{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T02:06:33Z","timestamp":1778983593799,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>The generalizability of artificial intelligence (AI) models is a major issue in the field of AI applications. Therefore, we aimed to overcome the generalizability problem of an AI model developed for a particular center for pneumothorax detection using a small dataset for external validation. Chest radiographs of patients diagnosed with pneumothorax (n\u2009=\u2009648) and those without pneumothorax (n\u2009=\u2009650) who visited the Ankara University Faculty of Medicine (AUFM; center 1) were obtained. A deep learning-based pneumothorax detection algorithm (PDA-Alpha) was developed using the AUFM dataset. For implementation at the Health Sciences University (HSU; center 2), PDA-Beta was developed through external validation of PDA-Alpha using 50 radiographs with pneumothorax obtained from HSU. Both PDA algorithms were assessed using the HSU test dataset (n\u2009=\u2009200) containing 50 pneumothorax and 150 non-pneumothorax radiographs. We compared the results generated by the algorithms with those of physicians to demonstrate the reliability of the results. The areas under the curve for PDA-Alpha and PDA-Beta were 0.993 (95% confidence interval (CI): 0.985\u20131.000) and 0.986 (95% CI: 0.962\u20131.000), respectively. Both algorithms successfully detected the presence of pneumothorax on 49\/50 radiographs; however, PDA-Alpha had seven false-positive predictions, whereas PDA-Beta had one. The positive predictive value increased from 0.525 to 0.886 after external validation (p\u2009=\u20090.041). The physicians\u2019 sensitivity and specificity for detecting pneumothorax were 0.585 and 0.988, respectively. The performance scores of the algorithms were increased with a small dataset; however, further studies are required to determine the optimal amount of external validation data to fully address the generalizability issue.<\/jats:p>","DOI":"10.1177\/10815589231208479","type":"journal-article","created":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T23:50:25Z","timestamp":1697413825000},"page":"88-99","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Can the generalizability issue of artificial intelligence be overcome? Pneumothorax detection algorithm"],"prefix":"10.1177","volume":"72","author":[{"given":"Elvan Burak","family":"Verdi","sequence":"first","affiliation":[{"name":"Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammed","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"School of Engineering, TOBB University of Economics and Technology, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deniz","family":"Do\u011fan M\u00fclazimo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Health Sciences University G\u00fclhane Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdussamet","family":"T\u00fcrker","sequence":"additional","affiliation":[{"name":"School of Engineering, TOBB University of Economics and Technology, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asl\u0131han","family":"G\u00fcr\u00fcn Kaya","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6zlem","family":"I\u015f\u0131k","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asl\u0131","family":"Bostano\u011flu Kara\u00e7in","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Health Sciences University G\u00fclhane Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6vg\u00fc","family":"Velio\u011flu Yakut","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00fclent Mustafa","family":"Yenig\u00fcn","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c7a\u011flar","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atilla Halil","family":"Elhan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6zlem","family":"\u00d6zdemir Kumbasar","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ak\u0131n","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayten","family":"Kay\u0131 Cang\u0131r","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cant\u00fcrk","family":"Ta\u015f\u00e7\u0131","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Health Sciences University G\u00fclhane Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet Murat","family":"\u00d6zbayo\u011flu","sequence":"additional","affiliation":[{"name":"School of Engineering, TOBB University of Economics and Technology, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serhat","family":"Erol","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,11,10]]},"reference":[{"key":"bibr1-10815589231208479","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00022-2019"},{"key":"bibr2-10815589231208479","doi-asserted-by":"publisher","DOI":"10.5152\/eajem.2018.52523"},{"key":"bibr3-10815589231208479","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-92523-2"},{"key":"bibr4-10815589231208479","doi-asserted-by":"publisher","DOI":"10.1097\/RLI.0000000000000707"},{"key":"bibr5-10815589231208479","first-page":"203","author":"World Health Organization. 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