A Retrospective Multi-Source Clinical Validation of Lenek Intelligent Radiology Assistant: An Artificial Intelligence-Based Chest Radiograph Screening and Triage System for High-Burden Pulmonary and Cardiac Conditions in India

ABSTRACT Background A critical radiologist shortage exists in India, leading to delayed chest radiograph (CXR) interpretation. This leads to disease progression, higher morbidity, and mortality. Artificial intelligence-based CXR interpretation by Lenek Intelligent Radiology Assistant (LIRA) is a promising solution. This study aims to establish the screening and triaging capabilities of LIRA by assessing its accuracy in detecting abnormalities and pathologies in CXRs from geographically diverse institutions. Methods We conducted a retrospective multi-source validation of the diagnostic accuracy of LIRA for the detection of general abnormalities, tuberculosis, consolidation, pleural effusion, pneumothorax, and cardiomegaly. De-identified chest radiographs were input into LIRA models. The obtained interpretations were compared to the established ground truth reporting for the calculation of sensitivity, specificity, and AUROC with 95% CI for individual pathologies across varying probability thresholds. Results LIRA demonstrated high sensitivity for general abnormality detection (AUROC 0.93-0.986, 84.4-97.1% sensitivity, 88.9-92.4% specificity) and tuberculosis triaging (Shenzhen & Montgomery: 88.5-89.7% sensitivity, 89.9-90.5% specificity; Jaypee: 98.7% sensitivity, 63.6% specificity). For consolidation (AUROC 0.884-0.895, 96.4-96.9% sensitivity, 70.8-77.1% specificity), pleural effusion (AUROC 0.942-0.967, 79.7-99.1% sensitivity, 81.2-87.7% specificity), pneumothorax (AUROC 0.87, 90.6-94.8% sensitivity, 79.5-82.7% specificity) and cardiomegaly (AUROC 0.883, 95.1% sensitivity, 81.6% specificity), the model exhibited commendable accuracy as well. Conclusions The diagnostic performance of LIRA was consistent across various pathologies and chest radiographs from diverse geographic locations, with particular strengths in abnormality detection and tuberculosis screening. The risk-stratified triaging and high sensitivity of LIRA make it a reliable adjunct solution to address radiologist shortages, reduce turnaround times, and support India’s tuberculosis elimination goals.