Utility of artificial intelligence in the detection of pleuroparenchymal abnormalities on chest X-ray
Author Block: C. Argüelles Llera, L. garcía del barrio, A. Ezponda Casajus; Pamplona/ES
Purpose: To evaluate AI performance in detecting pleuroparenchymal abnormalities (pneumothorax [PTX], pleural effusion [PEF], pulmonary lesion/nodule [LES], consolidation [CO], and atelectasis [AT]) on posteroanterior chest X-ray, comparing AI, an experienced thoracic radiologist, and their combination (Radiologist+AI), using the radiologist supported by AI (Radiologist_IA) as reference.
Methods or Background: In this prospective cohort, an expert radiologist reported images blinded to AI output. AI results (AI-Rad Companion Chest X-Ray, Siemens Healthineers) were recorded separately, then the radiologist reviewed AI findings. The final report (Radiologist_IA) served as reference. Sensitivity, specificity, weighted kappa (κ), and AUC were calculated. DeLong’s and McNemar’s tests were used.
Results or Findings: Agreement between AI and the radiologist was moderate, highest for PEF (κ = 0.63) and PTX (κ = 0.475). The radiologist achieved near-perfect sensitivities (~100%) and specificities (>98%). AI showed high sensitivity for PTX (100%) but lower for AT (35.3%) and CO (53.1%). For LES, AI sensitivity (0.803) exceeded the radiologist (0.727), though specificity was higher for the radiologist (0.994 vs. 0.855). Radiologist AUC was superior to AI for PEF, CO, and AT (all p < 0.001). Radiologist+AI increased LES sensitivity (0.97 vs. 0.727; p = 0.178), not significant. LES AUC was 0.8608 (radiologist) vs. 0.9121 (Radiologist+AI, p = 0.178).
Conclusion: AI shows acceptable performance in detecting pleuroparenchymal abnormalities on chest X-ray, especially PTX. Radiologist interpretation remains most reliable; AI integration enhances sensitivity, supporting its role as a clinical adjunct.
Limitations: Not applicable.
Funding for this study: None.
Has your study been approved by an ethics committee? Not applicable
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