AI-assisted detection for chest X-rays (AID-CXR): a multi-reader multi-case study protocol

Farhaan Khan*, Indrajeet Das, Marusa Kotnik, Louise Wing, Edwin Van Beek, John Murchison, Jong Seok Ahn, Sang Hyup Lee, Ambika Seth, Abdala Trinidad Espinosa Morgado, Howell Fu, Alex Novak, Nabeeha Salik, Alan Campbell, Ruchir Shah, Fergus Gleeson, Sarim Ather

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION: A chest X-ray (CXR) is the most common imaging investigation performed worldwide. Advances in machine learning and computer vision technologies have led to the development of several artificial intelligence (AI) tools to detect abnormalities on CXRs, which may expand diagnostic support to a wider field of health professionals. There is a paucity of evidence on the impact of AI algorithms in assisting healthcare professionals (other than radiologists) who regularly review CXR images in their daily practice.

AIMS: To assess the utility of an AI-based CXR interpretation tool in assisting the diagnostic accuracy, speed and confidence of a varied group of healthcare professionals.

METHODS AND ANALYSIS: The study will be conducted using 500 retrospectively collected inpatient and emergency department CXRs from two UK hospital trusts. Two fellowship-trained thoracic radiologists with at least 5 years of experience will independently review all studies to establish the ground truth reference standard with arbitration from a third senior radiologist in case of disagreement. The Lunit INSIGHT CXR tool (Seoul, Republic of Korea) will be applied and compared against the reference standard. Area under the receiver operating characteristic curve (AUROC) will be calculated for 10 abnormal findings: pulmonary nodules/mass, consolidation, pneumothorax, atelectasis, calcification, cardiomegaly, fibrosis, mediastinal widening, pleural effusion and pneumoperitoneum. Performance testing will be carried out with readers from various clinical professional groups with and without the assistance of Lunit INSIGHT CXR to evaluate the utility of the algorithm in improving reader accuracy (sensitivity, specificity, AUROC), confidence and speed (paired sample t-test). The study is currently ongoing with a planned end date of 31 December 2024.

ETHICS AND DISSEMINATION: The study has been approved by the UK Healthcare Research Authority. The use of anonymised retrospective CXRs has been authorised by Oxford University Hospital's information governance teams. The results will be presented at relevant conferences and published in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER: Protocol ID 310995-B (awaiting approval), ClinicalTrials.gov.

Original languageEnglish
Article numbere080554
JournalBMJ Open
Volume14
Issue number12
DOIs
Publication statusPublished - 20 Dec 2024

Keywords / Materials (for Non-textual outputs)

  • Humans
  • Artificial Intelligence
  • Radiography, Thoracic/methods
  • Retrospective Studies
  • Algorithms
  • ROC Curve
  • Research Design
  • Radiologists
  • United Kingdom
  • Lung Diseases/diagnostic imaging

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