Applications and implementation of generative artificial intelligence in cardiovascular imaging with a focus on ethical and legal considerations: what cardiovascular imagers need to know!

Machine learning (ML) and deep learning (DL) have potential applications in medicine. This overview explores the applications of AI in cardiovascular imaging, focusing on echocardiography, cardiac MRI (CMR), coronary CT angiography (CCTA), and CT morphology and function. AI, particularly DL approaches like convolutional neural networks, enhances standardization in echocardiography. In CMR, undersampling techniques and DL-based reconstruction methods, such as variational neural networks, improve efficiency and accuracy. ML in CCTA aids in diagnosing coronary artery disease, assessing stenosis severity, and analyzing plaque characteristics. Automatic segmentation of cardiac structures and vessels using AI is discussed, along with its potential in congenital heart disease diagnosis and 3D printing applications. Overall, AI integration in cardiovascular imaging shows promise for enhancing diagnostic accuracy and efficiency across modalities. The growing use of Generative Adversarial Networks in cardiovascular imaging brings substantial advancements but raises ethical concerns. The "black box" problem in DL models poses challenges for interpretability crucial in clinical practice. Evaluation metrics like ROC curves, image quality, clinical relevance, diversity, and quantitative performance assess GAI models. Automation bias highlights the risk of unquestioned reliance on AI outputs, demanding careful implementation and ethical frameworks. Ethical considerations involve transparency, respect for persons, beneficence, and justice, necessitating standardized evaluation protocols. Health disparities emerge if AI training lacks diversity, impacting diagnostic accuracy. AI language models, like GPT-4, face hallucination issues, posing ethical and legal challenges in healthcare. Regulatory frameworks and ethical governance are crucial for fair and accountable AI. Ongoing research and development are vital to evolving AI ethics.