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

Not yet recruiting

Conditions

Study Type

Observational

Enrollment (Estimated)

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

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
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

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

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)

October 1, 2026

Primary Completion (Estimated)

October 1, 2027

Study Completion (Estimated)

November 1, 2027

Study Registration Dates

First Submitted

September 17, 2026

First Submitted That Met QC Criteria

September 17, 2026

First Posted (Actual)

September 22, 2026

Study Record Updates

Last Update Posted (Actual)

September 22, 2026

Last Update Submitted That Met QC Criteria

September 17, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID 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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