Artificial Intelligence In Medicine and Infections Diseases

GİRİŞ: KLİNİKTE YAPAY ZEKÂ; YARIN ARTIK BUGÜNDÜR
INTRODUCTION: ARTIFICIAL INTELLIGENCE IN CLINICAL PRACTICE: IT IS THE TIME
Prof. Dr. Ali Serdar FAKa
aMarmara Üniversitesi Hipertansiyon ve Ateroskleroz Eğitim, Uygulama ve Araştırma Merkezi, İstanbul, Türkiye
Fak AS. Klinikte yapay zekâ; yarın artık bugündür. Mülazımoğlu Durmuşoğlu L, Altıkardeş ZA, editörler. Tıpta ve Enfeksiyon Hastalıklarında Yapay Zekâ. 1. Baskı. Ankara: Türkiye Klinikleri; 2022. p.7-12.
Article Language: TR
ÖZET
Yapay zekâ uygulamaları tıp ve sağlık alanında diğer alanlara göre biraz gecikmeli ve yavaş olarak kullanıma girmişse de kullanım alanları günümüzde büyük bir ivmeyle genişlemektedir. Başlangıçta hız kısıtlayıcı etkenlerin birden fazla olduğunu söylemek mümkündür; öncelikle hasta mahremiyeti ve kişisel güvenliğe ilişkin kaygılar sağlık alanında her zaman olduğu gibi yapay zekâ ve dijital tıp uygulamalarında da temkinli tutuma ve yaklaşımlara neden olmaktadır. Sağlık ve bilişim alanlarının çok farklı ve geleneksel olarak birbirleriyle ilişkisiz alanlar olmaları nedeniyle disiplinlerin eşgüdüm içinde çalışabilmesi, süreç içinde yavaş mümkün olabilmektedir. Bir diğer etken de sağlık alanındaki yasal ve idari mevzuatın yapay zekâ araştırmalarına ve uygulamalarına yönelik getirdiği çerçevedir.

Sağlıkta yapay zekâ uygulamaları öncelikli olarak fazlaca görsel veri barındıran veya verileri sayılarla ifadesi nispeten kolay olan kardiyoloji, radyoloji, patoloji gibi alanlarda gelişmeye başlamıştır.

2017 yılına dek PubMed veri tabanında yapay zekâ temelli yayın sayısı 5600 dolayında olup bunların yaklaşık 3200'ünün konusu tanısal görüntüleme, 1200'ünün genetik, 900'den biraz fazlasının ise EKG ve kardiyak ritim analizidir.1 Hastalık alanı olarak ise onkolojik, nörolojik ve kardiyovasküler hastalıklar ilk üç sıradadır.

İlk dönem çalışmaların çoğu sağlık altyapısında elektronik tıbbi kayıt sistemi kullanılan ülkelerde yapılmıştır. Bu ülkeler; ilgili verileri toplama, temizleme ve ilgili disiplinlerle hızlıca işleyebilmenin avantajını kullanmışlardır.

2017 yılı itibarıyla iOS ve android tabanlı sağlık/fitness ile ilgili 165.000'in üzerinde uygulama olduğuna dikkat çeken A.B.D. Food and Drug Adminstration (FDA), bu tür uygulamaların daha bilimsel çerçevede geliştirilmesi ve kullanılması için çaba sarf edilmesi amacıyla kendi bünyesi içinde 'Digital Health Unit' kurduğunu açıkladı (Bugün sağlık/ fitness ile ilgili uygulama sayısının 450.000'in üzerinde olduğu biliniyor).2

2018 yılında American Medical Association, yapay zekânın hastalar, hekimler ve sağlık camiası için potansiyel önemli yararlarına işaret ederek 'çerçeve görüş' yayınladı.3

2019 yılı sonunda ortaya çıkan koronavirüs hastalığı-2019 (COVID-19) pandemisi ise herkes için uzaktan iletişim ihtiyaçlarını zorunlu kılarken, uzaktan sağlık ve dijital tıp teknolojilerinin önünü daha da açmış oldu.

Yine de son yıllarda mobil ve giyilebilir teknolojilerin hızla gelişmesi, biyolojik verilerin yaşamın her anında kolaylıkla elde edilir, iletilebilir ve anlık işlenebilir hâle gelmesi, yapay zekânın sağlıkta daha fazla kullanım alanı bulmasında esas rol oynayan etken olmuştur.

2021 yılında FDA, klinikte yapay zekâ araştırmaları ve kullanımı hakkında rehber yayınladı. 4 Bu rehber gerek sağlık alanında gerekse endüstride AR-GE faaliyetlerine yol gösterecek bir kaynak olarak değerlendirilebilir.

