Mitigating Algorithmic Bias in AI-Driven Cardiovascular Imaging for Fairer Diagnostics.

Background/Objectives: The research addresses algorithmic bias in deep learning models for cardiovascular risk prediction, focusing on fairness across demographic and socioeconomic groups to mitigate health disparities. It integrates fairness-aware algorithms, susceptible carrier-infected-recovered (SCIR) models, and interpretability frameworks to combine fairness with actionable AI insights supported by robust segmentation and classification metrics. Methods: The research utilised quantitative 3D/4D heart magnetic resonance imaging and tabular datasets from the Cardiac Atlas Project's (CAP) open challenges to explore AI-driven methodologies for mitigating algorithmic bias in cardiac imaging. The SCIR model, known for its robustness, was adapted with the Capuchin algorithm, adversarial debiasing, Fairlearn, and post-processing with equalised odds. The robustness of the SCIR model was further demonstrated in the fairness evaluation metrics, which included demographic parity, equal opportunity difference (0.037), equalised odds difference (0.026), disparate impact (1.081), and Theil Index (0.249). For interpretability, YOLOv5, Mask R-CNN, and ResNet18 were implemented with LIME and SHAP. Bias mitigation improved disparate impact (0.80 to 0.95), reduced equal opportunity difference (0.20 to 0.05), and decreased false favourable rates for males (0.0059 to 0.0033) and females (0.0096 to 0.0064) through balanced probability adjustment. Results: The SCIR model outperformed the SIR model (recovery rate: 1.38 vs 0.83) with a -10% transmission bias impact. Parameters (β=0.5, δ=0.2, γ=0.15) reduced susceptible counts to 2.53×10-12 and increased recovered counts to 9.98 by t=50. YOLOv5 achieved high Intersection over Union (IoU) scores (94.8%, 93.7%, 80.6% for normal, severe, and abnormal cases). Mask R-CNN showed 82.5% peak confidence, while ResNet demonstrated a 10.4% accuracy drop under noise. Performance metrics (IoU: 0.91-0.96, Dice: 0.941-0.980, Kappa: 0.95) highlighted strong predictive accuracy and reliability. Conclusions: The findings validate the effectiveness of fairness-aware algorithms in addressing cardiovascular predictive model biases. The integration of fairness and explainable AI not only promotes equitable diagnostic precision but also significantly reduces diagnostic disparities across vulnerable populations. This reduction in disparities is a key outcome of the research, enhancing clinical trust in AI-driven systems. The promising results of this study pave the way for future work that will explore scalability in real-world clinical settings and address limitations such as computational complexity in large-scale data processing.