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Title: artificial intelligence for literature reviews: opportunities and challenges.

Abstract: This manuscript presents a comprehensive review of the use of Artificial Intelligence (AI) in Systematic Literature Reviews (SLRs). A SLR is a rigorous and organised methodology that assesses and integrates previous research on a given topic. Numerous tools have been developed to assist and partially automate the SLR process. The increasing role of AI in this field shows great potential in providing more effective support for researchers, moving towards the semi-automatic creation of literature reviews. Our study focuses on how AI techniques are applied in the semi-automation of SLRs, specifically in the screening and extraction phases. We examine 21 leading SLR tools using a framework that combines 23 traditional features with 11 AI features. We also analyse 11 recent tools that leverage large language models for searching the literature and assisting academic writing. Finally, the paper discusses current trends in the field, outlines key research challenges, and suggests directions for future research.

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Artificial intelligence in disease diagnosis: a systematic literature review, synthesizing framework and future research agenda

Yogesh kumar.

1 Department of Computer Engineering, Indus Institute of Technology and Engineering, Indus University, Ahmedabad, 382115 India

Apeksha Koul

2 Shri Mata Vaishno Devi University, Jammu, India

Ruchi Singla

3 Department of Research, Innovations, Sponsored Projects and Entrepreneurship, CGC Landran, Mohali, India

Muhammad Fazal Ijaz

4 Department of Intelligent Mechatronics Engineering, Sejong University, Seoul, 05006 South Korea

Artificial intelligence can assist providers in a variety of patient care and intelligent health systems. Artificial intelligence techniques ranging from machine learning to deep learning are prevalent in healthcare for disease diagnosis, drug discovery, and patient risk identification. Numerous medical data sources are required to perfectly diagnose diseases using artificial intelligence techniques, such as ultrasound, magnetic resonance imaging, mammography, genomics, computed tomography scan, etc. Furthermore, artificial intelligence primarily enhanced the infirmary experience and sped up preparing patients to continue their rehabilitation at home. This article covers the comprehensive survey based on artificial intelligence techniques to diagnose numerous diseases such as Alzheimer, cancer, diabetes, chronic heart disease, tuberculosis, stroke and cerebrovascular, hypertension, skin, and liver disease. We conducted an extensive survey including the used medical imaging dataset and their feature extraction and classification process for predictions. Preferred reporting items for systematic reviews and Meta-Analysis guidelines are used to select the articles published up to October 2020 on the Web of Science, Scopus, Google Scholar, PubMed, Excerpta Medical Database, and Psychology Information for early prediction of distinct kinds of diseases using artificial intelligence-based techniques. Based on the study of different articles on disease diagnosis, the results are also compared using various quality parameters such as prediction rate, accuracy, sensitivity, specificity, the area under curve precision, recall, and F1-score.

Introduction

Healthcare is shaping up in front of our eyes with advances in digital healthcare technologies such as artificial intelligence (AI), 3D printing, robotics, nanotechnology, etc. Digitized healthcare presents numerous opportunities for reducing human errors, improving clinical outcomes, tracking data over time, etc. AI methods from machine learning to deep learning assume a crucial function in numerous well-being-related domains, including improving new clinical systems, patient information and records, and treating various illnesses (Usyal et al. 2020 ; Zebene et al. 2019 ). The AI techniques are also most efficient in identifying the diagnosis of different types of diseases. The presence of computerized reasoning (AI) as a method for improved medical services offers unprecedented occasions to recuperate patient and clinical group results, decrease costs, etc. The models used are not limited to computerization, such as providing patients, “family” (Musleh et al. 2019 ; Dabowsa et al. 2017 ), and medical service experts for data creation and suggestions as well as disclosure of data for shared evaluation building. AI can also help to recognize the precise demographics or environmental areas where the frequency of illness or high-risk behaviors exists. Researchers have effectively used deep learning classifications in diagnostic approaches to computing links between the built environment and obesity frequency (Bhatt et al. 2019 ; Plawiak et al. 2018 ).

AI algorithms must be trained on population-representative information to accomplish presentation levels essential for adaptable “accomplishment”. Trends, such as the charge for putting away and directing realities, information collection through electronic well-being records (Minaee et al. 2020 ; Kumar 2020 ), and exponential client state of information, have made a data-rich medical care biological system. This enlargement in health care data struggles with the lack of well-organized mechanisms for integrating and reconciling these data ahead of their current silos. However, numerous frameworks and principles facilitate summation and accomplish adequate data quantity for AI (Vasal et al. 2020 ). The challenges in the operational dynamism of AI technologies in healthcare systems are immeasurable despite the information that this is one of the most vital expansion areas in biomedical research (Kumar et al. 2020 ). The AI commune must build an integrated best practice method for execution and safeguarding by incorporating active best practices of principled inclusivity, software growth, implementation science, and individual–workstation interaction. At the same time, AI applications have an enormous ability to work on patient outcomes. Simultaneously, they could make significant hazards regarding inappropriate patient risk assessment, diagnostic inaccuracy, healing recommen­dations, privacy breaches, and other harms (Gouda et al. 2020 ; Khan and Member 2020 ).

Researchers have used various AI-based techniques such as machine and deep learning models to detect the diseases such as skin, liver, heart, alzhemier, etc. that need to be diagnosed early. Hence, in related work, the techniques like Boltzmann machine, K nearest neighbour (kNN), support vector machine (SVM), decision tree, logistic regression, fuzzy logic, and artificial neural network to diagnose the diseases are presented along with their accuracies. For example, a research study by Dabowsa et al. ( 2017 ) used a backpropagation neural network in diagnosing skin disease to achieve the highest level of accuracy. The authors used real-world data collected from the dermatology department. Ansari et al. ( 2011 ) used a recurrent neural network (RNN) to diagnose liver disease hepatitis virus and achieved 97.59%, while a feed-forward neural network achieved 100%. Owasis et al. ( 2019 ) got 97.057 area under the curve by using residual neural network and long short-term memory to diagnose gastrointestinal disease. Khan and Member ( 2020 ) introduced a computerized arrangement framework to recover the data designs. They proposed a five-phase machine learning pipeline that further arranged each stage in various sub levels. They built a classifier framework alongside information change and highlighted choice procedures inserted inside a test and information investigation plan. Skaane et al. ( 2013 ) enquired the property of digital breast tomosynthesis on period and detected cancer in residents based screening. They did a self-determining dual analysis examination by engaging ladies of 50–69 years and comparing full-field digitized mammography plus data building tool with full-field digital mammography. Accumulation of the data building tool resulted in a non-significant enhancement in sensitivity by 76.2% and a significant increase by 96.4%. Tigga et al. ( 2020 ) aimed to assess the diabetic risk among the patients based on their lifestyle, daily routines, health problems, etc. They experimented on 952 collected via an offline and online questionnaire. The same was applied to the Pima Indian Diabetes database. The random forest classifier stood out to be the best algorithm. Alfian et al. ( 2018 ) presented a personalized healthcare monitoring system using Bluetooth-based sensors and real-time data processing. It gathers the user’s vital signs data such as blood pressure, heart rate, weight, and blood glucose from sensor nodes to a smartphone. Katherine et al. ( 2019 ) gave an overview of the types of data encountered during the setting of chronic disease. Using various machine learning algorithms, they explained the extreme value theory to better quantify severity and risk in chronic disease. Gonsalves et al. ( 2019 ) aimed to predict coronary heart disease using historical medical data via machine learning technology. The presented work supported three supervised learning techniques named Naïve Bayes, Support vector machine, and Decision tree to find the correlations in coronary heart disease, which would help improve the prediction rate. The authors worked on the South African Heart Disease dataset of 462 instances and machine learning techniques using 10-fold cross-validation. Momin et al. ( 2019 ) proposed a secure internet of things-based healthcare system utilizing a body sensor network called body sensor network care to accomplish the requirements efficiently. The sensors used analogue to digital converter, Microcontroller, cloud database, network, etc. A study by Ijaz et al. ( 2018 ) has used IoT for a healthcare monitoring system for diabetes and hypertension patients at home and used personal healthcare devices that perceive and estimate a persons’ biomedical signals. The system can notify health personnel in real-time when patients experience emergencies. Shabut et al. ( 2018 ) introduced an examination to improve a smart, versatile, empowered master to play out a programmed discovery of tuberculosis. They applied administered AI method to achieve parallel grouping from eighteenth lower request shading minutes. Their test indicated a precision of 98.4%, particularly for the tuberculosis antigen explicit counteracting agent identification on the portable stage. Tran et al. ( 2019 ) provided the global trends and developments of artificial intelligence applications related to stroke and heart diseases to identify the research gaps and suggest future research directions. Matusoka et al. ( 2020 ) stated that the mindfulness, treatment, and control of hypertension are the most significant in overcoming stroke and cardiovascular infection. Rathod et al. ( 2018 ) proposed an automated image-based retrieval system for skin disease using machine learning classification. Srinivasu et al. ( 2021a , b ) proposed an effective model that can help doctors diagnose skin disease efficiently. The system combined neural networks with MobileNet V2 and Long Short Term Memory (LSTM) with an accuracy rate of 85%, exceeding other state-of-the-art deep models of deep learning neural networks. This system utilized the technique to analyse, process, and relegate the image data predicted based on various features. As a result, it gave more accuracy and generated faster results as compared to the traditional methods. Uehara et al. ( 2018 ) worked at the Japanese extremely chubby patients utilizing artificial brainpower with rule extraction procedure. They had 79 Non-alcoholic steatohepatitis, and 23 non- Non-alcoholic steatohepatitis patients analyse d to make the desired model. They accomplished the prescient exactness by 79.2%. Ijaz et al. ( 2020 ) propose a cervical cancer prediction model for early prediction of cervical cancer using risk factors as inputs. The authors utilize several machine learning approaches and outlier detection for different pre-processing tasks. Srinivasu et al. ( 2021a , b ) used an AW-HARIS algorithm to perform automated segmentation of CT scan images to identify abnormalities in the human liver. It is observed that the proposed approach has outperformed in the majority of the cases with an accuracy of 78%.

To fully understand how AI assists in the diagnosis and prediction of a disease, it is essential to understand the use and applicability of diverse techniques such as SVM, KNN, Naïve Bayes, Decision Tree, Ada Boost, Random Forest, K-Mean clustering, RNN, Convolutional neural networks (CNN), Deep-CNN, Generative Adversarial Networks (GAN), and Long short-term memory (LSTM) and many others for various disease detection system (Owasis et al. 2019 ; Nithya et al. 2020 ). We conducted an extensive survey based on the machine and deep learning models for disease diagnosis. The study covers the review of various diseases and their diagnostic methods using AI techniques. This contribution explains by addressing the four research questions: RQ1. What is the state-of-the-art research for AI in disease diagnosis? RQ2. What are the various types of diseases wherein AI is applied? RQ3. What are the emergent limitations and challenges that the literature advances for this research area? RQ4.What are the future avenues in healthcare that might benefit from the application of AI? The rest of the work is organized into various sections. Initially, a brief description of AI in healthcare and disease diagnosis using multiple machines and deep learning techniques is given in Sect.  1 . Then, it is named an introduction that includes Fig.  1 to describe all the papers taken from different organized sources for various diseases in the contribution sub-section. Materials and Methods is named as Sect.  2 , which includes the quality assessment and the investigation part regarding AI techniques and applications. Section  3 covers symptoms of diseases and challenges to diagnostics, a framework for AI in disease detection modelling, and various AI applications in healthcare. Section  4 includes the reported work of multiple diseases and the comparative analysis of different techniques with the used dataset, applied machine and deep learning methods with computed outcomes in terms of various parameters such as accuracy, sensitivity, specificity, the area under the curve, and F-score. In Sect.  5 , the discussion part is covered that answers the investigation part mentioned in Sect.  2 . Finally, in Sect.  6 , the work that helps researchers chooses the best approach for diagnosing the diseases is concluded along with the future scope.

Distribution of published papers for diseases diagnosis using artificial intelligence techniques

Contribution

Diseases usually are quantified by signs and symptoms. A sign is identified as an objective appearance of a disease that doctors can specify, whereas a symptom is a particular indication of the patient’s illness (Plawiak et al. 2018 ). Thus, every disease has various signs and symptoms, such as fever, which is found in countless conditions.

As shown in Fig.  1 , the number of papers reviewed under preferred reporting items for systematic reviews and Meta-Analysis (PRISMA) guidelines for different types of diseases using AI from the year 2009 to the year 2020. The present work emphasizes various diseases and their diagnostics measures using machine and deep learning classifications. To the best of our knowledge, most of the past work focused on disease diagnostics for one or two disease prediction systems. Hence, the present study explores ten different disease symptoms and their detection using AI techniques. Furthermore, this paper is unique, as it contains an elaborate discussion about various disease diagnoses and predictions based upon the extensive survey conducted for detection methods.

Materials and methods

We have directed this review according to the preferred reporting items for systematic reviews and Meta-Analysis guidelines. The survey offers the readers wide-ranging knowledge of the literature on AI (decision tree, which breaks down the dataset into smaller subsets and to build it, two types of entropy using frequencies are calculated in which X, S is a discrete random variable which occurs with probability p(i),…. p(c) and logarithm with base 2 gives the unit of bits or Shannons where entropy using the frequency table of one attribute is given as (Sabottke and Spieler 2020 )

and entropy using the frequency table of two attributes is given as

K-nearest neighbour algorithm is a supervised machine learning technique that is used to solve classification issues as well as to calculate the distance between the test data and the input to give the prediction by using Euclidean distance formula in which p, q are the two points in Euclidean n-space, and qi and pi are the Euclidean vectors starting from the origin of the space (Zaar et al. 2020 ).

Whereas regression is used to determine the relationship between independent and dependent variables. The equation Y represents it is equal to an X plus b, where Y is the dependent variable, an is the slope of the regression equation, x is the independent variable, and b is constant (Kolkur et al. 2018 )

where Y is the dependent variable, X is the independent variable; a is the intercept, b is the slope and is the residual error, Naïve Bayes which provides a way of calculating the posterior probability, P (c | x) from P(c), P(x) and P(x | c). Naïve Bayes classifier assumes that the effect of the value of an attribute (x) on a given class (c) is independent of the values of other predictors (Spann et al. 2020 )

P(c | x) is the posterior probability of class given attribute, P(x | c) is the likelihood which is the probability of the attribute given class, P(x) is the prior probability of attribute, P(c) is the prior probability of a class, k-means ( Fujita et al. 2020 ) which is used to define k centers, one for each cluster and these centres should be placed far away from each other. This algorithm also aims at minimizing an objective function which is known as squared error function, given by :

||x i -v j || is the Euclidean distance between x i -v j, Ci is the number of data points in ith cluster, C is the number of cluster center’s, convolution neural network which is a type of feed-forward artificial neural network in which the connectivity pattern between its neurons is inspired by the organization of the animal visual cortex. Convolution is the first step in the process that convolution neural network undergoes (Zhang et al. 2019 )

where (f*g)(t) = functions that are being convoluted, t = real number variable of functions f and g, g( τ ) = convolution of time function, τ ′  = first derivative of tau function, a recurrent neural network which is used for handling sequential data and its formula in which h(t) is a function f of the previously hidden state h(t − 1) and the current input x(t). The theta are the parameters of the function f is (Yang et al. 2020 )

Boltzmann machine, which optimizes the weights, a quantity related to the particular problem. Its main objective is to maximize the Consensus function (CF), which is given by the following formula (Zhou et al. 2019 )

where U i and U j are the set of units, w ij is the fixed weight, gradient descent which is an iterative process and is formulated by (Chang et al. 2018 )

where θ 1 is the next position, θ 0 is the current position, α is the small step, ∇ J θ is the direction of fastest increase) in healthcare (Zhang et al. 2017 ). The extensive survey also promotes expounding prevailing knowledge gaps and subsequent identification of paths for future research (Lin et al. 2019 ). The current study reformed the structure, which produced wide-ranging article valuation standards from earlier published articles. Articles incorporated in our research are selected using keywords like “Artificial Intelligence”, “Disease Detection”, “Disease diagnosis using machine learning”, “Disease diagnosis using deep learning”, “Artificial Intelligence in Healthcare”, and combinations of these keywords. In addition, research articles associated with the applications of AI-based techniques in predicting diseases and diagnosing them are incorporated for review. Table  1 lists the publications that are included or omitted based on a variety of criteria such as time, studies to define how old papers/articles can be accessed, the problem on which the article is based, comparative analysis of the work, methods to represent the techniques used, and research design to analyse the results that are obtained. These characteristics assisted us in carrying out the research study very quickly, without wasting time on irrelevant or unnecessary searches and investigations. The standards for inclusion and exclusion are developed by the requirements of the problem of an article.

Inclusion and exclusion parameters

Quality assessment

Research articles included in this review are identified using several quality evaluation constraints. The significance of the study is assessed based on inclusion and exclusion standards. All research articles included for review encompass machine or deep learning-based prediction models for automatically detecting and diagnosing diseases. Each research work incorporated in this study carried empirical research and had experimental outcomes. The description of these research articles is stated in a separate subsection entitled literature survey.

