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    Artificial intelligence predicts patients’ race from their medical images

    The miseducation of algorithms is a critical problem; when artificial intelligence mirrors unconscious thoughts, racism, and biases of the humans who generated these algorithms, it can lead to serious harm. Computer programs, for example, have wrongly flagged Black defendants as twice as likely to reoffend as someone who’s white. When an AI used cost as a proxy for health needs, it falsely named Black patients as healthier than equally sick white ones, as less money was spent on them. Even AI used to write a play relied on using harmful stereotypes for casting. 

    Removing sensitive features from the data seems like a viable tweak. But what happens when it’s not enough? 

    Examples of bias in natural language processing are boundless — but MIT scientists have investigated another important, largely underexplored modality: medical images. Using both private and public datasets, the team found that AI can accurately predict self-reported race of patients from medical images alone. Using imaging data of chest X-rays, limb X-rays, chest CT scans, and mammograms, the team trained a deep learning model to identify race as white, Black, or Asian — even though the images themselves contained no explicit mention of the patient’s race. This is a feat even the most seasoned physicians cannot do, and it’s not clear how the model was able to do this. 

    In an attempt to tease out and make sense of the enigmatic “how” of it all, the researchers ran a slew of experiments. To investigate possible mechanisms of race detection, they looked at variables like differences in anatomy, bone density, resolution of images — and many more, and the models still prevailed with high ability to detect race from chest X-rays. “These results were initially confusing, because the members of our research team could not come anywhere close to identifying a good proxy for this task,” says paper co-author Marzyeh Ghassemi, an assistant professor in the MIT Department of Electrical Engineering and Computer Science and the Institute for Medical Engineering and Science (IMES), who is an affiliate of the Computer Science and Artificial Intelligence Laboratory (CSAIL) and of the MIT Jameel Clinic. “Even when you filter medical images past where the images are recognizable as medical images at all, deep models maintain a very high performance. That is concerning because superhuman capacities are generally much more difficult to control, regulate, and prevent from harming people.”

    In a clinical setting, algorithms can help tell us whether a patient is a candidate for chemotherapy, dictate the triage of patients, or decide if a movement to the ICU is necessary. “We think that the algorithms are only looking at vital signs or laboratory tests, but it’s possible they’re also looking at your race, ethnicity, sex, whether you’re incarcerated or not — even if all of that information is hidden,” says paper co-author Leo Anthony Celi, principal research scientist in IMES at MIT and associate professor of medicine at Harvard Medical School. “Just because you have representation of different groups in your algorithms, that doesn’t guarantee it won’t perpetuate or magnify existing disparities and inequities. Feeding the algorithms with more data with representation is not a panacea. This paper should make us pause and truly reconsider whether we are ready to bring AI to the bedside.” 

    The study, “AI recognition of patient race in medical imaging: a modeling study,” was published in Lancet Digital Health on May 11. Celi and Ghassemi wrote the paper alongside 20 other authors in four countries.

    To set up the tests, the scientists first showed that the models were able to predict race across multiple imaging modalities, various datasets, and diverse clinical tasks, as well as across a range of academic centers and patient populations in the United States. They used three large chest X-ray datasets, and tested the model on an unseen subset of the dataset used to train the model and a completely different one. Next, they trained the racial identity detection models for non-chest X-ray images from multiple body locations, including digital radiography, mammography, lateral cervical spine radiographs, and chest CTs to see whether the model’s performance was limited to chest X-rays. 

    The team covered many bases in an attempt to explain the model’s behavior: differences in physical characteristics between different racial groups (body habitus, breast density), disease distribution (previous studies have shown that Black patients have a higher incidence for health issues like cardiac disease), location-specific or tissue specific differences, effects of societal bias and environmental stress, the ability of deep learning systems to detect race when multiple demographic and patient factors were combined, and if specific image regions contributed to recognizing race. 

    What emerged was truly staggering: The ability of the models to predict race from diagnostic labels alone was much lower than the chest X-ray image-based models. 

