Advances in artificial intelligence (AI) have achieved expert-level performance in medical imaging applications. Notably, self-supervised vision-language foundation models can detect a broad spectrum of pathologies without relying on explicit training annotations. However, it is crucial to ensure that these AI models do not mirror or amplify human biases, thereby disadvantaging historically marginalized groups such as females or Black patients. The manifestation of such biases could systematically delay essential medical care for certain patient subgroups. In this study, we investigate the algorithmic fairness of state-of-the-art vision-language foundation models in chest X-ray diagnosis across five globally-sourced datasets. Our findings reveal that compared to board-certified radiologists, these foundation models consistently underdiagnose marginalized groups, with even higher rates seen in intersectional subgroups, such as Black female patients. Such demographic biases present over a wide range of pathologies and demographic attributes. Further analysis of the model embedding uncovers its significant encoding of demographic information. Deploying AI systems with these biases in medical imaging can intensify pre-existing care disparities, posing potential challenges to equitable healthcare access and raising ethical questions about their clinical application.

人工智能在医学影像应用中取得了专家级性能。然而，研究发现目前的视觉语言基础模型在胸部X射线诊断中普遍存在算法公平性问题，导致偏见对待历史上被边缘化的群体，并延迟特定人群的重要医疗护理，严重加剧现有的护理差异，对公平医疗保障带来挑战。

医学影像中专家级视觉语言基础模型的人口统计偏见