Artificial intelligence and spine imaging: limitations, regulatory issues and future direction

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Abstract
Background As big data and artificial intelligence (AI) in spine care, and medicine as a whole, continue to be at the forefront of research, careful consideration to the quality and techniques utilized is necessary. Predictive modeling, data science, and deep analytics have taken center stage. Within that space, AI and machine learning (ML) approaches toward the use of spine imaging have gathered considerable attention in the past decade. Although several benefits of such applications exist, limitations are also present and need to be considered. Purpose The following narrative review presents the current status of AI, in particular, ML, with special regard to imaging studies, in the field of spinal research. Methods A multi-database assessment of the literature was conducted up to September 1, 2021, that addressed AI as it related to imaging of the spine. Articles written in English were selected and critically assessed. Results Overall, the review discussed the limitations, data quality and applications of ML models in the context of spine imaging. In particular, we addressed the data quality and ML algorithms in spine imaging research by describing preliminary results from a widely accessible imaging algorithm that is currently available for spine specialists to reference for information on severity of spine disease and degeneration which ultimately may alter clinical decision-making. In addition, awareness of the current, under-recognized regulation surrounding the execution of ML for spine imaging was raised. Conclusions Recommendations were provided for conducting high-quality, standardized AI applications for spine imaging.

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