Can Artificial Intelligence (AI) Be Used to Accurately Detect Tuberculosis (TB) from Chest X-Rays? An Evaluation of Five AI Products for TB Triaging in a High TB Burden Setting

Background: Artificial intelligence-powered computer aided detection (CAD) products can be trained to recognize tuberculosis (TB)-related abnormalities on chest radiographs in order to screen and triage for TB. There are a number of these products available commercially and interest in these tools in the field of TB has grown over the past few years. Methods: We evaluated five commercially available AI software products using a large dataset collected in three TB screening centers in Dhaka, Bangladesh. A total of 23,566 individuals whom visited these centers were consecutively enrolled in the study. All individuals received a CXR and an Xpert test. All CXR were read independently by a group of three Bangladeshi board-certified radiologists and five AI products: CAD4TB (v6.3.0), InferRead®DR (v2), Lunit INSIGHT for Chest Radiography (v4.9.0), JF CXR-1 (v2) and qXR (v3). Findings: All five AI products significantly outperformed the human readers. The areas under the receiver operating characteristic curves are qXR: 0·91 (95% CI:0·90-0·91), CAD4TB: 0.90 (95% CI:0·90-0·91), Lunit INSIGHT CXR: 0·89 (95% CI:0·88-0·89), InferRead®DR: 0·85 (95% CI:0·84-0·86) and JF CXR-1: 0·85 (95% CI:0·84-0·85). We also proposed a new analytical framework to evaluate tests used for screening and triaging and to inform threshold selection by consideration of both cost-effectiveness and ability to triage. Further, AI products performed differently across the subgroups of age, use cases, and prior TB history. Interpretation: These AI products can be useful screening and triage tools for active case finding in high TB-burden regions. Funding Statement: Government of Canada. Declaration of Interests: None declared. Ethics Approval Statement: All enrolled participants provided informed written consent. The study protocol was reviewed and approved by the Research Review Committee and the Ethical Review Committee at the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).