Artificial Intelligence Versus Anesthesiology Residents in Chest X-Ray Interpretation

September 23, 2026 updated by: Çiğdem Ünal Kantekin

Comparison of the Diagnostic Performance of an Artificial Intelligence System and Anesthesiology Residents in Interpreting Posteroanterior Chest Radiographs

This observational study will compare how accurately anesthesiology residents and an artificial intelligence system (hChestXR) identify abnormalities on chest X-rays. Approximately 35 volunteer anesthesiology residents at Kayseri City Hospital will review the same set of 150 anonymized posteroanterior chest radiographs selected from the hospital imaging archive. The set will include normal images and images showing findings such as infiltration, atelectasis, and pleural effusion. Two radiologists will independently assess the images and resolve disagreements by consensus to establish the reference standard. Residents will not see the radiologists' assessments or the artificial intelligence results while interpreting the images. The study will measure diagnostic accuracy and other measures of diagnostic performance. No additional imaging, treatment, or change in patient care is planned.

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.

Detailed Description

This single-center, cross-sectional, observational diagnostic accuracy study will be coordinated by the Department of Anesthesiology and Reanimation at Kayseri City Hospital. Volunteer resident assessments will be collected prospectively using retrospectively selected chest radiographs. The observational model is classified as Other because this is a comparative multi-reader, multi-case assessment of a fixed image set, without longitudinal follow-up.

A dataset of 150 posteroanterior chest radiographs will be selected from the hospital PACS to represent normal findings, common thoracic abnormalities, and a limited number of atypical or diagnostically challenging cases. The distribution of findings will be balanced to avoid marked overrepresentation or underrepresentation of particular abnormalities. All patient-identifying information will be removed before assessment.

Two radiologists will independently evaluate each radiograph. Disagreements will be resolved through joint review and consensus. Their final assessments will serve as the reference standard. The same radiographs will be analyzed by the hChestXR artificial intelligence system and independently interpreted by approximately 35 anesthesiology residents who provide informed consent. Residents will record suspected findings using a predefined multiple-choice assessment form and will be blinded to the radiologist and artificial intelligence assessments. Resident training year will also be recorded.

Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value will be calculated overall and by finding. Comparisons between resident and hChestXR performance will account for the paired image assessments and the multi-reader, multi-case structure of the data. McNemar testing will be used for appropriate paired comparisons, and analyses will account for variability across readers and radiographs. Agreement with the radiologist reference standard will be evaluated using Cohen's kappa. A multi-reader, multi-case approach will consider individual resident performance and variability across readers interpreting the same image set. Analyses will use SPSS version 31.0, with p < 0.05 considered statistically significant.

An a priori sample size calculation was performed to determine the number of resident readers. Assuming an absolute difference of 15 percentage points in diagnostic accuracy between anesthesiology residents and hChestXR, a standard deviation of 25 percentage points in reader-level accuracy, a two-sided significance level of 0.05, and 90% power, the required minimum sample size was 32 residents (standardized effect size, Cohen's d = 0.60). To allow for incomplete assessments or participant withdrawal, at least 35 anesthesiology residents are planned for enrollment. The 150 radiographs constitute the image dataset and are distinct from the enrolled resident participants.

The study involves no patient intervention. Resident assessment data will be coded and de-identified for analysis, and identifying information will remain confidential. The planned study period is October 15, 2026, through November 15, 2026. Ethics approval was granted by the Kayseri City Hospital Non-Interventional Clinical Research Ethics Committee on August 26, 2026 (decision number 1081).

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.
35

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Çiğdem Ünal Kantekin, MD
  • Phone Number: +90 505 443 30 56
  • Email: drcgdm@hotmail.com

Study Contact Backup

Study Locations

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

Yes

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Approximately 35 adult anesthesiology and reanimation residents working at Kayseri City Hospital who volunteer and provide written informed consent. Enrollment refers to resident readers, not to the 150 retrospectively selected, anonymized chest radiographs used as the assessment dataset.

