Korean J Radiol.  2023 Mar;24(3):259-270. 10.3348/kjr.2022.0651.

Conventional Versus Artificial Intelligence-Assisted Interpretation of Chest Radiographs in Patients With Acute Respiratory Symptoms in Emergency Department: A Pragmatic Randomized Clinical Trial

• Hwang EJ
• Goo JM
• Nam JG
• Park CM
• Hong KJ
• Kim KH

• KMID: 2539634
• DOI: http://doi.org/10.3348/kjr.2022.0651

Abstract

Objective
It is unknown whether artificial intelligence-based computer-aided detection (AI-CAD) can enhance the accuracy of chest radiograph (CR) interpretation in real-world clinical practice. We aimed to compare the accuracy of CR interpretation assisted by AI-CAD to that of conventional interpretation in patients who presented to the emergency department (ED) with acute respiratory symptoms using a pragmatic randomized controlled trial.
Materials and Methods
Patients who underwent CRs for acute respiratory symptoms at the ED of a tertiary referral institution were randomly assigned to intervention group (with assistance from an AI-CAD for CR interpretation) or control group (without AI assistance). Using a commercial AI-CAD system (Lunit INSIGHT CXR, version 2.0.2.0; Lunit Inc.). Other clinical practices were consistent with standard procedures. Sensitivity and false-positive rates of CR interpretation by duty trainee radiologists for identifying acute thoracic diseases were the primary and secondary outcomes, respectively. The reference standards for acute thoracic disease were established based on a review of the patient’s medical record at least 30 days after the ED visit.
Results
We randomly assigned 3576 participants to either the intervention group (1761 participants; mean age ± standard deviation, 65 ± 17 years; 978 males; acute thoracic disease in 472 participants) or the control group (1815 participants; 64 ± 17 years; 988 males; acute thoracic disease in 491 participants). The sensitivity (67.2% [317/472] in the intervention group vs. 66.0% [324/491] in the control group; odds ratio, 1.02 [95% confidence interval, 0.70–1.49]; P = 0.917) and false-positive rate (19.3% [249/1289] vs. 18.5% [245/1324]; odds ratio, 1.00 [95% confidence interval, 0.79–1.26]; P = 0.985) of CR interpretation by duty radiologists were not associated with the use of AI-CAD.
Conclusion
AI-CAD did not improve the sensitivity and false-positive rate of CR interpretation for diagnosing acute thoracic disease in patients with acute respiratory symptoms who presented to the ED.

Keyword

Chest radiography; Artificial intelligence; Deep learning; Computer-aided detection; Emergency radiology; Clinical trial; Diagnostic accuracy