Post-deployment performance of a deep learning algorithm for normal and abnormal chest X-ray classification: A study at visa screening centers in the United Arab Emirates

Background: Chest radiographs (CXRs) are widely used to screen for infectious diseases like tuberculosis and COVID-19 among migrants. At such high-volume settings, manual CXR reporting is challenging and integrating artificial intelligence (AI) algorithms into the workflow help to rule out normal findings in minutes, allowing radiologists to focus on abnormal cases.

Methods: In this post-deployment study, all the CXRs acquired during the visa screening process across 33 centers in United Arab Emirates from January 2021 to June 2022 (18 months) were included. The qXR v2.1 chest X-ray interpretation software was used to classify the scans into normal and abnormal, and its agreement against radiologist was evaluated. Additionally, a digital survey was conducted among 20 healthcare professionals with prior AI experience to understand real-world implementation challenges and impact.

Results: The analysis of 1309,443 CXRs from 1309,431 patients (median age: 35 years; IQR [29-42]; 1030,071 males [78.7 %]) in this study revealed a Negative Predictive Value (NPV) of 99.92 % (95 % CI: 99.92, 99.93), Positive Predictive Value (PPV) of 5.06 % (95 % CI: 4.99, 5.13) and overall percent agreement of the AI with radiologists of 72.90 % (95 % CI: 72.82, 72.98). In the survey, majority (88.2 %) of the radiologists agreed to turnaround time reduction after AI integration, while 82 % suggested that the AI improved their diagnostic accuracy.

Discussion: In contrast with the existing studies, this research uses a substantially large data. A high NPV and satisfactory agreement with human readers indicate that AI can reliably identify normal CXRs, making it suitable for routine applications.