Description

Inclusion Criteria:

  • An anesthesiology and reanimation resident working at Kayseri City Hospital.
  • Voluntarily agrees to participate in the study.
  • Provides written informed consent.
  • Agrees to evaluate the posteroanterior chest radiographs presented in the study.

Exclusion Criteria:

  • Failure to complete the 150-radiograph assessment.
  • Withdrawal of consent before completion of the assessment.

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: OTHER
  • 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.
Anesthesiology Residents

Approximately 35 volunteer anesthesiology and reanimation residents at Kayseri City Hospital will independently interpret 150 anonymized posteroanterior chest radiographs using a predefined multiple-choice form. Residents will be blinded to radiologist assessments and hChestXR outputs. Their diagnostic performance will be compared with hChestXR analysis of the same images, using the consensus of two radiologists as the reference standard. The artificial intelligence system is an image-level comparator, not a separate participant cohort. No treatment is assigned and no patient care is changed.

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
Diagnostic Accuracy for Detection of Thoracic Abnormalities
Time Frame: During completion of the 150-radiograph assessment, within the 1-month study period

Percentage of correctly classified image-finding pairs, calculated as (true positives + true negatives) / all evaluated image-finding classifications × 100, using the consensus of two radiologists as the reference standard. Accuracy will be calculated for each resident and for hChestXR overall and separately for each predefined thoracic finding.
During completion of the 150-radiograph assessment, within the 1-month study period

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Sensitivity for Detection of Thoracic Abnormalities
Time Frame: During completion of the 150-radiograph assessment, within the 1-month study period

Percentage of reference-positive classifications correctly identified: true positives / (true positives + false negatives) × 100. Sensitivity will be calculated for residents and hChestXR overall and by finding, using the consensus of two radiologists as the reference standard.
During completion of the 150-radiograph assessment, within the 1-month study period
Specificity for Detection of Thoracic Abnormalities
Time Frame: During completion of the 150-radiograph assessment, within the 1-month study period

Percentage of reference-negative classifications correctly identified: true negatives / (true negatives + false positives) × 100. Specificity will be calculated for residents and hChestXR overall and by finding, using the consensus of two radiologists as the reference standard.
During completion of the 150-radiograph assessment, within the 1-month study period
Positive Predictive Value
Time Frame: During completion of the 150-radiograph assessment, within the 1-month study period

Percentage of positive classifications confirmed by the radiologist reference standard: true positives / (true positives + false positives) × 100. Calculated for residents and hChestXR overall and by finding within the constructed study dataset.
During completion of the 150-radiograph assessment, within the 1-month study period
Negative Predictive Value
Time Frame: During completion of the 150-radiograph assessment, within the 1-month study period

Percentage of negative classifications confirmed by the radiologist reference standard: true negatives / (true negatives + false negatives) × 100. Calculated for residents and hChestXR overall and by finding within the constructed study dataset.
During completion of the 150-radiograph assessment, within the 1-month study period
Agreement With the Radiologist Reference Standard
Time Frame: During completion of the 150-radiograph assessment, within the 1-month study period

Agreement of resident interpretations and hChestXR classifications with the consensus radiologist reference standard will be assessed using Cohen's kappa. Cohen's kappa will be calculated separately for each resident and for hChestXR, with resident results summarized across readers. Kappa ranges from -1 to 1; 1 indicates perfect agreement, 0 agreement expected by chance, and negative values less agreement than expected by chance. Individual reader results will be evaluated within the multi-reader, multi-case framework.
During completion of the 150-radiograph assessment, within the 1-month study period

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.
Çiğdem Ünal Kantekin

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Çiğdem Ünal Kantekin, MD, Kayseri City Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 15, 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.
November 15, 2026

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 15, 2026

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 23, 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 23, 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 29, 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 29, 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 23, 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.
  • KCH-PAAG-AI-2026-1081

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared with third parties, in accordance with the confidentiality provisions of the study protocol. Data will be used for scientific analyses, and findings will be disseminated in aggregate through presentations and publications.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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