Artificial intelligence CAD tools in trauma imaging: a scoping review from the American Society of Emergency Radiology (ASER) AI/ML Expert Panel

Abstract

Background: AI/ML CAD tools can potentially improve outcomes in the high-stakes, high-volume model of trauma radiology. No prior scoping review has been undertaken to comprehensively assess tools in this subspecialty.

Purpose: To map the evolution and current state of trauma radiology CAD tools along key dimensions of technology readiness.

Methods: Following a search of databases, abstract screening, and full-text document review, CAD tool maturity was charted using elements of data curation, performance validation, outcomes research, explainability, user acceptance, and funding patterns. Descriptive statistics were used to illustrate key trends.

Results: A total of 4052 records were screened, and 233 full-text articles were selected for content analysis. Twenty-one papers described FDA-approved commercial tools, and 212 reported algorithm prototypes. Works ranged from foundational research to multi-reader multi-case trials with heterogeneous external data. Scalable convolutional neural network-based implementations increased steeply after 2016 and were used in all commercial products; however, options for explainability were narrow. Of FDA-approved tools, 9/10 performed detection tasks. Dataset sizes ranged from < 100 to > 500,000 patients, and commercialization coincided with public dataset availability. Cross-sectional torso datasets were uniformly small. Data curation methods with ground truth labeling by independent readers were uncommon. No papers assessed user acceptance, and no method included human-computer interaction. The USA and China had the highest research output and frequency of research funding.

Conclusions: Trauma imaging CAD tools are likely to improve patient care but are currently in an early stage of maturity, with few FDA-approved products for a limited number of uses. The scarcity of high-quality annotated data remains a major barrier.

Keywords: Artificial intelligence; Computer-aided detection; Emergency; Emergency radiology; Imaging; Machine learning; Radiology; Scoping review; Trauma.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart depicting study selection

Fig. 2

Percent plot of publications using siloed (non-public) single center, siloed multicenter, and public data over time

Fig. 3

Bubble plots depict the number of papers in each domain over time. A Papers by body region and imaging modality. B Papers by regulatory status. The final search date of June 6, 2022 (midway through year) accounts for fewer publications in 2022