Automatic AI tool for opportunistic screening of vertebral compression fractures on chest frontal radiographs: A multicenter study

Vertebral compression fractures (VCFs) are the most common type of osteoporotic fractures, yet they are often clinically silent and undiagnosed. Chest frontal radiographs (CFRs) are frequently used in clinical practice and a portion of VCFs can be detected through this technology. This study aimed to develop an automatic artificial intelligence (AI) tool using deep learning (DL) model for the opportunistic screening of VCFs from CFRs. The datasets were collected from four medical centers, comprising 19,145 vertebrae (T6-T12) from 2735 patients. Patients from Center 1, 2 and 3 were divided into the training and internal testing datasets in an 8:2 ratio (n = 2361, with 16,527 vertebrae). Patients from Center 4 were used as the external test dataset (n = 374, with 2618 vertebrae). Model performance was assessed using sensitivity, specificity, accuracy and the area under the curve (AUC). A reader study with five clinicians of different experience levels was conducted with and without AI assistance. In the internal testing dataset, the model achieved a sensitivity of 83.0 % and an AUC of 0.930 at the fracture level. In the external testing dataset, the model demonstrated a sensitivity of 78.4 % and an AUC of 0.942 at the fracture level. The model's sensitivity outperformed that of five clinicians with different levels of experience. Notably, AI assistance significantly improved sensitivity at the patient level for both junior clinicians (from 56.1 % without AI to 81.6 % with AI) and senior clinicians (from 65.0 % to 85.6 %). In conclusion, the automatic AI tool significantly increases clinicians' sensitivity in diagnosing fractures on CFRs, showing great potential for the opportunistic screening of VCFs.