ACADEMIA Letters

Machine Learning in Clinical, Academic, and Surgical

Medicine
Mohathir Sheikh, University of Calgary
Peter Anto Johnson, University of Alberta
John Christy Johnson, University of Alberta
Jasrita Singh, McMaster University
Catherine Mardon, Antarctic Institute of Canada
Austin Mardon, Antarctic Institute of Canada

Fundamentals of Machine Learning

Machine Learning (ML) is the use of computer systems that can perform intelligent predic-
tions on large datasets often consisting of millions of unique data points. Using algorithms
and statistical models to analyze and draw inferences from patterns in data. Recent progress
in ML has attained what appears to be human level of semantic understanding and informa-
tion extraction and sometimes the ability to detect abstract patterns with greater accuracy than
human experts (Nichols et al., 2018). One of the advantages of ML, is its ability to enable
computers to learn without being explicitly programmed allowing it to have many useful ap-
plications.
Currently there are several different ML algorithms in use today, which are referred to
as models. In medicine the desired model outcomes are generally either classification or re-
gression. Classification refers to making a prediction based on qualitative data (e.g., labelling
whether an image shows a dog or a cat) and regression is a prediction of a continuous vari-
able such as the height of an individual given a set of known variables (Nichols et al., 2018).
Machine learning uses deep learning and neural networks to make their predictions. Neural

Academia Letters, August 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: Peter Anto Johnson, paj1@ualberta.ca

Citation: Sheikh, M., Johnson, P.A., Johnson, J.C., Singh, J., Mardon, C., Mardon, A. (2021). Machine
Learning in Clinical, Academic, and Surgical Medicine. Academia Letters, Article 2643.
https://doi.org/10.20935/AL2643.
1
networks pass data through a web of nodes organised in interconnected layers much like the
biological counterpart it is named after. The advantage of using artificial neural networks is
the ability to perform classification without having to declare specific parameters to assist the
model (Nichols et al., 2018). Instead, neural nets use feature learning to find their own rules
of how to decompose features in the dataset (Nichols et al., 2018). Finally for the machine
learning model to be useful, it needs to be trained using a loss function. The loss function’s
purpose is to assess the difference between the prediction and the actual value and seek to
create a model that will minimize the total difference (Nichols et al., 2018).

Clinical Applications
Using machine learning in a clinal setting is not a novel concept. In medical imaging, ML is
used with computer vison tasks such as detection, segmentations and classification. For ex-
ample, in oncology, ML is applied to assist in detecting the presence or absence of metastases
on histological sections (Nichols et al., 2018). Using a color scale, computer-aided diagno-
sis can indicate the probability of each pixel in an image to be part of a metastatic region
(Nichols et al., 2018). In the past, detecting features in images such as edge detection of var-
ious boundaries using algorithms based on pixel intensity and gradients required inputs to be
set by the user. Now with improved deep learning methods and artificial neural networks,
the process can determine the settings through an iterative process to reduce the loss function
(Chartrand et al., 2017). Another benefit from the application of ML in imaging is the time
saved through automation. In the field of histopathology, automated segmentation using ML
has been successful in reducing the diagnostic workload (Litjens et al., 2016). Litjens et al.
also successfully identified all slides containing prostate cancer as well as micro- and macro-
metastases of breast cancer automatically, without the use of additional immunohistochemical
markers or human intervention (Litjens et al., 2016). Furthermore, with the increasing avail-
ability of large databases of raw data with attached diagnoses, improved training techniques,
network architecture and computer hardware, there has been significant breakthroughs in the
fields of dermatology, radiology, ophthalmology and cardiology (Chartrand et al., 2017).

Research Applications
Machine learning also plays a role in research. In the field of drug discovery, development
pipelines are often long, complex and depend on several factors. Using the computational
power of ML, scientists can mine through billions of potential drug compounds to quickly
discover treatments for currently incurable diseases. Additionally, ML can be applied in all

Academia Letters, August 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: Peter Anto Johnson, paj1@ualberta.ca

