Radiology Workflow Research Articles

Evaluation of techniques to improve a deep learning algorithm for the automatic detection of intracranial haemorrhage on CT head imaging

BackgroundDeep learning (DL) algorithms are playing an increasing role in automatic medical image analysis.PurposeTo evaluate the performance of a DL model for the automatic detection of intracranial haemorrhage and its subtypes on non-contrast CT (NCCT) head studies and to compare the effects of various preprocessing and model design implementations.MethodsThe DL algorithm was trained and externally validated on open-source, multi-centre retrospective data containing radiologist-annotated NCCT head studies. The training dataset was sourced from four research institutions across Canada, the USA and Brazil. The test dataset was sourced from a research centre in India. A convolutional neural network (CNN) was used, with its performance compared against similar models with additional implementations: (1) a recurrent neural network (RNN) attached to the CNN, (2) preprocessed CT image-windowed inputs and (3) preprocessed CT image-concatenated inputs. The area under the receiver operating characteristic curve (AUC-ROC) and microaveraged precision (mAP) score were used to evaluate and compare model performances.ResultsThe training and test datasets contained 21,744 and 491 NCCT head studies, respectively, with 8,882 (40.8%) and 205 (41.8%) positive for intracranial haemorrhage. Implementation of preprocessing techniques and the CNN-RNN framework increased mAP from 0.77 to 0.93 and increased AUC-ROC [95% confidence intervals] from 0.854 [0.816–0.889] to 0.966 [0.951–0.980] (p-value = 3.91 × 10−12).ConclusionsThe deep learning model accurately detected intracranial haemorrhage and improved in performance following specific implementation techniques, demonstrating clinical potential as a decision support tool and an automated system to improve radiologist workflow efficiency.Key points• The deep learning model detected intracranial haemorrhages on computed tomography with high accuracy.• Image preprocessing, such as windowing, plays a large role in improving deep learning model performance.• Implementations which enable an analysis of interslice dependencies can improve deep learning model performance.• Visual saliency maps can facilitate explainable artificial intelligence systems.• Deep learning within a triage system may expedite earlier intracranial haemorrhage detection.

Clinical Implementation of a Combined Artificial Intelligence and Natural Language Processing Quality Assurance Program for Pulmonary Nodule Detection in the Emergency Department Setting.

This quality assurance study assessed the implementation of a combined artificial intelligence (AI) and natural language processing (NLP) program for pulmonary nodule detection in the emergency department setting. The program was designed to function outside of normal reading workflows to minimize radiologist interruption. In all, 19,246 CT examinations including at least some portion of the lung anatomy performed in the emergent setting from October 1, 2021, to June 1, 2022, were processed by the combined AI-NLP program. The program used an AI algorithm trained on 6-mm to 30-mm pulmonary nodules to analyze CT images and an NLP to analyze radiological reports. Cases flagged as negative for pulmonary nodules by the NLP but positive by the AI algorithm were classified as suspected discrepancies. Discrepancies result in secondary review of examinations for possible addenda. Out of 19,246 CT examinations, 50 examinations (0.26%) resulted in secondary review, and 34 of 50 (68%) reviews resulted in addenda. Of the 34 addenda, 20 patients received instruction for new follow-up imaging. Median time to addendum was 11 hours. The majority of reviews and addenda resulted from missed pulmonary nodules on CT examinations of the abdomen and pelvis. A background quality assurance process using AI and NLP helped improve the detection of pulmonary nodules and resulted in increased numbers of patients receiving appropriate follow-up imaging recommendations. This was achieved without disrupting in-shift radiologist workflow or causing significant delays in patient follow for the diagnosed pulmonary nodule.

