The Impact of AI Assistance on Radiologist Performance and Healthcare Costs in LDCT-Based Lung Cancer Screening

Artificial intelligence (AI) technologies, particularly advanced medical imaging analysis systems like the AI diagnostic platform evaluated in this study, demonstrate significant potential for enhancing lung cancer screening programs in community healthcare settings.Although this AI system was not originally designed specifically for primary care implementation, it has shown promising capabilities in various clinical applications, including nodule detection, malignancy risk stratification, and workflow optimization in radiology departments. However, its effectiveness in improving screening accuracy and operational efficiency in resource-limited community health centers remains to be thoroughly investigated.

Lung cancer screening and diagnosis involve complex clinical processes,including image interpretation, risk factor assessment, and follow-up decision-making. Implementing AI tools like this diagnostic platform in community screening programs could potentially improve detection rates, standardize interpretations, and optimize resource allocation. Nevertheless, the system has not been rigorously validated for use in primary care settings and may carry limitations in generalizability across diverse patient populations and imaging equipment variations. Inappropriate implementation could lead to diagnostic errors or inefficient resource utilization. Therefore, evaluating how such AI systems can effectively support community-based screening while maintaining diagnostic accuracy and cost-effectiveness is of paramount importance.

In this randomized controlled trial, participating community health centers will be allocated to either an AI-assisted interpretation group or a conventional manual interpretation group. All screening cases will undergo standardized low-dose CT imaging, with results interpreted through the respective group's designated method. A panel of three expert radiologists will establish reference standards for all cases, while an independent review committee will blindly evaluate a subset of cases from both groups to assess interpretation consistency. The evaluation will focus on diagnostic performance metrics, operational efficiency parameters, and cost-effectiveness indicators. Two separate analyst teams, blinded to group assignments, will process and compare the outcomes using predefined statistical methods, with any discrepancies resolved through consensus discussions to ensure data reliability.

Inclusion criteria

• Aged 45-74 years
• Permanent resident of participating study communities
• No prior history of lung cancer and no lung cancer screening within the past 3 months
• Able to comprehend and voluntarily sign informed consent, with willingness to participate in long-term follow-up

Exclusion criteria

• Individuals with a confirmed diagnosis of lung cancer
• Those with severe comorbidities contraindicating CT imaging
• Inability to understand study protocols or provide informed consent due to cognitive impairment
• Concurrent participation in other clinical trials that may interfere with study outcomes
• Unable to comply with follow-up requirements