Citation: Sheikh, M., Johnson, P.A., Johnson, J.C., Singh, J., Mardon, C., Mardon, A. (2021). Machine
Learning in Clinical, Academic, and Surgical Medicine. Academia Letters, Article 2643.
https://doi.org/10.20935/AL2643.
2
stages of drug discovery. From target validation, identification of biomarkers to analyzing
data from clinical trials, ML can assist in yielding accurate predictions and insights (Vamath-
evan et al., 2019). Pharmaceutical companies currently use ML to help identify novel tar-
gets, provide stronger evidence for target-disease associations, increase disease mechanism
understanding and improve analysis of biometric data from patient monitoring devices (Va-
mathevan et al., 2019). ML has also made advances on molecular docking in the context of
drug design. ML approaches are used in predicting the structure of a ligand within a receptor
binding site to estimate the strength of binding (Zhang et al., 2019). The advantage of using
ML techniques is that it can find genes of interest that have not been previously identified
through conventional techniques. Furthermore, a study found the combination of ML meth-
ods with traditional virtual screening produced desirable results (Zhang et al., 2019). With
several successful applications of ML in the various stages of drug development, pharmaceu-
tical companies are increasing their investment in resources and technology to support ML
research. As mentioned earlier, these methods are also being applied in the clinical setting and
combined with drug discovery, could lead to significant advances in personalized medicine
(Vamathevan et al., 2019).

Surgery Application
Machine learning application has a lot of potential in helping physicians predict major com-
plications after and in some cases during surgeries. Currently the ability to accurately predict
major complications prior to the surgery is limited. This is an important area of concern as
complications after surgeries can double the 30-day mortality and are associated with long-
term consequences (Bihorac et al., 2020). In the United States alone, 1.5 million patients de-
velop a medical complication and at least 150,000 patients die within thirty days after surgery
(Bihorac et al., 2020). Having the ability to accurately predict the risks and benefits of surgery
can help identify patients that could benefit from intraoperative strategies to offset the risk (Bi-
horac et al., 2020). In a study by Bihorac et al., the team used machine learning on existing
clinical data in electronic health records to forecast the risk probabilities for eight major post-
operative complications including sepsis, neurologic and cardiovascular complications, and
death up to 24 months after the surgery (Bihorac et al., 2020). This model was able to calculate
risk scores with high discriminatory ability using readily available health records data.
Another study focused on using ML to help anticipate hypoxaemia during surgical pro-
cedures. Hypoxaemia, or low arterial blood oxygen tension, can occur during general anaes-
thesia and is associated with serious patient complications including cardiac arrest, cardiac
arrhythmias and decreased cognitive function (Lundberg et al., 2018). Currently anaesthe-

Academia Letters, August 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: Peter Anto Johnson, paj1@ualberta.ca

Citation: Sheikh, M., Johnson, P.A., Johnson, J.C., Singh, J., Mardon, C., Mardon, A. (2021). Machine
Learning in Clinical, Academic, and Surgical Medicine. Academia Letters, Article 2643.
https://doi.org/10.20935/AL2643.
3
siologists rely on pulse oximetry to monitor blood oxygen saturation; however, this method
is unable to predict nor help anaesthesiologists prevent hypoxemic episodes from occurring.
Real-time monitoring of blood-oxygen levels only allows anaesthesiologists to take reactive
actions to minimize the duration of a hypoxemic episodes (Lundberg et al., 2018). This study
outlines how using ML to help provide insights of how certain characteristics of the patient
or procedure can change the risk of hypoxaemia will improve the clinical understanding of
hypoxaemia risk. As a result, anaesthesiologists will have the ability to proactively prevent
hypoxaemia which will drastically minimize patient harm during surgery (Lundberg et al.,
2018).
Both studies outline promising findings and with further testing to externally validate their
approaches, steps can be taken to determine the feasibility of applying these models in real-
time clinical settings. These are just two examples, out of hundreds of other ongoing ML
projects, of how ML is currently being used in patient care. As ML algorithms and models are
constantly being improved and implemented around the world, there is an increased demand
to fund the research and development of ML in medicine. We have seen improvements in
patient care and outcomes due to assistance from ML compared to current practices in clinical
and research settings. With the availability of data increasing and computers becoming more
powerful, we are beginning to realise the true potential ML has to offer. As more studies work
with ML models and continue to publish novel results, it is becoming increasingly apparent
machine learning may be the tool necessary to revolutionize modern medicine.

References
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Academia Letters, August 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: Peter Anto Johnson, paj1@ualberta.ca

Citation: Sheikh, M., Johnson, P.A., Johnson, J.C., Singh, J., Mardon, C., Mardon, A. (2021). Machine
Learning in Clinical, Academic, and Surgical Medicine. Academia Letters, Article 2643.
https://doi.org/10.20935/AL2643.
4
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cbdd.13494

Academia Letters, August 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0

Corresponding Author: Peter Anto Johnson, paj1@ualberta.ca

Citation: Sheikh, M., Johnson, P.A., Johnson, J.C., Singh, J., Mardon, C., Mardon, A. (2021). Machine
Learning in Clinical, Academic, and Surgical Medicine. Academia Letters, Article 2643.
https://doi.org/10.20935/AL2643.
5