Pneumona Disease Detection using Deep Learning

Abstract: Pneumonia is a life-threatening respiratory disease that causes inflammation and fluid accumulation in the lungs. Chest X-ray is one of the most commonly used diagnostic tools to detect pneumonia. In recent years, deep learning techniques have been widely used in the medical field for image analysis and diagnosis. In this study, we propose a deep learning-based method for pneumonia detection using chest X-ray images. This study proposes a Convolutional Neural Network (CNN) based approach for detecting pneumonia using chest X-ray images. The proposed model consists of multiple layers of convolution, pooling, and fully connected layers, designed to extract features from input images and classify them into pneumonia and nonpneumonia categories. The model is trained on a publicly available dataset containing chest X-ray images of patients with and without pneumonia. The performance of the proposed model is evaluated using various metrics, including accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve (AUC-ROC). The results indicate that the proposed model achieved high accuracy, sensitivity, and specificity in detecting pneumonia from chest X-ray images, demonstrating its potential for clinical use in aiding radiologists in diagnosing and monitoring patients with pneumonia, particularly in cases where the diagnosis is challenging due to factors such as image quality or complex cases. Moreover, the proposed approach can be integrated into existing radiology workflows to automate the detection and classification of chest X-ray images, leading to faster and more accurate diagnoses, thereby improving patient outcomes

Utilization of Deep Convolutional Neural Networks for Accurate Chest X-Ray Diagnosis and Disease Detection.

Chest radiography is a widely used diagnostic imaging procedure in medical practice, which involves prompt reporting of future imaging tests and diagnosis of diseases in the images. In this study, a critical phase in the radiology workflow is automated using the three convolutional neural network (CNN) models, viz. DenseNet121, ResNet50, and EfficientNetB1 for fast and accurate detection of 14 class labels of thoracic pathology diseases based on chest radiography. These models were evaluated on an AUC score for normal versus abnormal chest radiographs using 112120 chest X-ray14 datasets containing various class labels of thoracic pathology diseases to predict the probability of individual diseases and warn clinicians of potential suspicious findings. With DenseNet121, the AUROC scores for hernia and emphysema were predicted as 0.9450 and 0.9120, respectively. Compared to the score values obtained for each class on the dataset, the DenseNet121 outperformed the other two models. This article also aims to develop an automated server to capture fourteen thoracic pathology disease results using a tensor processing unit (TPU). The results of this study demonstrate that our dataset can be used to train models with high diagnostic accuracy for predicting the likelihood of 14 different diseases in abnormal chest radiographs, enabling accurate and efficient discrimination between different types of chest radiographs. This has the potential to bring benefits to various stakeholders and improve patient care.

Artificial Intelligence (AI)-Based Systems for Automatic Skeletal Maturity Assessment through Bone and Teeth Analysis: A Revolution in the Radiological Workflow?

Bone age is an indicator of bone maturity and is useful for the treatment of different pediatric conditions as well as for legal issues. Bone age can be assessed by the analysis of different skeletal segments and teeth and through several methods; however, traditional bone age assessment is a complicated and time-consuming process, prone to inter- and intra-observer variability. There is a high demand for fully automated systems, but creating an accurate and reliable solution has proven difficult. Deep learning technology, machine learning, and Convolutional Neural Networks-based systems, which are rapidly evolving, have shown promising results in automated bone age assessment. We provide the background of bone age estimation, its usefulness and traditional methods of assessment, and review the currently artificial-intelligence-based solutions for bone age assessment and the future perspectives of these applications.

Clinical impact of artificial intelligence-based solutions on imaging of the pancreas and liver.

