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Research ArticleORIGINAL RESEARCH

AI Efficacy as a Function of Trainee Interpreter Proficiency: Lessons from a Randomized Controlled Trial

David A. Fussell, Cynthia C. Tang, Jake Sternhagen, Varun V. Marrey, Kelsey M. Roman, Jeremy Johnson, Michael J. Head, Hayden R. Troutt, Charles H. Li, Peter D. Chang, John Joseph and Daniel S. Chow
American Journal of Neuroradiology June 2024, ajnr.A8387; DOI: https://doi.org/10.3174/ajnr.A8387
David A. Fussell
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Cynthia C. Tang
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Jake Sternhagen
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Varun V. Marrey
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Kelsey M. Roman
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Jeremy Johnson
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Michael J. Head
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Hayden R. Troutt
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Charles H. Li
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Peter D. Chang
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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John Joseph
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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Daniel S. Chow
From the Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA (D.A.F., C.C.T., J.S., V.V.M., J.J., H.R.T., C.H.L., P.D.C., D.S.C); School of Medicine, University of California, Irvine, Irvine, CA, USA (M.J.H.); Paul Merage School of Business, University of California, Irvine, Irvine, CA, USA (J.J.).
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ABSTRACT

BACKGROUND AND PURPOSE: Recently, AI tools have been deployed with increasing speed in educational and clinical settings. However, the use of AI by trainees across different levels of experience has not been well studied. This study investigates the impact of AI assistance on diagnostic accuracy for intracranial hemorrhage (ICH) and large vessel occlusion (LVO) by medical students (MS) and resident trainees (RT).

MATERIALS AND METHODS: This prospective study was conducted between March 2023 and October 2023. MS and RT were asked to identify ICH and LVO in 100 non-contrast head CTs and 100 head CTAs, respectively. One group received diagnostic aid simulating AI for ICH only (n = 26), the other for LVO only (n = 28). Primary outcomes included accuracy, sensitivity, and specificity for ICH / LVO detection without and with aid. Study interpretation time was a secondary outcome. Individual responses were pooled and analyzed with chi-square; differences in continuous variables were assessed with ANOVA.

RESULTS: 48 participants completed the study, generating 10,779 ICH or LVO interpretations. With diagnostic aid, MS accuracy improved 11.0 points (P < .001) and RT accuracy showed no significant change. ICH interpretation time increased with diagnostic aid for both groups (P < .001) while LVO interpretation time decreased for MS (P < .001). Despite worse performance in detection of the smallest vs. the largest hemorrhages at baseline, MS were not more likely to accept a true positive AI result for these more difficult tasks. Both groups were considerably less accurate when disagreeing with the AI or when supplied with an incorrect AI result.

CONCLUSIONS: This study demonstrated greater improvement in diagnostic accuracy with AI for MS compared to RT. However, MS were less likely than RT to overrule incorrect AI interpretations and were less accurate, even with diagnostic aid, than the AI was by itself.

ABBREVIATIONS: ICH = intracranial hemorrhage; LVO = large vessel occlusion; MS = medical students; RT = resident trainees.

  • © 2024 by American Journal of Neuroradiology

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Accepted Manuscript
David A. Fussell, Cynthia C. Tang, Jake Sternhagen, Varun V. Marrey, Kelsey M. Roman, Jeremy Johnson, Michael J. Head, Hayden R. Troutt, Charles H. Li, Peter D. Chang, John Joseph, Daniel S. Chow
AI Efficacy as a Function of Trainee Interpreter Proficiency: Lessons from a Randomized Controlled Trial
American Journal of Neuroradiology Jun 2024, ajnr.A8387; DOI: 10.3174/ajnr.A8387

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Accepted Manuscript
AI Efficacy as a Function of Trainee Interpreter Proficiency: Lessons from a Randomized Controlled Trial
David A. Fussell, Cynthia C. Tang, Jake Sternhagen, Varun V. Marrey, Kelsey M. Roman, Jeremy Johnson, Michael J. Head, Hayden R. Troutt, Charles H. Li, Peter D. Chang, John Joseph, Daniel S. Chow
American Journal of Neuroradiology Jun 2024, ajnr.A8387; DOI: 10.3174/ajnr.A8387
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