PERSPECTIVE THE WRITER’S VOICE HBO’s Westworld imagines how artificial intelligence could have dire costs. Should health care professionals take note? tion facility, were likely enough to hook many viewers. As a budding physician with a passion for anatomy, I was further enthralled with how the show depicted the engineering of the androids’ human-like PHOTO COURTESY OF HBO / JOHN P. JOHNSON COURTESYPHOTO / JOHN P. OF HBO physiques from artificial primordial ele- ments. The onscreen procedure was equal parts fascinating and disturbing, invoking Vesalius’ grisly dissections, which founded our modern understanding of the human body. However, my strongest personal response to the show has been an unex- pected realization that the ethical issues AI poses in Westworld will likely be the foremost issues the field of radiology faces during my career. WHERE WILL AI TAKE US? In Westworld, the AI incorporated into “host” robots has advanced to the point of passing the famed Turing test. Westworld triggers Visitors to the titular theme park cannot distinguish these artificial beings from reflections about actual humans. Today, in the real world, advancements in deep learning are allow- ing AI to accumulate new information and radiology’s future understanding at a rate that humans can- not match. According to Keith J. Dreyer, BY JOSHUA T. OLSON DO, PhD, and vice chairman of Radiol- hen the Radiological Society of future AI applications, including the use ogy Computer and Information Sciences North America (RSNA) hosted its of machine learning to correlate imaging at Massachusetts General Hospital, the W2016 annual meeting in Chicago, findings with clinical data in electronic “point of singularity”—a time at which among the chief subjects discussed was medical records, as well as with relevant machine intelligence surpasses that of the evolution of machine learning and scientific literature—an innovation that all humans combined—could be just its impact on radiology. Session topics would usher in a new era of precision over a decade away, occurring as soon as touched on key developments in artificial medicine. 2029.2 Given Dreyer’s prediction, perhaps intelligence (AI), including the use of Last fall, as a medical student circling some elements of Westworld are not so computing technology to model the neural the Midwest on the residency interview far-fetched—but instead of playing out in networks of the human brain—a technique trail in pursuit of a position in the ra- an antiquated western theme park, they’ll labelled “deep learning.” Through deep diology field, I found myself splitting be set within the modern American health learning, computers have demonstrated an time between virtually attending the care system. ability to surpass humans in competitions RSNA meeting, preparing for upcoming Putting aside the plausibility of such measuring accuracy of visual recognition. interviews, and (like many of my col- a scenario, I find myself pondering the Not unexpectedly, the infusion of leagues) binge-watching HBO’s new hit implications AI poses for radiology. Given this technology into radiology work has TV series Westworld. In this remake of recent advances in visual recognition already begun. For example, computer- Michael Crichton’s 1973 science fiction software, will deep learning reach a point assisted identification of breast lesions thriller, theme-park robots revolt and where the technology doesn’t merely aug- now plays a major role in mammographic begin killing park visitors. The show’s ment the work of radiologists, but fully screening for breast cancer.1 At the RSNA scenic western vistas, juxtaposed with the replace it? Will other humans’ health care meeting, attendees discussed possible workings of a futuristic android produc- 16 | MINNESOTA MEDICINE | MARCH/APRIL 2017 THE WRITER’S VOICE PERSPECTIVE roles become obsolete, as well? Will tech- Most importantly, to what degree will that carries with it the potential to harm nology we employ while serving patients radiologists incorporate AI into the pro- humans, it will be the responsibility of ever be able to “think” in a manner we cesses of making life-or-death health care radiologists—along with the creators of consider “conscious”? If so, where will the management decisions? AI solutions deployed within the radiol- responsibility lie if machine error leads Undoubtedly, these are questions we’ll ogy field—to avoid such a grave mistake. to faulty or missed diagnoses—say, for grapple with in the coming years. Until We must address possible ramifications example, a missed lung nodule that leads then, I find myself ruminating on a fore- beforehand, so the evolution of machine to metastatic cancer? What will be our boding statement made by Dr. Robert learning will strengthen our work—and threshold of tolerance for such mistakes? Ford, Westworld’s park designer (played not hurt those who depend upon us. MM by Anthony Hopkins), Joshua T. Olson is an MD candidate (class of in this season’s final epi- 2017) at the University of Minnesota Medical sode: “Wasn’t it Oppen- School. heimer who said, ‘Any man whose mistakes REFERENCES: take 10 years to correct 1. Wang J, Yang X, Cai H, Tan W, Jin C, Li L. is quite the man?’ Well, Discrimination of breast cancer with microcalcifica- mine took 35.”3 This tions on mammography by deep learning. Sci Rep. 2016;6:27327. PHOTO COURTESY OF HBO / JOHN P. JOHNSON PHOTO COURTESYHBO / JOHN P. OF character didn’t an- 2. Dreyer K, Baron R. When Machines Think: ticipate that his earlier Radiology’s Next Frontier. Radiological Society of North America 2016 Scientific Assembly and Annual decisions surrounding Meeting, November 27-December 2, 2016, Chicago AI would, decades later, IL. Information at: archive.rsna.org/2016/16004761. html. have dire consequences. 3. “The Bicameral Mind.” Westworld. HBO. Anthony Hopkins As we now prepare to December 4, 2016. as Dr. Robert Ford. implement a profoundly disruptive technology You have worked hard. Protect what Your Link to Mental Health Resources you have worked for. Wealth Protection Strategies for High-Income, High Net-Worth individuals, their families, and their businesses. Thomas F. Miller Attorney at Law 40 YEARS EXPERIENCE • HIGHEST PEER REVIEWS Thomas F. Miller, P.A. 1000 Superior Boulevard, Suite 303, Wayzata, MN 55391 OFFICE: 952-404-3896 MOBILE: 612-991-5992 [email protected] MARCH/APRIL 2017 | MINNESOTA MEDICINE | 17.