Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit
<p><strong>Background:</strong> Interpreting point-of-care lung ultrasound (LUS) images from intensive care unit (ICU) patients can be challenging, especially in low- and middle- income countries (LMICs) where there is limited training available. Despite recent advances in the use...
| Główni autorzy: | , , , , , , , , , , , , , , , , , |
|---|---|
| Kolejni autorzy: | |
| Format: | Journal article |
| Język: | English |
| Wydane: |
BioMed Central
2023
|
| _version_ | 1826311004137455616 |
|---|---|
| author | Nhat, PTH Van Hao, N Tho, PV Kerdegari, H Pisani, L Thu, LNM Phuong, LT Duong, HTH Thuy, DB McBride, A Xochicale, M Schultz, MJ Razavi, R King, AP Thwaites, L Van Vinh Chau, N Yacoub, S Gomez, A |
| author2 | VITAL Consortium |
| author_facet | VITAL Consortium Nhat, PTH Van Hao, N Tho, PV Kerdegari, H Pisani, L Thu, LNM Phuong, LT Duong, HTH Thuy, DB McBride, A Xochicale, M Schultz, MJ Razavi, R King, AP Thwaites, L Van Vinh Chau, N Yacoub, S Gomez, A |
| author_sort | Nhat, PTH |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Interpreting point-of-care lung ultrasound (LUS) images from intensive care unit (ICU) patients can be challenging, especially in low- and middle- income countries (LMICs) where there is limited training available. Despite recent advances in the use of Artificial Intelligence (AI) to automate many ultrasound imaging analysis tasks, no AI-enabled LUS solutions have been proven to be clinically useful in ICUs, and specifically in LMICs. Therefore, we developed an AI solution that assists LUS practitioners and assessed its usefulness in a low resource ICU.</p>
<p><strong>Methods:</strong> This was a three-phase prospective study. In the first phase, the performance of four different clinical user groups in interpreting LUS clips was assessed. In the second phase, the performance of 57 non-expert clinicians with and without the aid of a bespoke AI tool for LUS interpretation was assessed in retrospective offline clips. In the third phase, we conducted a prospective study in the ICU where 14 clinicians were asked to carry out LUS examinations in 7 patients with and without our AI tool and we interviewed the clinicians regarding the usability of the AI tool.</p>
<p><strong>Results:</strong> The average accuracy of beginners’ LUS interpretation was 68.7% [95% CI 66.8–70.7%] compared to 72.2% [95% CI 70.0–75.6%] in intermediate, and 73.4% [95% CI 62.2–87.8%] in advanced users. Experts had an average accuracy of 95.0% [95% CI 88.2–100.0%], which was significantly better than beginners, intermediate and advanced users (p < 0.001). When supported by our AI tool for interpreting retrospectively acquired clips, the non-expert clinicians improved their performance from an average of 68.9% [95% CI 65.6–73.9%] to 82.9% [95% CI 79.1–86.7%], (p < 0.001). In prospective real-time testing, non-expert clinicians improved their baseline performance from 68.1% [95% CI 57.9–78.2%] to 93.4% [95% CI 89.0–97.8%], (p < 0.001) when using our AI tool. The time-to-interpret clips improved from a median of 12.1 s (IQR 8.5–20.6) to 5.0 s (IQR 3.5–8.8), (p < 0.001) and clinicians’ median confidence level improved from 3 out of 4 to 4 out of 4 when using our AI tool.</p>
<p><strong>Conclusions:</strong> AI-assisted LUS can help non-expert clinicians in an LMIC ICU improve their performance in interpreting LUS features more accurately, more quickly and more confidently.</p> |
| first_indexed | 2024-03-07T08:00:22Z |
| format | Journal article |
| id | oxford-uuid:5d72a1fa-cae6-4c4e-9bb7-060fb43e12b0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:00:22Z |
