The “CXR-Lung-Risk” model was developed using 147,497 chest X-rays of 40,643 asymptomatic smokers and never-smokers from the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial to predict lung-related mortality risk, based on a single chest X-ray image as input.
The researchers externally validated the model in a separate group of never-smokers having routine outpatient chest X-rays from 2013 to 2014. The primary outcome was six-year incident lung cancer, identified using International Classification of Disease codes. Risk scores were then converted to low, moderate and high-risk groups based on externally derived risk thresholds.
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Of 17,407 patients (mean age 63 years) included in the study, 28% were deemed high risk by the deep learning model, and 2.9% of these patients later had a diagnosis of lung cancer. The high-risk group well exceeded the 1.3% six-year risk threshold where lung cancer screening CT is recommended by National Comprehensive Cancer Network guidelines.
After adjusting for age, sex, race, previous lower respiratory tract infection and prevalent chronic obstructive pulmonary disease, there was still a 2.1 times greater risk of developing lung cancer in the high-risk group compared to the low-risk group.
“This AI tool opens the door for opportunistic screening for never-smokers at high risk of lung cancer, using existing chest X-rays in the electronic medical record,” said senior author Michael T. Lu, M.D., M.P.H., director of artificial intelligence and co-director of CIRC at MGH. “Since cigarette smoking rates are declining, approaches to detect lung cancer early in those who do not smoke are going to be increasingly important.”
Additional co-authors are Saman Doroodgar Jorshery, M.D., Ph.D., and Vineet K. Raghu, Ph.D
The researchers report support from the Boston University School of Medicine Student Committee on Medical School Affairs, National Academy of Medicine/Johnson & Johnson Innovation Quickfire Challenge, and the Risk Management Corporation of the Harvard Medical Institutions Incorporated.
About RSNA
RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois
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