A New Model of Organizing Mass Screening Based on Stand-Alone Artificial Intelligence Used for Fluorography Image Triage

Abstract

Introduction: A rapid development of artificial intelligence software, including that for the analysis of digital fluorography images, has been noted recently. Pre-registered as a medical device, this software can be used for stand-alone analysis and triage of test results, allowing radiologists to focus on pathological findings. Objective: To substantiate the possibility and efficiency of using artificial intelligence software for stand-alone analysis and triage of digital fluorography images. Materials and methods: 88,048 digital fluorograms obtained in the first quarter of 2023 were processed using the artificial intelligence software registered in the Russian Federation as a medical device and a ROC analysis of the findings was carried out. Results: We established that default software settings with the sensitivity of 90.4 % (95 % CI: 88.2–92.7) produced specificity of 75.5 % (95 % CI: 75.2–75.8) and accuracy of 75.6 % (95 % CI: 75.3–75.9). At the maximum sensitivity of 100.0 % (95 % CI: 100–100), specificity was 77.4 % (95 % CI: 74.8–80.0) and accuracy was as high as 77.9 % (95 % CI: 75.3–80.5). We have proposed a model of organizing health care which provides for stand-alone sorting of fluorography images by the software, saving normal results without their verification by a radiologist, and sending images with abnormal findings to a radiologist for diagnosis (in the future, as artificial intelligence improves, the latter will be immediately sent to a physician of the clinical specialty). Conclusions: The established optimal scenario includes the use of artificial intelligence software to identify normal findings, which examination by a radiologist is optional when the algorithm is set to maximum sensitivity. Only the findings classified as abnormal will be subject to mandatory revision. The annual economic benefit gained by practical implementation of this approach nationwide can reach 5.6 billion rubles.