Artificial intelligence (AI) has experienced substantial progress over the last ten years in many fields of application, including healthcare. In hepatology and pancreatology, major attention to date has been paid to its application to the assisted or even automated interpretation of radiological images, where AI can generate accurate and reproducible imaging diagnosis, reducing the physicians' workload. AI can provide automatic or semi-automatic segmentation and registration of the liver and pancreatic glands and lesions. Furthermore, using radiomics, AI can introduce new quantitative information which is not visible to the human eye to radiological reports. AI has been applied in the detection and characterization of focal lesions and diffuse diseases of the liver and pancreas, such as neoplasms, chronic hepatic disease, or acute or chronic pancreatitis, among others. These solutions have been applied to different imaging techniques commonly used to diagnose liver and pancreatic diseases, such as ultrasound, endoscopic ultrasonography, computerized tomography (CT), magnetic resonance imaging, and positron emission tomography/CT. However, AI is also applied in this context to many other relevant steps involved in a comprehensive clinical scenario to manage a gastroenterological patient. AI can also be applied to choose the most convenient test prescription, to improve image quality or accelerate its acquisition, and to predict patient prognosis and treatment response. In this review, we summarize the current evidence on the application of AI to hepatic and pancreatic radiology, not only in regard to the interpretation of images, but also to all the steps involved in the radiological workflow in a broader sense. Lastly, we discuss the challenges and future directions of the clinical application of AI methods.

Implementation of GAN-Based, Synthetic T2-Weighted Fat Saturated Images in the Routine Radiological Workflow Improves Spinal Pathology Detection.

(1) Background and Purpose: In magnetic resonance imaging (MRI) of the spine, T2-weighted (T2-w) fat-saturated (fs) images improve the diagnostic assessment of pathologies. However, in the daily clinical setting, additional T2-w fs images are frequently missing due to time constraints or motion artifacts. Generative adversarial networks (GANs) can generate synthetic T2-w fs images in a clinically feasible time. Therefore, by simulating the radiological workflow with a heterogenous dataset, this study's purpose was to evaluate the diagnostic value of additional synthetic, GAN-based T2-w fs images in the clinical routine. (2) Methods: 174 patients with MRI of the spine were retrospectively identified. A GAN was trained to synthesize T2-w fs images from T1-w, and non-fs T2-w images of 73 patients scanned in our institution. Subsequently, the GAN was used to create synthetic T2-w fs images for the previously unseen 101 patients from multiple institutions. In this test dataset, the additional diagnostic value of synthetic T2-w fs images was assessed in six pathologies by two neuroradiologists. Pathologies were first graded on T1-w and non-fs T2-w images only, then synthetic T2-w fs images were added, and pathologies were graded again. Evaluation of the additional diagnostic value of the synthetic protocol was performed by calculation of Cohen's ĸ and accuracy in comparison to a ground truth (GT) grading based on real T2-w fs images, pre- or follow-up scans, other imaging modalities, and clinical information. (3) Results: The addition of the synthetic T2-w fs to the imaging protocol led to a more precise grading of abnormalities than when grading was based on T1-w and non-fs T2-w images only (mean ĸ GT versus synthetic protocol = 0.65; mean ĸ GT versus T1/T2 = 0.56; p = 0.043). (4) Conclusions: The implementation of synthetic T2-w fs images in the radiological workflow significantly improves the overall assessment of spine pathologies. Thereby, high-quality, synthetic T2-w fs images can be virtually generated by a GAN from heterogeneous, multicenter T1-w and non-fs T2-w contrasts in a clinically feasible time, which underlines the reproducibility and generalizability of our approach.

Addressing the Challenges of Implementing Artificial Intelligence Tools in Clinical Practice: Principles From Experience

The multitude of artificial intelligence (AI)–based solutions, vendors, and platforms poses a challenging proposition to an already complex clinical radiology practice. Apart from assessing and ensuring acceptable local performance and workflow fit to improve imaging services, AI tools require multiple stakeholders, including clinical, technical, and financial, who collaborate to move potential deployable applications to full clinical deployment in a structured and efficient manner. Postdeployment monitoring and surveillance of such tools require an infrastructure that ensures proper and safe use. Herein, the authors describe their experience and framework for implementing and supporting the use of AI applications in radiology workflow.

