Abstract
PURPOSE: To assess the impact of a commercially available computed tomography (CT)-based artificial intelligence (AI) software for detecting acute intracranial hemorrhage (AIH) on radiologists' diagnostic performance and workflow in a real-world clinical setting. METHODS: This retrospective study included a total of 956 non-contrast brain CT scans obtained over a 70-day period, interpreted independently by 2 board-certified general radiologists. Of these, 541 scans were interpreted during the initial 35 days before the implementation of AI software, and the remaining 415 scans were interpreted during the subsequent 35 days, with reference to AIH probability scores generated by the software. To assess the software's impact on radiologists' performance in detecting AIH, performance before and after implementation was compared. Additionally, to evaluate the software's effect on radiologists' workflow, Kendall's Tau was used to assess the correlation between the daily chronological order of CT scans and the radiologists' reading order before and after implementation. The early diagnosis rate for AIH (defined as the proportion of AIH cases read within the first quartile by radiologists) and the median reading order of AIH cases were also compared before and after implementation. RESULTS: A total of 956 initial CT scans from 956 patients [mean age: 63.14 ± 18.41 years; male patients: 447 (47%)] were included. There were no significant differences in accuracy [from 0.99 (95% confidence interval: 0.99-1.00) to 0.99 (0.98-1.00), P = 0.343], sensitivity [from 1.00 (0.99-1.00) to 1.00 (0.99-1.00), P = 0.859], or specificity [from 1.00 (0.99-1.00) to 0.99 (0.97-1.00), P = 0.252] following the implementation of the AI software. However, the daily correlation between the chronological order of CT scans and the radiologists' reading order significantly decreased [Kendall's Tau, from 0.61 (0.48-0.73) to 0.01 (0.00-0.26), P < 0.001]. Additionally, the early diagnosis rate significantly increased [from 0.49 (0.34-0.63) to 0.76 (0.60-0.93), P = 0.013], and the daily median reading order of AIH cases significantly decreased [from 7.25 (Q1-Q3: 3-10.75) to 1.5 (1-3), P < 0.001] after the implementation. CONCLUSION: After the implementation of CT-based AI software for detecting AIH, the radiologists' daily reading order was considerably reprioritized to allow more rapid interpretation of AIH cases without compromising diagnostic performance in a real-world clinical setting. CLINICAL SIGNIFICANCE: With the increasing number of CT scans and the growing burden on radiologists, optimizing the workflow for diagnosing AIH through CT-based AI software integration may enhance the prompt and efficient treatment of patients with AIH.