May 20, 2024

Radiologists vs. Robots: Outperforming AI in Identifying Lung Diseases on Chest X-Rays

While commercially offered and FDA-approved AI tools are readily available to help radiologists, Dr. Plesner stated the medical usage of deep-learning-based AI tools for radiological diagnosis remains in its infancy.
” While AI tools are significantly being approved for use in radiological departments, there is an unmet need to further test them in real-life clinical scenarios,” Dr. Plesner said. “AI tools can assist radiologists in analyzing chest X-rays, however their real-life diagnostic accuracy remains uncertain.”
( A) Posteroanterior chest radiograph in a 71-year-old male patient who underwent examination due to progression of dyspnea reveals bilateral fibrosis (arrows) (B) Posteroanterior chest radiograph in a 31-year-old female client referred for radiography due to month-long coughing shows subtle airspace opacity at the best cardiac border (arrows). (D) Posteroanterior chest radiograph in a 78-year-old male client referred to rule out pneumothorax shows really subtle apical right-sided pneumothorax (arrows). (F) Anteroposterior chest radiograph in a 76-year-old female patient referred for radiography due to suspicion of congestion and/or pneumonia shows an extremely subtle left-sided pleural effusion (arrow), which was missed out on by all 3 AI tools that were capable of analyzing anteroposterior chest radiographs for pleural effusion.
Research study Findings
Dr. Plesner and a team of researchers compared the efficiency of four commercially offered AI tools with a swimming pool of 72 radiologists in analyzing 2,040 consecutive adult chest X-rays taken control of a two-year duration at 4 Danish healthcare facilities in 2020. The mean age of the client group was 72 years. Of the sample chest X-rays, 669 (32.8%) had at least one target finding.
The chest X-rays were examined for 3 typical findings: airspace illness (a chest X-ray pattern, for instance, brought on by pneumonia or lung edema), pneumothorax (collapsed lung), and pleural effusion (an accumulation of water around the lungs).
AI tools achieved sensitivity rates ranging from 72 to 91% for airspace disease, 63 to 90% for pneumothorax, and 62 to 95% for pleural effusion.
” The AI tools revealed moderate to a high level of sensitivity similar to radiologists for detecting airspace illness, pneumothorax, and pleural effusion on chest X-rays,” he said. “However, they produced more false-positive results (predicting illness when none was present) than the radiologists, and their efficiency decreased when multiple findings were present and for smaller sized targets.”
Comparing Predictive Values
For pneumothorax, positive predictive worths– the possibility that patients with a positive screening test genuinely have the illness– for the AI systems ranged between 56 and 86%, compared to 96% for the radiologists.
” AI carried out worst at identifying airspace disease, with positive predictive worths varying between 40 and 50%,” Dr. Plesner said. “In this tough and senior patient sample, the AI forecasted airspace disease where none was present five to six out of 10 times. You can not have an AI system working on its own at that rate.”
According to Dr. Plesner, the goal of radiologists is to stabilize the ability of finding and omitting disease, preventing both substantial overlooked illness and overdiagnosis.
” AI systems seem excellent at finding disease, but they arent as good as radiologists at identifying the absence of disease particularly when the chest X-rays are complex,” he stated. “Too numerous false-positive medical diagnoses would lead to unneeded imaging, radiation exposure, and increased costs.”
Dr. Plesner said the majority of research studies typically tend to evaluate the capability of AI to figure out the existence or lack of a single disease, which is a lot easier task than real-life circumstances where clients typically present with multiple diseases.
” In lots of previous research studies declaring AI superiority over radiologists, the radiologists reviewed only the image without access to the patients scientific history and previous imaging studies,” he said. “In everyday practice, a radiologists interpretation of an imaging exam is a synthesis of these 3 data points. We speculate that the next generation of AI tools might become considerably more powerful if capable of this synthesis also, however no such systems exist yet.”
Concluding Thoughts
” Our study demonstrates that radiologists typically outperform AI in real-life circumstances where there is a variety of clients,” he said. “While an AI system works at identifying regular chest X-rays, AI should not be self-governing for making diagnoses.”
Dr. Plesner kept in mind that these AI tools might improve radiologists self-confidence in their medical diagnoses by offering a 2nd appearance at chest X-rays.
Reference: “Commercially Available Chest Radiograph AI Tools for Detecting Airspace Disease, Pneumothorax, and Pleural Effusion” by Louis Lind Plesner, Felix C. Müller, Mathias W. Brejnebøl, Lene C. Laustrup, Finn Rasmussen, Olav W. Nielsen, Mikael Boesen and Michael Brun Andersen, 26 September 2023, Radiology.DOI: 10.1148/ radiol.231236.

( A) Posteroanterior chest radiograph in a 71-year-old male client who underwent examination due to progression of dyspnea shows bilateral fibrosis (arrows) (B) Posteroanterior chest radiograph in a 31-year-old female patient referred for radiography due to month-long coughing programs subtle airspace opacity at the ideal heart border (arrows). (D) Posteroanterior chest radiograph in a 78-year-old male client referred to rule out pneumothorax shows really subtle apical right-sided pneumothorax (arrows). (F) Anteroposterior chest radiograph in a 76-year-old female patient referred for radiography due to suspicion of congestion and/or pneumonia shows an extremely subtle left-sided pleural effusion (arrow), which was missed by all 3 AI tools that were capable of examining anteroposterior chest radiographs for pleural effusion. Dr. Plesner and a group of researchers compared the efficiency of 4 commercially offered AI tools with a swimming pool of 72 radiologists in translating 2,040 successive adult chest X-rays taken over a two-year duration at four Danish hospitals in 2020. Of the sample chest X-rays, 669 (32.8%) had at least one target finding.

In a current research study published in the journal Radiology, radiologists were found to be more skilled than AI tools in identifying or omitting three typical lung illness from over 2,000 chest X-rays.
Radiologists exceeded AI in properly finding three common lung diseases from chest X-rays, according to a study in the Radiology journal. AI tools, while sensitive, produced more incorrect positives, making them less trustworthy for self-governing diagnoses but useful for 2nd viewpoints.
In a research study of more than 2,000 chest X-rays, radiologists outperformed AI in accurately identifying the presence and absence of 3 common lung illness, according to a research study released on September 26 in Radiology, a journal of the Radiological Society of North America (RSNA).
The Role of Radiography
” Chest radiography is a common diagnostic tool, but considerable training and experience is required to translate examinations correctly,” stated lead researcher Louis L. Plesner, M.D., resident radiologist and Ph.D. fellow in the Department of Radiology at Herlev and Gentofte Hospital in Copenhagen, Denmark.