Abstract
Chest X-rays (CXRs) are the first-line investigation in patients presenting to emergency departments (EDs) with dyspnoea and are a valuable adjunct to clinical management of COVID-19 associated lung disease. Artificial intelligence (AI) has the potential to facilitate rapid triage of CXRs for further patient testing and/or isolation. In this work we develop an AI algorithm, CovIx, to differentiate normal, abnormal, non-COVID-19 pneumonia, and COVID-19 CXRs using a multicentre cohort of 293,143 CXRs. The algorithm is prospectively validated in 3289 CXRs acquired from patients presenting to ED with symptoms of COVID-19 across four sites in NHS Greater Glasgow and Clyde. CovIx achieves area under receiver operating characteristic curve for COVID-19 of 0.86, with sensitivity and F1-score up to 0.83 and 0.71 respectively, and performs on-par with four board-certified radiologists. AI-based algorithms can identify CXRs with COVID-19 associated pneumonia, as well as distinguish non-COVID pneumonias in symptomatic patients presenting to ED. Pre-trained models and inference scripts are freely available at https://github.com/beringresearch/bravecx-covid.
Highlights
An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the COVID-19 pandemic of 20201
No single feature on chest radiography is diagnostic of COVID-19 pneumonia[18] and early or mild disease is often accompanied by a paucity of radiological signs[15,18]
DeepCOVID-XR, an ensemble of convolutional neural networks trained on a large multi-centre cohort of n = 14,788 images (n = 4253 COVID-19 positive) and validated on an external testing set from a single institution, performed on par with a consensus of five thoracic radiologists[24]
Summary
An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the COVID-19 pandemic of 20201. Whilst most COVID-19 patients have a mild clinical course, a proportion of patients demonstrate rapid deterioration from the onset of symptoms into severe illness with or without acute respiratory distress syndrome (ARDS)[5,6]. In mainland China, CT was often the investigation of choice for COVID-1914,15 Such practice was burdensome on radiology departments and challenging for infection control[16]. While awaiting the RT-PCR result, most suspected COVID-19 patients are clinically diagnosed with the triad of clinical assessment, CXR, and blood tests. Despite their utility, radiological interpretation of CXRs in suspected COVID-19 patients remains challenging due to the idiosyncratic nature of this disease.
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