    For example, the bone density test used images where the thicker part of the bone appeared white, and the thinner part appeared more gray or translucent. Scientists assumed that since Black people generally have higher bone mineral density, the color differences helped the AI models to detect race. To cut that off, they clipped the images with a filter, so the model couldn’t color differences. It turned out that cutting off the color supply didn’t faze the model — it still could accurately predict races. (The “Area Under the Curve” value, meaning the measure of the accuracy of a quantitative diagnostic test, was 0.94–0.96). As such, the learned features of the model appeared to rely on all regions of the image, meaning that controlling this type of algorithmic behavior presents a messy, challenging problem. 

    The scientists acknowledge limited availability of racial identity labels, which caused them to focus on Asian, Black, and white populations, and that their ground truth was a self-reported detail. Other forthcoming work will include potentially looking at isolating different signals before image reconstruction, because, as with bone density experiments, they couldn’t account for residual bone tissue that was on the images. 

    Notably, other work by Ghassemi and Celi led by MIT student Hammaad Adam has found that models can also identify patient self-reported race from clinical notes even when those notes are stripped of explicit indicators of race. Just as in this work, human experts are not able to accurately predict patient race from the same redacted clinical notes.

    “We need to bring social scientists into the picture. Domain experts, which are usually the clinicians, public health practitioners, computer scientists, and engineers are not enough. Health care is a social-cultural problem just as much as it’s a medical problem. We need another group of experts to weigh in and to provide input and feedback on how we design, develop, deploy, and evaluate these algorithms,” says Celi. “We need to also ask the data scientists, before any exploration of the data, are there disparities? Which patient groups are marginalized? What are the drivers of those disparities? Is it access to care? Is it from the subjectivity of the care providers? If we don’t understand that, we won’t have a chance of being able to identify the unintended consequences of the algorithms, and there’s no way we’ll be able to safeguard the algorithms from perpetuating biases.”

    “The fact that algorithms ‘see’ race, as the authors convincingly document, can be dangerous. But an important and related fact is that, when used carefully, algorithms can also work to counter bias,” says Ziad Obermeyer, associate professor at the University of California at Berkeley, whose research focuses on AI applied to health. “In our own work, led by computer scientist Emma Pierson at Cornell, we show that algorithms that learn from patients’ pain experiences can find new sources of knee pain in X-rays that disproportionately affect Black patients — and are disproportionately missed by radiologists. So just like any tool, algorithms can be a force for evil or a force for good — which one depends on us, and the choices we make when we build algorithms.”

    The work is supported, in part, by the National Institutes of Health. More

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    What words can convey

    From search engines to voice assistants, computers are getting better at understanding what we mean. That’s thanks to language-processing programs that make sense of a staggering number of words, without ever being told explicitly what those words mean. Such programs infer meaning instead through statistics — and a new study reveals that this computational approach can assign many kinds of information to a single word, just like the human brain.

    The study, published April 14 in the journal Nature Human Behavior, was co-led by Gabriel Grand, a graduate student in electrical engineering and computer science who is affiliated with MIT’s Computer Science and Artificial Intelligence Laboratory, and Idan Blank PhD ’16, an assistant professor at the University of California at Los Angeles. The work was supervised by McGovern Institute for Brain Research investigator Ev Fedorenko, a cognitive neuroscientist who studies how the human brain uses and understands language, and Francisco Pereira at the National Institute of Mental Health. Fedorenko says the rich knowledge her team was able to find within computational language models demonstrates just how much can be learned about the world through language alone.

    The research team began its analysis of statistics-based language processing models in 2015, when the approach was new. Such models derive meaning by analyzing how often pairs of words co-occur in texts and using those relationships to assess the similarities of words’ meanings. For example, such a program might conclude that “bread” and “apple” are more similar to one another than they are to “notebook,” because “bread” and “apple” are often found in proximity to words like “eat” or “snack,” whereas “notebook” is not.

    The models were clearly good at measuring words’ overall similarity to one another. But most words carry many kinds of information, and their similarities depend on which qualities are being evaluated. “Humans can come up with all these different mental scales to help organize their understanding of words,” explains Grand, a former undergraduate researcher in the Fedorenko lab. For example, he says, “dolphins and alligators might be similar in size, but one is much more dangerous than the other.”

