Artificial Intelligence Algorithm Detecting Lung Infection in Supine Chest Radiographs of Critically Ill Patients With a Diagnostic Accuracy Similar to Board-Certified Radiologists

Rueckel, Johannes; Kunz, Wolfgang G.; Hoppe, Boj F.; Patzig, Maximilian; Notohamiprodjo, Mike; Meinel, Felix G.; Cyran, Clemens C.; Ingrisch, Michael; Ricke, Jens und Sabel, Bastian O. (2020): Artificial Intelligence Algorithm Detecting Lung Infection in Supine Chest Radiographs of Critically Ill Patients With a Diagnostic Accuracy Similar to Board-Certified Radiologists. In: Critical Care Medicine, Bd. 48, Nr. 7, E574-E583

Abstract

Objectives: Interpretation of lung opacities in ICU supine chest radiographs remains challenging. We evaluated a prototype artificial intelligence algorithm to classify basal lung opacities according to underlying pathologies. Design: Retrospective study. The deep neural network was trained on two publicly available datasets including 297,541 images of 86,876 patients. Patients: One hundred sixty-six patients received both supine chest radiograph and CT scans (reference standard) within 90 minutes without any intervention in between. Measurements and Main Results: Algorithm accuracy was referenced to board-certified radiologists who evaluated supine chest radiographs according to side-separate reading scores for pneumonia and effusion (0 = absent, 1 = possible, and 2 = highly suspected). Radiologists were blinded to the supine chest radiograph findings during CT interpretation. Performances of radiologists and the artificial intelligence algorithm were quantified by receiver-operating characteristic curve analysis. Diagnostic metrics (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) were calculated based on different receiver-operating characteristic operating points. Regarding pneumonia detection, radiologists achieved a maximum diagnostic accuracy of up to 0.87 (95% CI, 0.78-0.93) when considering only the supine chest radiograph reading score 2 as positive for pneumonia. Radiologist's maximum sensitivity up to 0.87 (95% CI, 0.76-0.94) was achieved by additionally rating the supine chest radiograph reading score 1 as positive for pneumonia and taking previous examinations into account. Radiologic assessment essentially achieved nonsignificantly higher results compared with the artificial intelligence algorithm: artificial intelligence-area under the receiver-operating characteristic curve of 0.737 (0.659-0.815) versus radiologist's area under the receiver-operating characteristic curve of 0.779 (0.723-0.836), diagnostic metrics of receiver-operating characteristic operating points did not significantly differ. Regarding the detection of pleural effusions, there was no significant performance difference between radiologist's and artificial intelligence algorithm: artificial intelligence-area under the receiver-operating characteristic curve of 0.740 (0.662-0.817) versus radiologist's area under the receiver-operating characteristic curve of 0.698 (0.646-0.749) with similar diagnostic metrics for receiver-operating characteristic operating points. Conclusions: Considering the minor level of performance differences between the algorithm and radiologists, we regard artificial intelligence as a promising clinical decision support tool for supine chest radiograph examinations in the clinical routine with high potential to reduce the number of missed findings in an artificial intelligence-assisted reading setting.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0090-3493
• Sprache: Englisch