AI-supported chest x-ray analysis for lung cancer detection - systematic review of clinical outcomes and organisational implications
Erdos J, Grabenhofer L
Record ID 32018015448
English
Authors' objectives:
Artificial intelligence (AI) applications in diagnostic imaging are increasingly used to support image interpretation, prioritise examinations, and optimise clinical workflows. Against the backdrop of rising imaging volumes, limited human resources, and increasing diagnostic complexity, AI-supported digital health technologies (DHTs) are discussed as potential tools to alleviate pressures on radiology services. This assessment aimed to identify and prioritise AI-enabled DHTs relevant for Austrian hospitals and to evaluate the clinical effectiveness, organisational implications, and resource considerations of one prioritised application.
Authors' results and conclusions:
Following a stakeholder-based prioritisation process, AI-supported analysis of chest X-ray images for suspected lung cancer was selected for detailed assessment. Three HTAs and two additional primary studies were included, comprising 15 unique primary studies evaluating 14 AI software products. Most studies were retrospective and conducted in single-centre settings. No study reported patient-relevant clinical outcomes such as mortality, morbidity, health-related quality of life, or safety. In some studies, AI-assisted image interpretation increased sensitivity without consistent improvements in specificity. Stand-alone AI systems demonstrated high negative predictive values but frequently low positive predictive values. Evidence on organisational effects and costs was limited.
The currently available evidence is insufficient to demonstrate an added value of the selected AI-supported DHT for chest X-ray interpretation for lung cancer detection in Austrian hospitals. Substantial uncertainties remain regarding diagnostic accuracy, workflow integration, and resource implications.
Authors' recommendations:
Prospective studies under real-world care conditions are required before routine implementation can be recommended.
Authors' methods:
Relevant AI applications in diagnostic imaging were first identified and prioritised through expert consultation and structured shortlisting. A systematic review was then conducted according to a predefined protocol. The literature search followed a two-step approach, first identifying high-quality HTAs and systematic reviews, followed by an update search for primary studies. Evidence was synthesised narratively.
Details
Project Status:
Completed
Year Published:
2026
URL for published report:
https://eprints.aihta.at/1598/1/HTA-Projektbericht_Nr.171b.pdf
URL for additional information:
https://eprints.aihta.at/1598/
English language abstract:
An English language summary is available
Publication Type:
Full HTA
Country:
Austria
MeSH Terms
- Lung Neoplasms
- Mass Chest X-Ray
- Artificial Intelligence
- Carcinoma, Non-Small-Cell Lung
- Mass Screening
Keywords
- Artificial intelligence
- chest X-ray
- lung cancer detection
- diagnostic imaging
- radiology
- systematic review
Contact
Organisation Name:
Austrian Institute for Health Technology Assessment
Contact Address:
Josefstaedter Strasse 39, A-1080 Vienna, Austria
Contact Name:
office@aihta.at
Contact Email:
office@aihta.at
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.