    Grand and Blank, who was then a graduate student at the McGovern Institute, wanted to know whether the models captured that same nuance. And if they did, how was the information organized?

    To learn how the information in such a model stacked up to humans’ understanding of words, the team first asked human volunteers to score words along many different scales: Were the concepts those words conveyed big or small, safe or dangerous, wet or dry? Then, having mapped where people position different words along these scales, they looked to see whether language processing models did the same.

    Grand explains that distributional semantic models use co-occurrence statistics to organize words into a huge, multidimensional matrix. The more similar words are to one another, the closer they are within that space. The dimensions of the space are vast, and there is no inherent meaning built into its structure. “In these word embeddings, there are hundreds of dimensions, and we have no idea what any dimension means,” he says. “We’re really trying to peer into this black box and say, ‘is there structure in here?’”

    Specifically, they asked whether the semantic scales they had asked their volunteers use were represented in the model. So they looked to see where words in the space lined up along vectors defined by the extremes of those scales. Where did dolphins and tigers fall on line from “big” to “small,” for example? And were they closer together along that line than they were on a line representing danger (“safe” to “dangerous”)?

    Across more than 50 sets of world categories and semantic scales, they found that the model had organized words very much like the human volunteers. Dolphins and tigers were judged to be similar in terms of size, but far apart on scales measuring danger or wetness. The model had organized the words in a way that represented many kinds of meaning — and it had done so based entirely on the words’ co-occurrences.

    That, Fedorenko says, tells us something about the power of language. “The fact that we can recover so much of this rich semantic information from just these simple word co-occurrence statistics suggests that this is one very powerful source of learning about things that you may not even have direct perceptual experience with.” More

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    Unlocking new doors to artificial intelligence

    Artificial intelligence research is constantly developing new hypotheses that have the potential to benefit society and industry; however, sometimes these benefits are not fully realized due to a lack of engineering tools. To help bridge this gap, graduate students in the MIT Department of Electrical Engineering and Computer Science’s 6-A Master of Engineering (MEng) Thesis Program work with some of the most innovative companies in the world and collaborate on cutting-edge projects, while contributing to and completing their MEng thesis.

    During a portion of the last year, four 6-A MEng students teamed up and completed an internship with IBM Research’s advanced prototyping team through the MIT-IBM Watson AI Lab on AI projects, often developing web applications to solve a real-world issue or business use cases. Here, the students worked alongside AI engineers, user experience engineers, full-stack researchers, and generalists to accommodate project requests and receive thesis advice, says Lee Martie, IBM research staff member and 6-A manager. The students’ projects ranged from generating synthetic data to allow for privacy-sensitive data analysis to using computer vision to identify actions in video that allows for monitoring human safety and tracking build progress on a construction site.

    “I appreciated all of the expertise from the team and the feedback,” says 6-A graduate Violetta Jusiega ’21, who participated in the program. “I think that working in industry gives the lens of making sure that the project’s needs are satisfied and [provides the opportunity] to ground research and make sure that it is helpful for some use case in the future.”

    Jusiega’s research intersected the fields of computer vision and design to focus on data visualization and user interfaces for the medical field. Working with IBM, she built an application programming interface (API) that let clinicians interact with a medical treatment strategy AI model, which was deployed in the cloud. Her interface provided a medical decision tree, as well as some prescribed treatment plans. After receiving feedback on her design from physicians at a local hospital, Jusiega developed iterations of the API and how the results where displayed, visually, so that it would be user-friendly and understandable for clinicians, who don’t usually code. She says that, “these tools are often not acquired into the field because they lack some of these API principles which become more important in an industry where everything is already very fast paced, so there’s little time to incorporate a new technology.” But this project might eventually allow for industry deployment. “I think this application has a bunch of potential, whether it does get picked up by clinicians or whether it’s simply used in research. It’s very promising and very exciting to see how technology can help us modify, or I can improve, the health-care field to be even more custom-tailored towards patients and giving them the best care possible,” she says.

