Implementation of an AI Algorithm in Clinical Practice to Reduce Missed Incidental Pulmonary Embolisms on Chest CT and Its Impact on Short-Term Survival.

OBJECTIVES: A substantial number of incidental pulmonary embolisms (iPEs) in computed tomography scans are missed by radiologists in their daily routine. This study analyzes the radiological reports of iPE cases before and after implementation of an artificial intelligence (AI) algorithm for iPE detection. Furthermore, we investigate the anatomic distribution patterns within missed iPE cases and mortality within a 90-day follow-up in patients before and after AI use. MATERIALS AND METHODS: This institutional review board-approved observational single-center study included 5298 chest computed tomography scans performed for reasons other than suspected pulmonary embolism (PE). We compared 2 cohorts: cohort 1, consisting of 1964 patients whose original radiology reports were generated before the implementation of an AI algorithm, and cohort 2, consisting of 3334 patients whose scans were analyzed after the implementation of an Food and Drug Administration-approved and CE-certified AI algorithm for iPE detection (Aidoc Medical, Tel Aviv, Israel). For both cohorts, any discrepancies between the original radiology reports and the AI results were reviewed by 2 thoracic imaging subspecialized radiologists. In the original radiology report and in case of discrepancies with the AI algorithm, the expert review served as reference standard. Sensitivity, specificity, prevalence, negative predictive value (NPV), and positive predictive value (PPV) were calculated. The rates of missed iPEs in both cohorts were compared statistically using STATA (Version 17.1). Kaplan-Meier curves and Cox proportional hazards models were used for survival analysis. RESULTS: In cohort 1 (mean age 70.6 years, 48% female [n = 944], 52% male [n = 1020]), the prevalence of confirmed iPE was 2.2% (n = 42), and the AI detected 61 suspicious iPEs, resulting in a sensitivity of 95%, a specificity of 99%, a PPV of 69%, and an NPV of 99%. Radiologists missed 50% of iPE cases in cohort 1. In cohort 2 (mean age 69 years, 47% female [n = 1567], 53% male [n = 1767]), the prevalence of confirmed iPEs was 1.7% (56/3334), with AI detecting 59 suspicious cases (sensitivity 90%, specificity 99%, PPV 95%, NPV 99%). The rate of missed iPEs by radiologists dropped to 7.1% after AI implementation, showing a significant improvement (P < 0.001). Most overlooked iPEs (61%) were in the right lower lobe. The survival analysis showed no significantly decreased 90-day mortality rate, with a hazards ratio of 0.95 (95% confidence interval, 0.45-1.96; P = 0.88). CONCLUSIONS: The implementation of an AI algorithm significantly reduced the rate of missed iPEs from 50% to 7.1%, thereby enhancing diagnostic accuracy. Despite this improvement, the 90-day mortality rate remained unchanged. These findings highlight the AI tool's potential to assist radiologists in accurately identifying iPEs, although its implementation does not significantly affect short-term survival. Notably, most missed iPEs were located in the right lower lobe, suggesting that radiologists should pay particular attention to this area during evaluations.

Understanding the needs of women undergoing breast ultrasound: Are male radiologists still needed?

INTRODUCTION: A trend towards less male radiologists specializing in breast ultrasound was observed. A common notion in the field of breast radiology is, that female patients feel more comfortable being treated by female radiologists. The aim of the study was to understand and report the needs of women undergoing breast ultrasound with regards to the sex of the radiologist performing the investigation. METHODS: Informed consent was obtained from all patients prior to inclusion in a prospective bi-center quality study. At center 1 (72 patients), the women were examined exclusively by female radiologists, at center 2 (100 patients) only by male radiologists. After the examination the patients were asked about their experiences and their wishes for the future. RESULTS: Overall, women made no distinction between female and male radiologists; 25% of them wanted a female radiologist and 1.2% wanted a male radiologist. The majority (74%) stated that it made no difference whether a female or male radiologist performed the examination. The majority of women in group 2, who were investigated exclusively by male radiologists, stated that they had no preferences with regard to the sex of the radiologist (93%); 5% of the women wished to be investigated solely by a female radiologist and 2% exclusively by a male radiologist. DISCUSSION: The majority of women undergoing breast ultrasound are unconcerned about the radiologist's sex. It would appear that women examined by male radiologists are less selective about the sex of the examining radiologist. TRIAL REGISTRATION: Written informed consent was obtained from all patients. All patient data were anonymized. The physicians had no access to any further personal data. National regulations did not require dedicated ethics approval with anonymized lists or retrospective questionnaires.

The Swiss Approach - feasibility of a national low-dose CT lung cancer screening program.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths in Switzerland. Despite this, there is no lung cancer screening program in the country. In the United States, low-dose computed tomography (LDCT) lung cancer screening is partially established and endorsed by guidelines. Moreover, evidence is growing that screening reduces lung cancer-related mortality and this was recently shown in a large European randomized controlled trial. Implementation of a lung cancer screening program, however, is challenging and depends on many country-specific factors. The goal of this article is to outline a potential Swiss lung cancer screening program. FRAMEWORK: An exhaustive literature review on international screening models as well as interviews and site visits with international experts were initiated. Furthermore, workshops and interviews with national experts and stakeholders were conducted to share experiences and to establish the basis for a national Swiss lung cancer screening program. SCREENING APPROACH: General practitioners, pulmonologists and the media should be part of the recruitment process. Decentralisation of the screening might lead to a higher adherence rate. To reduce stigmatisation, the screening should be integrated in a "lung health check". Standardisation and a common quality level are mandatory. The PLCOm2012 risk calculation model with a threshold of 1.5% risk for developing cancer in the next six years should be used in addition to established inclusion criteria. Biennial screening is preferred. LUNG RADS and NELSON+ are applied as classification models for lung nodules. CONCLUSION: Based on data from recent studies, literature research, a health technology assessment, the information gained from this project and a pilot study the Swiss Interest Group for lung cancer screening (CH-LSIG) recommends the timely introduction of a systematic lung cancer screening program in Switzerland. The final decision is for the Swiss Cancer Screening Committee to make.