Integrating AI into Radiology workflow: Levels of research, production, and feedback maturity

This report represents a roadmap for integrating Artificial Intelligence (AI)-based image analysis algorithms into existing Radiology workflows such that: (1) radiologists can significantly benefit from enhanced automation in various imaging tasks due to AI; and (2) radiologists' feedback is utilized to further improve the AI application. This is achieved by establishing three maturity levels where: (1) research enables the visualization of AI-based results/annotations by radiologists without generating new patient records; (2) production allows the AI-based system to generate results stored in an institution's Picture Archiving and Communication System; and (3) feedback equips radiologists with tools for editing the AI inference results for periodic retraining of the deployed AI systems, thereby allowing the continuous organic improvement of AI-based radiology-workflow solutions. A case study (i.e., detection of brain metastases with T1-weighted contrast-enhanced 3D MRI) illustrates the deployment details of a particular AI-based application according to the aforementioned maturity levels. It is shown that the given AI application significantly improves with the feedback coming from radiologists; the number of incorrectly detected brain metastases (false positives) reduces from 14.2 to 9.12 per patient with the number of subsequently annotated datasets increasing from 93 to 217 as a result of radiologist adjudication.