Machine Learning Augmented Interpretation of Chest X-rays: A Systematic Review

Limitations of the chest X-ray (CXR) have resulted in attempts to create machine learning systems to assist clinicians and improve interpretation accuracy. An understanding of the capabilities and limitations of modern machine learning systems is necessary for clinicians as these tools begin to permeate practice. This systematic review aimed to provide an overview of machine learning applications designed to facilitate CXR interpretation. A systematic search strategy was executed to identify research into machine learning algorithms capable of detecting >2 radiographic findings on CXRs published between January 2020 and September 2022. Model details and study characteristics, including risk of bias and quality, were summarized. Initially, 2248 articles were retrieved, with 46 included in the final review. Published models demonstrated strong standalone performance and were typically as accurate, or more accurate, than radiologists or non-radiologist clinicians. Multiple studies demonstrated an improvement in the clinical finding classification performance of clinicians when models acted as a diagnostic assistance device. Device performance was compared with that of clinicians in 30% of studies, while effects on clinical perception and diagnosis were evaluated in 19%. Only one study was prospectively run. On average, 128,662 images were used to train and validate models. Most classified less than eight clinical findings, while the three most comprehensive models classified 54, 72, and 124 findings. This review suggests that machine learning devices designed to facilitate CXR interpretation perform strongly, improve the detection performance of clinicians, and improve the efficiency of radiology workflow. Several limitations were identified, and clinician involvement and expertise will be key to driving the safe implementation of quality CXR machine learning systems.

Myocardial Segmentation of Tagged Magnetic Resonance Images with Transfer Learning Using Generative Cine-To-Tagged Dataset Transformation.

The use of deep learning (DL) segmentation in cardiac MRI has the potential to streamline the radiology workflow, particularly for the measurement of myocardial strain. Recent efforts in DL motion tracking models have drastically reduced the time needed to measure the heart's displacement field and the subsequent myocardial strain estimation. However, the selection of initial myocardial reference points is not automated and still requires manual input from domain experts. Segmentation of the myocardium is a key step for initializing reference points. While high-performing myocardial segmentation models exist for cine images, this is not the case for tagged images. In this work, we developed and compared two novel DL models (nnU-net and Segmentation ResNet VAE) for the segmentation of myocardium from tagged CMR images. We implemented two methods to transform cardiac cine images into tagged images, allowing us to leverage large public annotated cine datasets. The cine-to-tagged methods included (i) a novel physics-driven transformation model, and (ii) a generative adversarial network (GAN) style transfer model. We show that pretrained models perform better (+2.8 Dice coefficient percentage points) and converge faster (6×) than models trained from scratch. The best-performing method relies on a pretraining with an unpaired, unlabeled, and structure-preserving generative model trained to transform cine images into their tagged-appearing equivalents. Our state-of-the-art myocardium segmentation network reached a Dice coefficient of 0.828 and 95th percentile Hausdorff distance of 4.745 mm on a held-out test set. This performance is comparable to existing state-of-the-art segmentation networks for cine images.

Unsupervised anomaly detection in brain MRI: Learning abstract distribution from massive healthy brains

PurposeTo develop a general unsupervised anomaly detection method based only on MR images of normal brains to automatically detect various brain abnormalities. Materials and methodsIn this study, a novel method based on three-dimensional deep autoencoder network is proposed to automatically detect and segment various brain abnormalities without being trained on any abnormal samples. A total of 578 normal T2w MR volumes without obvious abnormalities were used for model training and validation. The proposed 3D autoencoder was evaluated on two different datasets (BraTs dataset and in-house dataset) containing T2w volumes from patients with glioblastoma, multiple sclerosis and cerebral infarction. Lesions detection and segmentation performance were reported as AUC, precision-recall curve, sensitivity, and Dice score. ResultsIn anomaly detection, AUCs for three typical lesions were as follows: glioblastoma, 0.844; multiple sclerosis, 0.858; cerebral infarction, 0.807. In anomaly segmentation, the mean Dice for glioblastomas was 0.462. The proposed network also has the ability to generate an anomaly heatmap for visualization purpose. ConclusionOur proposed method was able to automatically detect various brain anomalies such as glioblastoma, multiple sclerosis, and cerebral infarction. This work suggests that unsupervised anomaly detection is a powerful approach to detect arbitrary brain abnormalities without labeled samples. It has the potential to support diagnostic workflow in radiology as an automated tool for computer-aided image analysis.

