Autonomous artificial intelligence in pediatric radiology: the use and perception of BoneXpert for bone age assessment

BACKGROUND: The autonomous artificial intelligence (AI) system for bone age rating (BoneXpert) was designed to be used in clinical radiology practice as an AI-replace tool, replacing the radiologist completely. OBJECTIVE: The aim of this study was to investigate how the tool is used in clinical practice. Are radiologists more inclined to use BoneXpert to assist rather than replace themselves, and how much time is saved? MATERIALS AND METHODS: We sent a survey consisting of eight multiple-choice questions to 282 radiologists in departments in Europe already using the software. RESULTS: The 97 (34%) respondents came from 18 countries. Their answers revealed that before installing the automated method, 83 (86%) of the respondents took more than 2 min per bone age rating; this fell to 20 (21%) respondents after installation. Only 17/97 (18%) respondents used BoneXpert to completely replace the radiologist; the rest used it to assist radiologists to varying degrees. For instance, 39/97 (40%) never overruled the automated reading, while 9/97 (9%) overruled more than 5% of the automated ratings. The majority 58/97 (60%) of respondents checked the radiographs themselves to exclude features of underlying disease. CONCLUSION: BoneXpert significantly reduces reporting times for bone age determination. However, radiographic analysis involves more than just determining bone age. It also involves identification of abnormalities, and for this reason, radiologists cannot be completely replaced. AI systems originally developed to replace the radiologist might be more suitable as AI assist tools, particularly if they have not been validated to work autonomously, including the ability to omit ratings when the image is outside the range of validity. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00247-022-05295-w.