    Another 6-A graduate student, Spencer Compton, was also considering aiding professionals to make more informed decisions, for use in settings including health care, but he was tackling it from a causal perspective. When given a set of related variables, Compton was investigating if there was a way to determine not just correlation, but the cause-and-effect relationship between them (the direction of the interaction) from the data alone. For this, he and his collaborators from IBM Research and Purdue University turned to a field of math called information theory. With the goal of designing an algorithm to learn complex networks of causal relationships, Compton used ideas relating to entropy, the randomness in a system, to help determine if a causal relationship is present and how variables might be interacting. “When judging an explanation, people often default to Occam’s razor” says Compton. “We’re more inclined to believe a simpler explanation than a more complex one.” In many cases, he says, it seemed to perform well. For instance, they were able to consider variables such as lung cancer, pollution, and X-ray findings. He was pleased that his research allowed him to help create a framework of “entropic causal inference” that could aid in safe and smart decisions in the future, in a satisfying way. “The math is really surprisingly deep, interesting, and complex,” says Compton. “We’re basically asking, ‘when is the simplest explanation correct?’ but as a math question.”

    Determining relationships within data can sometimes require large volumes of it to suss out patterns, but for data that may contain sensitive information, this may not be available. For her master’s work, Ivy Huang worked with IBM Research to generate synthetic tabular data using a natural language processing tool called a transformer model, which can learn and predict future values from past values. Trained on real data, the model can produce new data with similar patterns, properties, and relationships without restrictions like privacy, availability, and access that might come with real data in financial transactions and electronic medical records. Further, she created an API and deployed the model in an IBM cluster, which allowed users increased access to the model and abilities to query it without compromising the original data.

    Working with the advanced prototyping team, MEng candidate Brandon Perez also considered how to gather and investigate data with restrictions, but in his case it was to use computer vision frameworks, centered on an action recognition model, to identify construction site happenings. The team based their work on the Moments in Time dataset, which contains over a million three-second video clips with about 300 attached classification labels, and has performed well during AI training. However, the group needed more construction-based video data. For this, they used YouTube-8M. Perez built a framework for testing and fine-tuning existing object detection models and action recognition models that could plug into an automatic spatial and temporal localization tool — how they would identify and label particular actions in a video timeline. “I was satisfied that I was able to explore what made me curious, and I was grateful for the autonomy that I was given with this project,” says Perez. “I felt like I was always supported, and my mentor was a great support to the project.”

    “The kind of collaborations that we have seen between our MEng students and IBM researchers are exactly what the 6-A MEng Thesis program at MIT is all about,” says Tomas Palacios, professor of electrical engineering and faculty director of the MIT 6-A MEng Thesis program. “For more than 100 years, 6-A has been connecting MIT students with industry to solve together some of the most important problems in the world.” More

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    Q&A: More-sustainable concrete with machine learning

    As a building material, concrete withstands the test of time. Its use dates back to early civilizations, and today it is the most popular composite choice in the world. However, it’s not without its faults. Production of its key ingredient, cement, contributes 8-9 percent of the global anthropogenic CO2 emissions and 2-3 percent of energy consumption, which is only projected to increase in the coming years. With aging United States infrastructure, the federal government recently passed a milestone bill to revitalize and upgrade it, along with a push to reduce greenhouse gas emissions where possible, putting concrete in the crosshairs for modernization, too.

    Elsa Olivetti, the Esther and Harold E. Edgerton Associate Professor in the MIT Department of Materials Science and Engineering, and Jie Chen, MIT-IBM Watson AI Lab research scientist and manager, think artificial intelligence can help meet this need by designing and formulating new, more sustainable concrete mixtures, with lower costs and carbon dioxide emissions, while improving material performance and reusing manufacturing byproducts in the material itself. Olivetti’s research improves environmental and economic sustainability of materials, and Chen develops and optimizes machine learning and computational techniques, which he can apply to materials reformulation. Olivetti and Chen, along with their collaborators, have recently teamed up for an MIT-IBM Watson AI Lab project to make concrete more sustainable for the benefit of society, the climate, and the economy.

