Fig 1.
Flowchart of overall study process.
Table 1.
Characteristics of patients and RFs.
Fig 2.
Schematic diagram of five anatomic regions of rib arc.
Nj: within 1cm of junction of costal cartilage (green). Nv: within 1cm of costovertebral junction. A: anterior 1/3 length between Nj and Nv (blue). L: middle 1/3 length between Nj and Nv (yellow). P: posterior 1/3 length between Nj and Nv (orange). The 11th and 12th ribs don’t have Nj. (Nj = near the junction of costal cartilage, A = anterior, L = lateral, P = posterior, Nv = near vertebral bodies).
Fig 3.
Demonstration of fracture types.
(Ⅰ) Fresh fracture with no or minimal dislocation (A and B); (Ⅱ) fresh fracture with distinct dislocation (C); (III) healing fracture with periosteal reaction or callus formation (D); (Ⅳ) old fracture lack of periosteal reaction or callus formation (E and F).
Table 2.
Performance comparison of AI-assisted and AI-alone diagnosis versus double-reading at patient, rib, and lesion levels.
Fig 4.
Bar graph of the impact of report time, rib number, fracture location, and fracture type on the diagnostic performance of double-reading and AI-alone.
A: Radiologists showed lowest accuracy in the early morning, aligning with the highest lesion volume, suggesting a workload effect, and A gradual afternoon decline in accuracy was observed. AI demonstrated consistent diagnostic performance throughout all reporting times. B: Rib number significantly influenced the diagnostic accuracy of both radiologists and AI, with the upper ribs (1st-3rd) being more challenging to diagnose correctly. C: Fracture location significantly affected the diagnostic accuracy, with least accurate diagnoses in Nv and Nj for both AI and radiologists. D: Fracture type significantly affected the diagnostic accuracy, with least accurate diagnoses for fractures with subtle morphological changes (such as Type I and IV). Notably, AI outperformed dual radiologists in diagnosing type I fractures (85.3% vs. 46.9%). (Nj = near the junction of costal cartilage, A = anterior, L = lateral, P = posterior, Nv = near vertebral bodies).
Table 3.
The impact of patient characteristics and report timing on performance of AI and radiologists.
Table 4.
The impact of features of RF on performance of AI and radiologists.