Will facial recognition technology ultimately allow fully autonomous radiotherapy delivery, especially if you can be seated for treatment?

I was watching the BBC Panorama edition that aired on the May 26th 2021 called:

Are you scared yet, Human?

‘As artificial intelligence changes our world, it has sparked a new arms race between China and the US. Experts warn that without urgent regulation, we could lose control’.

It focused on CCTV based detection systems that can racially and emotionally profile humans such as the Uighurs in China by simply monitoring CCTV images with AI in both public and private places.

A little later this summer I traded in my old diesel car for a hybrid electric version and now more eco-friendly noticed that the latest definition of a self-driving car or autonomous electric vehicle is one that is ‘capable of sensing its environment and moving safely with little or no human input’ according to Wikipedia or according to PC magazine it’s a ‘computer-controlled car that drives itself’. This comes as driverless cars are now as we speak, being tested on the streets of New York City while Waymo, the Google car company is making representations to the UK Government to ensure that the numbers of autonomous vehicles allowed to be used in the UK are not capped.

This made me think about the not too distant future in radiotherapy. Many systems are now in use that regulate and monitor the patient’s position and anatomy automatically. Treatment delivery equipment more often has enhanced robotic control and couch systems or advanced image guidance that offer real time and potentially automated adaption of treatment. If you add in advances in Artificial Intelligence or AI then just how far into the future is the reality of fully autonomous radiotherapy?

Pic: Facial profiling image courtesy of BBC.

Potentially all that is required now is to use AI to accurately ID the patient, check emotionally that they are ready to go ahead, get them to lie on the couch and set themselves up! After all, many novel breath-hold systems ask for patient interaction through virtual reality systems or interactive computer screens and it’s not beyond imagination now that patient driven auto-set up using adapted VR and tattoo-less patient alignment camera systems, similar to those in use now could soon be possible.

However, if you add to this the latest developments in ‘Upright’ or seated radiotherapy delivery, perhaps we are nearer driverless radiotherapy than we think?

I’ve noticed that a new company called Leo Cancer Care offers CT imaging and both fixed beam proton therapy and conventional 6MV photons all delivered with the patient seated. They are raising large amounts of equity and development funding and claim that ‘It’s estimated that we spend two thirds of our lives upright, on our feet or seated. The clinical evidence is clear, our bodies naturally move less in the upright position. When targeting a cancerous tumour, this reduction in motion allows us to be more accurate when targeting radiation’.

Pic: Self-shielded treatment booth allows you to walk in and sit down for treatment

Pic: The door closes for treatment and beam ON.
Pic: Both images and more information is available from https://www.leocancercare.com/

The treatment ‘chair’ is contained in a ready-made, shielded ‘booth’ with a curved sliding door and has 6 degrees of freedom and cone beam CT for real time imaging on the 6MV photon-based system.

For a patient to be able to enter a small, self-contained and shielded treatment booth and simply sit down in a pre-defined position could eliminate much of the need for staff to ‘set-up’ the patient or certainly reduce the need monitor their overall position dynamically and so could well be a further ‘disruptive technology’ in our sector.

That got me thinking. If you add to this process a simple patient ID check using AI based facial recognition with a wellbeing assessment as discussed above, use some automated pre-treatment imaging using ‘deep-learning’ protocols that are all now reality in radiotherapy then we are potentially entering an era of driverless radiotherapy!

Probably a little like taking a photo at a railway station booth. Sit down, close the curtain, get the seat in the right position and smile!

With a nod to the past perhaps “Hello Mrs Smith, we are good to go but please keep still while the radiation ‘beam ON’ red light is shown” will be automatically relayed to the patient inside by the in-situ communication system, like a radiotherapy orientated ‘Big Brother’ ensuring everything is OK.

Pic: Photo-booths located at many railway stations won’t deliver radiotherapy but we could be heading that way!

In reality this would impact directly on historical issues with staffing levels and training and so is the great radiotherapy paradox perhaps one where advances in AI finally make us redundant and solve recruitment and retention by default or stealth? I don’t know but perhaps we should be a little bit concerned?

Rotating chairs and lasers have already been used to profile people and their faces.

One of my DHA directors, was Professor Alf Linney, a reader in Medical Graphics at UCL who designed a camera/laser-based scanning system that when a person sat in the system’s rotating chair, the face could be scanned in three dimensions. Taking detailed 3D measurements would be used mainly to assess medical or surgical interventions but also the software could be used to profile people for among other things, criminal tendencies. This type of system is now available with a hand held laser making the scanning a very simplistic and mobile process.

Pic: UCL ‘facia’ scanning system, image and measurement software

However, he was often called upon to analyse CCTV images of crime scenes using his software to decide whether the person the police were holding was in fact the person involved in the crime and recorded on the CCTV images using these detailed measurements of the face. This is now it seems is completely automated using AI and CCTV surveillance today.