The comprehensive selection of research papers is carried out in four phases: (1) identifying  where records are identified through various databases. At this phase, we must do the searches we’ve planned through the abstract and citation databases we’ve chosen. Take note of how many results the searches returned. We can also include data found in other places, such as Google Scholar or the reference lists of related papers. Then, in one citation management application, aggregate all of the records retrieved from the searches. Keep in mind that each database has its own set of rules for searching for terms of interest and combining keywords for a more efficient search. As a result, our search technique may vary significantly depending on the database, (2) screening  the selection process is done transparently by reporting on decisions made at various stages of the systematic review. One of the investigators reviews the title and abstract of each record to see if the publication provides information that might be useful or relevant to the systematic review. In certain situations, the title and abstract screening is done by two investigators. They don’t split the job amongst themselves! Each investigator screens every title and abstract, and then their judgments are compared. If one of them decides to leave out an item that the other thinks should be included, they may go over the entire text together and come to a common conclusion. They can also enlist the help of a third party (usually the project manager or main investigator) to decide whether or not the study should be included. Make sure that the most acceptable justification for excluding an item is chosen. (3) Eligibility  we study the complete contents of the articles that cleared the title and abstract screening to see whether they may assist in answering our research topic. Two investigators do this full-text screening. Each one examines the entire content of each article before deciding whether or not to include it. We must note the number of articles we remove and the number of articles under each cause for exclusion in the full-text screening, just as we did in the title/abstract screening. Hence, in this stage, full-text articles are assessed and then finally are included in qualitative analysis in (4) included  phase by utilizing the Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart as depicted in Fig.  2 . In this stage, we’ll know how many papers will be included in our systematic review after removing irrelevant studies from the full-text screen. We assess how many of these studies may be included in a quantitative synthesis, commonly known as “meta-analysis,“ in the fourth and final screening stage.

PRISMA flow chart

To address the RQ1, RQ2, RQ3, and RQ4, the current survey examined the number of articles on different disease diagnoses using AI techniques from various data sources, including Psychological Information, Excerpta Medica Database, Google Scholar, PubMed, Scopus, and Web of Science. The above sources are popular sources of information for articles on AI in health informatics in previous studies. As previously explained, articles are chosen based on specified inclusion and exclusion criteria (Zhang et al. 2017 ). These were derived from (Behera et al. 2019 ), where the authors established and accepted the variations. To better understand the state of research on AI in disease detection, peer-reviewed papers are cited. The current review suggests that AI and healthcare have developed a present synergy.

Investigation

Investigation 1: Why do we need AI?

Investigation 2: What is the impact of AI on medical diagnosis and treatment?

Investigation 3: Why is AI important, and how is it used to analyse these diseases?

Investigation 4: Which AI-based algorithm is used in disease diagnosis?

Investigation 5: What are the challenges faced by the researchers while using AI models in several disease diagnoses?

Investigation 6: How are AI-based techniques helping doctors in diagnosing diseases?

Artificial intelligence in disease diagnosis

Detecting any irresistible ailment is nearly an afterward movement and forestalling its spread requires ongoing data and examination. Hence, acting rapidly with accurate data tosses a significant effect on the lives of individuals around the globe socially and financially (Minaee et al. 2020 ). The best thing about applying AI in health care is to improve from gathering and processing valuable data to programming surgeon robots. This section expounds on the various techniques and applications of artificial intelligence, disease symptoms, diagnostics issues, and a framework for disease detection modelling using learning models and AI in healthcare applications (Kumar and Singla 2021 ).

Framework for AI in disease detection modelling

AI describes the capability of a machine to study the way a human learns, e.g., through image identification and detecting pattern in a problematic situation. AI in health care alters how information gets composed, analysed, and developed for patient care (Ali et al. 2019 ).

System planning is the fundamental abstract design of the system. It includes the framework’s views, the course of action of the framework, and how the framework carries on underneath clear conditions. A solid grip of the framework design can help the client realize the limits and boundaries of the said framework. Figure  3 shows a pictorial portrayal of the ailment recognition model using utilitarian machines and profound learning classification strategies. In pre-preparing, real-world information requires upkeep and pre-preparing before being taken care of by the calculation (Jo et al. 2019 ). Because of the justifiable explanation, real-world data regularly contains mistakes regarding the utilized measures yet cannot practice such blunders. Accordingly, information pre-preparing takes this crude information, cycles it, eliminates errors, and spares it an extra examination. Information experiences a progression of steps during pre-handling (Chen et al. 2019a , b ): Information is purged by various strategies in information cleaning. These strategies involve gathering information, such as filling the information spaces that are left clear or decreasing information, such as the disposal of commas or other obscure characters. In information osmosis, the information is joined from a combination of sources. The information is then amended for any blend of mistakes, and they are quickly taken care of. Information Alteration : Data in this progression is standardized, which depends upon the given calculation. Information standardization can be executed utilizing several ways (Nasser et al. 2019 ). This progression is obligatory in most information mining calculations, as the information wants to be as perfect as possible. Information is then mutual and developed. Information Lessening : This progression in the strategy centers to diminish the information to more helpful levels. Informational collection and test information : The informational collection is segregated into parts preparing and testing informational indexes. The preparation information is utilized to gauge the actual examples of the data (Sarao et al. 2020 ). Equivalent to information needed for preparing and testing, experimental data is often replicated from a similar informational index. After the model has been pre-handled, the jiffy step is to test the accuracy of the framework. Systematic model : Analytical displaying strategies are utilized to calculate the probability of a given occurrence function given commitment factors, and it is very productive in illness expectation. It tends to imagine what the individual is experiencing in light of their info indications and prior determinations (Keenan et al. 2020 ; Rajalakshmi et al. 2018 ).

Framework for disease detection system

Medical imaging for diseases diagnosis

Clinical Imaging is seen to assign the arrangement of procedures that produce pictures of the inside part of the body. The procedure and cycles are used to take pictures of the human body for clinical purposes, such as uncovering, analysing, or looking at an injury, brokenness, and pathology (Bibault et al. 2020 ). Computed tomography (CT) scan outputs are great representations of helpful indicative imaging that encourages exact conclusion, mediation, and evaluation of harms and dysfunctions that actual advisors address consistently (Chen et al. 2017 ). Additional contemplates demonstrate overuse of Imaging, for example, X-rays or magnetic resonance imaging (MRI) for intense and complicated work, as shown in Table  2 .

Medical imaging types with their respective descriptions

Symptoms of diseases and challenges to diagnostics

The disease may be severe, persistent, cruel, or benign. Of these terms, persistent and severe have to do with the interval of a disease, lethal and begin with the potential for causing death. Additionally, different manifestations that may be irrelevant could post the warnings for more restorative severe illness or situation. The followings are a couple of diseases with their sign and indications for events:

• Heart assault signs incorporate hurt, nervousness, crushing, or feeling of breadth in the focal point of the chest that endures more than a couple of moments; agony or anxiety in different territories of the chest area; succinctness of breath; cold perspiration; heaving; or unsteadiness (Aggarwal et al. 2020 ).
• Stroke signs incorporate facial listing, arm shortcoming, the intricacy with discourse, quickly creating happiness or equalization, unexpected absence of sensation or weak point, loss of vision, puzzlement, or agonizing torment (Lukwanto et al. 2015 ).
• Reproductive wellbeing manages the signs that develop the issues such as blood misfortune or spotting between periods; tingling, copying, disturbance at genital region; agony or disquiet during intercourse; genuine or sore feminine dying; extreme pelvic/stomach torment; strange vaginal release; the sentiment of totality in the lower mid-region; and customary pee or urinary weight (Kather et al. 2019 ).
• Breast issue side effects include areola release, abnormal bosom delicacy or torment, bosom or areola skin changes, knot or thickening in or close to bosom or in the underarm zone (Memon et al. 2019 ).
• Lung issue side effects include hacking of blood, succinctness of breath, difficult breathing, consistent hack, rehashed episodes of bronchitis or pneumonia, and puffing (Ma et al. 2020 ).
• Stomach or stomach-related issue manifestations incorporate rectal dying, blood in the stool or dark stools, changes in gut properties or not having the option to control guts, stoppage, loose bowels, indigestion or heartburn, or spewing blood (Kather et al. 2019 ).
• Bladder issue manifestations include confounded or excruciating pee, incessant pee, loss of bladder control, blood in pee, waking routinely to pee around evening time to pee or wetting the bed around evening time, or spilling pee (Shkolyar et al. 2019 ).
• Skin issue indications remember changes for skin moles, repetitive flushing and redness of face and neck, jaundice, skin sores that do not disappear or re-establish to wellbeing, new development or moles on the skin, and thick, red skin with bright patches (Rodrigues et al. 2020 ).
• Emotional issues include nervousness, sadness, weariness, feeling tense, flashbacks and bad dreams, lack of engagement in daily exercises, self-destructive musings, mind flights, and fancies (Krittanawong et al. 2018 ).
• Headache issues indications (excluding ordinary strain cerebral pains) incorporate migraines that please unexpectedly, “the most noticeably awful migraine of your life”, and cerebral pain connected with extreme energy, queasiness, heaving, and powerlessness to walk (Mueller 2020 ).

Above, we have described the variety of illness signals and their symptoms. In contrast, illness recognition errors in medication are reasonably regular, can have a stringent penalty, and are only now the foundation to materialize outstandingly in patient safety. Here we have critical issues for various diagnostic types while detecting the particular diseases (Chuang 2011 ; Park et al. 2020 ).

• Analysis that is accidentally deferred wrong, or on the other hand, missed as decided from a definitive delight of more amazing data.
• Any fault or malfunction in the analytical course which is essential to a missed finding or a conceded conclusion comprises a breakdown in occasional admittance to mind; elicitation or comprehension of side effects, images, research facility result; detailing and weighing of difference investigation; and ideal development and strength arrangement or appraisal.

Healthcare applications

The healthcare system has long been an early adopter of generally innovative technologies. Today, artificial intelligence and its subset machine and deep learning are on their way to becoming a mean element in the healthcare system, from creating new health check actions to treat patient records and accounts. One of the maximum burdens physician practices today is the association and performance of organizational tasks (Fukuda et al. 2019 ). By automating them, healthcare institutions could help resolve the trouble and allow physicians to do their best, i.e., spend more time with patients. The following are the details of the artificial intelligence techniques in healthcare applications as shown in Table  3 :

Healthcare applications and their purpose

Reported work

This section highlights the best finding for different diseases with their diagnosis methods via machine and deep learning algorithms. It covers the extensive survey on various diseases such as alzheimer’s, cancer, diabetes, chronic, heart disease, tuberculosis, stroke and cerebrovascular, hypertension, skin and liver disease (Chui et al. 2020 ).

Diagnosis of Alzheimer’s disease

Alzheimer’s is a disease that worsens the dementia symptoms over several years (Zebene et al. 2019 ). During its early stage, it affects memory loss, but in the end, it loses the ability to carry the conservation and respond to the environment. Usyal et al. ( 2020 ) decided on the analysis of dementia in Alzheimer’s through investigating neuron pictures. They utilized the alzheimer’s disease neuroimaging initiative convention that comprises T1 weighted magnetic resonance information for finding. The prescient shows the precision estimated the characterization models, affectability, and explicitness esteem. Ljubic et al. ( 2020 ) presented the method to diagnose Alzheimer’s disease from electronic medical record (EMR) data. The results acquired showed the accuracy by 90% on using the SCRL dataset. Soundarya et al. ( 2020 ) proposed the methodology in which description of shrink brain tissue is used for the ancient analysis of Alzheimer’s disease. They have implemented various machine and deep learning algorithms. The deep algorithm has been considered the better solution provider to recognize the ailment at its primary stage with reasonable accuracy. Park et al. ( 2020 ) used a vast range of organizational health data to test the chance of machine learning models to expect the outlook occurrence of Alzheimer’s disease. Lin et al. ( 2019 ) proposed a method that used the spectrogram features extracted from speech data to identify Alzheimer’s disease. The system used the voice data collected via the internet of things (IoT) and transmitted to the cloud server where the original data is stored. The received data is used for training the model to identify the Alzheimer’s disease symptoms.

As seen in Fig.  4 , (Subasi 2020 ) proposed a broad framework for detecting Alzheimer’s illness using AI methods. The learning process is the process of optimizing model parameters using a training dataset or prior practice. Learning models can be predictive, predicting the future, descriptive, collecting data from input data sources, and combining them. Two critical stages are performed in machine learning and deep learning: pre-processing the vast input and improving the model. The second phase involves effectively testing the learning model and resembling the answer. Oh et al. ( 2019 ) offered a technique for demonstrating the end-to-end learning of four binary classification problems using a volumetric convolutional neural network form. The trials are performed on the ADNI database, and the results indicated that the suggested technique obtained an accuracy of 86.60% and a precision of 73.95%, respectively. Raza et al. ( 2019 ) proposed a unique AI-based examination and observation of Alzheimer’s disorder. The analysis results appeared at 82% improvement in contrast with notable existing procedures.

Alzheimer’s disease detection using artificial intelligence techniques (Subasi 2020 )

Additionally, above 95% precision is accomplished to order the exercises of everyday living, which are very reassuring regarding checking the action profile of the subject. Lodha et al. ( 2018 ) used a machine-learning algorithm to process the data obtained by neuroimaging technologies to detect Alzheimer’s in its primitive stage. It uses various algorithms like support vector machine (SVM), gradient boosting, K-nearest neighbour, Random forest, a neural network that shows the accuracy rate 97.56, 97.25, 95.00, 97.86, 98.36, respectively. Lei et al. ( 2020 ) state that to evaluate Alzheimer’s ailment, a clinical score forecast using neuroimaging data is incredibly profitable since it can adequately reveal the sickness status. The proposed structure comprises three sections: determination dependent on joint learning, highlight encoding dependent on profound polynomial arrange and amass learning for relapse through help vector relapse technique. Jo et al. ( 2019 ) performed the deep learning approach and neuroimaging data for the analytical classification of Alzheimer’s disease. Autoencoder for feature selection formed accuracy up to 98.8% and 83.7% for guessing conversion from mild cognitive impairment, a prodromal stage of Alzheimer’s disease.

A deep neural network uses neuroimaging data without pre-processing for feature collection that yields accuracies up to 96.0% for Alzheimer’s disease categorization and 84.2% for the medical council of India conversion problems (Oomman et al. 2018 ). Chen et al. ( 2017 ) hypothesized the combination of diffusivity and kurtosis in diffusion kurtosis imaging to increase the capacity of diffusion kurtosis imaging in detecting Alzheimer’s disease. The method was applied on the 53 subjects, including 27 Alzheimer’s patients, which provides an accuracy of 96.23%. Janghel et al. ( 2020 ) used a convolution neural network to improve classification accuracy. They demonstrated a deep learning technique for identifying Alzheimer’s disease using data from the Alzheimer’s disease neuroimaging initiative database, which included magnetic resonance imaging and positron emission tomography scan pictures of Alzheimer’s patients, as well as an image of a healthy individual. The experiment attained an average classification accuracy of 99.95% for the magnetic resonance imaging dataset and 73.46% for the positron emission tomography scan dataset. Balaji et al. ( 2020 ) presented the gait classification system based on machine learning to help the clinician diagnose the stage of Parkinson’s disease. They used four supervised machine learning algorithms: decision tree, support vector machine, ensemble classifier, and Bayes’ classifier, which are used for statistical and kinematic analysis that predict the severity of Parkinson’s disease.

Diagnosis of cancer disease

Artificial Intelligence methods can affect several facets of cancer therapy, including drug discovery, drug development, and the clinical validation of these drugs. Pradhan et al. ( 2020 ) evaluated several machine learning algorithms which are flexible for lung cancer recognition correlated with the internet of things. They reviewed various papers to predict different diseases using a machine learning algorithm. They also identified and depicted various research directions based on the existing methodologies. Memon et al. ( 2019 ) proposed an AI calculation-based symptomatic framework which adequately grouped the threatening and favorable individuals in the climate of the internet of things. They tried the proposed strategy on the Wisconsin Diagnostic Breast Cancer. They exhibited that the recursive element determination calculation chose the best subset of highlights and the classifier support vector machine that accomplished high order precision of 99% and affectability 98%, and Matthew’s coefficient is 99%. Das et al. ( 2019 ) proposed another framework called the watershed Gaussian-based profound learning method to depict the malignant growth injury in processed tomography pictures of the liver. They took a test of 225 pictures which are used to build up the proposed model. Yue et al. ( 2018 ) reviewed the machine learning techniques that include artificial neural networks, support vector machines, decision trees, and k-nearest neighbor for disease diagnosis. The author has investigated the breast cancer-related applications and applied them to the Wisconsin breast cancer database. Han et al. ( 2020 ) focused on the research and user-friendly design of an intelligent recommendation model for cancer patients’ rehabilitation schemes. Their prediction also achieved up to 92%. Rodrigues et al. ( 2020 ) proposed utilizing the move learning approach and profound learning approach in an IoT framework to help the specialists analyse common skin sores, average nevi, and melanoma. This investigation utilized two datasets: the first gave by the International Skin Imaging Collaboration at the worldwide Biomedical Imaging Symposium. The DenseNet201 extraction model, joined with the K nearest neighbor classifier, accomplished an exactness of 96.805% for the International Society for Bioluminescence and Chemiluminescence - International Standard Industrial Classification dataset. Huang et al. ( 2020 ) reviewed the literature on the application of artificial intelligence for cancer diagnosis and prognosis and demonstrated how these methods were advancing the field. Kather et al. ( 2019 ) used deep learning to mine clinically helpful information from histology. It can also predict the survival and molecular alternations in gastrointestinal and liver cancer. Also, these methods could be used as an inexpensive biomarker only if the pathology workflows are used. Kohlberger et al. ( 2019 ) built up a convolution neural organization to restrict and measure the seriousness of out-of-fold districts on digitized slides. On contrasting it and pathologist-reviewed center quality, ConvFocus accomplished Spearman rank coefficients of 0.81 and 0.94 on two scanners and replicated the typical designs from stack checking. Tschandl et al. ( 2019 ) build an image-based artificial intelligence for skin cancer diagnosis to address the effects of varied representations of clinical expertise and multiple clinical workflows. They also found that excellent quality artificial intelligence-based clinical decision-making support improved diagnostic accuracy over earlier artificial intelligence or physicians. It is observed that the least experienced clinicians gain the most from AI-based support. Chambi et al. ( 2019 ) worked on the volumetric Optical coherence tomography datasets acquired from resected cerebrum tissue example of 21 patients with glioma tumours of various stages. They were marked as either non-destructive or limo-invaded based on histopathology assessment of the tissue examples. Unlabelled Optical coherence tomography pictures from the other nine patients were utilized as the approval dataset to evaluate the strategy discovery execution. Chen et al. ( 2019a , b ) proposed a cost-effective technique, i.e., ARM (augmented reality microscope), that overlays artificial intelligence-based information onto the current view of the model in real-time, enabling a flawless combination of artificial intelligence into routine workflows. They even anticipated that the segmented reality microscope would remove the barrier to using AI considered to enhance the accuracy and efficiency of cancer analysis.