Evaluation of the HD-GLIO Deep Learning Algorithm for Brain Tumour Segmentation on Postoperative MRI.

In the context of brain tumour response assessment, deep learning-based three-dimensional (3D) tumour segmentation has shown potential to enter the routine radiological workflow. The purpose of the present study was to perform an external evaluation of a state-of-the-art deep learning 3D brain tumour segmentation algorithm (HD-GLIO) on an independent cohort of consecutive, post-operative patients. For 66 consecutive magnetic resonance imaging examinations, we compared delineations of contrast-enhancing (CE) tumour lesions and non-enhancing T2/FLAIR hyperintense abnormality (NE) lesions by the HD-GLIO algorithm and radiologists using Dice similarity coefficients (Dice). Volume agreement was assessed using concordance correlation coefficients (CCCs) and Bland-Altman plots. The algorithm performed very well regarding the segmentation of NE volumes (median Dice = 0.79) and CE tumour volumes larger than 1.0 cm3 (median Dice = 0.86). If considering all cases with CE tumour lesions, the performance dropped significantly (median Dice = 0.40). Volume agreement was excellent with CCCs of 0.997 (CE tumour volumes) and 0.922 (NE volumes). The findings have implications for the application of the HD-GLIO algorithm in the routine radiological workflow where small contrast-enhancing tumours will constitute a considerable share of the follow-up cases. Our study underlines that independent validations on clinical datasets are key to asserting the robustness of deep learning algorithms.

Implementing a Streamlined Radiology Workflow to Close the Loop on Incidental Imaging Findings in the Emergency Department.

Actionable incidental findings (AIFs) are common imaging findings unrelated to the clinical indication for the imaging test for which follow-up is recommended. Increasing utilization of imaging in the emergency department (ED) in recent years has resulted in more patients with AIFs. When these findings are not properly communicated and followed up upon, there is harm to the patient's health outcome as well as possible increased financial costs for the patient, the health system, and potential litigation. Tracking these findings can be difficult, especially so in a large health system. In this report, we detail our experience implementing a closed-loop AIF program within the ED of 11 satellite hospitals of a large academic health system. Our new workflow streamlined radiologist reporting of AIFs through system macros and by using a standardized form integrated into the dictation software. Upon completion of the form, an automatic email is sent to a dedicated nurse navigator who documented the findings and closed the loop by coordinating follow-up imaging or clinic visits with patients, primary care providers, and specialists. Through the new workflow, a total of 1207 incidental finding reports have been submitted from July 2021 to May 2022. The vast majority of AIFs were identified on CT, and the most common categories included lung nodules, pancreas lesions, liver lesions, and other potentially cancerous lesions. At least 10 new cancers have been detected. We hope this report can help guide other health systems in the design of a closed-loop incidental findings program.

Automation of a Rule-based Workflow to Estimate Age from Brain MR Imaging of Infants and Children Up to 2 Years Old Using Stacked Deep Learning.

Myelination-related MR signal changes in white matter are helpful for assessing normal development in infants and children. A rule-based myelination evaluation workflow regarding signal changes on T1-weighted images (T1WIs) and T2-weighted images (T2WIs) has been widely used in radiology. This study aimed to simulate a rule-based workflow using a stacked deep learning model and evaluate age estimation accuracy. The age estimation system involved two stacked neural networks: a target network-to extract five myelination-related images from the whole brain, and an age estimation network from extracted T1- and T2WIs separately. A dataset was constructed from 119 children aged below 2 years with two MRI systems. A four-fold cross-validation method was adopted. The correlation coefficient (CC), mean absolute error (MAE), and root mean squared error (RMSE) of the corrected chronological age of full-term birth, as well as the mean difference and the upper and lower limits of 95% agreement, were measured. Generalization performance was assessed using datasets acquired from different MR images. Age estimation was performed in Sturge-Weber syndrome (SWS) cases. There was a strong correlation between estimated age and corrected chronological age (MAE: 0.98 months; RMSE: 1.27 months; and CC: 0.99). The mean difference and standard deviation (SD) were -0.15 and 1.26, respectively, and the upper and lower limits of 95% agreement were 2.33 and -2.63 months. Regarding generalization performance, the performance values on the external dataset were MAE of 1.85 months, RMSE of 2.59 months, and CC of 0.93. Among 13 SWS cases, 7 exceeded the limits of 95% agreement, and a proportional bias of age estimation based on myelination acceleration was exhibited below 12 months of age (P = 0.03). Stacked deep learning models automated the rule-based workflow in radiology and achieved highly accurate age estimation in infants and children up to 2 years of age.

