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BMJ Open. First published December 7, 2021 Authors: Jarrel Seah, Cyril Tang, Quinlan D Buchlak, Michael Robert Milne, Xavier Holt, Hassan Ahmad, John Lambert, Nazanin Esmaili, Luke Oakden-Rayner Peter Brotchie, Catherine M Jones Objectives: To evaluate the ability of a commercially available comprehensive chest radiography deep convolutional neural network (DCNN) to detect simple and tension pneumothorax, as stratified by the following subgroups: the presence of an intercostal drain; rib, clavicular, scapular or humeral fractures or rib resections; subcutaneous emphysema and erect versus non-erect positioning. The hypothesis was that performance would not differ significantly in each of these subgroups when compared with the overall test dataset. Design: A retrospective case–control study was undertaken. Setting: Community radiology clinics and hospitals in Australia and the USA. Participants: A test dataset of 2557 chest radiography studies was ground-truthed by three subspecialty thoracic radiologists for the presence of simple or tension pneumothorax as well as each subgroup other than positioning. Radiograph positioning was derived from radiographer annotations on the images.

Lancet Digital Health, July 1 2021. Authors: Jarrel C Y Seah, Cyril H M Tang, Quinlan D Buchlak, Xavier G Holt, Jeffrey B Wardman, Anuar Aimoldin, Nazanin Esmaili, Hassan Ahmad, Hung Pham, John F Lambert, Ben Hachey, Stephen J F Hogg, Benjamin P Johnston, Christine Bennett, Luke Oakden-Rayner, Peter Brotchie, Catherine M Jones Summary: Background Chest x-rays are widely used in clinical practice; however, interpretation can be hindered by human error and a lack of experienced thoracic radiologists. Deep learning has the potential to improve the accuracy of chest x-ray interpretation. We therefore aimed to assess the accuracy of radiologists with and without the assistance of a deep-learning model. Methods: In this retrospective study, a deep-learning model was trained on 821 681 images (284 649 patients) from five data sets from Australia, Europe, and the USA. 2568 enriched chest x-ray cases from adult patients (≥16 years) who had at least one frontal chest x-ray were included in the test dataset; cases were representative of inpatient, outpatient, and emergency settings. 20 radiologists reviewed cases with and without the assistance of the deep-learning model with a 3-month washout period. We assessed the change in accuracy of chest x-ray interpretation across 127 clinical findings when the deep-learning model was used as a decision support by calculating area under the receiver operating characteristic curve (AUC) for each radiologist with and without the deep-learning model. We also compared AUCs for the model alone with those of unassisted radiologists. If the lower bound of the adjusted 95% CI of the difference in AUC between the model and the unassisted radiologists was more than –0·05, the model was considered to be non-inferior for that finding. If the lower bound exceeded 0, the model was considered to be superior. Findings: Unassisted radiologists had a macroaveraged AUC of 0·713 (95% CI 0·645–0·785) across the 127 clinical findings, compared with 0·808 (0·763–0·839) when assisted by the model. The deep-learning model statistically significantly improved the classification accuracy of radiologists for 102 (80%) of 127 clinical findings, was statistically non-inferior for 19 (15%) findings, and no findings showed a decrease in accuracy when radiologists used the deep-learning model. Unassisted radiologists had a macroaveraged mean AUC of 0·713 (0·645–0·785) across all findings, compared with 0·957 (0·954–0·959) for the model alone. Model classification alone was significantly more accurate than unassisted radiologists for 117 (94%) of 124 clinical findings predicted by the model and was non-inferior to unassisted radiologists for all other clinical findings. :