An artificial intelligence life cycle: From conception to production

Artificial Intelligence in the Management of Heart Failure

Artificial intelligence (AI) has the potential to revolutionize the management of heart failure. AI-based tools can guide the diagnosis and treatment of known risk factors, identify asymptomatic structural heart disease, improve cardiomyopathy diagnosis and symptomatic heart failure treatment, and uncover patients transitioning to advanced disease. By integrating multimodal data, including omics, imaging, signals, and electronic health records, state-of-the-art algorithms allow for a more tailored approach to patient care, addressing the unique needs of the individual. The past decade has led to the development of numerous AI solutions targeting each aspect of the heart failure syndrome. However, significant barriers to implementation remain and have limited clinical uptake. Data-privacy concerns, real-world model performance, integration challenges, trust in AI, model governance, and concerns about fairness and bias are some of the topics requiring additional research and the development of best practices. This review highlights progress in the use of AI to guide the diagnosis and management of heart failure while underscoring the importance of overcoming key implementation challenges that are currently slowing progress.

Rethinking clinical trials for medical AI with dynamic deployments of adaptive systems

There is a growing recognition of the need for clinical trials to safely and effectively deploy artificial intelligence (AI) in clinical settings. We introduce dynamic deployment as a framework for AI clinical trials tailored for the dynamic nature of large language models, making possible complex medical AI systems which continuously learn and adapt in situ from new data and interactions with users while enabling continuous real-time monitoring and clinical validation.

Explanation and elaboration of MedinAI: guidelines for reporting artificial intelligence studies in medicines, pharmacotherapy, and pharmaceutical services

The increasing adoption of artificial intelligence (AI) in medicines, pharmacotherapy, and pharmaceutical services necessitates clear guidance on reporting standards. While the MedinAI Statement (Bottacin in Int J Clin Pharm, https://doi.org/10.1007/s11096-025-01905-3, 2025) provides core guidelines for reporting AI studies in these fields, detailed explanations and practical examples are crucial for optimal implementation. This companion document was developed to offer comprehensive guidance and real-world examples for each guideline item. The document elaborates on all 14 items and 78 sub-items across four domains: core, ethical considerations in medication and pharmacotherapy, medicines as products, and services related to medicines and pharmacotherapy. Through clear, actionable guidance and diverse examples, this document enhances MedinAI's utility, enabling researchers and stakeholders to improve the quality and transparency of AI research reporting across various contexts, study designs, and development stages.

Guidelines for reporting artificial intelligence studies in medicines, pharmacotherapy, and pharmaceutical services: MedinAI development, validation and statement

BACKGROUND

Artificial intelligence (AI) applications in medicines, pharmacotherapy, and pharmaceutical services are expanding, yet the lack of standardized reporting guidelines for scientific studies hinders transparency, comparability, and reproducibility in evidence-based healthcare decision-making.

AIM

To develop and validate comprehensive reporting guidelines for AI studies in these fields through expert consensus.

METHOD

Following the Guidance for Developers of Health Research Reporting Guidelines (Moher in PLoS Med, https://doi.org/10.1371/journal.pmed.1000217 , 2010), this study was conducted between May and October 2024 in two phases. Phase 1 involved drafting the initial guidelines through literature reviews and structured expert discussions by an internal committee. Phase 2 employed the Delphi method for validation and refinement. Twenty-six experts from nine countries, representing clinical pharmacy, pharmaceutical services, computer science, and AI, participated in the first round, with 21 completing the second round. Items were included if they received a median ≥ 7 on a 9-point evaluation scale, with ≥ 75% agreement defining publication consensus.

RESULTS

The final MedinAI guidelines comprise 14 items and 78 sub-items across four domains: core aspects, ethical considerations in medication and pharmacotherapy, medicines as products, and services related to medicines and pharmacotherapy. All items achieved consensus (median = 8, with 95.2% agreement on publication readiness). MedinAI's items adapt to different AI development stages, and its structure operates in parallel with EQUATOR Network reporting guidelines for most study designs (CONSORT, STROBE, PRISMA, SPIRIT, etc.), ensuring versatility.

CONCLUSION

MedinAI provides validated reporting guidelines for AI studies in medicines, pharmacotherapy and pharmaceutical services, promoting transparency, comparability, reproducibility, responsible and ethical AI development for these fields.

