• James S Bowness, Robert Morse, Owen Lewis, James Lloyd, David Burckett-St Laurent, Boyne Bellew, MacfarlaneAlan J RAJRDepartment of Anaesthesia, NHS Greater Glasgow & Clyde, Glasgow, UK; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK., Amit Pawa, Alasdair Taylor, J Alison Noble, and Helen Higham.
• Nuffield Department of Clinical Anaesthesia, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK. Electronic address: james.bowness@jesus.ox.ac.uk.
• Br J Anaesth. 2023 Oct 26; 132 (5): 106310721063-72.

BackgroundScanNavTMAnatomy Peripheral Nerve Block (ScanNav™) is an artificial intelligence (AI)-based device that produces a colour overlay on real-time B-mode ultrasound to highlight key anatomical structures for regional anaesthesia. This study compares consistency of identification of sono-anatomical structures between expert ultrasonographers and ScanNav™.MethodsNineteen experts in ultrasound-guided regional anaesthesia (UGRA) annotated 100 structures in 30 ultrasound videos across six anatomical regions. These annotations were compared with each other to produce a quantitative assessment of the level of agreement amongst human experts. The AI colour overlay was then compared with all expert annotations. Differences in human-human and human-AI agreement are presented for each structure class (artery, muscle, nerve, fascia/serosal plane) and structure. Clinical context is provided through subjective assessment data from UGRA experts.ResultsFor human-human and human-AI annotations, agreement was highest for arteries (mean Dice score 0.88/0.86), then muscles (0.80/0.77), and lowest for nerves (0.48/0.41). Wide discrepancy exists in consistency for different structures, both with human-human and human-AI comparisons; highest for sartorius muscle (0.91/0.92) and lowest for the radial nerve (0.21/0.27).ConclusionsHuman experts and the AI system both showed the same pattern of agreement in sono-anatomical structure identification. The clinical significance of the differences presented must be explored; however the perception that human expert opinion is uniform must be challenged. Elements of this assessment framework could be used for other devices to allow consistent evaluations that inform clinical training and practice. Anaesthetists should be actively engaged in the development and adoption of new AI technology.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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