Utilization of Artificial Intelligence–based Intracranial Hemorrhage Detection on Emergent Noncontrast CT Images in Clinical Workflow

Authors implemented an artificial intelligence (AI)-based detection tool for intracranial hemorrhage (ICH) on noncontrast CT images into an emergent workflow, evaluated its diagnostic performance, and assessed clinical workflow metrics compared with pre-AI implementation. The finalized radiology report constituted the ground truth for the analysis, and CT examinations (n = 4450) before and after implementation were retrieved using various keywords for ICH. Diagnostic performance was assessed, and mean values with their respective 95% CIs were reported to compare workflow metrics (report turnaround time, communication time of a finding, consultation time of another specialty, and turnaround time in the emergency department). Although practicable diagnostic performance was observed for overall ICH detection with 93.0% diagnostic accuracy, 87.2% sensitivity, and 97.8% negative predictive value, the tool yielded lower detection rates for specific subtypes of ICH (eg, 69.2% 74 of 107 for subdural hemorrhage and 77.4% 24 of 31 for acute subarachnoid hemorrhage). Common false-positive findings included postoperative and postischemic defects (23.6%, 37 of 157), artifacts (19.7%, 31 of 157), and tumors (15.3%, 24 of 157). Although workflow metrics such as communicating a critical finding (70 minutes 95% CI: 54, 85 vs 63 minutes 95% CI: 55, 71) were on average reduced after implementation, future efforts are necessary to streamline the workflow all along the workflow chain. It is crucial to define a clear framework and recognize limitations as AI tools are only as reliable as the environment in which they are deployed. Keywords: CT, CNS, Stroke, Diagnosis, Classification, Application Domain © RSNA, 2022.