{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T08:41:13Z","timestamp":1793868073515,"version":"4.6.1"},"reference-count":10,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T00:00:00Z","timestamp":1726790400000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012095","name":"Scottish Government","doi-asserted-by":"publisher","award":["Detect Cancer Earlier (DCE) Programme. INGN23RM028"],"award-info":[{"award-number":["Detect Cancer Earlier (DCE) Programme. INGN23RM028"]}],"id":[{"id":"10.13039\/100012095","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Qure.ai","award":["N\/a"],"award-info":[{"award-number":["N\/a"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,8,7]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Diagnosing and treating lung cancer in early stages is essential for survival outcomes. The chest X-ray (CXR) remains the primary screening tool to identify lung cancers in the UK; however, there is a shortfall of radiologists, while demand continues to increase. Image analysis by machine-learning software has the potential to support radiology workflows with a focus on immediate triage of suspicious X-rays. The RADICAL study will evaluate Qure.ai\u2019s \u2018qXR\u2019 software in reducing reporting time for suspicious X-rays in NHS Greater Glasgow &amp; Clyde.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a stepped-wedge cluster-randomised study consisting of a retrospective technical evaluation and prospective clinical effectiveness study alongside the assessment of acceptability via qualitative work and evaluation of cost-effectiveness via a cost utility analysis. The primary objective is to assess the clinical effectiveness of qXR to prioritise patients suspected with lung cancer on CXR for follow-up CT. Secondary objectives will look at the utility, safety, technical performance, health economics and acceptability of the intervention. The study period is 24 months, consisting of an initial 12\u2009month data collection period and a 12\u2009month follow-up period. All the standard care CXRs from outpatient and primary care requests will be securely transmitted to Qure.ai software \u2018qXR\u2019 for interpretation. Images with features of cancer will be flagged as \u2018Urgent Suspicion of Cancer\u2019 and be prioritised for radiologist review within the existing reporting workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      The study will follow the principles of Good Clinical Practice. The protocol was granted REC approval in August 2023 from North West\u2014Greater Manchester West Research Ethics Committee (REC 23\/NW\/0211). This study was registered on clinicaltrials.gov (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06044454\">NCT06044454<\/jats:ext-link>\n                      ). An interim report will be produced for use by the Scottish Government. The results from this study will be presented at artificial intelligence, radiology and respiratory meetings and published in peer-reviewed journals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06044454\">NCT06044454<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-081062","type":"journal-article","created":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T04:00:31Z","timestamp":1726891231000},"page":"e081062","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Radiograph accelerated detection and identification of cancer in the lung (RADICAL): a mixed methods study to assess the clinical effectiveness and acceptability of Qure.ai artificial intelligence software to prioritise chest X-ray (CXR) interpretation"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct06044454","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06044454","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06044454","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0802-054X","authenticated-orcid":false,"given":"Sean F","family":"Duncan","sequence":"first","affiliation":[{"name":"Digital Health Validation Lab, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7262-7000","authenticated-orcid":false,"given":"Alex","family":"McConnachie","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Blackwood","sequence":"additional","affiliation":[{"name":"NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B","family":"Stobo","sequence":"additional","affiliation":[{"name":"Radiology, Queen Elizabeth University Hospital, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2531-7712","authenticated-orcid":false,"given":"John D","family":"Maclay","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK"},{"name":"School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Wu","sequence":"additional","affiliation":[{"name":"Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evi","family":"Germeni","sequence":"additional","affiliation":[{"name":"Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Robert","sequence":"additional","affiliation":[{"name":"Qure.AI, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Banu","family":"Bilgili","sequence":"additional","affiliation":[{"name":"Qure.AI, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamie","family":"Kumar","sequence":"additional","affiliation":[{"name":"Qure.AI, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hall","sequence":"additional","affiliation":[{"name":"Radiology, Queen Elizabeth University Hospital, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4866-2049","authenticated-orcid":false,"given":"David J","family":"Lowe","sequence":"additional","affiliation":[{"name":"Digital Health Validation Lab, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK"},{"name":"Emergency Department, Queen Elizabeth University Hospital Campus, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"key":"2025121514544540000_14.9.e081062.1","unstructured":"C. R. UK . Lung cancer mortality statistics, 31 May 2022. Available: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/lung-cancer\/mortality#ref"},{"key":"2025121514544540000_14.9.e081062.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034351","article-title":"Effect of time interval from diagnosis to treatment for non-small cell lung cancer on survival: a national cohort study in Taiwan","volume":"10","author":"Tsai","year":"2020","journal-title":"BMJ Open"},{"key":"2025121514544540000_14.9.e081062.3","unstructured":"N. England . Cancer Waiting Times, 2023. Available: https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/cancer-waiting-times\/ [Accessed 6 Sep 2023]."},{"key":"2025121514544540000_14.9.e081062.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30388-0"},{"key":"2025121514544540000_14.9.e081062.5","unstructured":"N. England . Implementing a Timed Lung Cancer Diagnostic Pathway. NHS, 2022."},{"key":"2025121514544540000_14.9.e081062.6","unstructured":"R. c. o. radiologists. 2019. Available: https:\/\/www.rcr.ac.uk\/system\/files\/publication\/field_publication_files\/clinical-radiology-uk-workforce-census-2019-report.pdf [Accessed 6 Sep 2023]."},{"key":"2025121514544540000_14.9.e081062.7","unstructured":"C. Q. commision. 2018. Available: https:\/\/www.cqc.org.uk\/sites\/default\/files\/20180718-radiology-reporting-review-report-final-for-web.pdf [Accessed 6 Sep 2023]."},{"key":"2025121514544540000_14.9.e081062.8","unstructured":"N. S. Centre for Sustainable Delivery, 2023. Available: https:\/\/www.nhscfsd.co.uk\/our-work\/earlier-cancer-diagnosis\/diagnostics\/optimal-cancer-diagnostic-pathways\/nhs-scotland-optimal-lung-cancer-diagnostic-pathway\/ [Accessed 29 Sep 2023]."},{"key":"2025121514544540000_14.9.e081062.9","doi-asserted-by":"crossref","first-page":"102321","DOI":"10.1016\/j.techsoc.2023.102321","article-title":"Artificial intelligence innovation in healthcare: Literature review, exploratory analysis, and future research","volume":"74","author":"Zahlan","year":"2023","journal-title":"Technol Soc"},{"key":"2025121514544540000_14.9.e081062.10","unstructured":"NICE . Artificial intelligence-derived software to analyse chest x-rays for suspected lung cancer in primary care referrals: early value assessment. National Institute for Health and Care Excellence; 2023."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-081062","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T22:54:53Z","timestamp":1765839293000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-081062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":10,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,20]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/bmjopen-2023-081062"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-081062","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}