Role of AI in clinical decision-making: an analysis of FDA medical device approvals

The U.S. Food and Drug Administration (FDA) plays an important role in ensuring safety and effectiveness of AI/ML-enabled devices through its regulatory processes. In recent years, there has been an increase in the number of these devices cleared by FDA. This study analyzes 104 FDA-approved ML-enabled medical devices from May 2021 to April 2023, extending previous research to provide a contemporary perspective on this evolving landscape. We examined clinical task, device task, device input and output, ML method and level of autonomy. Most approvals (n = 103) were via the 510(k) premarket notification pathway, indicating substantial equivalence to existing devices. Devices predominantly supported diagnostic tasks (n = 81). The majority of devices used imaging data (n = 99), with CT and MRI being the most common modalities. Device autonomy levels were distributed as follows: 52% assistive (requiring users to confirm or approve AI provided information or decision), 27% autonomous information, and 21% autonomous decision. The prevalence of assistive devices indicates a cautious approach to integrating ML into clinical decision-making, favoring support rather than replacement of human judgment.