Ekim 2022 itibarıyla, ağırlıklı olarak radyoloji, onkoloji ve kardiyoloji alanlarında olmak üzere FDA tarafından klinik onay almış yapay zekâ temelli 523 cihaz/sistem bulunmaktadır.5

Ülkemizin sağlık altyapısı dijital dönüşüme potansiyel olarak uygundur ve bu alanda önemli adımlar atılmıştır. 2018'de Cumhurbaşkanlığı Dijital Dönüşüm Ofisi kurulmuştur. Hastanelerimizdeki elektronik tıbbi kayıt ve arşiv sistemi ulusal ölçekte önemli bir başarıdır. Bu sistem aynı zamanda önemli bir veri arşivi olabilir. Keza e-Nabız sistemi hem sağlık profesyonelleri için hem de konuyla ilgili tüm araştırmacılar için yine ulusal ölçekte veri barındıran bir altyapıdır.

Ülkemizde sağlıkta yapay zekâ konusunda farkındalık son yıllarda dünya ile paralel olarak artmaktadır. Marmara Üniversitesi Tıp Fakültesi, 2017-2018 öğretim yılından bu yana tıp eğitimi programında 'Digital Health' seçmeli stajı bulundurmaktadır. 2022-2023 yılından itibaren de Mühendislik Fakültesi ile ortak 'Digital Health' dersi açılmıştır.

Türkiye Klinikleri, 2020 yılında 'Kardiyolojide Dijital Dönüşüm' başlığı ile kitap çıkarmıştır.6

Türkiye Klinikleri'nin yayınlanan 'Tipta ve Enfeksiyon Hastalıklarında Yapay Zekâ' konulu bu kitabının da, özellikle enfeksiyon hastalıklarında yapay zekâya ayrılmış olması, konuya verilen önemin yanı sıra hâlen devam etmekte olan COVID-19 pandemisi dönemi itibarıyla da anlam taşımaktadır.

COVID-19 pandemisiyle ilgili olarak yapay zekâ temelli tanısal ve kısa ve uzun dönem prognostik öngörme araştırmaları giderek daha fazla yayınlanmakta.

COVID-19'a karşı birlikte kullanılan farklı aşı türlerinin etkileri başta olmak üzere e-Nabız'da ve sağlık altyapısında var olan pandemi verileri kullanılarak kapsamlı yapay zekâ çalışmalarının ülkemizden de yayınlandığını görmek, hepimizi mutlu edecektir.

Bugünden itibaren klinikte kendini kanıtlamış yapay zekâ uygulamaları ile daha fazla karşılaşacağız. Yapay zekâyı bazen gerçek yaşam verilerini daha etkin ve daha hızlı analiz eden, çoğu zaman da veriler arasında insan gözünün görmekte zorlanacağı ilişkileri açığa çıkarıp sağlık profesyonellerine klinik karar destek sistemi olarak hizmet eden bir araç olarak görmek gerekli. Sonuçta yapay zekâ klinik kullanımımıza girdikçe, hekim hasta ilişkisi için daha çok ve daha nitelikli bir zamanımız olacak.

Hekimler olarak mesleğimizi daha iyi şartlarda uygulayabilmek ve insan/toplum sağlığını geliştirilebilmek için yapay zekâyı artık daha çok kullanacağız ancak yapay zekânın geliştirilmesine klinik katkı sunmamız da tabii ki bizden beklenmektedir.

Prof. Dr. Ali Serdar FAK
Editör Yardımcısı

KAYNAKLAR

1. Jiang F, Jiang Y, Zhi H, Dong Y, Li H, Ma S, et al. Artificial intelligence in healthcare: past, present and future. Stroke Vasc Neurol. 2017;2(4):230-43. doi: 10.1136/svn-2017-000101.
2. U.S. Food&During Administration [Internet]. Fostering Medical Innovation: A Plan for Digital Health Devices. Available from: https://www.fda.gov/news-events/fda-voices/fostering-medical-innovation-plan-digital-health-devices (Cited: 17.10.2022).
3. AMA [Internet]. Copyright 1995-2022 American Medical Association. Augmented intelligence. Available from: https://policysearch.ama-assn.org/policyfinder/detail/augmented%20intelligence?uri=%2FAMADoc%2FHOD.xml-H-480.940.xml (Cited: 17.10.2022).
4. U.S. Food&During Administration [Internet]. Artificial Intelligence and Machine Learning in Software as a Medical Device. Available from: https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-software-medical-device (Cited: 17.10.2022).
5. U.S. Food&During Administration [Internet]. Artificial Intelligence and Machine Learning (AI/ML)-Enabled Medical Devices. Available from: https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-aimlenabled-medical-devices (Cited: 17.10.2022).
6. Fak AS. Kardiyolojide Dijital Dönüşüm: Bugün ve Yarın. 1. Baskı. Ankara: Türkiye Klinikleri; 2020.
ABSTRACT
Artificial intelligence applications have emerged a little later and slowly in the field of medicine and health compared to other fields, however the areas of use are expanding with great momentum today. In the beginning, concerns about patient privacy and personal safety in the field of health care caused cautious attitudes and approaches in artificial intelligence and digital medicine applications.

Since the fields of health and informatics are very different and traditionally unrelated fields, it was only possible for the related disciplines to work in coordination slowly in the process. Another speed limiting factor is the framework brought by the legal and administrative legislation in the field of health for artificial intelligence research and applications.

