Abstract
To evaluate the diagnostic accuracy of artificial intelligence (AI) assisted radiologists and standard double-reading in real-world clinical settings for rib fractures (RFs) detection on CT images. This study included 243 consecutive chest trauma patients (mean age, 58.1 years; female, 166) with rib CT scans. All CT scans were interpreted by two radiologists. The CT images were re-evaluated by primary readers with AI assistance in a blinded manner. Reference standards were established by two musculoskeletal radiologists. The re-evaluation results were then compared with those from the initial double-reading. The primary analysis focused on demonstrate superiority of AI-assisted sensitivity and the noninferiority of specificity at patient level, compared to standard double-reading. Secondary endpoints were at the rib and lesion levels. Stand-alone AI performance was also assessed. The influence of patient characteristics, report time, and RF features on the performance of AI and radiologists was investigated. At patient level, AI-assisted radiologists significantly improved sensitivity by 25.0% (95% CI: 10.5, 39.5; P < 0.001 for superiority), compared to double-reading, from 69.2% to 94.2%. And, the specificity of AI-assisted diagnosis (100%) was noninferior to double-reading (98.2%) with a difference of 1.8% (95% CI: -3.8, 7.4; P = 0.999 for noninferiority). The diagnostic accuracy of both radiologists and AI was influenced by patient gender, rib number, fracture location, and fracture type. Radiologist performance was affected by report time, whereas AI's diagnostic accuracy was influenced by patient age and the side of the rib involved. AI-assisted additional-reader workflow might be a feasible strategy to instead of traditional double-reading, potentially offering higher sensitivity and specificity compared to standard double-reading in real-word clinical practice.