# The Effect of Simulated Dose Reduction on the Performance of Artificial Intelligence in Chest Radiography

## TL;DR

This paper studies how reducing simulated radiation dose in chest X-rays affects AI model performance, finding minimal impact on most models.

## Contribution

The study introduces a low-dose simulation method and evaluates its effect on CNN performance in chest radiography.

## Key findings

- The average absolute change in AUROC due to simulated dose reduction was less than 0.005.
- Only 6 out of 28 test sets showed significant differences in performance after dose reduction.
- Patient positioning had a greater effect on AI performance than simulated dose reduction.

## Abstract

Chest imaging plays a pivotal role in screening and monitoring patients, and various predictive artificial intelligence (AI) models have been developed in support of this. However, little is known about the effect of decreasing the radiation dose and, thus, image quality on AI performance. This study aims to design a low-dose simulation and evaluate the effect of this simulation on the performance of CNNs in plain chest radiography. Seven pathology labels and corresponding images from Medical Information Mart for Intensive Care datasets were used to train AI models at two spatial resolutions. These 14 models were tested using the original images, 50% and 75% low-dose simulations. We compared the area under the receiver operator characteristic (AUROC) of the original images and both simulations using DeLong testing. The average absolute change in AUROC related to simulated dose reduction for both resolutions was <0.005, and none exceeded a change of 0.014. Of the 28 test sets, 6 were significantly different. An assessment of predictions, performed through the splitting of the data by gender and patient positioning, showed a similar trend. The effect of simulated dose reductions on CNN performance, although significant in 6 of 28 cases, has minimal clinical impact. The effect of patient positioning exceeds that of dose reduction.