Artificial Intelligence in Clinical Medicine: Challenges Across Diagnostic Imaging, Clinical Decision Support, Surgery, Pathology, and Drug Discovery

A comprehensive PubMed search was performed without language or publication date restrictions, combining Medical Subject Headings (MeSH) and free-text keywords for AI with domain-specific terms. The search yielded 2047 records, of which 243 duplicates were removed, leaving 1804 unique studies. After screening titles and abstracts, 1482 records were excluded due to irrelevance, preclinical scope, or lack of patient-level outcomes. Full-text review of 322 articles led to the exclusion of 172 studies (no clinical validation or outcomes, n = 64; methodological studies, n = 43; preclinical and in vitro-only, n = 39; conference abstracts without peer-reviewed full text, n = 26). Ultimately, 150 studies met inclusion criteria and were analyzed qualitatively. Data extraction focused on study context, AI technique, dataset characteristics, comparator benchmarks, and reported outcomes, such as diagnostic accuracy, area under the curve (AUC), efficiency, and clinical improvements.

AI demonstrated strong performance in diagnostic imaging, achieving expert-level accuracy in tasks such as cancer detection (AUC up to 0.94). CDSS showed promise in predicting adverse events (sepsis, atrial fibrillation), though real-world outcome evidence was mixed. In surgery, AI enhanced intraoperative guidance and risk stratification. Pathology benefited from AI-assisted diagnosis and molecular inference from histology. AI also accelerated drug discovery through protein structure prediction and virtual screening. However, challenges included limited explainability, data bias, lack of prospective trials, and regulatory hurdles.