Diabetes detection

Diabetes Mellitus, also known as diabetes, is the leading cause of high blood sugar. AI is cost-effective to reduce the ophthalmic complications and preventable blindness associated with diabetes. This section covers the study of various researchers that worked on detecting diabetes in patients (Chaki et al. 2020 ). Kaur and Kumari ( 2018 ) used machine learning models on Pima Indian diabetes dataset to see patterns with risk factors with the help of the R data manipulation tool. They also analyse d five predictive models using the R data manipulation tool and support vector machine learning algorithm: linear kernel support vector machine, multifactor dimensionality reduction, and radial basis function.

As shown in Fig.  5 , blood glucose prediction has been categorized in three different parts: physiology-based, information-driven, and hybrid-based. Woldaregy et al. ( 2019 ) developed a compact guide in machine learning and a hybrid system that focused on predicting the blood glucose level in type 1 diabetes. They mentioned various machine learning methods crucial to regulating an artificial pancreas, decision support system, blood glucose alarm applications. They had also portrayed the knowledge about the blood glucose predictor that gave information to track and predict blood glucose levels as many factors could affect the blood glucose levels like BMI, stress, illness, medications, amount of sleep, etc. Thus blood glucose prediction provides the forecasting of an individual’s blood glucose level based on the past and current history of the patient to give an alarm to delay any complications. Chaki et al. ( 2020 ) provided detailed information to detect diabetes mellitus and self-management techniques to prove its importance to the scientists that work in this area. They also analyse d and diagnosed diabetes mellitus via its dataset, pre-processing techniques, feature extraction methods, machine learning algorithms, classification, etc. Mercaldo et al. ( 2017 ) proposed a method to classify diabetes-affected patients using a set of characteristics selected by a world health organization and obtained the precision value and recall value 0.770 and 0.775, respectively, with the help of the Hoeffding tree algorithm. Mujumdar et al. ( 2019 ) proposed the model for prediction, classification of diabetes, and external factors like glucose, body mass index, insulin, age, etc. They also analyse d that classification accuracy proved to be much more efficient with the new dataset than their used dataset. Kavakiotis et al. ( 2017 ) conducted a systematic review regarding the machine learning applications, data mining techniques, and tools used in the diabetes field to showcase the prediction and diagnosis of diabetes, its complications, and genetic conditions and situation, including the physical condition care management. After the in-depth search, it had been found that supervised learning methods characterized 85%, and the rest, 15%, were characterized by unsupervised learning methods. Aggarwal et al. ( 2020 ) demonstrated the non-linear heart rate variability in the prediction of diabetes using an artificial neural network and support vector machine. The author computed 526 datasets and obtained the classification accuracy of 90.5% with a support vector machine. Besides that, they evaluated thirteen non-linear heart rate variability parameters for the training and testing of artificial neural networks. Lukmanto et al. ( 2015 ) worked on many diabetes mellitus patients to provide an advantage for researchers to fight against it. Their main objective was to leverage fuzzy support vector machine and F-score feature selection to classify and detect diabetes mellitus. The methodology is applied to the Pima Indian Diabetes dataset, where they got an accuracy of 89.02% to predict the diabetes mellitus patients. Wang et al. ( 2017 ) proposed a weighted rank support vector machine to overcome the imbalanced problem seen during the daily dose system of drugs, leading to poor prediction results. They also employed the area under the curve (AUC) to show the model’s effectiveness and improved the average precision of their proposed algorithm. Carter et al. ( 2018 ) showcased the performance of 46 different machine learning models compared on re-sampled trained and tested data. The model obtained the area under the curve of 0.73 of training data and 0.90 of tested data. Nazir et al. ( 2019 ) proposed a technique to minutely detect the diabetic retinopathy’s different stages via tetragonal local octa pattern features that are further classified by extreme machine learning. For classifying periodic heart rate variability signals and diabetes, Swapna et al. ( 2018 ) presented a deep learning architecture. The authors used long short term memory, a convolution neural network, to extract the dynamic features of heart rate variability. They achieved an accuracy of 95.7% on using electrocardiography signals along with the support vector machine classification.

Blood glucose prediction approaches (Woldaregy et al. 2019 )

Diagnose chronic diseases

Researchers have shown that artificial intelligence helps in the streamlining care of chronic diseases. Therefore, various machine learning algorithms are developed to identify patients at higher risk of chronic disease. The other techniques based on AI are stated below (Jain et al. 2018 ).

Jain et al. ( 2018 ) presented a survey to showcase feature choice and arrangement methods to analyse and anticipate the constant illnesses. They utilized dimensionality decrease strategies to improve the presentation of AI calculation. To put it plainly, they introduced different component determination techniques and their inalienable points of interest and impediments. He et al. ( 2019 ) proposed a kernel-based structure for training the chronic illness detector to forecast and track the disease’s progression. Their approach was based on an enhanced version of a structured output support vector machine for longitudinal data processing. Tang et al. ( 2020 ) utilized deep residual networks to identify chronic obstructive pulmonary disease automatically. After gathering data from the PanCad project, which includes ex-smokers and current smokers at high risk of lung cancer, the residual network was trained to diagnose chronic obstructive pulmonary disease using computed topography scans. Additionally, they ran three rounds of cross-validation on it. With the help of three-fold cross-validation, the experiment had an area under the curve of 0.889. Ma et al. ( 2020 ) proposed the heterogeneous changed artificial neural organization to identify, divide, and determine persistent renal disappointment utilizing the web of medical things stage. The proposed strategy was named uphold vector machine and multilayer perceptron alongside the back engendering calculation. They used ultrasound images and later performed segmentation in that image. Especially in Kidney segmentation, it performed very well by achieving high results. Aldhyani et al. ( 2020 ) proposed the system that was used to increase the accuracy in detecting chronic disease by using machine learning algorithms. The machine learning methods such as Naïve Bayes, support vector machine, K nearest neighbour, and random forest were presented and compared. They also used a rough k-means algorithm to figure out the ambiguity in chronic disease to improve its performance. The Naïve Bayes method and RKM achieved an accuracy of 80.55% for diabetic disease, the support vector machine achieved 100% accuracy for kidney disease, and the support vector machine achieved 97.53% for cancer disease. Chui and Alhalabi ( 2017 ) reviewed the chronic disease diagnosis in smart health care. They provide a summarized view of optimization algorithms and machine learning algorithms. The authors also gave information regarding Alzheimer’s disease, dementia, tuberculosis, etc., followed by the challenges during the deployment phase of the disease diagnosis. Nam et al. ( 2019 ) introduced the internet of things and digital biomarkers and their relationships to artificial intelligence and other current trends. They have also discussed the role of artificial intelligence in the internet of things for chronic disease detection. Battineni et al. ( 2020 ) reviewed the applications of predictive models of machine learning to diagnose chronic disease. After going through 453 papers, they selected only 22 studies from where it was concluded that there were no standard methods that would determine the best approach in real-time clinical practice. The commonly used algorithms were support vector machine, logistic regression, etc. Wang et al. ( 2018 ) analyse d chronic kidney disease using machine learning techniques based on chronic kidney disease dataset and performed ten-fold cross-validation testing. The dataset had been pre-processed for completing and normalizing the missing data. They achieved the detection accuracy of 99% and were further tested using four patient data samples to predict the disease. Kim et al. ( 2019 ) indicated the constant sicknesses in singular patients that utilized a character repetitive neural organization to regard the information in each class as a word, mainly when an enormous bit of its information esteem is absent. They applied the Char-recurrent neural network to characterize the Korea National Health and Nutrition Examination Survey cases. They indicated the aftereffects of higher precision for the Char-recurrent neural network than for the customary multilayer perceptron model. Ani et al. ( 2017 ) proposed a patient monitoring system for stroke-affected people that reduced future recurrence by alarming the doctor and provided the data analytics and decision-making based on the patient’s real-time health parameters. That helped the doctors in systematic diagnosis followed by tailored treatment of the disease.

Heart disease diagnosis

Researchers suggest that artificial intelligence can predict the possible periods of death for heart disease patients. Thus multiple algorithms have been used to predict the heart rate severity along with its diagnosis. Escamila et al. ( 2019 ) proposed a dimensionality decrease strategy to discover the highlights of coronary illness utilizing the highlight determination procedure. The dataset used was the UCIrvine artificial intelligence vault called coronary illness which contains 74 highlights. The most remarkable precision was accomplished by the chi-square and head segment investigation alongside the irregular woods classifier. Tuli et al. ( 2019 ) proposed a Health fog framework to integrate deep learning in edge computing devices and incorporate it into the real-life application of heart detecting disease. They consisted of the hardware and software components, including body area sensor network, gateway, fogbus module, data filtering, pre-processing, resource manager, deep learning module, and ensembling module. The health fog model was an internet of things-based fog enabled model that can help effectively manage the data of heart patients and diagnose it to identify the heart rate severity.

George et al. ( 2018 ) aimed to describe the obstacles Indian nurses face in becoming active and valued members of the cardiovascular healthcare team as cardiovascular disease imposed substantial and increasing physical, psychological, societal, and financial burdens. As shown in Fig.  6 , there are numerous possible facts for health intelligent mediations to support helping cardiovascular health and decreasing hazard for cardiovascular disease. So the focus has started on the inhibition of cardiovascular disease and, more importantly, on the advancement of cardiovascular health. Several findings revealed that depression is connected with inferior cardiovascular health between adults without cardiovascular disease.

Cardiovascular health promotion and disease prevention (George et al. 2018 )

Haq et al. ( 2018 ) created a system based on machine learning to diagnose the cardiac disease guess using its dataset and worked on seven prominent feature learning-based algorithms. It was also observed that the machine learning-based decision support system assisted the doctors in diagnosing the heart patients effectively. Khan and Member ( 2020 ) proposed a framework to estimate the cardio disease using a customized deep convolution network for categorizing the fetched sensor information into the usual and unusual state. Their results demonstrated that if there would be the utmost amount of records, the multi-task cascaded convolution neural network achieved an accuracy of 98.2%. Ahmed ( 2017 ) explained the architecture for heart rate and other techniques to understand using machine learning algorithms such as K nearest neighbour classification to predict the heart attack during collecting heart rate datasets. The author also mentioned the six data types predicting heart attack in three different levels (Patel 2016 ). The dataset used consists of 303 instances and 76 attributes. They worked on a technique that could reduce the number of deaths from heart diseases. They compared various decision tree algorithms to present the heart disease diagnosis using Waikato Environment for Knowledge Analysis. They aimed to fetch the hidden patterns by using data mining techniques linked to heart disease to predict its presence. Saranya et al. ( 2019 ) proposed a cloud-based approach based on sensors for an automated disease predictive system to calculate various parameters of patients like blood pressure, heartbeat rate, and temperature. As per their knowledge, this method could reduce the time complexity of the doctor and patient in providing medical treatment quickly. The best part was that anyone could access it from anywhere. Isravel et al. ( 2020 ) presented a pre-processing approach that might enhance the accuracy in identifying the electrocardiographic signals. They evaluated the classification using different classifying algorithms such as K nearest neighbour, Naïve Bayes, and Decision tree to detect normal and irregular heartbeat sounds. Also, after trying, it was discovered that pre-processing approach increased the performance of classifying algorithms. The devices utilized for IoT set up were the LM35 sensor, Pulse sensor, AD8232 electrocardiographic sensor, and Arduino Uno. Thai et al. ( 2017 ) proposed a new lightweight method to remove the noise from electrocardiographic signals to perform minute diagnosis and prediction. Initially, they worked on the Sequential Recursive algorithm for the transformation of signals into digital format. The same was sent to the Discrete Wavelet Transform algorithm to detect the peaks in the data for removing the noises. Then features were extracted from the electrocardiographic dataset from Massachusetts Institute of Technology-Beth Israel Hospital to perform diagnosis and prediction and remove the redundant features using Fishers Linear Discriminant. Nashif et al. ( 2018 ) proposed a cloud-based heart disease prediction system for detecting heart disease using machine learning models derived from Java Based Open Access Data Mining Platform, Waikato Environment for Knowledge Analysis. They got an accuracy level of 97.53% using a support vector machine with 97.50% sensitivity and 94.94% specificity. They used an efficient software tool that trained the large dataset and compared multiple machine learning techniques. The smartphone used to detect and predict heart disease based on the information acquired from the patients. Hardware components are used to monitor the system continuously. Babu et al. ( 2019 ) aimed to determine whether the heart attack could occur using hereditary or not. Thus to work on it, initially, they collected and compared the previous data of parents with their child dataset to find the prediction and accurate values. It could help them to determine how healthy the child is. The authors used different parameters to show the dependent and independent parameters to find whether the person gets a heart attack.

Tuberculosis disease detection

AI is placed as an answer for aid in the battle against tuberculosis. Computerized reasoning applications in indicative radiology might have the option to give precise methods for recognizing the infections for low pay countries. Romero et al. ( 2020 ) performed the classification tree analysis to reveal the associations between predictors of tuberculosis in England. They worked on the American Public Health Association data ranging from demographic herd properties and tuberculosis variables using Sam Tuberculosis management. They used a machine-learning algorithm, performed data preparation, data reduction, and data analysis, and finally got the results. Horvath et al. ( 2020 ) performed the automatic scanning and analysis on 531 slides of tuberculosis, out of which 56 were from the positive specimen. They also validated a scanning and analysis system to combine fully automated microscopy using deep learning analysis. Their proposed system achieved the highest sensitivity by detecting 40 out of 56 positive slides. Sathitratanacheewin et al. ( 2020 ) developed a convolution neural network model using tuberculosis. They used a specified chest X-ray dataset taken from the national library of medical Shenzhen no. 3 hospitals and did its testing with a non-tuberculosis chest X-ray dataset taken from the national institute of health care and center. The deep convolution neural network model achieved the region of curve area under the curve by 0.9845 and 0.8502 for detecting tuberculosis and the specificity 82% and sensitivity of 72%. Bahadur et al. ( 2020 ) proposed an automatic technique to detect the abnormal chest X-ray images that contained at least one pathology such as infiltration, fibrosis, pleural effusion, etc., because of tuberculosis. This technique is based on a hierarchical structure for extracting the feature where feature sets are used in two hierarchy levels to group healthy and unhealthy people. The authors used 800 chest X-ray images taken from two public datasets named Montgomery and Shenzhen. López-Úbeda et al. ( 2020 ) explored the machine learning methods to detect tuberculosis in Spanish radiology reports. They also mentioned the deep learning classification algorithms with the purpose of its evaluation and comparison and to carry such a task. The authors have used the data of 5947 radiology reports collected from high-tech media. Ullah et al. ( 2020 ) presented the study of Raman Spectroscopy and machine learning based on principal component analysis and hierarchical component analysis to analyse tuberculosis either in positive form or negative form. They also showed Raman results which indicated the irregularities in the blood composition collected from tuberculosis-negative patients. Panicker et al. ( 2018 ) introduced the programmed technique for the location of tuberculosis bacilli from tiny smear pictures. They performed picture binarization and grouping of distinguished districts utilizing convolution neural organization. They did an assessment utilizing 22 sputum smear minuscule pictures. The results demonstrated 97.13% review, 78.4% accuracy, 86.76% F-score for predicting tuberculosis. Lai et al. ( 2020 ) compared the artificial neural network outcomes, support vector machine, and random forest while diagnosing anti-tuberculosis drugs on Taipei Medical University Wanfang Hospital patients. They selected the features via univariate risk factor analysis and literature evaluation. The authors achieved the specificity by 90.4% and sensitivity of 80%. Gao et al. ( 2019 ) investigated the applications of computed topography pulmonary images to detect tuberculosis at five levels of severity. They proposed a deep Res Net to predict the severity scores and analyse the high severity probability. They also calculate overall severity probability, separate probabilities of both high severity and low severity forces. Singh et al. ( 2020 ) worked to discover tuberculosis sores in the lungs. They proposed a computerized recognition strategy utilizing a profound learning technique known as Antialiased Convolution Neural Network proposed by Richard Zhang. Their dataset included 3D computed topography pictures, which were cut into 2D pictures. They applied division on each cutting picture utilizing UNet and Link net design.

