AI-Based Assessment of Chest Diseases on Chest X-ray Imaging Using DenseNet-121 and a CheXpert-Trained Model

September 17, 2026 updated by: Ibrahim Mohamed Ibrahim, Assiut University

AI-Based Assessment of Chest Diseases on Chest X-ray Imaging Using DenseNet-121 and a CheXpert-Trained Model: A Comparative Diagnostic Accuracy Study

Chest X-rays are widely used to detect thoracic and lung conditions, but reviewing high volumes of radiographs can lead to workload strain and variation between interpreters. Artificial intelligence (AI), particularly deep learning neural networks like DenseNet-121, has shown strong potential to assist clinicians with automated image interpretation. However, AI models trained on large international datasets, such as CheXpert, may perform differently across distinct patient populations due to variations in imaging technique, patient demographics, and disease presentation.

The primary purpose of this study is to compare the diagnostic accuracy of a DenseNet-121 model trained or fine-tuned on local data against a DenseNet-121 model pretrained on the CheXpert dataset for identifying thoracic pathologies. Both models will evaluate de-identified frontal chest radiographs from adult patients. Model predictions will be compared against a reference standard established by expert radiologist consensus, with discordant findings resolved using chest computed tomography (CT). Findings will evaluate whether local model adaptation improves diagnostic precision and workflow efficiency in clinical settings.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
100

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

N/A

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

The study population comprises adult patients aged 18 years and older who undergo frontal chest radiography within institutional radiology departments. Eligible subjects have de-identified, diagnostic-quality frontal chest X-ray images with available reference diagnostic labels verified through expert radiologist consensus and chest CT adjudication. Pediatric cases, non-diagnostic images, incomplete metadata, and duplicate scans are excluded.

Description

Inclusion Criteria:

  • Adult patients aged 18 years or older.
  • Undergoing frontal chest radiography.
  • Diagnostic-quality frontal chest radiographs.
  • Availability of reference diagnostic labels (verified by expert radiologist consensus or chest CT).

Exclusion Criteria:

  • Pediatric patients (under 18 years of age).
  • Non-diagnostic or poor-quality chest radiographs.
  • Incomplete clinical or imaging metadata.
  • Duplicate radiographic images or repeat patient entries.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: COHORT
  • Time Perspectives: CROSS_SECTIONAL

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Adult Frontal Chest Radiography Cohort

This cohort includes adult patients aged 18 years and older who undergo diagnostic-quality frontal chest radiography with available reference diagnostic labels. De-identified chest radiographs from this group are evaluated by two deep learning architectures: a study-trained/fine-tuned DenseNet-121 convolutional neural network and a CheXpert-pretrained DenseNet-121 model. Model predictions are evaluated against reference standards derived from expert radiologist consensus, with discordant cases adjudicated via chest computed tomography (CT).

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Area Under the Receiver Operating Characteristic Curve (AUROC)
Time Frame: Baseline

AUROC will be calculated to assess and compare the diagnostic performance of the study-trained DenseNet-121 model versus the CheXpert-pretrained DenseNet-121 model in detecting thoracic pathologies on frontal chest radiographs. AI predictions will be compared against the reference standard of expert radiologist consensus, with discordant findings adjudicated by chest CT. AUROC values range from 0.5 (no discrimination) to 1.0 (perfect discrimination).
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Assiut University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
October 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
October 1, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
November 1, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 17, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 17, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
September 22, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 22, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 17, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • AI Chest X-Ray Assessment

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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