[58]  Bradley J. Erickson,et al.  Deep Learning and Machine Learning in Imaging: Basic Principles , 2019, Artificial Intelligence in Medical Imaging.

[59]  Mustafa Suleyman,et al.  Key challenges for delivering clinical impact with artificial intelligence , 2019, BMC Medicine.

[60]  J. McNulty,et al.  Artificial intelligence: The opinions of radiographers and radiation therapists in Ireland. , 2021, Radiography.

[61]  K. Shadan,et al.  Available online: , 2012 .

[62]  Ali S. Tejani Identifying and Addressing Barriers to an Artificial Intelligence Curriculum. , 2020, Journal of the American College of Radiology : JACR.

[63]  François Gallant,et al.  Perceptions of Canadian radiation oncologists, radiation physicists, radiation therapists and radiation trainees about the impact of artificial intelligence in radiation oncology - national survey. , 2020, Journal of medical imaging and radiation sciences.

[64]  Phillip M Cheng,et al.  Artificial Intelligence for Medical Image Analysis: A Guide for Authors and Reviewers. , 2019, AJR. American journal of roentgenology.

[65]  R Nick Bryan,et al.  Artificial Intelligence: Threat or Boon to Radiologists? , 2017, Journal of the American College of Radiology : JACR.