Stroke and cerebrovascular disease detection

AI can analyse and detect stroke signs in medical images as if the system suspects a stroke in the patient. It immediately gives the signal to the patient or doctor. Researchers have proposed various methodologies to showcase the impact of AI in stroke and cerebrovascular detection (Singh et al. 2009 ). O’Connell et al. ( 2017 ) assessed the diagnostic capability and temporal stability for the detection of stroke. They observed the mostly identical patterns between the stroke patients and controls across the ten patients. They achieved the specificity and sensitivity of 90% across the research. Labovitz et al. ( 2017 ) stated the use of AI for daily monitoring of patients for the identification and medication. They achieved the improvement by 50%on plasma drug concentration levels. Abedi et al. ( 2020 ) also presented a framework to build up the decision support system using an artificial neural network, which improved patient care and outcome. Singh et al. ( 2009 ) compared the different methods to predict stroke on the cardiovascular health study dataset. They also used the decision tree algorithm for the feature selection process, principal component analysis to reduce the classification algorithm’s dimension, and a backpropagation neural network. Biswas et al. ( 2020 ) introduced an AI-based system for the location and estimation of carotid plaque as carotid intima-media thickness for the same and solid atherosclerotic carotid divider discovery and plaque estimations.

Hypertension disease detection

Researchers have found that AI has been able to diagnose hypertension by taking input data from blood pressure, demographics, etc. Krittanawong et al. ( 2018 ) summarized the review about the recent computer science and medical field advancements. They also illustrated the innovative approach of artificial intelligence to predict the early stages of hypertension. They also stated that AI plays a vital role in investigating the risk factors for hypertension. However, on the side, it has also been restricted by researchers because of its limitations in designing, etc. Arsalan et al. ( 2019 ) conducted the experiments using three publicly available datasets as digitized retinal imagery for vessel extraction (DRIVE), structured analysis of retina (STARE) for hypertension detection. They achieved the accuracy for all datasets with sensitivity, specificity, area under the curve, and accuracy of 80.22%, 98.1%, 98.2%, 96.55%, respectively. Kanegae et al. ( 2020 ) used machine learning techniques to validate the prediction of risk for new-onset hypertension. They used data in a split form for the model construction and development and validation to test its performance. The models they used were XGBoost and ensemble, in which the XGBoost model was considered the best predictor because it was systolic blood pressure nature during cardio ankle vascular. Figure  7 shows the structure of heart during its normal phase as well as in hypertension phase. When the human heart is in hypertension phase, its pulmonary arteries gets constricted because of which the right ventricle did not get the blood in to the lungs.

Pulmonary hypertension (Kanegae et al. 2020 )

Koshimizu et al. ( 2020 ) has also described artificial intelligence in pulse the executives, which was utilized to foresee the chance of circulatory strain utilizing enormous scope information. The authors also focused on the measure that was used to control blood pressure using an artificial neural network. In a nutshell, they were trying to prove that an artificial neural network is beneficial for high blood pressure organization and can also use it to create medical confirmation for the realistic organization of hypertension. Mueller et al. ( 2020 ) stated that using artificial analytic tools to the large dataset based on hypertension would generate questionable results and would also miss treatments and the potential targets. The author also stated that the vision of hypertension would be challenging to achieve and doubtlessly not happen in the future. Chaikijuraja et al. ( 2020 ) also noted the merits of using artificial intelligence to detect hypertension as artificial intelligence can recognize hypertension’s risk factors and phenotypes.

Moreover, it is used to interpret data from randomized trials that contained blood pressure targets associated with cardio vascular outcomes. Kiely et al. ( 2019 ) investigated the prescient model dependent on the medical care assets that could be sued to screen huge populaces to distinguish the patients at great danger of pneumonic blood vessel hypertension. They took the information of 709 patients from 2008 to 2016 with pneumonic blood vessel hypertension and contrasted it and separated associate of 2,812,458 who was delegated non-aspiratory blood vessel hypertension just as the prescient model was created and approved by utilizing cross approval. Kwon et al. ( 2020 ) did the past group learning of information taken on or after successive diseased people from two health care sectors to predict pulmonary hypertension using electrocardiography with the help of artificial intelligence. Sakr et al. ( 2018 ) assessed and analyse d AI strategies, such as Logit Boost, Bayesian Network Classifier, locally weighted Naïve Bayes, counterfeit neural organization, Support Vector Machine, and Random Tree Forest foresee the people to recognize hypertension. Thus, AI provides insights for hypertension healthcare and implements prescient, customized, and pre-emptive methodologies in clinical practice.

Skin disease diagnosis

Researchers have developed an AI system that can precisely group cutaneous skin problems and fill in as an auxiliary instrument to improve the demonstrative exactness of clinicians. Chakraborty et al. ( 2017 ) proposed a neural-based location technique for various skin disorders. They utilized two infected skin pictures named Basel Cell Carcinoma and Skin Angioma. Non-overwhelming arranging hereditary calculation is used to prepare the counterfeit neural organization, contrasted with the neural network particle swarm optimization classifier and neural network Caesarean Section classifier. Zaar et al. ( 2020 ) collected the clinical images of skin disease from the department of Dermatology at the Sahlgrenska University, where artificial intelligence algorithms had been used for the classification, thereby achieving the diagnosis accuracy by 56.4% for the top five suggested diseases. Kumar et al. ( 2019 ) used a dual-stage approach that combined computer vision and machine learning to evaluate and recognize skin diseases. During training and testing of the diseases, the method produced an accuracy of up to 95%. Kolkur et al. ( 2018 ) developed a system that identified skin disease based on input symptoms. They collected the data of the symptoms of ten skin diseases and got 90% above accuracy.

Liver disease detection

Researchers have found that AI can treat liver disease at its early diagnosis to work on its endurance and heal rate. Abdar et al. ( 2018 ) showed that efficient early liver disease recognition through Multilayer Perceptron Neural Network calculation depends on different choice tree calculations, such as chi-square programmed communication indicator and characterization, and relapse tree with boosting strategy. Their technique had the option to analyse and characterize the liver malady proficiently. Khaled et al. ( 2018 ) introduced an artificial neural network for the diagnosis of hepatitis virus. Protein and Histology is utilized as an info variable for the fake neural organization model, and it also showed the correct prediction of diagnosis by 93%. Spann et al. ( 2020 ) provided the strengths of machine learning tools and their potential as machine learning is applied to liver disease research, including clinical, molecular, demographic, pathological, and radiological data. Nahar and Ara ( 2018 ) explored the early guess of liver ailment using various decision tree techniques. The choice tree methods utilized were J48, Licensed Massage Therapist, Random Forest, Random Tree, REP tree, Decision Stump, and Hoeffding Trees. Their primary purpose was to calculate and compare the performances of various decision tree techniques. Farokhzad et al. ( 2016 ) used fuzzy logic for diagnosing liver sickness. Using this method, where they had two triangular membership and Gussy membership functions, they reached 79–83% accuracy.

Comparative analysis

In addition to the above mentioned reported work, the comparative analysis illustrated in Table  4 showcase the detailed information such as type of dataset, techniques, and the predicted outcomes regarding the work done by the researchers on different diseases, which in return helped the author to look for the best technique for detecting or diagnosing any particular disease.

Comparative analysis for different disease detection

From Table  4 , we can observe that AI techniques have proven to be the best for detecting diseases with improved results. AI uses machine and deep learning models that work upon training and testing data sets so that the system can see the disease and diagnose it early. In the AI-based model, we initially need to train human beings to remember the data and provide accurate results. However, it also deals with the problem. Suppose the training data produced the incorrect analysis of disease because of insufficient information, which artificial intelligence cannot factor. As a result, it will become a horrible condition for the patients as AI cannot assure us whether the prediction regarding disease detection is accurate.

On assaying the accuracy of algorithms in diagnosing the disease, deep learning classifiers have dominated over machine learning models in the field of disease diagnosis. Deep learning models have proved to be best in terms of scalp disease by 99%, Alzheimer disease by 96%, thyroid disease by 99%, 96% in skin disease, 99.37% in case of Arrhythmia disease, 95.7% in diabetic disease, while as machine learning models achieved 89% in diabetic disease, 88.67% in tuberculosis, 86.84% in Alzheimer disease, etc.

We have presented recently published research studies that employed AI-based Learning techniques for diagnosing the disease in the current review. This study highlights research on disease diagnosis prediction and predicting the post-operative life expectancy of diseased patients using AI-based learning techniques.

Investigation 1 : Why do we need AI?

We know that AI is the simulation of human processes by machines (computer systems) and that this simulation includes learning, reasoning, and self-correction. We require AI since the amount of labour we must perform is rising daily. As a result, it’s a good idea to automate regular tasks. It conserves the organization’s staff and also boosts production (Vasal et al. 2020 ).

In terms of the healthcare industry, AI in health refers to a set of diverse technologies that enable robots to detect, comprehend, act, and learn1 to execute administrative and clinical healthcare activities. AI has the potential to transform healthcare by addressing some of the industry’s most pressing issues. For example, AI can result in improved patient outcomes and increased productivity and efficiency in care delivery (Gouda et al. 2020 ). It can also enhance healthcare practitioners’ daily lives by spending more time caring for patients, therefore increasing staff morale and retention. In addition, it may potentially help bring life-saving medicines to market more quickly. Figure  8 shows the significance of AI in the medical field.

Importance of artificial intelligence in healthcare

Investigation 2 : Why is AI important, and how is it used to analyse the disease?

The emergence of new diseases remains a critical parameter in human health and society. Hence, the advances in AI allow for rapid processing and analysis of such massive and complex data. It recommends the correct decision for over ten different diseases (as mentioned in the literature) with at least 98% accuracy.

Doctors use technologies such as computed tomography scan or magnetic resonance imaging to produce a detailed 3D map of the area that needs to be diagnosed. Later, AI technology analyse s the system-generated image using machine and deep learning models to spot the diseased area’s features in seconds. As shown in the framework section, an artificial intelligence model using machine and deep learning algorithms is initially trained with the help of a particular disease dataset (Owasis et al. 2019 ). The dataset is then pre-processed using data cleaning and transformation techniques so that the disease symptoms in the form of feature vectors can be extracted and further diagnosed.

Suppose doctors do not use AI techniques. In that case, it will cause a delay in treating the patients as it is tough to interpret the scanned image manually, and it also takes a considerable amount of time. But, on the other hand, it shows that an AI technique helps the patients and helps the doctors save the patient’s life by treating them as early as possible (Luo et al. 2019 ).

Investigation 3 : What is the impact of AI in medical diagnosis?

Due to advancements in computer power, learning algorithms, and the availability of massive datasets (big data) derived from medical records and wearable health monitors. The best part of implementing AI in healthcare is that it helps to enhance various areas, including illness detection, disease classification, decision-making processes, giving optimal treatment choices, and ultimately, helping people live longer. In terms of disease diagnosis, AI has been used to enhance medical diagnosis (Chen et al. 2019a , b ). For example, the technology, which is currently in use in China, may detect hazardous tumors and nodules in patients with lung cancer, allowing physicians to provide an early diagnosis rather than sending tissue samples to a lab for testing, allowing for earlier treatment (Keenan et al. 2020 ). Figure  9 illustrates the influence of artificial intelligence and other approaches.

Comparison between AI and other techniques

Investigation 4 : Which AI-based algorithm is used in disease diagnosis?

Disease detection algorithms driven by AI demonstrated to be an effective tool for identifying undiagnosed patients with under-diagnosed, uncoded, and rare diseases. Therefore, AI models for disease detection have an ample opportunity to drive earlier diagnosis for patients in need and guide pharmaceutical companies with highly advanced, targeted diagnostics to help these patients get correctly diagnosed and treated earlier in their disease journey (Keenan et al. 2020 ). The research work mentioned in the literature has covered both machine and deep learning models for diagnosing the diseases such as cancer, diabetes, chronic, heart disease, alzheimer, stroke and cerebrovascular, hypertension, skin, and liver disease. Machine learning models, Random Forest Classifier, Logistic Regression, Fuzzy logics, Gradient Boosting Machines, Decision Tree, K nearest neighbour (KNN), and Support vector machines (SVM) are primarily used in literature. Among deep learning models, Convolutional Neural Networks (CNN) have been used most commonly for disease diagnosis. In addition, faster Recurrent Convolution Neural Network, Multilayer Perceptron, Long Short Term Memory (LSTM) have also been used extensively in the literature. Figure  10 displays the usage of AI-based prediction models in the literature.

Artificial intelligence-based prediction models

Investigation 5 : What are the challenges faced by the researchers while using AI models in several disease diagnosis?

Although AI-based techniques have marked their significance in disease diagnosis, there are still many challenges faced by the researchers that need to be addressed.

• i. Limited Data size  The most common challenge faced by most of the studies was insufficient data to train the model. A small sample size implies a smaller training set which does not authenticate the efficiency of the proposed approaches. On the other hand, good sample size can train the model better than the limited one (Rajalakshmi et al. 2018 ).
• ii. High dimensionality  Another data-related issue faced in cancer research is high dimensionality. High dimensionality is referred to a vast number of features as compared to cases. However, multiple dimensionality reduction techniques are available to deal with this issue (Bibault et al. 2020 ).
• iii. Efficient feature selection technique  Many studies have achieved exceptional prediction outcomes. However, a computationally effective feature selection method is required to eradicate the data cleaning procedures while generating high disease prediction accuracy (Koshimizu et al. 2020 ).
• iv. Model Generalizability  A shift in research towards improving the generalizability of the model is required. Most of the studies have proposed a prediction model that is validated on a single site. There is a need to validate the models on multiple sites that can help improve the model’s generalizability (Fukuda et al. 2019 ).
• v. Clinical Implementation  AI-based models have proved their dominance in medical research; still, the practical implementation of the models in the clinics is not incorporated. These models need to be validated in a clinical setting to assist the medical practitioner in affirming the diagnosis verdicts (Huang et al. 2020 ).

Investigation 6 : How artificial intelligence-based techniques are helping doctors in diagnosing diseases?

AI improves the lives of patients, physicians, and hospital managers by doing activities usually performed by people but in a fraction of the time and the expense. For example, AI assists physicians in making suggestions by evaluating vast amounts of healthcare data such as electronic health records, symptom data, and physician reports to improve health outcomes and eventually save the patient’s life (Kohlberger et al. 2019 ). Additionally, this data aids in the improvement and acceleration of decision-making while diagnosing and treating patients’ illnesses using artificial intelligence-based approaches. Not only that, AI assists physicians in detecting diseases by utilizing complicated algorithms, hundreds of biomarkers, imaging findings from millions of patients, aggregated published clinical studies, and thousands of physicians’ notes to improve the accuracy of diagnosis.

Conclusion and future scope

When it comes to disease diagnosis, accuracy is critical for planning, effective treatment and ensuring the well-being of patients. AI is a vast and diverse realm of data, algorithms, analytics, deep learning, neural networks, and insights that is constantly expanding and adapting to the needs of the healthcare industry and its patients. According to the findings of this study, AI approaches in the healthcare system, particularly for illness detection, are essential. Aiming at illuminating how machine and deep learning techniques work in various disease diagnosis areas, the current study has been divided into several sections that cover the diagnosis of alzheimer’s, cancer, diabetes, chronic diseases, heart disease, stroke and cerebrovascular disease, hypertension, skin disease, and liver disease. The introduction and contribution were covered in the first section, followed by an evaluation of the quality of the work and an examination of AI approaches and applications. Later, various illness symptoms and diagnostic difficulties, a paradigm for AI in disease detection models, and various AI applications in healthcare were discussed. The reported work on multiple diseases and the comparative analysis of different techniques with the used dataset as well as the results of an applied machine and deep learning methods in terms of multiple parameters such as accuracy, sensitivity, specificity, an area under the curve, and F-score has also been portrayed. Finally, the work that assisted researchers in determining the most effective method for detecting illnesses is finished, as in future scope. In a nutshell, medical experts better understand how AI may be used for illness diagnosis, leading to more appropriate proposals for the future development of AI based techniques.

Contrary to considerable advancements over the past several years, the area of accurate clinical diagnostics faces numerous obstacles that must be resolved and improved constantly to treat emerging illnesses and diseases effectively. Even healthcare professionals recognize the barriers that must be overcome before sickness may be detected in conjunction with artificial intelligence. Even doctors do not entirely rely on AI-based approaches at this time since they are unclear of their ability to anticipate illnesses and associated symptoms. Thus much work is required to train the AI-based systems so that there will be an increase in the accuracy to predict the methods for diagnosing diseases. Hence, in the future, AI-based research should be conducted by keeping the flaw mentioned earlier in consideration to provide a mutually beneficial relationship between AI and clinicians. In addition to this, a decentralized federated learning model should also be applied to create a single training model for disease datasets at remote places for the early diagnosis of diseases.

Acknowledgements

This research work was supported by Sejong University research fund. Yogesh Kumar and Muhammad Fazal Ijaz contributed equally to this work and are first co-authors.

Declarations

The authors declare that they have no conflict of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with the animals performed by any of the authors.

Informed consent was obtained from all individual participants included in the study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Yogesh Kumar, Email: [email protected] .

Apeksha Koul, Email: moc.liamg@9oluokahskepa .

Ruchi Singla, Email: moc.oohay@algnisihcur .

Muhammad Fazal Ijaz, Email: rk.ca.gnojes@lazaf .

