ArticleJMIR AI2024
The Impact of Expectation Management and Model Transparency on Radiologists' Trust and Utilization of AI Recommendations for Lung Nodule Assessment on Computed Tomography: Simulated Use Study.
Article in JMIR AI, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Applying artificial intelligence to ensure high quality and equitable lung cancer screening.Translational lung cancer research · 2026Review
- Artificial intelligence for predicting and preventing adverse pregnancy outcomes addressing bias and clinical translation.Frontiers in digital health · 2026Review
- Trust in artificial intelligence-based follow-up in hospital information systems: development and validation of a new scale.BMC psychology · 2025Article
- Human-centered explainability evaluation in clinical decision-making: a critical review of the literature.Journal of the American Medical Informatics Association : JAMIA · 2025Review
- Intersection of Performance, Interpretability, and Fairness in Neural Prototype Tree for Chest X-Ray Pathology Detection: Algorithm Development and Validation Study.JMIR formative research · 2024Article
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11 authors.
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Abstract
backgroundMany promising artificial intelligence (AI) and computer-aided detection and diagnosis systems have been developed, but few have been successfully integrated into clinical practice. This is partially owing to a lack of user-centered design of AI-based computer-aided detection or diagnosis (AI-CAD) systems.
objectiveWe aimed to assess the impact of different onboarding tutorials and levels of AI model explainability on radiologists' trust in AI and the use of AI recommendations in lung nodule assessment on computed tomography (CT) scans.
methodsIn total, 20 radiologists from 7 Dutch medical centers performed lung nodule assessment on CT scans under different conditions in a simulated use study as part of a 2×2 repeated-measures quasi-experimental design. Two types of AI onboarding tutorials (reflective vs informative) and 2 levels of AI output (black box vs explainable) were designed. The radiologists first received an onboarding tutorial that was either informative or reflective. Subsequently, each radiologist assessed 7 CT scans, first without AI recommendations. AI recommendations were shown to the radiologist, and they could adjust their initial assessment. Half of the participants received the recommendations via black box AI output and half received explainable AI output. Mental model and psychological trust were measured before onboarding, after onboarding, and after assessing the 7 CT scans. We recorded whether radiologists changed their assessment on found nodules, malignancy prediction, and follow-up advice for each CT assessment. In addition, we analyzed whether radiologists' trust in their assessments had changed based on the AI recommendations.
resultsBoth variations of onboarding tutorials resulted in a significantly improved mental model of the AI-CAD system (informative P=.01 and reflective P=.01). After using AI-CAD, psychological trust significantly decreased for the group with explainable AI output (P=.02). On the basis of the AI recommendations, radiologists changed the number of reported nodules in 27 of 140 assessments, malignancy prediction in 32 of 140 assessments, and follow-up advice in 12 of 140 assessments. The changes were mostly an increased number of reported nodules, a higher estimated probability of malignancy, and earlier follow-up. The radiologists' confidence in their found nodules changed in 82 of 140 assessments, in their estimated probability of malignancy in 50 of 140 assessments, and in their follow-up advice in 28 of 140 assessments. These changes were predominantly increases in confidence. The number of changed assessments and radiologists' confidence did not significantly differ between the groups that received different onboarding tutorials and AI outputs.
conclusionsOnboarding tutorials help radiologists gain a better understanding of AI-CAD and facilitate the formation of a correct mental model. If AI explanations do not consistently substantiate the probability of malignancy across patient cases, radiologists' trust in the AI-CAD system can be impaired. Radiologists' confidence in their assessments was improved by using the AI recommendations.
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