AI Enhances Lung Ultrasound Interpretation Across Clinicians with Varying Expertise Levels

Background/Objective: Lung ultrasound (LUS) is a valuable tool for detecting pulmonary conditions, but its accuracy depends on user expertise. This study evaluated whether an artificial intelligence (AI) tool could improve clinician performance in detecting pleural effusion and consolidation/atelectasis on LUS scans. Methods: In this multi-reader, multi-case study, 14 clinicians of varying experience reviewed 374 retrospectively selected LUS scans (cine clips from the PLAPS point, obtained using three different probes) from 359 patients across six centers in the U.S. and Canada. In phase one, readers scored the likelihood (0-100) of pleural effusion and consolidation/atelectasis without AI. After a 4-week washout, they re-evaluated all scans with AI-generated bounding boxes. Performance metrics included area under the curve (AUC), sensitivity, specificity, and Fleiss' Kappa. Subgroup analyses examined effects by reader experience. Results: For pleural effusion, AUC improved from 0.917 to 0.960, sensitivity from 77.3% to 89.1%, and specificity from 91.7% to 92.9%. Fleiss' Kappa increased from 0.612 to 0.774. For consolidation/atelectasis, AUC rose from 0.870 to 0.941, sensitivity from 70.7% to 89.2%, and specificity from 85.8% to 89.5%. Kappa improved from 0.427 to 0.756. Conclusions: AI assistance enhanced clinician detection of pleural effusion and consolidation/atelectasis in LUS scans, particularly benefiting less experienced users.