Big Brother

Having just read Orwell’s 1984 in combination with a new book called ‘A State of Fear’ by Laura Dodsworth that looks at how the UK Government has weaponised fear during the Covid pandemic, where our personal and medical data, identity and freedom to leave our homes at any time we wish or do what we want to do have been compromised by authoritarian rules, behavioural science and control through fear, we really do seem to be entering a new era of ‘Big Brother’, a point of view that is further strengthened by organisations such as Independent SAGE who seem very reluctant to move on or lose their new-found power to scare us witless.

However, based on advances in radiotherapy delivery as discussed, if we automate patient ID, wellbeing checks and positioning, this ‘Big Brother’ technology might well be our future too?

So how does facial recognition work?

The Panorama documentary discussed that a new Huawei patent mentions the use of Uighur-spotting technology that identifies people who appear to be of this ethnic group for security reasons.

Huawei had however previously said none of its technologies ware designed to identify ethnic groups and so it now plans to alter the patent! It would say that wouldn’t it.

You can find out more about the Panorama program here: https://www.bbc.co.uk/news/technology-55634388

It is alleged that Chinese authorities are using this high-tech surveillance against Uighurs and detaining many of them in detainment camps where children are sometimes separated from their parents however they claim that the camps offer voluntary education and training. It has been suggested that more than 1 million people have been held to date!

Pic: The Telegraph. Facial recognition can instantly profile ethnic groups in busy indoor and outside settings

The patent outlined ways to use deep-learning AI techniques to identify various features of people photographed or filmed in the streets and focuses on solving the fact that different body postures, for example whether someone is sitting or standing affects accuracy.

But importantly the document also lists attributes by which a person might be targeted, which it says can include ’race’ while it also seems to be able to asses states of emotion too. These tracking systems have been installed in police stations to the extent that ‘human-rights’ groups have described it as ‘shocking’.

Xinjiang province is home to 12 million ethnic minority Uyghurs, most of whom are Muslim.

Could CCTV profiling be banned outside China?

Privacy regulators in Europe have called for a full ban on facial recognition systems monitoring people in all publicly accessible spaces including shops and stadiums as the technology moves relentlessly towards 1984 style ‘Orwellian’ control possibilities.

Their proposal classifies so-called real-time remote biometric identification systems that include facial recognition systems as high-risk, meaning people need to be given clear information about how they’re being watched and how secure the data taken is. The police would also be generally banned from using such systems, with some exceptions however, as I have already discussed, facial recognition has been used in court cases for many years already in the UK.

Apple, Amazon and Google are in a ‘race for your face’.

The Chinese government also uses its facial recognition technology to create ‘social credits’. Its large-scale surveillance using CCTV cameras monitors criminals or ethnic groups and the behaviour of all individuals with the intent of turning the data into a score. Seemingly harmless offenses like buying too many video games or jaywalking can lower your score. China uses that score to decide whether the individual should be allowed to get a loan, buy a house or even much simpler things like board a plane or access the internet. If you buy alcohol then you lose points it seems and so a nice cold Tsing Tao beer with my favourite sweet and sour pork will now be frowned upon in China!

UK Obesity diktat.

This is also worryingly similar to the new ‘Obesity’ diktat from Boris Johnson announced in the last few days whereby your diet and exercise will be monitored by the government and it will make recommendations as to what you should eat, how far you should walk, cycle or run or attend the gym. Based on your progress and where you are spending your money, your food choices in supermarkets will be monitored and you will get credits as a reward by way of discounts in stores, incentives to buy fitness devices and other things. However, illnesses related to being obese cost the NHS £6 billion a year and have contributed to our higher than average Covid-19 death rates in the UK and so you could argue that this is a good idea.

Positive uses of AI and CCTV.

Shopping centres have created concept stores where cameras could recognize your face and make personalized shopping recommendations just as Google and Amazon do when you go on the internet and start reading articles, using facebook or shopping. Companies can already use this technology for dynamic staff attendance recording and in-house security and safety systems.

IBM have vowed to oppose the technology if not used for the human good.

Lastly, IBM has recently said that it ‘firmly opposes and will not condone the uses of any technology, including facial recognition technology offered by other vendors, for mass surveillance, racial profiling, violations of basic human rights and freedoms’.

This announcement comes as United States encounters calls for police reform following the killing of George Floyd from movements such as Black Lives Matter. IBM has said that AI systems used in law enforcement needed testing ‘for bias’. However, some have said it was a ‘cynical’ move from a company that has been influential in creating this technology for the police in the USA!

So facial recognition is set to play a huge part in our future lives whether it be for an enhanced shopping experience, security profiling or even ‘driverless’ radiotherapy.

RadPro August 2021 Blog – A radiographer’s life, a 40-year career in radiotherapy by Duncan Hynd