• Sohee Park, Sang Min Lee, Namkug Kim, Jooae Choe, Yongwon Cho, Kyung-Hyun Do, and Joon Beom Seo.
• Department of Radiology and Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138736, South Korea.
• Eur Radiol. 2019 Oct 1; 29 (10): 5341-5348.

ObjectivesTo retrospectively evaluate the diagnostic performance of a convolutional neural network (CNN) model in detecting pneumothorax on chest radiographs obtained after percutaneous transthoracic needle biopsy (PTNB) for pulmonary lesions.MethodsA CNN system for computer-aided diagnosis on chest radiographs was developed using the full 26-layer You Only Look Once model. A total of 1596 chest radiographs with pneumothorax were used for training. To validate the clinical feasibility of this model, follow-up chest radiographs obtained after PTNB for 1333 pulmonary lesions in 1319 patients in 2016 were prepared as an independent test set. Two experienced radiologists determined the presence of pneumothorax by consensus. The diagnostic performance of the CNN model was assessed using the jackknife free-response receiver operating characteristic method.ResultsThe incidence of pneumothorax was 17.9% (247/1379) on 3-h follow-up chest radiographs and 23.3% (309/1329) on 1-day follow-up chest radiographs. Twenty-three (1.7% of all PTNBs) cases required drainage catheter insertion. Our approach had a sensitivity, a specificity, and an area under the curve (AUC), respectively, of 61.1% (151/247), 93.0% (1053/1132), and 0.898 for 3-h follow-up chest radiographs and 63.4% (196/309), 93.5% (954/1020), and 0.905 for 1-day follow-up chest radiographs. The overall accuracy was 87.3% (1204/1379) for 3-h follow-up radiographs and 86.5% (1150/1329) for 1-day follow-up radiographs. The CNN model found all 23 cases of pneumothorax requiring drainage.ConclusionsOur CNN model had good performance for detection of pneumothorax on chest radiographs after PTNB, especially for those requiring further procedures. It can be used as a screening tool prior to radiologist interpretation.Key Points• The CNN model had good performance for detection of pneumothorax on chest radiographs after PTNB and showed high specificity and negative predictive value. • The CNN model found all cases of pneumothorax requiring drainage after PTNB. • The CNN model can be used as a screening tool prior to radiologist interpretation.

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