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• Volume 13, Issue 7
• Artificial intelligence in systematic reviews: promising when appropriately used
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• http://orcid.org/0000-0003-1727-0608 Sanne H B van Dijk 1 , 2 ,
• Marjolein G J Brusse-Keizer 1 , 3 ,
• Charlotte C Bucsán 2 , 4 ,
• http://orcid.org/0000-0003-1071-6769 Job van der Palen 3 , 4 ,
• Carine J M Doggen 1 , 5 ,
• http://orcid.org/0000-0002-2276-5691 Anke Lenferink 1 , 2 , 5
• 1 Health Technology & Services Research, Technical Medical Centre , University of Twente , Enschede , The Netherlands
• 2 Pulmonary Medicine , Medisch Spectrum Twente , Enschede , The Netherlands
• 3 Medical School Twente , Medisch Spectrum Twente , Enschede , The Netherlands
• 4 Cognition, Data & Education, Faculty of Behavioural, Management & Social Sciences , University of Twente , Enschede , The Netherlands
• 5 Clinical Research Centre , Rijnstate Hospital , Arnhem , The Netherlands
• Correspondence to Dr Anke Lenferink; a.lenferink{at}utwente.nl

Background Systematic reviews provide a structured overview of the available evidence in medical-scientific research. However, due to the increasing medical-scientific research output, it is a time-consuming task to conduct systematic reviews. To accelerate this process, artificial intelligence (AI) can be used in the review process. In this communication paper, we suggest how to conduct a transparent and reliable systematic review using the AI tool ‘ASReview’ in the title and abstract screening.

Methods Use of the AI tool consisted of several steps. First, the tool required training of its algorithm with several prelabelled articles prior to screening. Next, using a researcher-in-the-loop algorithm, the AI tool proposed the article with the highest probability of being relevant. The reviewer then decided on relevancy of each article proposed. This process was continued until the stopping criterion was reached. All articles labelled relevant by the reviewer were screened on full text.

Results Considerations to ensure methodological quality when using AI in systematic reviews included: the choice of whether to use AI, the need of both deduplication and checking for inter-reviewer agreement, how to choose a stopping criterion and the quality of reporting. Using the tool in our review resulted in much time saved: only 23% of the articles were assessed by the reviewer.

Conclusion The AI tool is a promising innovation for the current systematic reviewing practice, as long as it is appropriately used and methodological quality can be assured.

PROSPERO registration number CRD42022283952.

• systematic review
• statistics & research methods
• information technology

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/bmjopen-2023-072254

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Strengths and limitations of this study

Potential pitfalls regarding the use of artificial intelligence in systematic reviewing were identified.

Remedies for each pitfall were provided to ensure methodological quality. A time-efficient approach is suggested on how to conduct a transparent and reliable systematic review using an artificial intelligence tool.

The artificial intelligence tool described in the paper was not evaluated for its accuracy.

Medical-scientific research output has grown exponentially since the very first medical papers were published. 1–3 The output in the field of clinical medicine increased and keeps doing so. 4 To illustrate, a quick PubMed search for ‘cardiology’ shows a fivefold increase in annual publications from 10 420 (2007) to 52 537 (2021). Although the medical-scientific output growth rate is not higher when compared with other scientific fields, 1–3 this field creates the largest output. 3 Staying updated by reading all published articles is therefore not feasible. However, systematic reviews facilitate up-to-date and accessible summaries of evidence, as they synthesise previously published results in a transparent and reproducible manner. 5 6 Hence, conclusions can be drawn that provide the highest considered level of evidence in medical research. 5 7 Therefore, systematic reviews are not only crucial in science, but they have a large impact on clinical practice and policy-making as well. 6 They are, however, highly labour-intensive to conduct due to the necessity of screening a large amount of articles, which results in a high consumption of research resources. Thus, efficient and innovative reviewing methods are desired. 8

An open-source artificial intelligence (AI) tool ‘ASReview’ 9 was published in 2021 to facilitate the title and abstract screening process in systematic reviews. Applying this tool facilitates researchers to conduct more efficient systematic reviews: simulations already showed its time-saving potential. 9–11 We used the tool in the study selection of our own systematic review and came across scenarios that needed consideration to prevent loss of methodological quality. In this communication paper, we provide a reliable and transparent AI-supported systematic reviewing approach.

We first describe how the AI tool was used in a systematic review conducted by our research group. For more detailed information regarding searches and eligibility criteria of the review, we refer to the protocol (PROSPERO registry: CRD42022283952). Subsequently, when deciding on the AI screening-related methodology, we applied appropriate remedies against foreseen scenarios and their pitfalls to maintain a reliable and transparent approach. These potential scenarios, pitfalls and remedies will be discussed in the Results section.

In our systematic review, the AI tool ‘ASReview’ (V.0.17.1) 9 was used for the screening of titles and abstracts by the first reviewer (SHBvD). The tool uses an active researcher-in-the-loop machine learning algorithm to rank the articles from high to low probability of eligibility for inclusion by text mining. The AI tool offers several classifier models by which the relevancy of the included articles can be determined. 9 In a simulation study using six large systematic review datasets on various topics, a Naïve Bayes (NB) and a term frequency-inverse document frequency (TF-IDF) outperformed other model settings. 10 The NB classifier estimates the probability of an article being relevant, based on TF-IDF measurements. TF-IDF measures the originality of a certain word within the article relative to the total number of articles the word appears in. 12 This combination of NB and TF-IDF was chosen for our systematic review.

Before the AI tool can be used for the screening of relevant articles, its algorithm needs training with at least one relevant and one irrelevant article (ie, prior knowledge). It is assumed that the more prior knowledge, the better the algorithm is trained at the start of the screening process, and the faster it will identify relevant articles. 9 In our review, the prior knowledge consisted of three relevant articles 13–15 selected from a systematic review on the topic 16 and three randomly picked irrelevant articles.

After training with the prior knowledge, the AI tool made a first ranking of all unlabelled articles (ie, articles not yet decided on eligibility) from highest to lowest probability of being relevant. The first reviewer read the title and abstract of the number one ranked article and made a decision (‘relevant’ or ‘irrelevant’) following the eligibility criteria. Next, the AI tool took into account this additional knowledge and made a new ranking. Again, the next top ranked article was proposed to the reviewer, who made a decision regarding eligibility. This process of AI making rankings and the reviewer making decisions, which is also called ‘researcher-in-the-loop’, was repeated until the predefined data-driven stopping criterion of – in our case – 100 subsequent irrelevant articles was reached. After the reviewer rejected what the AI tool puts forward as ‘most probably relevant’ a hundred times, it was assumed that there were no relevant articles left in the unseen part of the dataset.

The articles that were labelled relevant during the title and abstract screening were each screened on full text independently by two reviewers (SHBvD and MGJB-K, AL, JvdP, CJMD, CCB) to minimise the influence of subjectivity on inclusion. Disagreements regarding inclusion were solved by a third independent reviewer.

How to maintain reliability and transparency when using AI in title and abstract screening

A summary of the potential scenarios, and their pitfalls and remedies, when using the AI tool in a systematic review is given in table 1 . These potential scenarios should not be ignored, but acted on to maintain reliability and transparency. Figure 1 shows when and where to act on during the screening process reflected by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart, 17 from literature search results to publishing the review.

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Flowchart showing when and where to act on when using ASReview in systematic reviewing. Adapted the PRISMA flowchart from Haddaway et al . 17

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Per-scenario overview of potential pitfalls and how to prevent these when using ASReview in a systematic review

In our systematic review, by means of broad literature searches in several scientific databases, a first set of potentially relevant articles was identified, yielding 8456 articles, enough to expect the AI tool to be efficient in the title and abstract screening (scenario ① was avoided, see table 1 ). Subsequently, this complete set of articles was uploaded in reference manager EndNote X9 18 and review manager Covidence, 19 where 3761 duplicate articles were removed. Given that EndNote has quite low sensitivity in identifying duplicates, additional deduplication in Covidence was considered beneficial. 20 Deduplication is usually applied in systematic reviewing, 20 but is increasingly important prior to the use of AI. Since multiple decisions regarding a duplicate article weigh more than one, this will disproportionately influence classification and possibly the results ( table 1 , scenario ② ). In our review, a deduplicated set of articles was uploaded in the AI tool. Prior to the actual AI-supported title and abstract screening, the reviewers (SHBvD and AL, MGJB-K) trained themselves with a small selection of 74 articles. The first reviewer became familiar with the ASReview software, and all three reviewers learnt how to apply the eligibility criteria, to minimise personal influence on the article selection ( table 1 , scenario ③ ).

Defining the stopping criterion used in the screening process is left to the reviewer. 9 An optimal stopping criterion in active learning is considered a perfectly balanced trade-off between a certain cost (in terms of time spent) of screening one more article versus the predictive performance (in terms of identifying a new relevant article) that could be increased by adding one more decision. 21 The optimal stopping criterion in systematic reviewing would be the moment that screening additional articles will not result in more relevant articles being identified. 22 Therefore, in our review, we predetermined a data-driven stopping criterion for the title and abstract screening as ‘100 consecutive irrelevant articles’ in order to prevent the screening from being stopped before or a long time after all relevant articles were identified ( table 1 , scenario ④ ).

Due to the fact that the stopping criterion was reached after 1063 of the 4695 articles, only a part of the total number of articles was seen. Therefore, this approach might be sensitive to possible mistakes when articles are screened by only one reviewer, influencing the algorithm, possibly resulting in an incomplete selection of articles ( table 1 , scenario ③ ). 23 As a remedy, second reviewers (AL, MGJB-K) checked 20% of the titles and abstracts seen by the first reviewer. This 20% had a comparable ratio regarding relevant versus irrelevant articles over all articles seen. The percentual agreement and Cohen’s Kappa (κ), a measure for the inter-reviewer agreement above chance, were calculated to express the reliability of the decisions taken. 24 The decisions were agreed in 96% and κ was 0.83. A κ equal of at least 0.6 is generally considered high, 24 and thus it was assumed that the algorithm was reliably trained by the first reviewer.

The reporting of the use of the AI tool should be transparent. If the choices made regarding the use of the AI tool are not entirely reported ( table 1 , scenario ⑤ ), the reader will not be able to properly assess the methodology of the review, and review results may even be graded as low-quality due to the lack of transparent reporting. The ASReview tool offers the possibility to extract a data file providing insight into all decisions made during the screening process, in contrast to various other ‘black box’ AI-reviewing tools. 9 This file will be published alongside our systematic review to provide full transparency of our AI-supported screening. This way, the screening with AI is reproducible (remedy to scenario ⑥ , table 1 ).

Results of AI-supported study selection in a systematic review

We experienced an efficient process of title and abstract screening in our systematic review. Whereas the screening was performed with a database of 4695 articles, the stopping criterion was reached after 1063 articles, so 23% were seen. Figure 2A shows the proportion of articles identified as being relevant at any point during the AI-supported screening process. It can be observed that the articles are indeed prioritised by the active learning algorithm: in the beginning, relatively many relevant articles were found, but this decreased as the stopping criterion (vertical red line) was approached. Figure 2B compares the screening progress when using the AI tool versus manual screening. The moment the stopping criterion was reached, approximately 32 records would have been found when the titles and abstract would have been screened manually, compared with 142 articles labelled relevant using the AI tool. After the inter-reviewer agreement check, 142 articles proceeded to the full text reviewing phase, of which 65 were excluded because these were no articles with an original research format, and three because the full text could not be retrieved. After full text reviewing of the remaining 74 articles, 18 articles from 13 individual studies were included in our review. After snowballing, one additional article from a study already included was added.

Relevant articles identified after a certain number of titles and abstracts were screened using the AI tool compared with manual screening.

In our systematic review, the AI tool considerably reduced the number of articles in the screening process. Since the AI tool is offered open source, many researchers may benefit from its time-saving potential in selecting articles. Choices in several scenarios regarding the use of AI, however, are still left open to the researcher, and need consideration to prevent pitfalls. These include the choice whether or not to use AI by weighing the costs versus the benefits, the importance of deduplication, double screening to check inter-reviewer agreement, a data-driven stopping criterion to optimally use the algorithm’s predictive performance and quality of reporting of the AI-related methodology chosen. This communication paper is, to our knowledge, the first elaborately explaining and discussing these choices regarding the application of this AI tool in an example systematic review.

The main advantage of using the AI tool is the amount of time saved. Indeed, in our study, only 23% of the total number of articles were screened before the predefined stopping criterion was met. Assuming that all relevant articles were found, the AI tool saved 77% of the time for title and abstract screening. However, time should be invested to become acquainted with the tool. Whether the expected screening time saved outweighs this time investment is context-dependent (eg, researcher’s digital skills, systematic reviewing skills, topic knowledge). An additional advantage is that research questions previously unanswerable due to the insurmountable number of articles to screen in a ‘classic’ (ie, manual) review, now actually are possible to answer. An example of the latter is a review screening over 60 000 articles, 25 which would probably never have been performed without AI supporting the article selection.

Since the introduction of the ASReview tool in 2021, it was applied in seven published reviews. 25–31 An important note to make is that only one 25 clearly reported AI-related choices in the methods and a complete and transparent flowchart reflecting the study selection process in the Results section. Two reviews reported a relatively small number (<400) of articles to screen, 26 27 of which more than 75% of the articles were screened before the stopping criterion was met, so the amount of time saved was limited. Also, three reviews reported many initial articles (>6000) 25 28 29 and one reported 892 articles, 31 of which only 5%–10% needed to be screened. So in these reviews, the AI tool saved an impressive amount of screening time. In our systematic review, 3% of the articles were labelled relevant during the title and abstract screening and eventually, <1% of all initial articles were included. These percentages are low, and are in line with the three above-mentioned reviews (1%–2% and 0%–1%, respectively). 25 28 29 Still, relevancy and inclusion rates are much lower when compared with ‘classic’ systematic reviews. A study evaluating the screening process in 25 ‘classic’ systematic reviews showed that approximately 18% was labelled relevant and 5% was actually included in the reviews. 32 This difference is probably due to more narrow literature searches in ‘classic’ reviews for feasibility purposes compared with AI-supported reviews, resulting in a higher proportion of included articles.

In this paper, we show how we applied the AI tool, but we did not evaluate it in terms of accuracy. This means that we have to deal with a certain degree of uncertainty. Despite the data-driven stopping criterion there is a chance that relevant articles were missed, as 77% was automatically excluded. Considering this might have been the case, first, this could be due to wrong decisions of the reviewer that would have undesirably influenced the training of the algorithm by which the articles were labelled as (ir)relevant and the order in which they were presented to the reviewer. Relevant articles could have therefore remained unseen if the stopping criterion was reached before they were presented to the reviewer. As a remedy, in our own systematic review, of the 20% of the articles screened by the first reviewer, relevancy was also assessed by another reviewer to assess inter-reviewer reliability, which was high. It should be noted, though, that ‘classic’ title and abstract screening is not necessarily better than using AI, as medical-scientific researchers tend to assess one out of nine abstracts wrongly. 32 Second, the AI tool may not have properly ranked highly relevant to irrelevant articles. However, given that simulations proved this AI tool’s accuracy before 9–11 this was not considered plausible. Since our study applied, but did not evaluate, the AI tool, we encourage future studies evaluating the performance of the tool across different scientific disciplines and contexts, since research suggests that the tool’s performance depends on the context, for example, the complexity of the research question. 33 This could not only enrich the knowledge about the AI tool, but also increases certainty about using it. Also, future studies should investigate the effects of choices made regarding the amount of prior knowledge that is provided to the tool, the number of articles defining the stopping criterion, and how duplicate screening is best performed, to guide future users of the tool.

Although various researcher-in-the-loop AI tools for title and abstract screening have been developed over the years, 9 23 34 they often do not develop into usable mature software, 34 which impedes AI to be permanently implemented in research practice. For medical-scientific research practice, it would therefore be helpful if large systematic review institutions, like Cochrane and PRISMA, would consider to ‘officially’ make AI part of systematic reviewing practice. When guidelines on the use of AI in systematic reviews are made available and widely recognised, AI-supported systematic reviews can be uniformly conducted and transparently reported. Only then we can really benefit from AI’s time-saving potential and reduce our research time waste.

Our experience with the AI tool during the title and abstract screening was positive as it has highly accelerated the literature selection process. However, users should consider applying appropriate remedies to scenarios that may form a threat to the methodological quality of the review. We provided an overview of these scenarios, their pitfalls and remedies. These encourage reliable use and transparent reporting of AI in systematic reviewing. To ensure the continuation of conducting systematic reviews in the future, and given their importance for medical guidelines and practice, we consider this tool as an important addition to the review process.

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• Bornmann L ,
• Haunschild R ,
• Michels C ,
• Haghani M ,
• Zwack CC , et al
• McKenzie JE ,
• Bossuyt PM , et al
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Contributors SHBvD proposed the methodology and conducted the study selection. MGJB-K, CJMD and AL critically reflected on the methodology. MGJB-K and AL contributed substantially to the study selection. CCB, JvdP and CJMD contributed to the study selection. The manuscript was primarily prepared by SHBvD and critically revised by all authors. All authors read and approved the final manuscript.

Funding The systematic review is conducted as part of the RE-SAMPLE project. RE-SAMPLE has received funding from the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 965315).