Artificial intelligence applications in health have started to develop primarily in areas such as cardiology, radiology and pathology, which contain a lot of visual data or whose data are relatively easy to express in numbers.

Until 2017, the number of publications based on artificial intelligence in the PubMed database was around 5600, of which about 3200 were related to diagnostic imaging, 1200 to genetics, and a little more than 900 to ECG and cardiac rhythm analysis.1 In terms of disease area, oncological, neurological and cardiovascular diseases are in the first three places. Most of these studies have been conducted in countries that use electronic medical record systems in their healthcare infrastructure.

These countries have taken advantage of the ability to collect and clean up relevant data and process it quickly with relevant disciplines.

Pointing out that as of 2017, there are over 165,000 applications related to iOS and android-based health/fitness, the U.S.A. Food and Drug Administrationannounced that it has established a 'Digital Health Unit' within its own body in order to make efforts to develop and use such applications in a more scientific framework (Today the number of applications related to health/fitness is well over 450,000).2,3

While the coronavirus disease-19 (COVID-19) pandemic, which emerged at the end of 2019, required remote communication needs for everyone, it further paved the way for remote health and digital medicine technologies.

Nevertheless, the rapid development of mobile and wearable technologies in recent years, the fact that biological data can be easily obtained, transmitted and instantly processed in every moment of life has been the main factor in finding more development and uses of artificial intelligence in health.

In 2021, the FDA published guidance on artificial intelligence research and use in the clinic.4 This guide can be considered as a resource that will guide R&D activities both in the field of health and in the industry.

As of October 2022, there are 523 artificial intelligence-based devices / systems that have received clinical approval by the FDA, mainly in the fields of radiology, oncology and cardiology.5

Our country's health infrastructure is potentially suitable for digital transformation and important steps have been taken in this area. The Presidential Digital Transformation Office was established in 2018. The electronic medical record and archive system in our hospitals is an important achievement on a national scale. This system can also be an important data archive. Likewise, the e-Nabız system is an infrastructure that contains data on a national scale for both health professionals and all researchers related to the subject.

Awareness of artificial intelligence in health in Türkiye has been increasing in parallel with the world in recent years. Since the 2017-2018 academic year, Marmara University School of Medicine has an elective internship in the medical education program "Digital Health". As of 2022-2023, a joint 'Digital Health' course has been opened also with the Faculty of Engineering.

Türkiye Klinikleri has published a book with the title 'Digital Transformation in Cardiology' in 2020.6

The fact that this book of Türkiye Klinikleri; 'Artificial Intelligence in Medicine and Infectious Diseases' is devoted to artificial intelligence, especially in infectious diseases, is also meaningful in terms of the ongoing COVID-19 pandemic period, as well as the importance given to the subject.

Artificial intelligence-based diagnostic and short- and long-term prognostic prediction research is being published more and more in relation to the COVID-19 pandemic.

We would all be more than happy to see comprehensive artificial intelligence studies being performed in our country by using the pandemic data available in eNabız and health infrastructure, especially the effects of different vaccine types used together against COVID-19.

It is necessary to see artificial intelligence as a tool that sometimes analyzes reallife data more effectively and faster, and often serves as a clinical decision support system for healthcare professionals by revealing relationships between data that are difficult for the human eye to see. As a result, as artificial intelligence enters our clinical practice, we will have more quality time for the doctor-patient relationship.

From now on we will use artificial intelligence in our daily practice in order to be able to practice our profession in better conditions and to improve human / public health, nevertheless we are also expected to contribute clinically to the development of artificial intelligence as well.

Prof. Dr. Ali Serdar FAK
Associate Editor

REFERENCES

1. Jiang F, Jiang Y, Zhi H, Dong Y, Li H, Ma S, et al. Artificial intelligence in healthcare: past, present and future. Stroke Vasc Neurol. 2017;2(4):230-43. doi: 10.1136/svn-2017-000101.
2. U.S. Food&During Administration [Internet]. Fostering Medical Innovation: A Plan for Digital Health Devices. Available from: https://www.fda.gov/news-events/fda-voices/fostering-medical-innovation-plan-digital-health-devices (Cited: 17.10.2022).
3. AMA [Internet]. Copyright 1995-2022 American Medical Association. Augmented intelligence. Available from: https://policysearch.ama-assn.org/policyfinder/detail/augmented%20intelligence?uri=%2FAMADoc%2FHOD.xml-H-480.940.xml (Cited: 17.10.2022).
4. U.S. Food&During Administration [Internet]. Artificial Intelligence and Machine Learning in Software as a Medical Device. Available from: https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-software-medical-device (Cited: 17.10.2022).
5. U.S. Food&During Administration [Internet]. Artificial Intelligence and Machine Learning (AI/ML)-Enabled Medical Devices. Available from: https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-aimlenabled-medical-devices (Cited: 17.10.2022).
6. Fak AS. Kardiyolojide Dijital Dönüşüm: Bugün ve Yarın. 1. Baskı. Ankara: Türkiye Klinikleri; 2020.

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