| publishDate | 2023 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:5d72a1fa-cae6-4c4e-9bb7-060fb43e12b02023-09-28T11:42:37ZClinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unitJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5d72a1fa-cae6-4c4e-9bb7-060fb43e12b0EnglishSymplectic ElementsBioMed Central2023Nhat, PTHVan Hao, NTho, PVKerdegari, HPisani, LThu, LNMPhuong, LTDuong, HTHThuy, DBMcBride, AXochicale, MSchultz, MJRazavi, RKing, APThwaites, LVan Vinh Chau, NYacoub, SGomez, AVITAL Consortium<p><strong>Background:</strong> Interpreting point-of-care lung ultrasound (LUS) images from intensive care unit (ICU) patients can be challenging, especially in low- and middle- income countries (LMICs) where there is limited training available. Despite recent advances in the use of Artificial Intelligence (AI) to automate many ultrasound imaging analysis tasks, no AI-enabled LUS solutions have been proven to be clinically useful in ICUs, and specifically in LMICs. Therefore, we developed an AI solution that assists LUS practitioners and assessed its usefulness in a low resource ICU.</p> <p><strong>Methods:</strong> This was a three-phase prospective study. In the first phase, the performance of four different clinical user groups in interpreting LUS clips was assessed. In the second phase, the performance of 57 non-expert clinicians with and without the aid of a bespoke AI tool for LUS interpretation was assessed in retrospective offline clips. In the third phase, we conducted a prospective study in the ICU where 14 clinicians were asked to carry out LUS examinations in 7 patients with and without our AI tool and we interviewed the clinicians regarding the usability of the AI tool.</p> <p><strong>Results:</strong> The average accuracy of beginners’ LUS interpretation was 68.7% [95% CI 66.8–70.7%] compared to 72.2% [95% CI 70.0–75.6%] in intermediate, and 73.4% [95% CI 62.2–87.8%] in advanced users. Experts had an average accuracy of 95.0% [95% CI 88.2–100.0%], which was significantly better than beginners, intermediate and advanced users (p < 0.001). When supported by our AI tool for interpreting retrospectively acquired clips, the non-expert clinicians improved their performance from an average of 68.9% [95% CI 65.6–73.9%] to 82.9% [95% CI 79.1–86.7%], (p < 0.001). In prospective real-time testing, non-expert clinicians improved their baseline performance from 68.1% [95% CI 57.9–78.2%] to 93.4% [95% CI 89.0–97.8%], (p < 0.001) when using our AI tool. The time-to-interpret clips improved from a median of 12.1 s (IQR 8.5–20.6) to 5.0 s (IQR 3.5–8.8), (p < 0.001) and clinicians’ median confidence level improved from 3 out of 4 to 4 out of 4 when using our AI tool.</p> <p><strong>Conclusions:</strong> AI-assisted LUS can help non-expert clinicians in an LMIC ICU improve their performance in interpreting LUS features more accurately, more quickly and more confidently.</p> |
| spellingShingle | Nhat, PTH Van Hao, N Tho, PV Kerdegari, H Pisani, L Thu, LNM Phuong, LT Duong, HTH Thuy, DB McBride, A Xochicale, M Schultz, MJ Razavi, R King, AP Thwaites, L Van Vinh Chau, N Yacoub, S Gomez, A Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit |
| title | Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit |
| title_full | Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit |
| title_fullStr | Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit |
| title_full_unstemmed | Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit |
| title_short | Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit |
| title_sort | clinical benefit of ai assisted lung ultrasound in a resource limited intensive care unit |
| work_keys_str_mv | AT nhatpth clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT vanhaon clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT thopv clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT kerdegarih clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT pisanil clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT thulnm clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT phuonglt clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT duonghth clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT thuydb clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT mcbridea clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT xochicalem clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT schultzmj clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT razavir clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT kingap clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT thwaitesl clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT vanvinhchaun clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT yacoubs clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit AT gomeza clinicalbenefitofaiassistedlungultrasoundinaresourcelimitedintensivecareunit |