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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This manuscript presents a comprehensive review of the use of Artificial Intelligence (AI) in Systematic Literature Reviews (SLRs). A SLR is a rigorous and organised methodology that assesses and integrates prior research on a given topic. Numerous tools have been developed to assist and partially automate the SLR process. The increasing role of AI in this field shows great potential in providing more effective support for researchers, moving towards the semi-automatic creation of literature reviews. Our study focuses on how AI techniques are applied in the semi-automation of SLRs, specifically in the screening and extraction phases. We examine 21 leading SLR tools using a framework that combines 23 traditional features with 11 AI features. We also analyse 11 recent tools that leverage large language models for searching the literature and assisting academic writing. Finally, the paper discusses current trends in the field, outlines key research challenges, and suggests directions for future research. We highlight three primary research challenges: integrating advanced AI solutions, such as large language models and knowledge graphs, improving usability, and developing a standardised evaluation framework. We also propose best practices to ensure more robust evaluations in terms of performance, usability, and transparency. Overall, this review offers a detailed overview of AI-enhanced SLR tools for researchers and practitioners, providing a foundation for the development of next-generation AI solutions in this field.

Introduction

In this page, we report the tables we have developed when conducting our analysis on the Systematic Literature Review Tools.

Systematic Literature Review Tools analysed through AI and Generic Features

Screening phase of systematic literature review tools analysed through ai features.

• Extraction Phase of Systematic Literature Review Tools analysed through AI Features
• Systematic Literature Review Tools analysed based on AI Features

Figures of the paper

Prisma checklist.

• Codebase Snowballing

How to cite

In this section, we report three tables that describe the 21 systematic literature review tools examined according to both generic and AI-based features. In Section 1.1 and Section 1.2 , we present the analysis of the AI features for the screening and the extraction phases, respectively. In Section 1.3 , we report the analysis of the tools according to the generic features. A copy of these tables is persistently available on ORKG.

-: No information available

Extraction phase of Systematic Literature Review Tools analysed through AI Features

Systematic Literature Review Tools analysed based on General Features

-: No information available NA: Not applicable because the tools are specifically for extraction

In this section we attach all the figures of the mauscript in high defininition (300DPI).

In the following table we report our PRISMA checklist, using the model from "Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71".

Here is the codebase we developed for the snowballing search on Semantic Scholar.

F. Bolaños Burgos, A. Salatino, F. Osborne, and E. Motta. Artificial intelligence for systematic literature reviews: Opportunities and challenges. Submitted to Artificial Intelligence Review, 2024.

This work is licensed under CC BY 4.0

Artificial intelligence in education: : A systematic literature review

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ISSN : 1463-6689

Article publication date: 20 September 2022

Issue publication date: 4 April 2023

The purpose of this study is to present a systematic literature review of academic peer-reviewed articles in English published between 2005 and 2021. The articles were reviewed based on the following features: research topic, conceptual and theoretical characterization, artificial intelligence (AI) methods and techniques.

Design/methodology/approach

This study examines the extent to which AI features within academic research in retail industry and aims to consolidate existing knowledge, analyse the development on this topic, clarify key trends and highlight gaps in the scientific literature concerning the role of AI in retail.

The findings of this study indicate an increase in AI literature within the field of retailing in the past five years. However, this research field is fairly fragmented in scope and limited in methodologies, and it has several gaps. On the basis of a structured topic allocation, a total of eight priority topics were identified and highlighted that (1) optimizing the retail value chain and (2) improving customer expectations with the help of AI are key topics in published research in this field.

Research limitations/implications

This study is based on academic peer-reviewed articles published before July 2021; hence, scientific outputs published after the moment of writing have not been included.

Originality/value

This study contributes to the in-depth and systematic exploration of the extent to which retail scholars are aware of and working on AI. To the best of the author’s knowledge, this study is the first systematic literature review within retailing research dealing with AI technology.

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Heins, C. (2023), "Artificial intelligence in retail – a systematic literature review", Foresight , Vol. 25 No. 2, pp. 264-286. https://doi.org/10.1108/FS-10-2021-0210

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Artificial intelligence in systematic reviews: promising when appropriately used

Affiliations.

• 1 Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
• 2 Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
• 3 Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
• 4 Cognition, Data & Education, Faculty of Behavioural, Management & Social Sciences, University of Twente, Enschede, The Netherlands.
• 5 Clinical Research Centre, Rijnstate Hospital, Arnhem, The Netherlands.
• 6 Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands [email protected].
• PMID: 37419641
• PMCID: PMC10335470
• DOI: 10.1136/bmjopen-2023-072254

Background: Systematic reviews provide a structured overview of the available evidence in medical-scientific research. However, due to the increasing medical-scientific research output, it is a time-consuming task to conduct systematic reviews. To accelerate this process, artificial intelligence (AI) can be used in the review process. In this communication paper, we suggest how to conduct a transparent and reliable systematic review using the AI tool 'ASReview' in the title and abstract screening.

Methods: Use of the AI tool consisted of several steps. First, the tool required training of its algorithm with several prelabelled articles prior to screening. Next, using a researcher-in-the-loop algorithm, the AI tool proposed the article with the highest probability of being relevant. The reviewer then decided on relevancy of each article proposed. This process was continued until the stopping criterion was reached. All articles labelled relevant by the reviewer were screened on full text.

Results: Considerations to ensure methodological quality when using AI in systematic reviews included: the choice of whether to use AI, the need of both deduplication and checking for inter-reviewer agreement, how to choose a stopping criterion and the quality of reporting. Using the tool in our review resulted in much time saved: only 23% of the articles were assessed by the reviewer.

Conclusion: The AI tool is a promising innovation for the current systematic reviewing practice, as long as it is appropriately used and methodological quality can be assured.

Prospero registration number: CRD42022283952.

Keywords: information technology; statistics & research methods; systematic review.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

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Conflict of interest statement

Competing interests: None declared.

Flowchart showing when and where…

Flowchart showing when and where to act on when using ASReview in systematic…

Relevant articles identified after a…

Relevant articles identified after a certain number of titles and abstracts were screened…

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Exploring the factors driving AI adoption in production: a systematic literature review and future research agenda

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• Published: 23 August 2024

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• Heidi Heimberger   ORCID: orcid.org/0000-0003-3390-0219 1 , 2 ,
• Djerdj Horvat   ORCID: orcid.org/0000-0003-3747-3402 1 &
• Frank Schultmann   ORCID: orcid.org/0000-0001-6405-9763 1  

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Our paper analyzes the current state of research on artificial intelligence (AI) adoption from a production perspective. We represent a holistic view on the topic which is necessary to get a first understanding of AI in a production-context and to build a comprehensive view on the different dimensions as well as factors influencing its adoption. We review the scientific literature published between 2010 and May 2024 to analyze the current state of research on AI in production. Following a systematic approach to select relevant studies, our literature review is based on a sample of articles that contribute to production-specific AI adoption. Our results reveal that the topic has been emerging within the last years and that AI adoption research in production is to date still in an early stage. We are able to systematize and explain 35 factors with a significant role for AI adoption in production and classify the results in a framework. Based on the factor analysis, we establish a future research agenda that serves as a basis for future research and addresses open questions. Our paper provides an overview of the current state of the research on the adoption of AI in a production-specific context, which forms a basis for further studies as well as a starting point for a better understanding of the implementation of AI in practice.

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1 Introduction

The technological change resulting from deep digitisation and the increasing use of digital technologies has reached and transformed many sectors [ 1 ]. In manufacturing, the development of a new industrial age, characterized by extensive automation and digitisation of processes [ 2 ], is changing the sector’s ‘technological reality’ [ 3 ] by integrating a wide range of information and communication technologies (such as Industry 4.0-related technologies) into production processes [ 4 ].

Although the evolution of AI traces back to the year 1956 (as part of the Dartmouth Conference) [ 5 ], its development has progressed rapidly, especially since the 2010s [ 6 ]. Driven by improvements, such as the fast and low-cost development of smart hardware, the enhancement of algorithms as well as the capability to manage big data [ 7 ], there is an increasing number of AI applications available for implementation today [ 8 ]. The integration of AI into production processes promises to boost the productivity, efficiency as well as automation of processes [ 9 ], but is currently still in its infancy [ 10 ] and manufacturing firms seem to still be hesitant to adopt AI in a production-context. This appears to be driven by the high complexity of AI combined with the lack of practical knowledge about its implementation in production and several other influencing factors [ 11 , 12 ].

In the literature, many contributions analyze AI from a technological perspective, mainly addressing underlying models, algorithms, and developments of AI tools. Various authors characterise both machine learning and deep learning as key technologies of AI [ 8 , 13 ], which are often applied in combination with other AI technologies, such as natural language recognition. While promising areas for AI application already exist in various domains such as marketing [ 14 ], procurement [ 15 ], supply chain management [ 16 ] or innovation management [ 17 ], the integration of AI into production processes also provides significant performance potentials, particularly in the areas of maintenance [ 18 ], quality control [ 19 ] and production planning and management [ 20 ]. However, AI adoption requires important technological foundations, such as the provision of data and the necessary infrastructure, which must be ensured [ 11 , 12 , 21 ]. Although the state of the art literature provides important insights into possible fields of application of AI in production, the question remains: To what extent are these versatile applications already in use and what is required for their successful adoption?

Besides the technology perspective of AI, a more human-oriented field of discussion is debated in scientific literature [ 22 ]. While new technologies play an essential role in driving business growth in the digital transformation of the production industry, the increasing interaction between humans and intelligent machines (also referred to as ‘augmentation’) creates stress challenges [ 23 ] and impacts work [ 24 ], which thus creates managerial challenges in organizations [ 25 , 26 ]. One of the widely discussed topics in this context is the fear of AI threatening jobs (including production jobs), which was triggered by e.g. a study of Frey, Osborne [ 27 ]. Another issue associated to the fear of machines replacing humans is the lack of acceptance resulting from the mistrust of technologies [ 28 , 29 ]. This can also be linked to the various ethical challenges involved in working with AI [ 22 ]. This perspective, which focuses on the interplay between AI and humans [ 30 ], reveals the tension triggered by AI. Although this is discussed from different angles, the question remains how these aspects influence the adoption of AI in production.

Another thematic stream of current literature can be observed in a series of contributions on the organizational aspects of the technology. In comparison to the two research areas discussed above, the number of publications in this area seems to be smaller. This perspective focuses on issues to implement AI, such as the importance of a profound management structure [ 31 , 32 ], leadership [ 33 ], implications on the organizational culture [ 34 ] as well as the need for digital capabilities and special organizational skills [ 33 ]. Although some studies on the general adoption of AI without a sectoral focus have already been conducted (such as by Chen, Tajdini [ 35 ] or Kinkel, Baumgartner, Cherubini [ 36 ]) and hence, some initial factors influencing the adoption of AI can be derived, the contributions from this perspective are still scarce, are usually not specifically analyzed in the context of production or lack a comprehensive view on the organization in AI adoption.

While non-industry specific AI issues have been researched in recent years, the current literature misses a production-specific analysis of AI adoption, providing an understanding of the possibilities and issues related to integrating AI into the production context. Moreover, the existing literature tells us little about relevant mechanisms and factors underlying the adoption of AI in production processes, which include both technical, human-centered as well as organizational issues. As organizational understanding of AI in a business context is currently still in its early stages, it is difficult to find an aggregate view on the factors that can support companies in implementing AI initiatives in production [ 37 , 38 ]. Addressing this gap, we aim to systematise the current scientific knowledge on AI adoption, with a focus on production. By drawing on a systematic literature review (SLR), we examine existing studies on AI adoption in production and explore the main issues regarding adoption that are covered in the analyzed articles. Building on these findings, we conduct a comprehensive analysis of the existing studies with the aim of systematically investigating the key factors influencing the adoption of AI in production. This systematic approach paves the way for the formulation of a future research agenda.

Our SLR addresses three research questions (RQs). RQ1: What are the statistical characteristics of existing research on AI adoption in production? To answer this RQ, we conduct descriptive statistics of the analyzed studies and provide information on time trends, methods used in the research, and country specifications. RQ2: What factors influence the adoption of AI in production? RQ2 specifies the adoption factors and forms the core component of our analysis. By adoption factors, we mean the factors that influence the use of AI in production (both positively and negatively) and that must therefore be analyzed and taken into account. RQ3: What research topics are of importance to advance the research field of AI adoption in production? We address this RQ by using the analyzed literature as well as the key factors of AI adoption as a starting point to derive RQs that are not addressed and thus provide an outlook on the topic.

2 Methodology

In order to create a sound information base for both policy makers and practitioners on the topic of AI adoption in production, this paper follows the systematic approach of a SLR. For many fields, including management research, a SLR is an important tool to capture the diversity of existing knowledge on a specific topic for a scientific investigation [ 39 ]. The investigator often pursues multiple goals, such as capturing and assessing the existing environment and advancing the existing body of knowledge with a proprietary RQ [ 39 ] or identifying key research topics [ 40 ].

Our SLR aims to select, analyze, and synthesize findings from the existing literature on AI adoption in production over the past 24 years. In order to identify relevant data for our literature synthesis, we follow the systematic approach of the Preferred Reporting Items for Systematic reviews (PRISMA) [ 41 ]. In evaluating the findings, we draw on a mixed-methods approach, combining some quantitative analyses, especially on the descriptive aspects of the selected publications, as well as qualitative analyses aimed at evaluating and comparing the contents of the papers. Figure  1 graphically summarizes the methodological approach that guides the content of the following sub-chapters.

Methodical procedure of our SLR following PRISMA [ 41 ]

2.1 Data identification

Following the development of the specific RQs, we searched for suitable publications. To locate relevant studies, we chose to conduct a publication analysis in the databases Scopus, Web of Science and ScienceDirect as these databases primarily contain international scientific articles and provide a broad overview of the interdisciplinary research field and its findings. To align the search with the RQs [ 42 ], we applied predefined key words to search the titles, abstracts, and keywords of Scopus, Web of Science and ScienceDirect articles. Our research team conducted several pre-tests to determine the final search commands for which the test results were on target and increased the efficiency of the search [ 42 ]. Using the combination of Boolean operators, we covered the three topics of AI, production, and adoption by searching combinations of ‘Artificial Intelligence’ AND ‘production or manufacturing’ AND ‘adopt*’ in the three scientific databases. Although ‘manufacturing’ tends to stand for the whole sector and ‘production’ refers to the process, the two terms are often used to describe the same context. We also follow the view of Burbidge, Falster, Riis, Svendsen [ 43 ] and use the terms synonymously in this paper and therefore also include both terms as keywords in the study location as well as in the analysis.

AI research has been credited with a resurgence since 2010 [ 6 ], which is the reason for our choice of time horizon. Due to the increase in publications within the last years, we selected articles published online from 2010 to May 8, 2024 for our analysis. As document types, we included conference papers, articles, reviews, book chapters, conference reviews as well as books, focusing exclusively on contributions in English in the final publication stage. The result of the study location is a list of 3,833 documents whose titles, abstracts, and keywords meet the search criteria and are therefore included in the next step of the analysis.

2.2 Data analysis

For these 3,833 documents, we then conducted an abstract analysis, ‘us[ing] a set of explicit selection criteria to assess the relevance of each study found to see if it actually does address the research question’ [ 42 ]. For this step, we again conducted double-blind screenings (including a minimum of two reviewers) as pilot searches so that all reviewers have the same understanding of the decision rules and make equal decisions regarding their inclusion for further analysis.

To ensure the paper’s focus on all three topics regarded in our research (AI, production, and adoption), we followed clearly defined rules of inclusion and exclusion that all reviewers had to follow in the review process. As a first requirement for inclusion, AI must be the technology in focus that is analysed in the publication. If AI was only mentioned and not further specified, we excluded the publication. With a second requirement, we checked the papers for the context of analysis, which in our case must be production. If the core focus is beyond production, the publication was also excluded from further analysis. The third prerequisite for further consideration of the publication is the analysis of the adoption of a technology in the paper. If technology adoption is not addressed or adoption factors are not considered, we excluded the paper. An article was only selected for full-text analysis if, after analyzing the titles, abstracts, and keywords, a clear focus on all three research areas was visible and the inclusion criteria were met for all three contexts.

By using this tripartite inclusion analysis, we were able to analyse the publications in a structured way and to reduce the 3,833 selected documents in our double-blind approach to 300 articles that were chosen for the full-text analysis. In the process of finding full versions of these publications, we had to exclude three papers as we could not access them. For the rest of the 297 articles we obtained full access and thus included them for further analysis. After a thorough examination of the full texts, we again had to exclude 249 publications because they did not meet our content-related inclusion criteria mentioned above, although the abstract analysis gave indications that they did. As a result, we finally obtained 47 selected papers on which we base the literature analysis and synthesis (see Fig.  1 ).

2.3 Descriptive analysis

Figure  2 summarises the results of the descriptive analysis on the selected literature regarding AI adoption in production that we analyse in our SLR. From Fig.  2 a), which illustrates annual publication trends (2010–2024), the increase in publications on AI adoption in production over the past 5 years is evident, yet slightly declining after a peak in 2022. After a steady increase until 2022, in which 11 articles are included in the final analysis, 2023 features ten articles, followed by three articles for 2024 until the cut-off date in May 2024. Of the 47 papers identified through our search, the majority (n = 33) are peer-reviewed journal articles and the remaining thirteen contributions conference proceedings and one book chapter (see Fig.  2 b)).

Descriptive analyses of the selected articles addressing AI adoption in production

The identified contributions reveal some additional characteristics in terms of the authors country base (Fig.  2 c)) and research methods used (Fig.  2 d)). Almost four out of ten of the publications were written in collaboration with authors from several countries (n = 19). Six of the papers were published by authors from the United States, five from Germany and four from India. In terms of the applied research methods used by the researchers, a wide range of methods is used (see Fig.  2 c), with qualitative methods (n = 22) being the most frequently used.

