International Multicenter Validation of an Expanded AI Diagnostic System for 18 Pathologies in Thoracic and Musculoskeletal Radiography

Abstract

Background: Conventional radiography faces high error rates (3–10%) due to heavy clinical workloads. While AI has emerged as a supportive tool, there is an evidence gap regarding the clinical utility of integrated AI systems in detecting both skeletal and thoracic abnormalities. Objectives: This large-scale, international multicenter study aims to validate the performance of a unified radiographic AI suite across an expanded diagnostic scope while confirming its continued robustness. Methods: A retrospective performance evaluation was conducted using 21,581 adult and pediatric X-rays collected from 20 countries. The reference standard was established through independent review by two expert readers, with adjudication of a third radiologist in cases of discordance. Diagnostic metrics, including Area Under the Curve (AUC), sensitivity, and specificity, were calculated for all 18 pathologies. Subgroup analysis was performed by patients’ age, sex, and country of acquisition. Results: For the nine findings within the expanded scope, AUC values exceeded 96.1%, with sensitivity and specificity ranges from 94.5 to 98.8% and 86.6 to 96.1%, respectively. Similarly, for the nine historically validated findings, AUCs remained above 96.1%, with sensitivity and specificity localized between 94.5 and 97.8% and 84.6 and 89.4%, respectively. Consistency was maintained across subgroups. Conclusions: The results confirm the potential of deep learning to transition from narrow, task-specific tools to a unified, high-performance diagnostic system.

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