Head-to-Head CT-Anchored Comparison of Two Commercial AI Tools for Chest X-ray Abnormality Detection

In 1707 CT-anchored chest radiographs, vendor A had higher sensitivity for fractures, nodules and pleural effusions, while vendor B had higher specificity. Only 55.4% of CT-confirmed abnormalities were visible on X-ray.

• Retrospective cohort: 1707 chest radiographs from 1680 patients, each paired with CT within 14 days (2 days for rapidly progressive findings).
• Of 3573 CT-confirmed abnormalities, 1981 (55.4%) were radiographically visible and served as the reference-positive set.
• Vendor A showed higher sensitivity for fractures, nodules, and pleural effusions (p < 0.001); vendor B showed higher specificity for these findings (p < 0.05). No significant difference for airspace disease; pneumothorax numbers were limited.

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