The Ultrasound Journal (Jun 2021)

B-line quantification: comparing learners novice to lung ultrasound assisted by machine artificial intelligence technology to expert review

  • Frances M. Russell,
  • Robert R. Ehrman,
  • Allen Barton,
  • Elisa Sarmiento,
  • Jakob E. Ottenhoff,
  • Benjamin K. Nti

DOI
https://doi.org/10.1186/s13089-021-00234-6
Journal volume & issue
Vol. 13, no. 1
pp. 1 – 7

Abstract

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Abstract Background The goal of this study was to assess the ability of machine artificial intelligence (AI) to quantitatively assess lung ultrasound (LUS) B-line presence using images obtained by learners novice to LUS in patients with acute heart failure (AHF), compared to expert interpretation. Methods This was a prospective, multicenter observational study conducted at two urban academic institutions. Learners novice to LUS completed a 30-min training session on lung image acquisition which included lecture and hands-on patient scanning. Learners independently acquired images on patients with suspected AHF. Automatic B-line quantification was obtained offline after completion of the study. Machine AI counted the maximum number of B-lines visualized during a clip. The criterion standard for B-line counts was semi-quantitative analysis by a blinded point-of-care LUS expert reviewer. Image quality was blindly determined by an expert reviewer. A second expert reviewer blindly determined B-line counts and image quality. Intraclass correlation was used to determine agreement between machine AI and expert, and expert to expert. Results Fifty-one novice learners completed 87 scans on 29 patients. We analyzed data from 611 lung zones. The overall intraclass correlation for agreement between novice learner images post-processed with AI technology and expert review was 0.56 (confidence interval [CI] 0.51–0.62), and 0.82 (CI 0.73–0.91) between experts. Median image quality was 4 (on a 5-point scale), and correlation between experts for quality assessment was 0.65 (CI 0.48–0.82). Conclusion After a short training session, novice learners were able to obtain high-quality images. When the AI deep learning algorithm was applied to those images, it quantified B-lines with moderate-to-fair correlation as compared to semi-quantitative analysis by expert review. This data shows promise, but further development is needed before widespread clinical use.

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