AI ECHO INSIGHT RCT for Automated Echo Reporting

The accuracy rate is defined as the proportion of transthoracic echocardiogram (TTE) studies for which the final cardiologist interpretation is not significantly different from the preliminary interpretation. We will assess the accuracy rate in the AI-assisted arm for non-inferiority versus the pooled accuracy rate across both the sonographer-assisted and cardiologist-only arms.

The investigators will measure the proportion of TTE studies for which the final cardiologist report is substantially different from the preliminary report (e.g., the rate of substantial change). We define a TTE report to be substantially different from another TTE interpretation if any of its key elements are substantially different (LVEF, right ventriuclar function, chamber size, valvular regurgitation severity, valvular stenosis severity, and right ventricular systolic pressure).

Accuracy rates will also be analyzed for superiority rather than non-inferiority. The proportion of TTE studies for which the final cardiologist interpretation is not significantly different from the preliminary interpretation will be compared individually between the AI-assisted arm and each comparator arm (sonographer-assisted and cardiologist-only).

• AI-prelim workflow vs. pooled sonographer-prelim and cardiologist-prelim workflow with a superiority test
• AI-prelim workflow vs. sonographer-prelim workflow with a superiority test
• AI-prelim workflow vs. cardiologist-prelim workflow with a superiority test

Accuracy is defined as the proportion of TTE studies for which the final cardiologist report is substantially different from the historical report (e.g., the rate of substantial change). We define a TTE report to be substantially different from another TTE interpretation if any of its key elements are substantially different (LVEF, right ventriuclar function, chamber size, valvular regurgitation severity, valvular stenosis severity, and right ventricular systolic pressure).

Accuracy is defined as the proportion of TTE studies for which the consensus cardiologist report is substantially different from the preliminary report (e.g., the rate of substantial change). We define a TTE report to be substantially different from another TTE interpretation if any of its key elements are substantially different (LVEF, right ventriuclar function, chamber size, valvular regurgitation severity, valvular stenosis severity, and right ventricular systolic pressure).

Accuracy is defined asthe proportion of TTE studies for which the final cardiologist report is substantially different from the preliminary report (e.g., the rate of substantial change). We define a TTE report to be substantially different from another TTE interpretation if any of its key elements are substantially different (LVEF, right ventricular function, chamber size, valvular regurgitation severity, valvular stenosis severity, and right ventricular systolic pressure).

• AI-prelim workflow vs. pooled sonographer-prelim and cardiologist-prelim workflow with a superiority test
• AI-prelim workflow vs. sonographer-prelim workflow with a superiority test
• AI-prelim workflow vs. cardiologist-prelim workflow with a superiority test

To assess whether AI-assisted interpretation saves time, the investigators will compare the mean time in seconds required for the cardiologist to complete the overreading process across the three arms (i.e., TTE interpretation workflows) in our trial. Specifically, we will perform the following comparisons:

• The mean cardiologist overread time in the AI-assisted arm versus the pooled results of the sonographer-assisted and cardiologist-only arms
• The mean cardiologist overread time in the AI-assisted arm versus the sonographer-assisted arm
• The mean cardiologist overread time in the AI-assisted arm versus the cardiologist-only arm

The investigators will measure the proportion of TTE studies for which the final cardiologist report is substantially different from the preliminary report (e.g., the rate of substantial change) in sonographer-prelim and cardiologist-prelim arms. We define a TTE report to be substantially different from another TTE interpretation if any of its key elements are substantially different (LVEF, right ventricular function, chamber size, valvular regurgitation severity, valvular stenosis severity, and right ventricular systolic pressure).

In each of the arms, at the completion of each study for the final cardiologist assessment, the cardiologist will be asked to guess whether the preliminary assessment was AI or human. This will be used to calculate a blinding index comparing the AI-prelim arm vs. a composite of the two standard of care arms, as well as comparing the AI-prelim arm with the sonographer-prelim arm individually and comparing the AI-prelim arm with the cardiologist-prelim arm individually.