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AI Outperforms Human Readers in Detecting Lung Nodules on X-Rays

By MedImaging International staff writers
Posted on 01 Feb 2024

Image: A new study tested a variety of AI algorithms head-to-head under similar conditions (Photo courtesy of 123RF)

Currently, over 150 artificial intelligence (AI)-based software products are available in the European market for radiology, with many addressing similar use cases. This makes it challenging for radiology departments to determine which software is most suitable for their needs. While software performance is a crucial factor in the procurement process, public data are scarce on the performance of these products. Clinical centers often lack the resources and personnel to thoroughly evaluate and compare multiple products before making a purchase. To address this issue, an initiative called Project AIR has been launched that aims to enhance market transparency for AI in radiology. Project AIR researchers have compiled a verified database of medical images for various clinical uses. This database allows for the comparative testing of multiple AI algorithms.

Now, in the first tests of the Project AIR concept, researchers discovered that out of seven AI algorithms trialed for detecting lung nodules in X-rays, four surpassed human readers in performance, while two algorithms for bone age prediction did not meet expectations. For testing the Project AIR concept, a team that included researchers from Radboud University (Nijmegen, the Netherlands) invited AI developers to participate. Between June 2022 and January 2023, nine products from eight vendors were validated: two for bone age prediction and seven for lung nodule assessment (one vendor participated in both categories). The team observed that the two algorithms for bone age analysis, Visiana, and Vuno, demonstrated excellent correlation with the reference standard, achieving r correlation coefficients of 0.987-0.989 (with 1 indicating perfect agreement). In lung nodule analysis, there was a more significant variation in performance, with human readers averaging an Area Under the Curve (AUC) of 0.81. The AI algorithms from Annalise.ai, Lunit, Milvue, and Oxipit showed superior performance, with AUCs of 0.90, 0.93, 0.86, and 0.88, respectively. The next tests of the Project AIR concept will focus on AI algorithms for fracture detection.

“We have shown the feasibility of the Project AIR methodology for external validation of commercial artificial intelligence (AI) products in medical imaging,” noted the researchers. “It is conceivable that in the future, radiology departments will require vendors to participate in transparent and comparative evaluations as a prerequisite for purchasing AI products.”

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92 (157.83309936523): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800106 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

93 (!!!!! 1234.0545654297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

94 (624.17984008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

95 (985.14556884766): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800106 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

96 (603.91426086426): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

97 (448.94218444824): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

98 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

99 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

100 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

101 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

102 (149.01161193848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

103 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

104 (283.00285339355): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

105 (!!!!! 74280.023574829): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

106 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

107 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

108 (!!!!! 1058.1016540527): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800106 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800106 AND type='deeppockets_item' AND published='1' LIMIT 1

109 (!!!!! 934534.07287598): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

110 (!!!!! 924837.11242676): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

111 (123.97766113281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

112 (333.07075500488): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

113 (90.837478637695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

114 (199.0795135498): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

115 (207.18574523926): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

116 (82.015991210938): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

117 (988.00659179688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

118 (342.84591674805): SELECT name FROM jos_deeppockets WHERE id=211

119 (46.968460083008): SELECT name FROM jos_deeppockets WHERE id=211

120 (750.06484985352): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

121 (807.04689025879): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

122 (!!!!! 1981.9736480713): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

123 (!!!!! 1866.1022186279): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

124 (!!!!! 12217.998504639): TRUNCATE TABLE jos_trademed_module

125 (757.93266296387): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800106 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

126 (705.95741271973): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

127 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

128 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

129 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

130 (!!!!! 1543.0450439453): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

131 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

132 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

133 (!!!!! 1687.0498657227): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800106 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800106 AND type='deeppockets_item' AND published='1' LIMIT 1

134 (302.79159545898): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

135 (!!!!! 3879.0702819824): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

136 (!!!!! 3895.9980010986): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

137 (!!!!! 1535.8924865723): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

138 (241.99485778809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800106 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800106 AND published='1' LIMIT 1

139 (46.968460083008): select jos_twitters.link from jos_twitters where cat=10

140 (96.08268737793): select jos_facebook.link from jos_facebook where cat=10

141 (129.93812561035): select jos_google_plus.link from jos_google_plus where cat=10

142 (78.916549682617): select jos_linkedin.link from jos_linkedin where cat=10

143 (421.04721069336): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

144 (!!!!! 6769.8955535889): insert into jos_banners_delta values (14615,'2025-04-29 15:29:50','18.220.147.154','view'),(14202,'2025-04-29 15:29:50','18.220.147.154','view'),(14203,'2025-04-29 15:29:50','18.220.147.154','view')

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