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25 April 2023 Integration and evaluation of chest X-ray artificial intelligence in clinical practice
Koon-Pong Wong, Suzanne Y. Homer, Sindy H. Wei, Nazanin Yaghmai, Oscar A. Estrada Paz, Timothy J. Young, Russell G. Buhr, Igor Barjaktarevic, Liza Shrestha, Morgan Daly, Jonathan Goldin, Dieter R. Enzmann, Matthew S. Brown
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Journal of Medical Imaging, Vol. 10, Issue 5, 051805 (April 2023). https://doi.org/10.1117/1.JMI.10.5.051805
Abstract

Purpose

To integrate and evaluate an artificial intelligence (AI) system that assists in checking endotracheal tube (ETT) placement on chest x-rays (CXRs) in clinical practice.

Approach

In clinical use over 17 months, 214 CXR images were ordered to check ETT placement with AI assistance by intensive care unit (ICU) physicians. The system was built on the SimpleMind Cognitive AI platform and integrated into a clinical workflow. It automatically identified the ETT and checked its placement relative to the trachea and carina. The ETT overlay and misplacement alert messages generated by the AI system were compared with radiology reports as the reference. A survey study was also conducted to evaluate usefulness of the AI system in clinical practice.

Results

The alert messages indicating that either the ETT was misplaced or not detected had a positive predictive value of 42% (21/50) and negative predictive value of 98% (161/164) based on the radiology reports. In the survey, radiologist and ICU physician users indicated that they agreed with the AI outputs and that they were useful.

Conclusions

The AI system performance in real-world clinical use was comparable to that seen in previous experiments. Based on this and physician survey results, the system can be deployed more widely at our institution, using insights gained from this evaluation to make further algorithm improvements and quality assurance of the AI system.
© 2023 Society of Photo-Optical Instrumentation Engineers (SPIE)
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Koon-Pong Wong, Suzanne Y. Homer, Sindy H. Wei, Nazanin Yaghmai, Oscar A. Estrada Paz, Timothy J. Young, Russell G. Buhr, Igor Barjaktarevic, Liza Shrestha, Morgan Daly, Jonathan Goldin, Dieter R. Enzmann, and Matthew S. Brown "Integration and evaluation of chest X-ray artificial intelligence in clinical practice," Journal of Medical Imaging 10(5), 051805 (25 April 2023). https://doi.org/10.1117/1.JMI.10.5.051805
Received: 15 January 2023; Accepted: 3 April 2023; Published: 25 April 2023
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KEYWORDS
Artificial intelligence
Chest imaging
Clinical practice
Picture Archiving and Communication System
Radiology
Computing systems
Imaging systems
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