Application of artificial intelligence in the diagnosis of scaphoid fractures: impact of automated detection of scaphoid fractures in a real-life study

We evaluated the diagnostic performance of two AI software programs (BoneView and RBfracture) in assisting non-specialist radiologists (NSRs) in detecting scaphoid fractures using conventional wrist radiographs (X-rays). We retrospectively analyzed 724 radiographs from 264 patients with wrist trauma. Patients were classified into two groups: Group 1 included cases with a definitive diagnosis by a specialist radiologist (SR) based on X-rays (either scaphoid fracture or not), while Group 2 comprised indeterminate cases for the SRs requiring a CT scan for a final diagnosis. Indeterminate cases were defined as negative or doubtful X-rays in patients with persistent clinical symptoms. The X-rays were evaluated by AI and two NSRs, independently and in combination. We compared their diagnostic performances using sensitivity, specificity, area under the curve (AUC), and Cohen's kappa for diagnostic agreement. Group 1 included 174 patients, with 80 cases (45.97%) of scaphoid fractures. Group 2 had 90 patients, of which 44 with uncertain diagnoses and 46 negative cases with persistent symptoms. Scaphoid fractures were identified in 51 patients (56.67%) in Group 2 after further CT imaging. In Group 1, AI performed similarly to NSRs (AUC: BoneView 0.83, RBfracture 0.84, NSR1 0.88, NSR2 0.90), without significant contribution of AI to the performance of NSRs. In Group 2, performances were lower (AUC: BoneView 0.62, RBfracture 0.65, NSR1 0.46, NSR2 0.63), but AI assistance significantly improved NSR performance (NSR2 + BoneView AUC = 0.75, p = 0.003; NSR2 + RBfracture AUC = 0.72, p = 0.030). Diagnostic agreement between NSR1 with AI support and SR was moderate (kappa = 0.576), and substantial for NSR2 (kappa = 0.712). AI tools may effectively assist NSRs, especially in complex scaphoid fracture cases.