LAUSR

Background: Artificial intelligence (AI) algorithms can provide rapid and precise radiographic bone age (BA) assessment. This study assessed the effects of an AI algorithm on the BA assessment performance of radiologists, and evaluated how automation bias could affect radiologists. Methods: In this prospective randomized crossover study, six radiologists with varying levels of experience (senior, mid-level, and junior) assessed cases from a test set of 200 standard BA radiographs. The test set was equally divided into two subsets: datasets A and B. Each radiologist assessed BA independently without AI assistance (A− B−) and with AI assistance (A+ B+). We used the mean of assessments made by two experts as the ground truth for accuracy assessment; subsequently, we calculated the mean absolute difference (MAD) between the radiologists’ BA predictions and ground-truth BA and evaluated the proportion of estimates for which the MAD exceeded one year. Additionally, we compared the radiologists’ performance under conditions of early AI assistance with their performance under conditions of delayed AI assistance; the radiologists were allowed to reject AI interpretations. Results: The overall accuracy of senior, mid-level, and junior radiologists improved significantly with AI assistance than without AI assistance (MAD: 0.74 vs 0.46 years, p < 0.001; proportion of assessments for which MAD exceeded 1 year: 24.0% vs 8.4%, p < 0.001). The proportion of improved BA predictions with AI assistance (16.8%) was significantly higher than that of less accurate predictions with AI assistance (2.3%; p < 0.001). No consistent timing effect was observed between conditions of early and delayed AI assistance. Most disagreements between radiologists and AI occurred over images for patients aged ≤8 years. Senior radiologists had more disagreements than other radiologists. Conclusion: The AI algorithm improved the BA assessment accuracy of radiologists with varying experience levels. Automation bias was prone to affect less experienced radiologists.