Systematic Review of Artificial Intelligence in Acute Respiratory Distress Syndrome for COVID-19 Lung Patients: A Biomedical Imaging Perspective

Jasjit Suri, Sushant Agarwal, Suneet Gupta, Anudeep Puvvula, Klaudija Viskovic, Neha Suri, Azra Alizad, Ayman El-Baz, Luca Saba, Mostafa Fatemi, D. Subbaram Naidu

Research output: Contribution to journalReview articlepeer-review


SARS-CoV-2 has infected over ∼165 million people worldwide causing Acute Respiratory Distress Syndrome (ARDS) and has killed ∼3.4 million people. Artificial Intelligence (AI) has shown to benefit in the biomedical image such as X-ray/Computed Tomography in diagnosis of ARDS, but there are limited AI-based systematic reviews (aiSR). The purpose of this study is to understand the Risk-of-Bias (RoB) in a non-randomized AI trial for handling ARDS using novel AtheroPoint-AI-Bias (AP(ai)Bias). Our hypothesis for acceptance of a study to be in low RoB must have a mean score of 80% in a study. Using the PRISMA model, 42 best AI studies were analyzed to understand the RoB. Using the AP(ai)Bias paradigm, the top 19 studies were then chosen using the raw-cutoff of 1.9. This was obtained using the intersection of the cumulative plot of 'mean score vs. study' and score distribution. Finally, these studies were benchmarked against ROBINS-I and PROBAST paradigm. Our observation showed that AP(ai)Bias, ROBINS-I, and PROBAST had only 32%, 16%, and 26% studies, respectively in low-moderate RoB (cutoff>2.5), however none of them met the RoB hypothesis. Further, the aiSR analysis recommends six primary and six secondary recommendations for the non-randomized AI for ARDS. The primary recommendations for improvement in AI-based ARDS design inclusive of (i) comorbidity, (ii) inter-and intra-observer variability studies, (iii) large data size, (iv) clinical validation, (v) granularity of COVID-19 risk, and (vi) cross-modality scientific validation. The AI is an important component for diagnosis of ARDS and the recommendations must be followed to lower the RoB.

Original languageEnglish (US)
Pages (from-to)4128-4139
Number of pages12
JournalIEEE Journal of Biomedical and Health Informatics
Issue number11
StatePublished - Nov 1 2021


  • AI
  • ARDS
  • COVID-19
  • CT
  • Risk-of-Bias

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics
  • Electrical and Electronic Engineering
  • Health Information Management


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