2.4 Factor analysis

In order to derive a comprehensive list of factors that influence the use of AI in production at different levels, we follow a qualitative content analysis. It is based on inductive category development, avoiding prefabricated categories in order to allow new categories to emerge based on the content at hand [ 44 , 45 ]. To do this, we first read the entire text to gain an understanding of the content and then derive codes [ 46 ] that seem to capture key ideas [ 45 ]. The codes are subsequently sorted into distinct categories, each of which is clearly defined and establishes meaningful connections between different codes. Based on an iterative process with feedback loops, the assigned categories are continuously reviewed and updated as revisions are made [ 44 ].

Various factors at different levels are of significance to AI and influence technology adoption [ 47 , 48 ]. To identify the specific factors that are of importance for AI adoption in production, we analyze the selected contributions in terms of the factors considered, compare them with each other and consequently obtain a list of factors through a bottom-up approach. While some of the factors are based on empirical findings, others are expected factors that result from the research findings of the respective studies. Through our analysis, a list of 35 factors emerges that influence AI adoption in production which occur with varying frequency in the studies analyzed by our SLR. Table 1 visualizes each factor in the respective contributions sorted by the frequency of occurrence.

The presence of skills is considered a particularly important factor in AI adoption in the studies analyzed (n = 35). The availability of data (n = 25) as well as the need for ethical guidelines (n = 24) are also seen as key drivers of AI adoption, as data is seen as the basis for the implementation of AI and ethical issues must be addressed in handling such an advanced technology. As such, these three factors make up the accelerants of AI adoption in production that are most frequently cited in the studies analyzed.

Also of importance are issues of managerial support (n = 22), as well as performance measures and IT infrastructure (n = 20). Some factors were also mentioned, but only addressed by one study at a time: government support, industrial sector, product complexity, batch size, and R&D Intensity. These factors are often used as quantitatively measurable adoption factors, especially in empirical surveys, such the study by Kinkel, Baumgartner, Cherubini [ 36 ].

3 Factors influencing AI adoption

The 35 factors presented characteristically in Sect.  2.4 serve as the basis for our in-depth analysis and for developing a framework of influences on AI adoption in production which are grouped into supercategories. A supercategory describes a cluster of topics to which various factors of AI adoption in production can be assigned. We were able to define seven categories that influence AI adoption in production: the internal influences of ‘business and structure’, ‘organizational effectiveness’, ‘technology and system’, ‘data management’ as well as the external influences of the ‘regulatory environment’, ‘business environment’ and ‘economic environment’ (see Fig.  3 ). The factors that were mentioned most frequently (occurrence in at least half of the papers analyzed) are marked accordingly (*) in Fig.  3 .

Framework of factors influencing AI adoption in production

3.1 Internal Environment

The internal influences on AI adoption in production refer to factors that an organization carries internally and that thus also influence adoption from within. Such factors can usually be influenced and clearly controlled by the organization itself.

3.1.1 Business and structure

The supercategory ‘business and structure’ includes the various factors and characteristics that impact a company’s performance, operations, and strategic decision-making. By considering and analyzing these business variables when implementing AI in production processes, companies can develop effective strategies to optimize their performance, increase their competitiveness, and adapt to changes in the business environment.

To understand and grasp the benefits in the use of AI, quantitative performance measures for the current and potential use of AI in industrial production systems help to clarify the value and potential benefits of AI use [ 49 , 54 , 74 , 79 , 91 ]. Assessing possible risks [ 77 ] as well as the monetary expected benefits for AI (e.g. Return on Investment (ROI)) in production plays an important role for adoption decisions in market-oriented companies [ 57 , 58 , 63 , 65 , 78 ]. Due to financial constraints, managers behave cautiously in their investments [ 78 ], so they need to evaluate AI adoption as financially viable to want to make the investment [ 61 , 63 , 93 ] and also drive acceptance [ 60 ]. AI systems can significantly improve cost–benefit structures in manufacturing, thereby increasing the profitability of production systems [ 73 ] and making companies more resilient [ 75 ]. However, in most cases, the adoption of AI requires high investments and the allocation of resources (s.a. personnel or financial) for this purpose [ 50 , 51 , 57 , 80 , 94 ]. Consequently, a lack of budgets and high expected transition costs often hinder the implementation of smart concepts [ 56 , 62 , 67 , 82 , 84 , 92 ]. It is up to management to provide necessary funding for AI adoption [ 53 , 59 , 79 ], which is required, for example, for skill development of employees [ 59 , 61 , 63 ], IT adaptation [ 62 , 66 ], AI development [ 74 ] or hardware deployment [ 68 ]. In their empirical study, Kinkel, Baumgartner, Cherubini [ 36 ] confirm a positive correlation between company size and the intensity in the use of AI technologies. Large companies generally stand out with a higher propensity to adopt [ 53 ] as they have less difficulties in comparison to small firms regarding the availability of resources [ 69 ], such as know-how, budget [ 68 , 84 ] and general data organization [ 68 ]. Others argue that small companies tend to be more open to change and are characterized by faster decision-making processes [ 68 , 93 ]. Product complexity also influences a company’s propensity for AI. Companies that produce rather simple products are more likely to digitize, which in turn offers good starting points for AI adoption. On the other hand, complex product manufacturers (often characterized by small batch sizes) are often less able to standardize and automate [ 36 ]. The company’s produced batch size has a similar influence on AI adoption. Small and medium batch sizes in particular hinder the integration of intelligent technologies, as less automation often prevails here as well. Nevertheless, even small and medium lot sizes can benefit economically from AI [ 36 ]. Since a high R&D intensity indicates a high innovation capability of a company, it is assumed to have a positive influence on AI adoption, as companies with a high R&D intensity already invest heavily in and use new innovations. This in turn speaks for existing competencies, know how and structures [ 36 ].

3.1.2 Organizational effectiveness

This supercategory focuses on the broader aspects that contribute to the effectiveness, development, and success of an organization when implementing AI in a production context. As the factors are interconnected and influence each other, decision makers should consider them carefully.

Users´ trust in AI is an essential factor to enable successful AI adoption and use in production [ 52 , 68 , 78 , 79 , 88 , 90 ]. From the users´ perspective, AI often exhibits the characteristics of a black box because its inherent processes are not fully understood [ 50 , 90 ] which can lead individuals to develop a fear towards the unknown [ 71 ]. Because of this lack of understanding, successful interaction between humans and AI is not guaranteed [ 90 ], as trust is a foundation for decisions that machines are intended to make autonomously [ 52 , 91 ]. To strengthen faith in AI systems [ 76 , 80 ], AI users can be involved in AI design processes in order to understand appropriate tools [ 54 , 90 ]. In this context, trust is also discussed in close connection with transparency and regulation [ 79 ]. User resistance is considered a barrier to implementing new information technologies, as adoption requires change [ 53 , 62 , 92 ]. Ignorance, as a kind of resistance to change, is a main obstacle to successful digital transformation [ 51 , 56 , 65 ]. Some employees may resist the change brought about by AI because they fear losing their jobs [ 52 ] or have other concerns [ 78 ]. Overcoming resistance to technology adoption requires organizational change and is critical for the success of adoption [ 50 , 51 , 62 , 67 , 71 , 80 ]. Therefore, change management is important to create awareness of the importance of AI adoption and increase acceptance of the workforce [ 66 , 68 , 74 , 83 ]. Management commitment is seen as a significant driver of technology adoption [ 53 , 59 , 81 , 82 , 86 ] and a lack of commitment can negatively impact user adoption and workforce trust and lead to skepticism towards technology [ 86 ]. The top management’s understanding and support for the benefits of the adopted technology [ 53 , 56 , 67 , 78 , 93 , 94 ] enhances AI adoption, can prioritize its implementation and also affects the performance of the AI-enabled application [ 55 , 60 , 83 ]. Preparing, enabling, and thus empowering the workforce, are considered the management’s responsibility in the adoption of digital technologies [ 59 , 75 ]. This requires intelligent leadership [ 52 ] as decision makers need to integrate their workforce into decision-making processes [ 75 ]. Guidelines can support managers by providing access to best practices that help in the adoption of AI [ 50 ]. Critical measures to manage organizational change include the empowerment of visionaries or appointed AI champions leading the change and the collaborative development of digital roadmaps [ 54 , 62 ]. To demonstrate management commitment, managers can create such a dedicated role, consisting of an individual or a small group that is actively and enthusiastically committed to AI adoption in production. This body is considered the adoption manager, point of contact and internal driver of adoption [ 62 , 74 , 80 ]. AI initiatives in production do not necessarily have to be initiated by management. Although management support is essential for successful AI adoption, employees can also actively drive integration initially and thus realize pilot projects or initial trials [ 66 , 80 ]. The development of strategies as well as roadmaps is considered another enabling and necessary factor for the adoption of AI in production [ 50 , 53 , 54 , 62 , 71 , 93 ]. While many major AI strategies already exist at country level to further promote research and development of AI [ 87 ], strategy development is also important at the firm level [ 76 , 77 , 81 ]. In this context, strategies should not be delegated top-down, but be developed in a collaborative manner, i.e. by engaging the workforce [ 75 ] and be in alignment with clear visions [ 91 , 94 ]. Roadmaps are used to improve planning, support implementation, facilitate the adoption of smart technologies in manufacturing [ 93 ] and should be integrated into both business and IT strategy [ 62 , 66 ]. In practice, clear adoption roadmaps that provide approaches on how to effectively integrate AI into existing strategies and businesses are often lacking [ 56 , 87 ]. The need for AI-related skills in organizations is a widely discussed topic in AI adoption analyses [ 79 ]. In this context, the literature points both at the need for specific skills in the development and design of AI applications [ 57 , 71 , 72 , 73 , 76 , 93 ] as well as the skills in using the technology [ 53 , 65 , 73 , 74 , 75 , 84 , 93 ] which availability in the firm is not always given [ 49 ]. AI requires new digital skills [ 36 , 50 , 52 , 55 , 56 , 59 , 61 , 63 , 66 , 78 , 80 ], where e.g. advanced analytics [ 64 , 75 , 81 ], programming skills [ 68 ] and cybersecurity skills [ 78 , 93 ] gain importance. The lack of skills required for AI is seen as a major challenge of digital transformation, as a skilled workforce is considered a key resource for companies [ 51 , 54 , 56 , 60 , 62 , 67 , 69 , 70 , 82 , 93 ]. This lack of a necessary skillset hinders the adoption of AI tools in production systems [ 58 , 77 ]. Closely related to skills is the need for new training concepts, which organizations need to consider when integrating digital technologies [ 49 , 50 , 51 , 56 , 59 , 63 , 71 , 74 , 75 ]. Firms must invest in qualification in order to create necessary competences [ 73 , 78 , 80 , 81 , 92 ]. Additionally, education must target and further develop the skills required for effectively integrating intelligent technologies into manufacturing processes [ 54 , 61 , 62 , 83 ]. Regarding this issue, academic institutions must develop fitting curricula for data driven manufacturing engineering [ 64 ]. Another driving factor of AI adoption is the innovation culture of an organization, which is influenced by various drivers. For example, companies that operate in an environment with high innovation rates, facing intense competitive pressures are considered more likely to see smart technologies as a tool for strategic change [ 83 , 91 , 93 ]. These firms often invest in more expensive and advanced smart technologies as the pressure and resulting competition forces them to innovate [ 93 ]. Another way of approach this is that innovation capability can also be supported and complemented by AI, for example by intelligent systems supporting humans in innovation or even innovating on their own [ 52 ].The entrepreneurial orientation of a firm is characterized in particular by innovativeness [ 66 ], productivity [ 63 ], risk-taking [ 86 ] as well as continuous improvement [ 50 ]. Such characteristics of an innovating culture are considered essential for companies to recognise dynamic changes in the market and make adoption decisions [ 51 , 71 , 81 , 84 , 86 , 94 ]. The prevalence of a digital mindset in companies is important for technology adoption, as digital transformation affects the entire organizational culture and behavior [ 59 , 80 , 92 ] and a lack of a digital culture [ 50 , 65 ] as well as a ‘passive mindset’ [ 78 ] can hinder the digital transformation of firms. Organizations need to develop a corresponding culture [ 66 , 67 , 71 ], also referred to as ‘AI-ready-culture’ [ 54 ], that promotes development and encourages people and data through the incorporation of technology [ 71 , 75 ]. With the increasing adoption of smart technologies, a ‘new digital normal’ is emerging, characterized by hybrid work models, more human–machine interactions and an increased use of digital technologies [ 75 , 83 ].

3.1.3 Technology and System

The ‘technology and system’ supercategory focuses on the broader issues related to the technology and infrastructure that support organizational operations and provide the technical foundation for AI deployment.

By IT infrastructure we refer to issues regarding the foundational systems and IT needed for AI adoption in production. Industrial firms and their IT systems must achieve a mature technological readiness in order to enable successful AI adoption [ 51 , 60 , 67 , 69 , 83 ]. A lack of appropriate IT infrastructure [ 68 , 71 , 78 , 91 ] or small maturity of Internet of Things (IoT) technologies [ 70 ]) hinders the efficient use of data in production firms [ 56 ] which is why firms must update their foundational information systems for successful AI adoption [ 53 , 54 , 62 , 66 , 72 , 75 ]. IT and data security are fundamental for AI adoption and must be provided [ 50 , 51 , 68 , 82 ]. This requires necessary developments that can ensure security during AI implementation while complying with legal requirements [ 52 , 72 , 78 ]. Generally, security concerns are common when implementing AI innovations [ 72 , 79 , 91 , 94 ]. This fear of a lack of security can also prevent the release of (e.g. customer) data in a production environment [ 56 ]. Additionally, as industrial production systems are vulnerable to failures as well as cyberattacks, companies need to address security and cybersecurity measures [ 49 , 76 , 88 , 89 ]. Developing user-friendly AI solutions can facilitate the adoption of smart solutions by increasing user understanding and making systems easy to use by employees as well as quick to integrate [ 50 , 72 , 84 ]. When developing user-friendly solutions which satisfy user needs [ 76 ], it is particularly important to understand and integrate the user perspective in the development process [ 90 ]. If employees find technical solutions easy to use, they are more confident in its use and perceived usefulness increases [ 53 , 67 , 68 ]. The compatibility of AI with a firm and its existing systems, i.e., the extent to which AI matches existing processes, structures, and infrastructures [ 53 , 54 , 56 , 60 , 78 , 80 , 82 , 83 , 93 , 94 ], is considered an important requirement for the adoption of AI in IT systems [ 91 ]. Along with compatibility also comes connectivity, which is intended to ensure the links within the overall network and avoid silo thinking [ 59 ]. Connectivity and interoperability of AI-based processes within the company’s IT manufacturing systems must be ensured at different system levels and are considered key factors in the development of AI applications for production [ 50 , 72 , 89 ]. The design of modular AI solutions can increase system compatibility [ 84 ]. Firms deciding for AI adoption must address safety issues [ 51 , 54 , 59 , 72 , 73 , 78 ]. This includes both safety in the use and operation of AI [ 60 , 69 ]. In order to address safety concerns of integrating AI solutions in industrial systems [ 49 ], systems must secure high reliability [ 71 ]. AI can also be integrated as a safety enabler, for example, by providing technologies to monitor health and safety in the workplace to prevent fatigue and injury [ 75 ].

3.1.4 Data management

Since AI adoption in the organization is strongly data-driven, the ‘data management’ supercategory is dedicated to the comprehensive aspects related to the effective and responsible management of data within the organization.

Data privacy must be guaranteed when creating AI applications based on industrial production data [ 49 , 58 , 59 , 60 , 72 , 76 , 78 , 79 , 82 , 88 , 89 , 91 , 94 ] as ‘[M]anufacturing industries generate large volumes of unstructured and sensitive data during their daily operations’ [ 89 ]. Closely related to this is the need for anonymization and confidentiality of data [ 61 , 69 , 70 , 78 ]. The availability of large, heterogeneous data sets is essential for the digital transformation of organizations [ 52 , 59 , 78 , 80 , 88 , 89 ] and is considered one of the key drivers of AI innovation [ 62 , 68 , 72 , 86 ]. In production systems, lack of data availability is often a barrier to AI adoption [ 58 , 70 , 77 ]. In order to enable AI to establish relationships between data, the availability of large input data that is critical [ 62 , 76 , 81 ]. New AI models are trained with this data and can adapt as well as improve as they receive new data [ 59 , 62 ]. Big data can thus significantly improve the quality of AI applications [ 59 , 71 ]. As more and more data is generated in manufacturing [ 85 ], AI opens up new opportunities for companies to make use of it [ 62 ]. However, operational data are often unstructured, as they come from different sources and exist in diverse formats [ 85 , 87 ]. This challenges data processing, as data quality and origin are key factors in the management of data [ 78 , 79 , 80 , 88 , 89 , 91 ]. To make production data valuable and usable for AI, consistency of data and thus data integrity is required across manufacturing systems [ 50 , 62 , 77 , 84 ]. Another key prerequisites for AI adoption is data governance [ 56 , 59 , 67 , 68 , 71 , 78 , 88 ] which is an important asset to make use of data in production [ 50 ] and ensure the complex management of heterogenous data sets [ 89 ]. The interoperability of data and thus the foundation for the compatibility of AI with existing systems, i.e., the extent to which AI matches existing processes, structures, and infrastructures [ 53 , 56 , 84 , 93 ], is considered another important requirement for the adoption of AI in IT systems. Data interoperability in production systems can be hindered by missing data standards as different machines use different formats [ 87 ]. Data processing refers to techniques used to preparing data for analysis which is essential to obtain consistent results from data analytics in production [ 58 , 72 , 80 , 81 , 84 ]. In this process, the numerous, heterogeneous data from different sensors are processed in such a way that they can be used for further analyses [ 87 ]. The capability of production firms to process data and information is thus important to enable AI adoption [ 77 , 86 , 93 ]. With the increasing data generation in the smart and connected factory, the strategic relevance of data analytics is gaining importance [ 55 , 69 , 78 ], as it is essential for AI systems in performing advanced data analyses [ 49 , 67 , 72 , 86 , 88 ]. Using analytics, valuable insights can be gained from the production data obtained using AI systems [ 58 , 77 , 87 ]. In order to enable the processing of big data, a profound data infrastructure is necessary [ 65 , 75 , 87 ]. Facilities must be equipped with sensors, that collect data and model information, which requires investments from firms [ 72 ]. In addition, production firms must build the necessary skills, culture and capabilities for data analytics [ 54 , 75 , 87 , 93 ]. Data storage, one of the foundations and prerequisites for smart manufacturing [ 54 , 68 , 71 , 74 ], must be ensured in order to manage the larg amounts of data and thus realize the adoption of intelligent technologies in production [ 50 , 59 , 72 , 78 , 84 , 87 , 88 , 89 ].

