"It depends": Configuring AI to Improve Clinical Usefulness Across Contexts

Artifcial Intelligence (AI) repeatedly match or outperform radiologists in lab experiments. However, real-world implementations of radiological AI-based systems are found to provide little to no clinical value. This paper explores how to design AI for clinical usefulness in diferent contexts. We conducted 19 design sessions and design interventions with 13 radiologists from 7 clinical sites in Denmark and Kenya, based on three iterations of a functional AI-based prototype. Ten sociotechnical dependencies were identifed as crucial for the design of AI in radiology. We conceptualised four technical dimensions that must be confgured to the intended clinical context of use: AI functionality, AI medical focus, AI decision threshold, and AI Explainability. We present four design recommendations on how to address dependencies pertaining to the medical knowledge, clinic type, user expertise level, patient context, and user situation that condition the confguration of these technical dimensions.