Independent bone-level diagnostic accuracy study of an AI tool for detecting appendicular skeletal fractures on radiographs

Abstract

Question Can a commercially available AI tool reliably detect fractures across anatomical regions, confounding factors, and individual bones -and are there patterns in diagnostic limitations? Findings The AI tool achieved 89% sensitivity and 88% specificity with consistent accuracy across subgroups. However, accuracy dropped for old fractures and irregular short bones. Clinical relevance Despite broad regulatory approval, AI fracture tools may overlook clinically relevant weaknesses. Our in-depth evaluation highlights limitations, guiding responsible clinical use and future research to support safe AI implementation in radiology and informed medicolegal regulation.

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