Evolution of an Artificial Intelligence-Powered Application for Mammography

Background: The implementation of radiological artificial intelligence (AI) solutions remains challenging due to limitations in existing testing methodologies. This study assesses the efficacy of a comprehensive methodology for performance testing and monitoring of commercial-grade mammographic AI models. Methods: We utilized a combination of retrospective and prospective multicenter approaches to evaluate a neural network based on the Faster R-CNN architecture with a ResNet-50 backbone, trained on a dataset of 3641 mammograms. The methodology encompassed functional and calibration testing, coupled with routine technical and clinical monitoring. Feedback from testers and radiologists was relayed to the developers, who made updates to the AI model. The test dataset comprised 112 medical organizations, representing 10 manufacturers of mammography equipment and encompassing 593,365 studies. The evaluation metrics included the area under the curve (AUC), accuracy, sensitivity, specificity, technical defects, and clinical assessment scores. Results: The results demonstrated significant enhancement in the AI model's performance through collaborative efforts among developers, testers, and radiologists. Notable improvements included functionality, diagnostic accuracy, and technical stability. Specifically, the AUC rose by 24.7% (from 0.73 to 0.91), the accuracy improved by 15.6% (from 0.77 to 0.89), sensitivity grew by 37.1% (from 0.62 to 0.85), and specificity increased by 10.7% (from 0.84 to 0.93). The average proportion of technical defects declined from 9.0% to 1.0%, while the clinical assessment score improved from 63.4 to 72.0. Following 2 years and 9 months of testing, the AI solution was integrated into the compulsory health insurance system. Conclusions: The multi-stage, lifecycle-based testing methodology demonstrated substantial potential in software enhancement and integration into clinical practice. Key elements of this methodology include robust functional and diagnostic requirements, continuous testing and updates, systematic feedback collection from testers and radiologists, and prospective monitoring.

Bridging Artificial Intelligence and Medical Education: Navigating the Alignment Paradox

The integration of artificial intelligence (AI) into medical education presents both unprecedented opportunities and significant challenges, epitomized by the "alignment paradox." This paradox asks: How do we ensure AI systems remain aligned with our educational goals? For instance, AI could create highly personalized learning pathways, but this might conflict with educators' intentions for structured skill development. This paper proposes a framework to address this paradox, focusing on four key principles: ethics, robustness, interpretability, and scalable oversight. We examine the current landscape of AI in medical education, highlighting its potential to enhance learning experiences, improve clinical decision making, and personalize education. We review ethical considerations, emphasize the importance of robustness across diverse healthcare settings, and present interpretability as crucial for effective human-AI collaboration. For example, AI-based feedback systems like i-SIDRA enable real-time, actionable feedback, enhancing interpretability while reducing cognitive overload. The concept of scalable oversight is introduced to maintain human control while leveraging AI's autonomy. We outline strategies for implementing this oversight, including directable behaviors and human-AI collaboration techniques. With this road map, we aim to support the medical education community in responsibly harnessing AI's power in its educational systems.

Building an Ethical and Trustworthy Biomedical AI Ecosystem for the Translational and Clinical Integration of Foundation Models

Foundation Models (FMs) are gaining increasing attention in the biomedical artificial intelligence (AI) ecosystem due to their ability to represent and contextualize multimodal biomedical data. These capabilities make FMs a valuable tool for a variety of tasks, including biomedical reasoning, hypothesis generation, and interpreting complex imaging data. In this review paper, we address the unique challenges associated with establishing an ethical and trustworthy biomedical AI ecosystem, with a particular focus on the development of FMs and their downstream applications. We explore strategies that can be implemented throughout the biomedical AI pipeline to effectively tackle these challenges, ensuring that these FMs are translated responsibly into clinical and translational settings. Additionally, we emphasize the importance of key stewardship and co-design principles that not only ensure robust regulation but also guarantee that the interests of all stakeholders-especially those involved in or affected by these clinical and translational applications-are adequately represented. We aim to empower the biomedical AI community to harness these models responsibly and effectively. As we navigate this exciting frontier, our collective commitment to ethical stewardship, co-design, and responsible translation will be instrumental in ensuring that the evolution of FMs truly enhances patient care and medical decision-making, ultimately leading to a more equitable and trustworthy biomedical AI ecosystem.

