Deep learning to automate Brasfield chest radiographic scoring for cystic fibrosis

The aim of this study was to evaluate the hypothesis that a deep convolutional neural network (DCNN) model could facilitate automated Brasfield scoring of chest radiographs (CXRs) for patients with cystic fibrosis (CF), performing similarly to a pediatric radiologist. All frontal/lateral chest radiographs (2058 exams) performed in CF patients at a single institution from January 2008–2018 were retrospectively identified, and ground-truth Brasfield scoring performed by a board-certified pediatric radiologist. 1858 exams (90.3%) were used to train and validate the DCNN model, while 200 exams (9.7%) were reserved for a test set. Five board-certified pediatric radiologists independently scored the test set according to the Brasfield method. DCNN model vs. radiologist performance was compared using Spearman correlation (ρ) as well as mean difference (MD), mean absolute difference (MAD), and root mean squared error (RMSE) estimation. For the total Brasfield score, ρ for the model-derived results computed pairwise with each radiologist's scores ranged from 0.79–0.83, compared to 0.85–0.90 for radiologist vs. radiologist scores. The MD between model estimates of the total Brasfield score and the average score of radiologists was −0.09. Based on MD, MAD, and RMSE, the model matched or exceeded radiologist performance for all subfeatures except air-trapping and large lesions. A DCNN model is promising for predicting CF Brasfield scores with accuracy similar to that of a pediatric radiologist. •Deep learning may allow automated Brasfield chest X-ray scoring in cystic fibrosis.•The model implemented achieves performance close to that of pediatric radiologists.•Further development and testing could facilitate a clinically distributable tool.