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Julius Henning Niehoff, Jana Kalaitzidis, Jan Robert Kröger, Denise Schönbeck, Jan Borggrefe, Arwed Elias Michael

• The AI-Rad Companion Chest X-ray (AI-Rad, Siemens Healthineers) is an artificial-intelligence based application for the analysis of chest X-rays. The purpose of the present study is to evaluate the performance of the AI-Rad. In total, 499 radiographs were retrospectively included. Radiographs were independently evaluated by radiologists and the AI-Rad. Findings indicated by the AI-Rad and findings described in the written report (WR) were compared to the findings of a ground truth reading (consensus decision of two radiologists after assessing additional radiographs and CT scans). The AI-Rad can offer superior sensitivity for the detection of lung lesions (0.83 versus 0.52), consolidations (0.88 versus 0.78) and atelectasis (0.54 versus 0.43) compared to the WR. However, the superior sensitivity is accompanied by higher false-detection-rates. The sensitivity of the AI-Rad for the detection of pleural effusions is lower compared to the WR (0.74 versus 0.88). The negative-predictive-values (NPV) of the AI-Rad for the detection of all pre-defined findings are on a high level and comparable to the WR. The seemingly advantageous high sensitivity of the AI-Rad is partially offset by the disadvantage of a high false-detection-rate. At the current stage of development, therefore, the high NPVs may be the greatest benefit of the AI-Rad giving radiologists the possibility to re-insure their own negative search for pathologies and thus boosting their confidence in their reports.