Abstract
BACKGROUND: Accurate and timely detection of pneumothorax on chest radiographs is critical in emergency and critical care settings. While subtle cases remain challenging for clinicians, artificial intelligence (AI) offers promise as a diagnostic aid. This retrospective diagnostic accuracy study evaluates a deep learning model developed using Google Cloud Vertex AI for pneumothorax detection on chest X-rays. METHODS: A total of 152 anonymized frontal chest radiographs (76 pneumothorax, 76 normal), confirmed by computed tomography (CT), were collected from a single center between 2023 and 2024. The median patient age was 50 years (range: 18-95), with 67.1% male. The AI model was trained using AutoML Vision and evaluated in both cloud and edge deployment environments. Diagnostic accuracy metrics-including sensitivity, specificity, and F1 score-were compared with those of 15 physicians from four specialties (general practice, emergency medicine, thoracic surgery, radiology), stratified by experience level. Subgroup analysis focused on minimal pneumothorax cases. Confidence intervals were calculated using the Wilson method. RESULTS: In cloud deployment, the AI model achieved an overall diagnostic accuracy of 0.95 (95% CI: 0.83, 0.99), sensitivity of 1.00 (95% CI: 0.83, 1.00), specificity of 0.89 (95% CI: 0.69, 0.97), and F1 score of 0.95 (95% CI: 0.86, 1.00). Comparable performance was observed in edge mode. The model outperformed junior clinicians and matched or exceeded senior physicians, particularly in detecting minimal pneumothoraces, where AI sensitivity reached 0.93 (95% CI: 0.79, 0.97) compared to 0.55 (95% CI: 0.38, 0.69) - 0.84 (95% CI: 0.69, 0.92) among human readers. CONCLUSION: The Google Cloud Vertex AI model demonstrates high diagnostic performance for pneumothorax detection, including subtle cases. Its consistent accuracy across edge and cloud settings supports its integration as a second reader or triage tool in diverse clinical workflows, especially in acute care or resource-limited environments.