3.2 External environment

The external drivers of AI adoption in production influence the organization through conditions and events from outside the firm and are therefore difficult to control by the organization itself.

3.2.1 Regulatory environment

This supercategory captures the broader concept of establishing rules, standards, and frameworks that guide the behavior, actions, and operations of individuals, organizations, and societies when implementing AI.

AI adoption in production faces many ethical challenges [ 70 , 72 , 79 ]. AI applications must be compliant with the requirements of organizational ethical standards and laws [ 49 , 50 , 59 , 60 , 62 , 75 ] which is why certain issues must be examined in AI adoption and AI design [ 62 , 73 , 82 , 91 ] so that fairness and justice are guaranteed [ 78 , 79 , 92 ]. Social rights, cultural values and norms must not be violated in the process [ 49 , 52 , 53 , 81 ]. In this context, the explainability and transparency of AI decisions also plays an important role [ 50 , 54 , 58 , 70 , 78 , 89 ] and can address the characteristic of AI of a black box [ 90 ]. In addition, AI applications must be compliant with legal and regulatory requirements [ 51 , 52 , 59 , 77 , 81 , 82 , 91 ] and be developed accordingly [ 49 , 76 ] in order to make organization processes using AI clear and effective [ 65 ]. At present, policies and regulation of AI are still in its infancy [ 49 ] and missing federal regulatory guidelines, standards as well as incentives hinder the adoption of AI [ 67 ] which should be expanded simultaneously to the expansion of AI technology [ 60 ]. This also includes regulations on the handling of data (e.g. anonymization of data) [ 61 , 72 ].

3.2.2 Business environment

The factors in the ‘business environment’ supercategory refer to the external conditions and influences that affect the operations, decision making, and performance of the company seeking to implement AI in a production context.

Cooperation and collaboration can influence the success of digital technology adoption [ 52 , 53 , 59 , 72 ], which is why partnerships are important for adoption [ 53 , 59 ] and can positively influence its future success [ 52 , 67 ]. Both intraorganizational and interorganizational knowledge sharing can positively influence AI adoption [ 49 ]. In collaborations, companies can use a shared knowledge base where data and process sharing [ 51 , 59 , 94 ] as well as social support systems strengthen feedback loops between departments [ 79 , 80 ]. With regard to AI adoption in firms, vendors as well as service providers need to collaborate closely to improve the compatibility and operational capability of smart technologies across different industries [ 82 , 93 ]. Without external IT support, companies can rarely integrate AI into their production processes [ 66 ], which is why thorough support from vendors can significantly facilitate the integration of AI into existing manufacturing processes [ 80 , 91 ]. Public–private collaborations can also add value and governments can target AI dissemination [ 60 , 74 ]. The support of the government also positively influences AI adoption. This includes investing in research projects and policies, building a regulatory setting as well as creating a collaborative environment [ 60 ]. Production companies are constantly exposed to changing conditions, which is why the dynamics of the environment is another factor influencing the adoption of AI [ 52 , 63 , 72 , 86 ]. Environmental dynamics influence the operational performance of firms and can favor an entrepreneurial orientation of firms [ 86 ]. In order to respond to dynamics, companies need to develop certain capabilities and resources (i.e. dynamic capabilities) [ 86 ]. This requires the development of transparency, agility, as well as resilience to unpredictable changes, which was important in the case of the COVID-19 pandemic, for example, where companies had to adapt quickly to changing environments [ 75 ]. A firm’s environment (e.g. governments, partners or customers) can also pressure companies to adopt digital technologies [ 53 , 67 , 82 , 91 ]. Companies facing intense competition are considered more likely to invest in smart technologies, as rivalry pushes them to innovate and they hope to gain competitive advantages from adoption [ 36 , 66 , 82 , 93 ].

3.2.3 Economic environment

By considering both the industrial sector and country within the subcategory ‘economic environment’, production firms can analyze the interplay between the two and understand how drivers can influence the AI adoption process in their industrial sector’s performance within a particular country.

The industrial sector of a firm influences AI adoption in production from a structural perspective, as it indicates variations in product characteristics, governmental support, the general digitalization status, the production environment as well as the use of AI technologies within the sector [ 36 ]. Another factor that influences AI adoption is the country in which a company is located. This influences not only cultural aspects, the availability of know-how and technology orientation, but also regulations, laws, standards and subsidies [ 36 ]. From another perspective, AI can also contribute to the wider socio-economic growth of economies by making new opportunities easily available and thus equipping e.g. more rural areas with advanced capabilities [ 78 ].

3.3 Future research directions

The analysis of AI adoption in production requires a comprehensive analysis of the various factors that influence the introduction of the innovation. As discussed by Kinkel, Baumgartner, Cherubini [ 36 ], our research also concludes that organizational factors have a particularly important role to play. After evaluating the individual drivers of AI adoption in production in detail in this qualitative synthesis, we draw a conclusion from the results and derive a research agenda from the analysis to serve as a basis for future research. The RQs emerged from the analyzed factors and are presented in Table  2 . We developed the questions based on the literature review and identified research gaps for every factor that was most frequently mentioned. From the factors analyzed and RQs developed, the internal environment has a strong influence on AI adoption in production, and organizational factors play a major role here.

Looking at the supercategory ‘business and environment’, performance indicators and investments are considered drivers of AI adoption in production. Indicators to measure the performance of AI innovations are necessary here so that managers can perform cost–benefit analyses and make the right decision for their company. There is a need for research here to support possible calculations and show managers a comprehensive view of the costs and benefits of technology in production. In terms of budget, it should be noted that AI adoption involves a considerable financial outlay that must be carefully weighed and some capital must be available to carry out the necessary implementation efforts (e.g., staffing costs, machine retrofits, change management, and external IT service costs). Since AI adoption is a complex process and turnkey solutions can seldom be implemented easily and quickly, but require many changes (not only technologically but also on an organizational level), it is currently difficult to estimate the necessary budgets and thus make them available. Especially the factors of the supercategory ‘organizational effectiveness’ drive AI adoption in production. Trust of the workforce is considered an important driver, which must be created in order to successfully implement AI. This requires measures that can support management in building trust. Closely related to this are the necessary change management processes that must be initiated to accompany the changes in a targeted manner. Management itself must also play a clear role in the introduction of AI and communicate its support, as this also influences the adoption. The development of clear processes and measures can help here. Developing roadmaps for AI adoption can facilitate the adoption process and promote strategic integration with existing IT and business strategy. Here, best practice roadmaps and necessary action steps can be helpful for companies. Skills are considered the most important driver for AI adoption in manufacturing. Here, there is a lack of clear approaches that support companies in identifying the range of necessary skills and, associated with this, also opportunities to further develop these skills in the existing workforce. Also, building a culture of innovation requires closer research that can help companies foster a conducive environment for AI adoption and the integration of other smart technologies. Steps for developing a positive mindset require further research that can provide approaches for necessary action steps and measures in creating a positive digital culture. With regard to ‘technology and system’, the factors of IT infrastructure and security in particular are driving AI adoption in production. Existing IT systems must reach a certain maturity to enable AI adoption on a technical level. This calls for clear requirements that visualize for companies which systems and standards are in place and where developments are needed. Security must be continuously ensured, for which certain standards and action catalogs must be developed. With regard to the supercategory ‘data management’, the availability of data is considered the basis for successful AI adoption, as no AI can be successfully deployed without data. In the production context in particular, this requires developments that support companies in the provision of data, which usually arises from very heterogeneous sources and forms. Data analytics must also be closely examined, and production companies usually need external support in doing so. The multitude of data also requires big data storage capabilities. Here, groundwork is needed to show companies options about the possibilities of different storage options (e.g., on premis vs. cloud-based).

In the ‘regulatory environment’, ethics in particular is considered a driver of AI adoption in production. Here, fundamental ethical factors and frameworks need to be developed that companies can use as a guideline to ensure ethical standards throughout the process. Cooperations and environmental dynamism drive the supercategory ‘business environment’. Collaborations are necessary to successfully implement AI adoption and action is needed to create the necessary contact facilitation bodies. In a competitive environment, companies have to make quick decisions under strong pressure, which also affects AI adoption. Here, guidelines and also best practice approaches can help to simplify decisions and quickly demonstrate the advantage of the solutions. There is a need for research in this context.

4 Conclusions

The use of AI technologies in production continues to gain momentum as managers hope to increase efficiency, productivity and reduce costs [ 9 , 13 , 20 ]. Although the benefits of AI adoption speak for themselves, implementing AI is a complex decision that requires a lot of knowledge, capital and change [ 95 ] and is influenced by various internal and external factors. Therefore, managers are still cautious about implementing the technology in a production context. Our SLR seeks to examine the emergent phenomenon of AI in production with the precise aim of understanding the factors influencing AI adoption and the key topics discussed in the literature when analyzing AI in a production context. For this purpose, we use the current state of research and examine the existing studies based on the methodology of a systematic literature analysis and respond to three RQs.

We answer RQ1 by closely analyzing the literature selected in our SLR to identify trends in current research on AI adoption in production. In this process, it becomes clear that the topic is gaining importance and that research has increased over the last few years. In the field of production, AI is being examined from various angles and current research addresses aspects from a business, human and technical perspective. In our response to RQ2 we synthesized the existing literature to derive 35 factors that influence AI adoption in production at different levels from inside or outside the organization. In doing so, we find that AI adoption in production poses particularly significant challenges to organizational effectiveness compared to other digital technologies and that the relevance of data management takes on a new dimension. Production companies often operate more traditionally and are sometimes rigid when it comes to change [ 96 , 97 ], which can pose organizational challenges when adopting AI. In addition, the existing machines and systems are typically rather heterogeneous and are subject to different digitalization standards, which in turn can hinder the availability of the necessary data for AI implementation [ 98 , 99 ]. We address RQ3 by deriving a research agenda, which lays a foundation for further scientific research and deepening the understanding of AI adoption in production. The results of our analysis can further help managers to better understand AI adoption and to pay attention to the different factors that influence the adoption of this complex technology.

4.1 Contributions

Our paper takes the first step towards analysing the current state of the research on AI adoption from a production perspective. We represent a holistic view on the topic, which is necessary to get a better understanding of AI in a production-context and build a comprehensive view on the different dimensions as well as factors influencing its adoption. To the best of our knowledge, this is the first contribution that systematises research about the adoption of AI in production. As such, it makes an important contribution to current AI and production research, which is threefold:

First, we highlight the characteristics of studies conducted in recent years on the topic of AI adoption in production, from which several features and developments can be deduced. Our results confirm the topicality of the issue and the increasing relevance of research in the field.

Having laid the foundations for understanding AI in production, we focused our research on the identification and systematization of the most relevant factors influencing AI adoption in production at different levels. This brings us to the second contribution, our comprehensive factor analysis of AI adoption in production provides a framework for further research as well as a potential basis for managers to draw upon when adopting AI. By systematizing the relevant factors influencing AI adoption in production, we derived a set of 35 researched factors associated with AI adoption in production. These factors can be clustered in two areas of analysis and seven respective supercategories. The internal environment area includes four levels of analysis: ‘business and structure’ (focusing on financial aspects and firm characteristics), ‘organizational effectiveness’ (focusing on human-centred factors), ‘technology and system’ (based on the IT infrastructure and systems) as well as ‘data management’ (including all data related factors). Three categories are assigned to the external environment: the ‘regulatory environment’ (such as ethics and the regulatory forms), the ‘business environment’ (focused on cooperation activities and dynamics in the firm environment) and the ‘economic environment’ (related to sectoral and country specifics).

Third, the developed research plan as outlined in Table  2 serves as an additional outcome of the SLR, identifying key RQs in the analyzed areas that can serve as a foundation for researchers to expand the research area of AI adoption in production. These RQs are related to the mostly cited factors analyzed in our SLR and aim to broaden the understanding on the emerging topic.

The resulting insights can serve as the basis for strategic decisions by production companies looking to integrate AI into their processes. Our findings on the factors influencing AI adoption as well as the developed research agenda enhance the practical understanding of a production-specific adoption. Hence, they can serve as the basis for strategic decisions for companies on the path to an effective AI adoption. Managers can, for example, analyse the individual factors in light of their company as well as take necessary steps to develop further aspects in a targeted manner. Researchers, on the other hand, can use the future research agenda in order to assess open RQs and can expand the state of research on AI adoption in production.

4.2 Limitations

Since a literature review must be restricted in its scope in order to make the analyses feasible, our study provides a starting point for further research. Hence, there is a need for further qualitative and quantitative empirical research on the heterogeneous nature of how firms configure their AI adoption process. Along these lines, the following aspects would be of particular interest for future research to improve and further validate the analytical power of the proposed framework.

First, the lack of research on AI adoption in production leads to a limited number of papers included in this SLR. As visualized in Fig.  2 , the number of publications related to the adoption of AI in production has been increasing since 2018 but is, to date, still at an early stage. For this reason, only 47 papers published until May 2024 addressing the production-specific adoption of AI were identified and therefore included in our analysis for in-depth investigation. This rather small number of papers included in the full-text analysis gives a limited view on AI adoption in production but allows a more detailed analysis. As the number of publications in this research field increases, there seems to be a lot of research happening in this field which is why new findings might be constantly added and developed as relevant in the future [ 39 ]. Moreover, in order to research AI adoption from a more practical perspective and thus to build up a broader, continuously updated view on AI adoption in production, future literature analyses could include other publication formats, e.g. study reports of research institutions and companies, as well discussion papers.

Second, the scope of the application areas of AI in production has been increasing rapidly. Even though our overview of the three main areas covered in the recent literature serves as a good basis for identifying the most dominant fields for AI adoption in production, a more detailed analysis could provide a better overview of possibilities for manufacturing companies. Hence, a further systematisation as well as evaluation of application areas for AI in production can provide managers with the information needed to decide where AI applications might be of interest for the specific company needs.

Third, the systematisation of the 35 factors influencing AI adoption in production serve as a good ground for identifying relevant areas influenced by and in turn influencing the adoption of AI. Further analyses should be conducted in order to extend this view and extend the framework. For example, our review could be combined with explorative research methods (such as case studies in production firms) in order to add the practical insights from firms adopting AI. This integration of practical experiences can also help exploit and monitor more AI-specific factors by observing AI adoption processes. In enriching the factors through in-depth analyses, the results of the identified AI adoption factors could also be examined in light of theoretical contributions like the technology-organization-environment (TOE) framework [ 47 ] and other adoption theories.

Fourth, in order to examine the special relevance of identified factors for AI adoption process and thus to distinguish it from the common factors influencing the adoption of more general digital technologies, there is a further need for more in-depth (ethnographic) research into their impacts on the adoption processes, particularly in the production context. Similarly, further research could use the framework introduced in this paper as a basis to develop new indicators and measurement concepts as well as to examine their impacts on production performance using quantitative methods.

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Heimberger, H., Horvat, D. & Schultmann, F. Exploring the factors driving AI adoption in production: a systematic literature review and future research agenda. Inf Technol Manag (2024). https://doi.org/10.1007/s10799-024-00436-z

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Impact of artificial intelligence on learning management systems: a bibliometric review.

1. Introduction

2. materials and methods, 2.1. document identification, 2.2. document processing, 3. result analysis, 3.1. document collection, 3.2. citations, 3.3. sources, 3.4. affiliations, 3.5. countries, 3.6. document analysis, 4. discussion.

5. Conclusions

Author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Vergara, D.; Lampropoulos, G.; Antón-Sancho, Á.; Fernández-Arias, P. Impact of Artificial Intelligence on Learning Management Systems: A Bibliometric Review. Multimodal Technol. Interact. 2024 , 8 , 75. https://doi.org/10.3390/mti8090075

Vergara D, Lampropoulos G, Antón-Sancho Á, Fernández-Arias P. Impact of Artificial Intelligence on Learning Management Systems: A Bibliometric Review. Multimodal Technologies and Interaction . 2024; 8(9):75. https://doi.org/10.3390/mti8090075

Vergara, Diego, Georgios Lampropoulos, Álvaro Antón-Sancho, and Pablo Fernández-Arias. 2024. "Impact of Artificial Intelligence on Learning Management Systems: A Bibliometric Review" Multimodal Technologies and Interaction 8, no. 9: 75. https://doi.org/10.3390/mti8090075

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