Advances in computing power, deep learning architectures, and expert labelled datasets have spurred the development of medical imaging artificial intelligence systems that rival clinical experts in a variety of scenarios. The National Institutes of Health in 2018 identified key focus areas for the future of artificial intelligence in medical imaging, creating a foundational roadmap for research in image acquisition, algorithms, data standardization, and translatable clinical decision support systems. Among the key issues raised in the report: data availability, need for novel computing architectures and explainable AI algorithms, are still relevant despite the tremendous progress made over the past few years alone. Furthermore, translational goals of data sharing, validation of performance for regulatory approval, generalizability and mitigation of unintended bias must be accounted for early in the development process. In this perspective paper we explore challenges unique to high dimensional clinical imaging data, in addition to highlighting some of the technical and ethical considerations in developing high-dimensional, multi-modality, machine learning systems for clinical decision support.
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