Emerging Value-Based Radiology in the Era of Artificial Intelligence

Radiology has a long history of adopting state-of-the-art digital technology to provide better diagnostic services and facilitate advances in image-based therapeutics throughout the healthcare system. The radiology community has been developing diagnostic artificial intelligence (AI) tools over the past 20 years, long before AI became fashionable in the public press. Currently, there are approximately four hundred Food and Drug Administration approved imaging AI products. However, the clinical adoption of these products in radiology has been relatively dismal, indicating that the current technology-push model needs to evolve into the demand-pull model. We will review the current state of AI use in radiology from the perspective of clinical adoption and explore the ways in which AI products will become an ensemble of critically important tools to help radiology transition from volume-based service to value-based healthcare. This transition will create new demands for AI technologies. We contrast the current “technology-push” model with a “demand-pull” model that will aligns technology with user priorities. We summarize the lessons learned from AI experience over the past twenty years, mainly working with computer-aided detection for breast cancers and lung cancers. The radiology community calls for AI tools that can do more than detection with increasing attention toward higher workflow efficiency and higher productivity of radiologists. Major radiological societies of North America and Europe promulgated the emerging concept of value-based radiology service, an integral part of overall value-based healthcare. The transition to value-based radiology will happen and that higher value will come from the effective use of AI throughout the radiology workflow. The value-based radiology will need to work with a full range of machine learning tools, including supervised, unsupervised, and reinforcement learning, as well as natural language processing and large language models (e.g., chatbots). The engineering community is rapidly developing many concepts and sophisticated software tools for data orchestration, AI orchestration, and automation orchestration. Current radiology operation has been supported by PACS, a monolithic IT infrastructure of past generations. This system will need to migrate to an intelligence management system to support the new workflow needed for high value radiology.

Generation of Radiology Findings in Chest X-Ray by Leveraging Collaborative Knowledge

Among all the sub-sections in a typical radiology report, the Clinical Indications, Findings, and Impression often reflect important details about the health status of a patient. The information included in Impression is also often covered in Findings. While Findings and Impression can be deduced by inspecting the image, Clinical Indications often require additional context. The cognitive task of interpreting medical images remains the most critical and often time-consuming step in the radiology workflow. Instead of generating an end-to-end radiology report, in this paper, we focus on generating the Findings from automated interpretation of medical images, specifically chest X-rays (CXRs). Thus, this work focuses on reducing the workload of radiologists who spend most of their time either writing or narrating the Findings. Unlike past research, which addresses radiology report generation as a single-step image captioning task, we have further taken into consideration the complexity of interpreting CXR images and propose a two-step approach: (a) detecting the regions with abnormalities in the image, and (b) generating relevant text for regions with abnormalities by employing a generative large language model (LLM). This two-step approach introduces a layer of interpretability and aligns the framework with the systematic reasoning that radiologists use when reviewing a CXR.

Enhancing radiology workflow: alert system for intracranial hemorrhages using deep learning and single-board computers

Enhancing radiology workflow: alert system for intracranial hemorrhages using deep learning and single-board computers

Improving artificial intelligence pipeline for liver malignancy diagnosis using ultrasound images and video frames.

