Deep Learning to Assess Long-term Mortality From Chest Radiographs

Question Is a convolutional neural network able to extract prognostic information from chest radiographs? Findings In this prognostic study of data from 2 randomized clinical trials (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [n 10 464] and National Lung Screening Trial [n 5493]), a convolutional neural network identified persons at high risk of long-term mortality based on their chest radiographs, even with adjustment for the radiologists' diagnostic findings and standard risk factors. Meaning Individuals at high risk of mortality based on chest radiography may benefit from prevention, screening, and lifestyle interventions. Importance Chest radiography is the most common diagnostic imaging test in medicine and may also provide information about longevity and prognosis. Objective To develop and test a convolutional neural network (CNN) (named CXR-risk) to predict long-term mortality, including noncancer death, from chest radiographs. Design, Setting, and Participants In this prognostic study, CXR-risk CNN development (n 41 856) and testing (n 10 464) used data from the screening radiography arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (n 52 320), a community cohort of asymptomatic nonsmokers and smokers (aged 55-74 years) enrolled at 10 US sites from November 8, 1993, through July 2, 2001. External testing used data from the screening radiography arm of the National Lung Screening Trial (NLST) (n 5493), a community cohort of heavy smokers (aged 55-74 years) enrolled at 21 US sites from August 2002, through April 2004. Data analysis was performed from January 1, 2018, to May 23, 2019. Exposure Deep learning CXR-risk score (very low, low, moderate, high, and very high) based on CNN analysis of the enrollment radiograph.