    Q: What applications does concrete have, and what properties make it a preferred building material?

    Olivetti: Concrete is the dominant building material globally with an annual consumption of 30 billion metric tons. That is over 20 times the next most produced material, steel, and the scale of its use leads to considerable environmental impact, approximately 5-8 percent of global greenhouse gas (GHG) emissions. It can be made locally, has a broad range of structural applications, and is cost-effective. Concrete is a mixture of fine and coarse aggregate, water, cement binder (the glue), and other additives.

    Q: Why isn’t it sustainable, and what research problems are you trying to tackle with this project?

    Olivetti: The community is working on several ways to reduce the impact of this material, including alternative fuels use for heating the cement mixture, increasing energy and materials efficiency and carbon sequestration at production facilities, but one important opportunity is to develop an alternative to the cement binder.

    While cement is 10 percent of the concrete mass, it accounts for 80 percent of the GHG footprint. This impact is derived from the fuel burned to heat and run the chemical reaction required in manufacturing, but also the chemical reaction itself releases CO2 from the calcination of limestone. Therefore, partially replacing the input ingredients to cement (traditionally ordinary Portland cement or OPC) with alternative materials from waste and byproducts can reduce the GHG footprint. But use of these alternatives is not inherently more sustainable because wastes might have to travel long distances, which adds to fuel emissions and cost, or might require pretreatment processes. The optimal way to make use of these alternate materials will be situation-dependent. But because of the vast scale, we also need solutions that account for the huge volumes of concrete needed. This project is trying to develop novel concrete mixtures that will decrease the GHG impact of the cement and concrete, moving away from the trial-and-error processes towards those that are more predictive.

    Chen: If we want to fight climate change and make our environment better, are there alternative ingredients or a reformulation we could use so that less greenhouse gas is emitted? We hope that through this project using machine learning we’ll be able to find a good answer.

    Q: Why is this problem important to address now, at this point in history?

    Olivetti: There is urgent need to address greenhouse gas emissions as aggressively as possible, and the road to doing so isn’t necessarily straightforward for all areas of industry. For transportation and electricity generation, there are paths that have been identified to decarbonize those sectors. We need to move much more aggressively to achieve those in the time needed; further, the technological approaches to achieve that are more clear. However, for tough-to-decarbonize sectors, such as industrial materials production, the pathways to decarbonization are not as mapped out.

    Q: How are you planning to address this problem to produce better concrete?

    Olivetti: The goal is to predict mixtures that will both meet performance criteria, such as strength and durability, with those that also balance economic and environmental impact. A key to this is to use industrial wastes in blended cements and concretes. To do this, we need to understand the glass and mineral reactivity of constituent materials. This reactivity not only determines the limit of the possible use in cement systems but also controls concrete processing, and the development of strength and pore structure, which ultimately control concrete durability and life-cycle CO2 emissions.

    Chen: We investigate using waste materials to replace part of the cement component. This is something that we’ve hypothesized would be more sustainable and economic — actually waste materials are common, and they cost less. Because of the reduction in the use of cement, the final concrete product would be responsible for much less carbon dioxide production. Figuring out the right concrete mixture proportion that makes endurable concretes while achieving other goals is a very challenging problem. Machine learning is giving us an opportunity to explore the advancement of predictive modeling, uncertainty quantification, and optimization to solve the issue. What we are doing is exploring options using deep learning as well as multi-objective optimization techniques to find an answer. These efforts are now more feasible to carry out, and they will produce results with reliability estimates that we need to understand what makes a good concrete.

    Q: What kinds of AI and computational techniques are you employing for this?

    Olivetti: We use AI techniques to collect data on individual concrete ingredients, mix proportions, and concrete performance from the literature through natural language processing. We also add data obtained from industry and/or high throughput atomistic modeling and experiments to optimize the design of concrete mixtures. Then we use this information to develop insight into the reactivity of possible waste and byproduct materials as alternatives to cement materials for low-CO2 concrete. By incorporating generic information on concrete ingredients, the resulting concrete performance predictors are expected to be more reliable and transformative than existing AI models.