A joint physics and radiobiology DREAM team vision - Towards better response prediction models to advance radiotherapy

Radiotherapy developed empirically through experience balancing tumour control and normal tissue toxicities. Early simple mathematical models formalized this practical knowledge and enabled effective cancer treatment to date. Remarkable advances in technology, computing, and experimental biology now create opportunities to incorporate this knowledge into enhanced computational models. The ESTRO DREAM (Dose Response, Experiment, Analysis, Modelling) workshop brought together experts across disciplines to pursue the vision of personalized radiotherapy for optimal outcomes through advanced modelling. The ultimate vision is leveraging quantitative models dynamically during therapy to ultimately achieve truly adaptive and biologically guided radiotherapy at the population as well as individual patient-based levels. This requires the generation of models that inform response-based adaptations, individually optimized delivery and enable biological monitoring to provide decision support to clinicians. The goal is expanding to models that can drive the realization of personalized therapy for optimal outcomes. This position paper provides their propositions that describe how innovations in biology, physics, mathematics, and data science including AI could inform models and improve predictions. It consolidates the DREAM team's consensus on scientific priorities and organizational requirements. Scientifically, it stresses the need for rigorous, multifaceted model development, comprehensive validation and clinical applicability and significance. Organizationally, it reinforces the prerequisites of interdisciplinary research and collaboration between physicians, medical physicists, radiobiologists, and computational scientists throughout model development. Solely by a shared understanding of clinical needs, biological mechanisms, and computational methods, more informed models can be created. Future research environment and support must facilitate this integrative method of operation across multiple disciplines.

Sustainable deployment of clinical prediction tools-a 360° approach to model maintenance

BACKGROUND

As the enthusiasm for integrating artificial intelligence (AI) into clinical care grows, so has our understanding of the challenges associated with deploying impactful and sustainable clinical AI models. Complex dataset shifts resulting from evolving clinical environments strain the longevity of AI models as predictive accuracy and associated utility deteriorate over time.

OBJECTIVE

Responsible practice thus necessitates the lifecycle of AI models be extended to include ongoing monitoring and maintenance strategies within health system algorithmovigilance programs. We describe a framework encompassing a 360° continuum of preventive, preemptive, responsive, and reactive approaches to address model monitoring and maintenance from critically different angles.

DISCUSSION

We describe the complementary advantages and limitations of these four approaches and highlight the importance of such a coordinated strategy to help ensure the promise of clinical AI is not short-lived.

Artificial intelligence (AI) or augmented intelligence? How big data and AI are transforming healthcare: Challenges and opportunities

The sanctity of the doctor-patient relationship is deeply embedded in tradition - the Hippocratic oath, medical ethics, professional codes of conduct, and legislation - all of which are being disrupted by big data and 'artificial' intelligence (AI). The transition from paper-based records to electronic health records, wearables, mobile health applications and mobile phone data has created new opportunities to scale up data collection. Databases of unimaginable magnitude can be harnessed to develop algorithms for AI and to refine machine learning. Complex neural networks now lie at the core of ubiquitous AI systems in healthcare. A transformed healthcare environment enhanced by innovation, robotics, digital technology, and improved diagnostics and therapeutics is plagued by ethical, legal and social challenges. Global guidelines are emerging to ensure governance in AI, but many low- and middle-income countries have yet to develop context- specific frameworks. Legislation must be developed to frame liability and account for negligence due to robotics in the same way human healthcare providers are held accountable. The digital divide between high- and low-income settings is significant and has the potential to exacerbate health inequities globally.

Exploring patient perspectives on how they can and should be engaged in the development of artificial intelligence (AI) applications in health care

BACKGROUND

Artificial intelligence (AI) is a rapidly evolving field which will have implications on both individual patient care and the health care system. There are many benefits to the integration of AI into health care, such as predicting acute conditions and enhancing diagnostic capabilities. Despite these benefits potential harms include algorithmic bias, inadequate consent processes, and implications on the patient-provider relationship. One tool to address patients' needs and prevent the negative implications of AI is through patient engagement. As it currently stands, patients have infrequently been involved in AI application development for patient care delivery. Furthermore, we are unaware of any frameworks or recommendations specifically addressing patient engagement within the field of AI in health care.

METHODS

We conducted four virtual focus groups with thirty patient participants to understand of how patients can and should be meaningfully engaged within the field of AI development in health care. Participants completed an educational module on the fundamentals of AI prior to participating in this study. Focus groups were analyzed using qualitative content analysis.

