Louis Plesner talks AI x-ray exam reads vs. radiologists'

Will Morton
Sep 28, 2023

In an interview with AuntMinnie.com, Louis Plesner, MD, of Herlev and Gentofte Hospital in Copenhagen, Denmark, discussed a study he led that was published September 26 in Radiology that found radiologists outperformed four commercially available algorithms for identifying diseases on chest x-rays.


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Lateral conventional attenuation (a, b, e, f) and co-registered dark-field (c, d, g, h) images of two spine specimens. Vertical (a, c, e, g) and horizontal (b, d, f, h) scans of the spine specimen of a 77-year-old female with osteoporosis (bone mineral density = 65.75 mg/dL) (a–d) and a non-osteoporotic spine specimen (e–h) of a 61-year-old female (bone mineral density = 169.38 mg/dL).
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Example of triage of no change in a pair of chest radiographs in the emergency department. (A) Baseline posteroanterior chest radiograph in a 63-year-old female patient shows a small amount of left (L) pleural effusion and partial atelectasis of the right middle lobe. (B) Follow-up posteroanterior chest radiograph obtained in the same patient 1 day later shows no significant change. (C) Gradient-weighted class activation map shows the algorithm determined no change in the image pair, without relevant highlighting, as the highlighted area is located over the gastroesophageal junction. Image courtesy of Radiology.
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The AI model is an encoder-decoder model trained to generate a text report given a chest x-ray and most recent comparison (anterior-posterior or posterior-anterior view only). The vision encoder weights were initialized from Vision Transformer (ViT) base and the text decoder weights were initialized from Robustly Optimized BERT Pretraining Approach (RoBERTa) base before training for 30 epochs on a data set of 900,000 chest x-rays (CXRs). cp indicates chest pain; sob = shortness of breath. Image courtesy of JAMA Open Network.
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XRAI (left) and GradCAM (right) heatmaps for true positive images. The original radiographs are on the left, the Grad-CAM activations and heatmaps are in the middle, and the XRAI activations and overlays are on the right. For the XRAI overlays, only regions reaching the 70th percentile of activation strength are shown. Images available under Creative Commons license (CC BY 4.0 DEED, Attribution 4.0 International) and courtesy of PLOS Digital Health.
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