Enhancing Early Lung Cancer Detection on Chest Radiographs with AI-assistance: A Multi-Reader Study

TL;DR

This study demonstrates that AI assistance significantly improves clinicians' ability to detect early lung cancer on chest X-rays, increasing detection rates and standardizing performance without additional resource use.

Contribution

It provides evidence that explainable AI can enhance early lung cancer detection accuracy among clinicians in a real-world clinical setting.

Findings

AI increased lung cancer detection by 17.4%

Improved detection of stage 1 and 2 lung cancers by 24% and 13%

Clinician performance became more standardized with AI assistance

Abstract

Objectives: The present study evaluated the impact of a commercially available explainable AI algorithm in augmenting the ability of clinicians to identify lung cancer on chest X-rays (CXR). Design: This retrospective study evaluated the performance of 11 clinicians for detecting lung cancer from chest radiographs, with and without assistance from a commercially available AI algorithm (red dot, Behold.ai) that predicts suspected lung cancer from CXRs. Clinician performance was evaluated against clinically confirmed diagnoses. Setting: The study analysed anonymised patient data from an NHS hospital; the dataset consisted of 400 chest radiographs from adult patients (18 years and above) who had a CXR performed in 2020, with corresponding clinical text reports. Participants: A panel of readers consisting of 11 clinicians (consultant radiologists, radiologist trainees and reporting radiographers) participated in this study. Main outcome measures: Overall accuracy, sensitivity, specificity and precision for detecting lung cancer on CXRs by clinicians, with and without AI input. Agreement rates between clinicians and performance standard deviation were also evaluated, with and without AI input. Results: The use of the AI algorithm by clinicians led to an improved overall performance for lung tumour detection, achieving an overall increase of 17.4% of lung cancers being identified on CXRs which would have otherwise been missed, an overall increase in detection of smaller tumours, a 24% and 13% increased detection of stage 1 and stage 2 lung cancers respectively, and standardisation of clinician performance. Conclusions: This study showed great promise in the clinical utility of AI algorithms in improving early lung cancer diagnosis and promoting health equity through overall improvement in reader performances, without impacting downstream imaging resources.