Implementing Precision Medicine and Artificial Intelligence in Plastic Surgery

Concepts and Future Prospects

You J. Kim, BS; Brian P. Kelley, MD; Jacob S. Nasser, BS; Kevin C. Chung, MD, MS

Disclosures

Plast Reconstr Surg Glob Open. 2019;7(3):e2113 

In This Article

Abstract and Introduction

Abstract

Precision medicine, or the individualization of evidence-based medicine, is forthcoming. As surgeons, we must be prepared for the integration of patient and system factors. Plastic surgeons regard themselves as innovators and early adopters. As such, we need our adaptability now more than ever to implement digital advancements and precision medicine into our practices. The integration of artificial intelligence (AI) technology and the capture of big data techniques should foster the next great leaps in medicine and surgery, allowing us to capture the detailed minutiae of precision medicine. The algorithmic process of artificial neural networks will guide large-scale analysis of data, including features such as pattern recognition and rapid quantification, to organize and distribute data to surgeons seamlessly. This vast digital collection of information, commonly termed "big data," is only one potential application of AI. By incorporating big data, the cognitive abilities of a surgeon can be complemented by the computer to improve patient-centered care. Furthermore, the use of AI will provide individual patients with increased access to the broadening world of precision medicine. Therefore, plastic surgeons must learn how to use AI within the contexts of our practices to keep up with an evolving field in medicine. Although rudimentary in its practice, we present a glimpse of the potential applications of AI in plastic surgery to incorporate the practice of precision medicine into the care that we deliver.

Introduction

As technology expands and our knowledge of biological processes increases, physicians must incorporate and synthesize an overwhelming amount of patient and medical data quickly and efficiently. This has presented challenges to busy medical providers. However, technology in the form of artificial intelligence (AI) machines and convenient user interfaces may ameliorate this problem by enhancing the practice of precision medicine. National investments in AI have already been initiated, but we are falling behind. In 2016, China opened an AI laboratory that focused on the development of AI-related technology, such as "machine learning, speech recognition, natural language processing, and computer vision."[1] Their advancements in AI applications have already made its way into the industry for online gaming and social services.[1] In late June, the U.S. Pentagon made an announcement for the creation of the Joint Artificial Intelligence Center, which would facilitate numerous AI-related projects.[2] This center would be supported by the U.S. Department of Defense, estimating a cost of $2 billion over 5 years.[2] The national awareness of AI's importance is certainly growing, now it is time to advocate for and demonstrate its application in healthcare.

Precision medicine is the individualization of evidence-based medicine, particularly through the incorporation of genetic data. The practice of precision medicine enables physicians to move away from traditional shotgun approaches to health care and provide more accurate, individualized treatment and prevention strategies.[3] The shift to precision medicine integrates a diverse array of patient-specific data, such as environmental influences, lifestyle, and genetic variability.[4] However, as a key component of individualized medicine, precision medicine will require powerful tools for this technology to be applied to the general population. The smart processing power of AI may be the answer to sort through the vast amount of applicable data being produced.[5,6] In essence, AI is the ability of machines to study algorithms to perform cognitive functions, such as complex data analysis and interpretation.[7] Although physicians can interpret these data manually, using thinking machines instead may provide a quicker, more efficient analysis, giving the physician instant feedback on active patient processes.[6] Physicians will need to become quick adopters of this technology to keep up with the ever-expanding medical knowledge and to best incorporate patient-specific precision medicine concepts into their practices.[3]

Plastic surgeons are innovators and are frequently at the forefront of novel advancements in medicine. From the development of skin grafts to transplantation, the field of plastic and reconstructive surgery has grown tremendously because of our ability to incorporate new technologies rapidly and successfully.[8,9] The plastic surgeon's ability to be "plastic" will enable us to fully capture the potential of thinking machines. In recent years, AI has been integrated into many fields that require imaging, including radiology and pathology.[10–12] For instance, AI has provided radiologists with "pre-screened images and identified features" to minimize their workload and focus their diagnostic ability.[10] We envision that when the field of plastic surgery embraces big data, the cognition involved in patient diagnosis, surgical planning, and outcome assessment may be accomplished by the computer.[6]

AI and precision medicine are becoming burgeoning tools in healthcare, and the computerization of intelligence will afford us incredible computational power and promise to revolutionize medicine.[5] AI technology already has started to influence the field of plastic surgery in the form of Snapchat. Using AI imaging techniques to recognize facial features, Snapchat places filters on users' faces to alter their appearance.[13] This AI advancement has led to the recent phenomena of "Snapchat dysmorphia," which has patients seeking cosmetic surgery to resemble their filtered selfies.[13] AI technology is emerging as an important tool in society, and we, as plastic surgeons, cannot ignore its presence. In this Special Topics article, we will focus on how big data in AI can be used to enhance the practice of precision medicine in plastic and reconstructive surgery.[6] Our objectives are to (1) summarize the role of big data and precision medicine, (2) discuss potential clinical applications in plastic surgery, and (3) present future directions to guide the incorporation of AI to the field of plastic surgery.

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