Recent developments of deep learning methods have demonstrated their feasibility in liver malignancy diagnosis using ultrasound (US) images. However, most of these methods require manual selection and annotation of US images by radiologists, which limit their practical application. On the other hand, US videos provide more comprehensive morphological information about liver masses and their relationships with surrounding structures than US images, potentially leading to a more accurate diagnosis. Here, we developed a fully automated artificial intelligence (AI) pipeline to imitate the workflow of radiologists for detecting liver masses and diagnosing liver malignancy. In this pipeline, we designed an automated mass-guided strategy that used segmentation information to direct diagnostic models to focus on liver masses, thus increasing diagnostic accuracy. The diagnostic models based on US videos utilized bi-directional convolutional long short-term memory modules with an attention-boosted module to learn and fuse spatiotemporal information from consecutive video frames. Using a large-scale dataset of 50063 US images and video frames from 11468 patients, we developed and tested the AI pipeline and investigated its applications. A dataset of annotated US images is available at https://doi.org/10.5281/zenodo.7272660.

Quantitative Susceptibility Mapping: Translating an Investigative Research Tool into High Volume Clinical Diagnostic Imaging.

Quantitative susceptibility mapping (QSM) is an MRI-based technique for iron quantification of targeted tissue. QSM provides information relevant to clinicians in a broad range of diagnostic contexts, including sickle cell disease, inflammatory/demyelinating processes, and neoplasms. However, major MRI vendors do not offer QSM post-processing in a form ready for general use. This work describes a vendor-agnostic approach for scaling QSM analysis from a research technique to a routine diagnostic test. We provide the details needed to seamlessly integrate hardware, software, and clinical systems to provide QSM processing for a busy clinical radiology workflow. This approach can be generalized to other advanced MRI acquisitions and analyses with proven diagnostic utility, yet without crucial MR vendor support.

Role of an Automated Deep Learning Algorithm for Reliable Screening of Abnormality in Chest Radiographs: A Prospective Multicenter Quality Improvement Study.

In medical practice, chest X-rays are the most ubiquitous diagnostic imaging tests. However, the current workload in extensive health care facilities and lack of well-trained radiologists is a significant challenge in the patient care pathway. Therefore, an accurate, reliable, and fast computer-aided diagnosis (CAD) system capable of detecting abnormalities in chest X-rays is crucial in improving the radiological workflow. In this prospective multicenter quality-improvement study, we have evaluated whether artificial intelligence (AI) can be used as a chest X-ray screening tool in real clinical settings. Methods: A team of radiologists used the AI-based chest X-ray screening tool (qXR) as a part of their daily reporting routine to report consecutive chest X-rays for this prospective multicentre study. This study took place in a large radiology network in India between June 2021 and March 2022. Results: A total of 65,604 chest X-rays were processed during the study period. The overall performance of AI achieved in detecting normal and abnormal chest X-rays was good. The high negatively predicted value (NPV) of 98.9% was achieved. The AI performance in terms of area under the curve (AUC), NPV for the corresponding subabnormalities obtained were blunted CP angle (0.97, 99.5%), hilar dysmorphism (0.86, 99.9%), cardiomegaly (0.96, 99.7%), reticulonodular pattern (0.91, 99.9%), rib fracture (0.98, 99.9%), scoliosis (0.98, 99.9%), atelectasis (0.96, 99.9%), calcification (0.96, 99.7%), consolidation (0.95, 99.6%), emphysema (0.96, 99.9%), fibrosis (0.95, 99.7%), nodule (0.91, 99.8%), opacity (0.92, 99.2%), pleural effusion (0.97, 99.7%), and pneumothorax (0.99, 99.9%). Additionally, the turnaround time (TAT) decreased by about 40.63% from pre-qXR period to post-qXR period. Conclusions: The AI-based chest X-ray solution (qXR) screened chest X-rays and assisted in ruling out normal patients with high confidence, thus allowing the radiologists to focus more on assessing pathology on abnormal chest X-rays and treatment pathways.