RESULTS

We found that participants in our study wanted to be engaged at the problem-identification stages using multiple methods such as surveys and interviews. Participants preferred that recruitment methodologies for patient engagement included both in-person and social media-based approaches with an emphasis on varying language modalities of recruitment to reflect diverse demographics. Patients prioritized the inclusion of underrepresented participant populations, longitudinal relationship building, accessibility, and interdisciplinary involvement of other stakeholders in AI development. We found that AI education is a critical step to enable meaningful patient engagement within this field. We have curated recommendations into a framework for the field to learn from and implement in future development.

CONCLUSION

Given the novelty and speed at which AI innovation is progressing in health care, patient engagement should be the gold standard for application development. Our proposed recommendations seek to enable patient-centered AI application development in health care. Future research must be conducted to evaluate the effectiveness of patient engagement in AI application development to ensure that both AI application development and patient engagement are done rigorously, efficiently, and meaningfully.

Institutionalised distrust and human oversight of artificial intelligence: towards a democratic design of AI governance under the European Union AI Act

Human oversight has become a key mechanism for the governance of artificial intelligence ("AI"). Human overseers are supposed to increase the accuracy and safety of AI systems, uphold human values, and build trust in the technology. Empirical research suggests, however, that humans are not reliable in fulfilling their oversight tasks. They may be lacking in competence or be harmfully incentivised. This creates a challenge for human oversight to be effective. In addressing this challenge, this article aims to make three contributions. First, it surveys the emerging laws of oversight, most importantly the European Union's Artificial Intelligence Act ("AIA"). It will be shown that while the AIA is concerned with the competence of human overseers, it does not provide much guidance on how to achieve effective oversight and leaves oversight obligations for AI developers underdefined. Second, this article presents a novel taxonomy of human oversight roles, differentiated along whether human intervention is constitutive to, or corrective of a decision made or supported by an AI. The taxonomy allows to propose suggestions for improving effectiveness tailored to the type of oversight in question. Third, drawing on scholarship within democratic theory, this article formulates six normative principles which institutionalise distrust in human oversight of AI. The institutionalisation of distrust has historically been practised in democratic governance. Applied for the first time to AI governance, the principles anticipate the fallibility of human overseers and seek to mitigate them at the level of institutional design. They aim to directly increase the trustworthiness of human oversight and to indirectly inspire well-placed trust in AI governance.

Digital Transformation of Cancer Care in the Era of Big Data, Artificial Intelligence and Data-Driven Interventions: Navigating the Field

OBJECTIVES

To navigate the field of digital cancer care and define and discuss key aspects and applications of big data analytics, artificial intelligence (AI), and data-driven interventions.

DATA SOURCES

Peer-reviewed scientific publications and expert opinion.

CONCLUSION

The digital transformation of cancer care, enabled by big data analytics, AI, and data-driven interventions, presents a significant opportunity to revolutionize the field. An increased understanding of the lifecycle and ethics of data-driven interventions will enhance development of innovative and applicable products to advance digital cancer care services.

IMPLICATIONS FOR NURSING PRACTICE

As digital technologies become integrated into cancer care, nurse practitioners and scientists will be required to increase their knowledge and skills to effectively use these tools to the patient's benefit. An enhanced understanding of the core concepts of AI and big data, confident use of digital health platforms, and ability to interpret the outputs of data-driven interventions are key competencies. Nurses in oncology will play a crucial role in patient education around big data and AI, with a focus on addressing any arising questions, concerns, or misconceptions to foster trust in these technologies. Successful integration of data-driven innovations into oncology nursing practice will empower practitioners to deliver more personalized, effective, and evidence-based care.

Participatory design of teacher dashboards: navigating the tension between teacher input and theories on teacher professional vision

In the field of AI in education, there is a movement toward human-centered design in which the primary stakeholders are collaborators in establishing the design and functionality of the AI system (participatory design). Several authors have noted that there is a potential tension in participatory design between involving stakeholders and, thus, increasing uptake of the system on the one hand, and the use of educational theory on the other hand. The goal of the present perspective article is to unpack this tension in more detail, focusing on the example of teacher dashboards. Our contribution to theory is to show that insights from the research field of teacher professional vision can help explain why stakeholder involvement may lead to tension. In particular, we discuss that the sources of information that teachers use in their professional vision, and which data sources could be included on dashboards, might differ with respect to whether they actually relate to student learning or not. Using this difference as a starting point for participatory design could help navigate the aforementioned tension. Subsequently, we describe several implications for practice and research that could help move the field of human centered design further.