Photoacoustic device fingerprints induce bias in deep learning models.

Deep learning (DL) models developed for established medical imaging modalities have shown increasing performance and reliability as a result of scaling efforts. In contrast, model development for emerging modalities such as photoacoustic imaging (PAI) remains challenged by data sparsity, which limits model generalizability and raises the susceptibility to bias. While recent studies in PAI have started to investigate subject-related confounders, the impact of hardware-related confounders remains unexplored, posing a critical risk for failure in multicentric deployment scenarios. We are the first to provide a multicentric analysis of hardware-induced bias in PAI. We analyzed device-specific characteristics in images from four device instances and two peripheral artery disease studies, and trained DL models to classify device origin and disease under varying levels of device-health correlations in the data. We showed that 1) multiple instances of the same PAI device type embed identifiable fingerprints in the images, 2) that DL models can leverage these fingerprints to reach [Formula: see text] accuracy in device detection and critically, 3) when a correlation between device instance and health status is present, models trained for disease diagnosis exploit these device-specific signatures as shortcuts, thereby producing biased and clinically misleading predictions. This research highlights the risk of overestimating algorithm performance when such confounding is overlooked, emphasizing the importance of bias evaluation and explainable artificial intelligence methods to identify potential shortcuts, finally enabling multicentric PAI studies.