An Artificial Intelligence-Based Chest X-ray Model on Human Nodule Detection Accuracy From a Multicenter Study.

Importance: Most early lung cancers present as pulmonary nodules on imaging, but these can be easily missed on chest radiographs. Objective: To assess if a novel artificial intelligence (AI) algorithm can help detect pulmonary nodules on radiographs at different levels of detection difficulty. Design, Setting, and Participants: This diagnostic study included 100 posteroanterior chest radiograph images taken between 2000 and 2010 of adult patients from an ambulatory health care center in Germany and a lung image database in the US. Included images were selected to represent nodules with different levels of detection difficulties (from easy to difficult), and comprised both normal and nonnormal control. Exposures: All images were processed with a novel AI algorithm, the AI Rad Companion Chest X-ray. Two thoracic radiologists established the ground truth and 9 test radiologists from Germany and the US independently reviewed all images in 2 sessions (unaided and AI-aided mode) with at least a 1-month washout period. Main Outcomes and Measures: Each test radiologist recorded the presence of 5 findings (pulmonary nodules, atelectasis, consolidation, pneumothorax, and pleural effusion) and their level of confidence for detecting the individual finding on a scale of 1 to 10 (1 representing lowest confidence; 10, highest confidence). The analyzed metrics for nodules included sensitivity, specificity, accuracy, and receiver operating characteristics curve area under the curve (AUC). Results: Images from 100 patients were included, with a mean (SD) age of 55 (20) years and including 64 men and 36 women. Mean detection accuracy across the 9 radiologists improved by 6.4% (95% CI, 2.3% to 10.6%) with AI-aided interpretation compared with unaided interpretation. Partial AUCs within the effective interval range of 0 to 0.2 false positive rate improved by 5.6% (95% CI, -1.4% to 12.0%) with AI-aided interpretation. Junior radiologists saw greater improvement in sensitivity for nodule detection with AI-aided interpretation as compared with their senior counterparts (12%; 95% CI, 4% to 19% vs 9%; 95% CI, 1% to 17%) while senior radiologists experienced similar improvement in specificity (4%; 95% CI, -2% to 9%) as compared with junior radiologists (4%; 95% CI, -3% to 5%). Conclusions and Relevance: In this diagnostic study, an AI algorithm was associated with improved detection of pulmonary nodules on chest radiographs compared with unaided interpretation for different levels of detection difficulty and for readers with different experience.

Deep learning in chest radiography: Detection of findings and presence of change.

BACKGROUND: Deep learning (DL) based solutions have been proposed for interpretation of several imaging modalities including radiography, CT, and MR. For chest radiographs, DL algorithms have found success in the evaluation of abnormalities such as lung nodules, pulmonary tuberculosis, cystic fibrosis, pneumoconiosis, and location of peripherally inserted central catheters. Chest radiography represents the most commonly performed radiological test for a multitude of non-emergent and emergent clinical indications. This study aims to assess accuracy of deep learning (DL) algorithm for detection of abnormalities on routine frontal chest radiographs (CXR), and assessment of stability or change in findings over serial radiographs. METHODS AND FINDINGS: We processed 874 de-identified frontal CXR from 724 adult patients (> 18 years) with DL (Qure AI). Scores and prediction statistics from DL were generated and recorded for the presence of pulmonary opacities, pleural effusions, hilar prominence, and enlarged cardiac silhouette. To establish a standard of reference (SOR), two thoracic radiologists assessed all CXR for these abnormalities. Four other radiologists (test radiologists), unaware of SOR and DL findings, independently assessed the presence of radiographic abnormalities. A total 724 radiographs were assessed for detection of findings. A subset of 150 radiographs with follow up examinations was used to asses change over time. Data were analyzed with receiver operating characteristics analyses and post-hoc power analysis. RESULTS: About 42% (305/ 724) CXR had no findings according to SOR; single and multiple abnormalities were seen in 23% (168/724) and 35% (251/724) of CXR. There was no statistical difference between DL and SOR for all abnormalities (p = 0.2-0.8). The area under the curve (AUC) for DL and test radiologists ranged between 0.837-0.929 and 0.693-0.923, respectively. DL had lowest AUC (0.758) for assessing changes in pulmonary opacities over follow up CXR. Presence of chest wall implanted devices negatively affected the accuracy of DL algorithm for evaluation of pulmonary and hilar abnormalities. CONCLUSIONS: DL algorithm can aid in interpretation of CXR findings and their stability over follow up CXR. However, in its present version, it is unlikely to replace radiologists due to its limited specificity for categorizing specific findings.

2013 ACR presidential address: a personal view on the future of radiology.

In this address, John A. Patti, MD, acknowledges the celebration and success that radiologists have experienced throughout their careers but also asks incisive questions about how they will face the future. Answers to those questions require an analysis of the past, an understanding of the present, serious and penetrating introspection, and engagement of a process for moving forward. An understanding of who we are and why we do what we do is essential to facilitate the changes that will be necessary if radiologists are to control the future, rather than having the future control radiologists.

Radiology in 2022: challenges and opportunities in the coming decade-proceedings of the 12th Annual ACR Forum.

The 2012 ACR Forum focused on the anticipated challenges and opportunities facing radiology in the next 10 years, centered on the themes of health care reform, future payment models, research and innovation, patient-centered radiology, and information management. The recommendations generated from the forum seek to inform ACR leadership on the best strategies to pursue to ensure the continued success of the profession in the coming decade.

Impact of generational differences on the future of radiology: proceedings of the 11th annual ACR Forum.

The 2011 ACR Forum focused on the impact of generational differences on the future of radiology, seeking to inform ACR leadership and members on how best to address the influence of the new integrated workforce on the specialty of radiology and on individual practices.

Managing hospital-radiologist relationships: proceedings of the Tenth Annual ACR Forum.

The annual ACR Forum brings together a multidisciplinary group to discuss a topic of present and future importance to radiologists. The 2010 gathering was dedicated to radiologist-hospital relationships. This article summarizes the conversations and details the advice of attendees to the ACR as to what actions might best benefit radiologists and the specialty.

The 2009 ACR Forum: health care payment models.

The 2009 ACR Forum addressed health care payment models, the strengths and weaknesses of different models under consideration, their implications for radiology, and the role radiologists should play in the debate.

ACR white paper: the value added that radiologists provide to the health care enterprise.

Radiologists represent arguably one of medicine's least heralded but most important specialties. Although they carry sterling credentials as imaging and radiation safety experts, radiologists have lacked widespread public recognition. As public and private stakeholders cast an even more intense spotlight on imaging, the vital role of radiologists must be better understood. During the January 2008 ACR Forum on Future Practice Models for Radiology, participants and ACR leaders discussed the value added that radiologists bring to the health care enterprise and recommended that the ACR further study that topic. The ACR, dedicated to providing quality patient care since its inception in 1924, convened the Task Force on Value Added to address these issues. The task force determined the component stakeholders in the health care enterprise to whom value is added, defined the nature of the value for each constituent component, described the process of adding that value, and anticipated future trends that may affect the value proposition. Recommendations to the ACR for future action are offered.

The economic environment of 2006: how safe is your practice and what you can do to protect it.

In 2006, there was no doubt that imaging was in the crosshairs of just about everyone who had a role in legislation, regulation, and payment involving these medical services. The information in this article was presented at the ACR's Annual Meeting and Chapter Leadership Conference in Washington, DC, on May 25, 2006. It describes the factors contributing to the current economic environment for medical imaging, the external responses to those factors, the dangers to practicing radiologists, and potential strategies to mitigate the damage.