{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T16:57:26Z","timestamp":1781024246893,"version":"3.54.1"},"reference-count":48,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Caries Res"],"abstract":"<jats:p>Background: Artificial intelligence (AI) systems for radiographic caries detection are commonly evaluated using a small set of performance metrics, yet these measures are frequently reported and interpreted without the contextual information required for clinically meaningful conclusions. Summary: This narrative review focuses on performance metrics \u2013 confusion-matrix measures (sensitivity, specificity, accuracy, predictive values, F1 score and related summaries) and discrimination metrics (area under the receiver operating characteristic curve and area under the precision recall curve) \u2013 and discusses how their interpretation depends on explicit reporting of the disease definition (grading cut-offs), unit of analysis (tooth surface\/patient), decision threshold(s), and prevalence\/case-mix. We additionally cover complementary metric-based assessments, including calibration (calibration curves, expected calibration error, Brier score), decision-analytic metrics (decision curve analysis and cost-sensitive clinical loss), and robustness summaries (uncertainty and subgroup\/worst-group performance). A structured summary is provided of formulae, interpretive limitations, and the minimum information that should accompany each metric to support transparent reporting, comparability, and transportability. Key Messages: AI-assisted radiographic caries detection cannot be judged by headline metrics alone; traditional performance measures should be reported with clear disease definitions, operating points, prevalence, and the clinical impact of false results. We provide a practical guide to improving the transparency, comparability and clinically meaningful interpretation of future studies.<\/jats:p>","DOI":"10.1159\/000551765","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T17:00:45Z","timestamp":1774544445000},"page":"1-14","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Diagnostic Performance Metrics in Imaging Artificial Intelligence: Lessons from Caries Detection on Radiographs"],"prefix":"10.1159","author":[{"given":"Carolina","family":"Ganss","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9278-2203","authenticated-orcid":false,"given":"Kirstin","family":"Vach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.85062"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1002\/cre2.70004"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-05597-3"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1186\/s13005-025-00496-8"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jebdp.2024.102077"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2024.105388"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdsr.2024.02.001"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1159\/000536277"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03953-8"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-078378"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/s2589-7500(20)30218-1"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01229-5"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.240300"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.2020200029"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-082505"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.2196\/58202"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00009"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2021.103610"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2024.105318"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12030937"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1159\/000546448"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-025-11890-w"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2024.105105"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1159\/000547245"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2021.103849"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1093\/dmfr\/twaf053"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.landig.2025.100916"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1186\/s13321-024-00837-w"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1159\/000527418"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1159\/000262092"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1186\/s12864-019-6413-7"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-014-3487-0"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0118432"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1093\/rpd\/ncp305"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.radi.2014.04.005"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2024.104886"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrai.2025.100030"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2023.107816"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1177\/09622802221122391"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-022-08685-8"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1080\/10543406.2016.1226335"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.202200302"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-07167-7"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1016\/j.metrad.2024.100084"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-022-06096-y"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2023.104593"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7336.539"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0000940"}],"container-title":["Caries 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