AI technologies recommended for use in detecting fractures

People who may have broken a bone could have their x-ray examined using artificial intelligence technologies, NICE has said in draft guidance. 

In addition to a trained healthcare professional reviewing the x-ray, an independent NICE committee has said one of 4 AI tools can be used to help detect fractures on X-rays in urgent care. 

The recommendation allows TechCare Alert, BoneView, RBfracture or Rayvolve to be used in urgent care settings in England while further evidence is generated to demonstrate the technology’s benefits in a real-world setting. 

Clinical evidence suggests that the AI technologies may improve fracture detection on X-rays in urgent care, compared with just a professional reviewing on their own, without increasing the risk of incorrect diagnoses.  

Using AI technologies may help reduce variation in care across the country, reduce the number of fractures that are missed at initial presentation, and prevent further injury or harm to people during the time between the initial assessment and a decision on further treatment.  

The committee heard missed fractures are reported to be the most common diagnostic error in the emergency department. Missed or delayed diagnosis of fractures on radiographs is reported to occur in around 3% to 10% of cases. 

Mark Chapman, director of HealthTech at NICE, said: “Every day across the NHS thousands of images are interpreted by expert radiologists and radiographers, but there is a high vacancy rate within these departments across the country and more support is needed to manage their workload. 

“These AI technologies are safe to use and could spot fractures which humans might miss given the pressure and demands these professional groups work under.  

“Using AI technology to help highly skilled professionals in urgent care centres to identify which of their patients has a fracture could potentially speed up diagnosis and reduce follow up appointments needed because of a fracture missed during an initial assessment.” 

The NHS Long Term Plan noted that in England “vacancy rates are 12.5% for radiologists and 15% for radiographers.” 

The committee noted that the use of these technologies is considered low risk as each image is reviewed by a professional and the AI isn’t working in isolation. Therefore, it is unlikely using the technologies will lead to an increase in unnecessary referrals to fracture clinics. An independent review carried out by the radiology department will still take place. 

After the consultation, responses will be considered by the committee who may then alter their recommendations before final guidance is published on our website. 

A consultation on the draft recommendations has begun and comments can be submitted until Tuesday 5 November 2024.