    Chen: The final objective is to figure out what constituents, and how much of each, to put into the recipe for producing the concrete that optimizes the various factors: strength, cost, environmental impact, performance, etc. For each of the objectives, we need certain models: We need a model to predict the performance of the concrete (like, how long does it last and how much weight does it sustain?), a model to estimate the cost, and a model to estimate how much carbon dioxide is generated. We will need to build these models by using data from literature, from industry, and from lab experiments.

    We are exploring Gaussian process models to predict the concrete strength, going forward into days and weeks. This model can give us an uncertainty estimate of the prediction as well. Such a model needs specification of parameters, for which we will use another model to calculate. At the same time, we also explore neural network models because we can inject domain knowledge from human experience into them. Some models are as simple as multi-layer perceptions, while some are more complex, like graph neural networks. The goal here is that we want to have a model that is not only accurate but also robust — the input data is noisy, and the model must embrace the noise, so that its prediction is still accurate and reliable for the multi-objective optimization.

    Once we have built models that we are confident with, we will inject their predictions and uncertainty estimates into the optimization of multiple objectives, under constraints and under uncertainties.

    Q: How do you balance cost-benefit trade-offs?

    Chen: The multiple objectives we consider are not necessarily consistent, and sometimes they are at odds with each other. The goal is to identify scenarios where the values for our objectives cannot be further pushed simultaneously without compromising one or a few. For example, if you want to further reduce the cost, you probably have to suffer the performance or suffer the environmental impact. Eventually, we will give the results to policymakers and they will look into the results and weigh the options. For example, they may be able to tolerate a slightly higher cost under a significant reduction in greenhouse gas. Alternatively, if the cost varies little but the concrete performance changes drastically, say, doubles or triples, then this is definitely a favorable outcome.

    Q: What kinds of challenges do you face in this work?

    Chen: The data we get either from industry or from literature are very noisy; the concrete measurements can vary a lot, depending on where and when they are taken. There are also substantial missing data when we integrate them from different sources, so, we need to spend a lot of effort to organize and make the data usable for building and training machine learning models. We also explore imputation techniques that substitute missing features, as well as models that tolerate missing features, in our predictive modeling and uncertainty estimate.

    Q: What do you hope to achieve through this work?

    Chen: In the end, we are suggesting either one or a few concrete recipes, or a continuum of recipes, to manufacturers and policymakers. We hope that this will provide invaluable information for both the construction industry and for the effort of protecting our beloved Earth.

    Olivetti: We’d like to develop a robust way to design cements that make use of waste materials to lower their CO2 footprint. Nobody is trying to make waste, so we can’t rely on one stream as a feedstock if we want this to be massively scalable. We have to be flexible and robust to shift with feedstocks changes, and for that we need improved understanding. Our approach to develop local, dynamic, and flexible alternatives is to learn what makes these wastes reactive, so we know how to optimize their use and do so as broadly as possible. We do that through predictive model development through software we have developed in my group to automatically extract data from literature on over 5 million texts and patents on various topics. We link this to the creative capabilities of our IBM collaborators to design methods that predict the final impact of new cements. If we are successful, we can lower the emissions of this ubiquitous material and play our part in achieving carbon emissions mitigation goals.

    Other researchers involved with this project include Stefanie Jegelka, the X-Window Consortium Career Development Associate Professor in the MIT Department of Electrical Engineering and Computer Science; Richard Goodwin, IBM principal researcher; Soumya Ghosh, MIT-IBM Watson AI Lab research staff member; and Kristen Severson, former research staff member. Collaborators included Nghia Hoang, former research staff member with MIT-IBM Watson AI Lab and IBM Research; and Jeremy Gregory, research scientist in the MIT Department of Civil and Environmental Engineering and executive director of the MIT Concrete Sustainability Hub.

    This research is supported by the MIT-IBM Watson AI Lab. More