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Cadamuro J, Cabitza F, Debeljak Z, De Bruyne S, Frans G, Perez SM, Ozdemir H, Tolios A, Carobene A, Padoan A. Potentials and pitfalls of ChatGPT and natural-language artificial intelligence models for the understanding of laboratory medicine test results. An assessment by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group on Artificial Intelligence (WG-AI). Clin Chem Lab Med 2023; 61:1158-1166. [PMID: 37083166 DOI: 10.1515/cclm-2023-0355] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES ChatGPT, a tool based on natural language processing (NLP), is on everyone's mind, and several potential applications in healthcare have been already proposed. However, since the ability of this tool to interpret laboratory test results has not yet been tested, the EFLM Working group on Artificial Intelligence (WG-AI) has set itself the task of closing this gap with a systematic approach. METHODS WG-AI members generated 10 simulated laboratory reports of common parameters, which were then passed to ChatGPT for interpretation, according to reference intervals (RI) and units, using an optimized prompt. The results were subsequently evaluated independently by all WG-AI members with respect to relevance, correctness, helpfulness and safety. RESULTS ChatGPT recognized all laboratory tests, it could detect if they deviated from the RI and gave a test-by-test as well as an overall interpretation. The interpretations were rather superficial, not always correct, and, only in some cases, judged coherently. The magnitude of the deviation from the RI seldom plays a role in the interpretation of laboratory tests, and artificial intelligence (AI) did not make any meaningful suggestion regarding follow-up diagnostics or further procedures in general. CONCLUSIONS ChatGPT in its current form, being not specifically trained on medical data or laboratory data in particular, may only be considered a tool capable of interpreting a laboratory report on a test-by-test basis at best, but not on the interpretation of an overall diagnostic picture. Future generations of similar AIs with medical ground truth training data might surely revolutionize current processes in healthcare, despite this implementation is not ready yet.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Federico Cabitza
- DISCo, Università degli Studi di Milano-Bicocca, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Zeljko Debeljak
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Clinical Institute of Laboratory Diagnostics, University Hospital Center Osijek, Osijek, Croatia
| | - Sander De Bruyne
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Glynis Frans
- Department of Laboratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Salomon Martin Perez
- Unidad de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Habib Ozdemir
- Department of Medical Biochemistry, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Türkiye
| | - Alexander Tolios
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Anna Carobene
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Padoan
- Department of Medicine (DIMED), University of Padova, Padova, Italy
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Beste LA, Icardi M, Hunt CM, Gylys-Colwell I, Lowy E, Taylor L, Morgan TR, Chang MF, Maier MM, Cheung R. Alanine Aminotransferase Results Differ by Analyzer Manufacturer in a National Integrated Health Setting, 2012-2017. Arch Pathol Lab Med 2019; 144:748-754. [PMID: 31697169 DOI: 10.5858/arpa.2018-0622-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Disease guidelines specify universal alanine aminotransferase (ALT) thresholds for clinical decision-making, yet the effect of variability among ALT analyzers remains unclear. OBJECTIVE.— To compare ALT results from different analyzers from 2012-2017. DESIGN.— Veterans Health Administration (VHA) laboratories perform external ALT proficiency testing using standardized College of American Pathologists (CAP) samples in analyzers by 5 manufacturers. In this operational analysis, we evaluated 22 950 ALT values from 80 independent CAP samples tested at 223 laboratories. Using mixed effects modeling, we estimated the association between analyzer manufacturer and CAP outcome, adjusting for manufacturer, facility, and calendar year. We performed subgroup analyses on CAP samples with overall means near clinical guideline-specified thresholds, including less than 50 U/L (n = 10) and less than 35 U/L (n = 5). RESULTS.— The VHA used Abbott Laboratories (n = 3175; 14%), Beckman Coulter Diagnostics (n = 8723; 38%), Roche Diagnostics (n = 2595; 11%), Siemens Healthineers USA (n = 5713; 25%), and Vitros/Ortho Clinical Diagnostics (n = 2744; 12%) analyzers. The CAP samples (n = 80 samples, n = 22 950 tests) covered a wide range of mean ALT values (21-268 U/L). The average difference in mean ALT value per sample between the highest-reading and lowest-reading manufacturers was 15.4 U/L (SD = 1.8) for the 10 samples with mean ALT less than 50 U/L, and it was 10.4 U/L (SD = 3.6) overall (n = 80). In linear mixed effects modeling, we found statistically significant differences in ALT values between the different manufacturers in each year. CONCLUSIONS.— We found statistically and clinically meaningful differences between analyzers across the ALT spectrum in each year, including at ALT levels lower than 50 U/L and lower than 35 U/L. Universal ALT thresholds should be avoided as a trigger for clinical action until differences between analyzers can be resolved.
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Affiliation(s)
- Lauren A Beste
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Michael Icardi
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Christine M Hunt
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Ina Gylys-Colwell
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Elliott Lowy
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Leslie Taylor
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Timothy R Morgan
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Michael F Chang
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Marissa M Maier
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
| | - Ramsey Cheung
- From the General Medicine Service (Dr Beste) and Health Services Research and Development (Drs Beste, Lowy, and Taylor, and Ms Gylys-Colwell), VA Puget Sound Health Care System, Seattle, Washington; General Internal Medicine, University of Washington School of Medicine, Seattle (Dr Beste); Pathology Service, VA Iowa City, Iowa City (Dr Icardi); Pathology Department, University of Iowa Carver College of Medicine, Iowa City (Dr Icardi); Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina (Dr Hunt); Gastroenterology Service, Duke University Medical Center, Durham, North Carolina (Dr Hunt); Department of Health Services, University of Washington School of Public Health, Seattle (Dr Lowy); Medical Service, VA Long Beach Healthcare System, Long Beach, California (Dr Morgan); Gastroenterology Section, University of California, Irvine (Dr Morgan); Medical Service, VA Portland Health Care System, Portland, Oregon (Drs Chang and Maier); Gastroenterology Service (Dr Chang) and Infectious Diseases Service (Dr Maier), Oregon Health and Sciences University School of Medicine, Portland; the Department of Medicine (Gastroenterology and Hepatology), VA Palo Alto Health Care System, Palo Alto, California (Dr Cheung); and Medical Service (Gastroenterology and Hepatology), Stanford University, Palo Alto, California (Dr Cheung)
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