Reconciling privacy and accuracy in AI for medical imaging

Artificial intelligence (AI) models are vulnerable to information leakage of their training data, which can be highly sensitive, for example, in medical imaging. Privacy-enhancing technologies, such as differential privacy (DP), aim to circumvent these susceptibilities. DP is the strongest possible protection for training models while bounding the risks of inferring the inclusion of training samples or reconstructing the original data. DP achieves this by setting a quantifiable privacy budget. Although a lower budget decreases the risk of information leakage, it typically also reduces the performance of such models. This imposes a trade-off between robust performance and stringent privacy. Additionally, the interpretation of a privacy budget remains abstract and challenging to contextualize. Here we contrast the performance of artificial intelligence models at various privacy budgets against both theoretical risk bounds and empirical success of reconstruction attacks. We show that using very large privacy budgets can render reconstruction attacks impossible, while drops in performance are negligible. We thus conclude that not using DP at all is negligent when applying artificial intelligence models to sensitive data. We deem our results to lay a foundation for further debates on striking a balance between privacy risks and model performance. Ziller and colleagues present a balanced investigation of the trade-off between privacy and performance when training artificially intelligent models for medical imaging analysis tasks. The authors evaluate the use of differential privacy in realistic threat scenarios, leading to their conclusion to promote the use of differential privacy, but implementing it in a manner that also retains performance.