{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:45:08Z","timestamp":1785386708174,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chungbuk National University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Artificial intelligence (AI) techniques can be a solution for delayed or misdiagnosed pneumothorax. This study developed, a deep-learning-based AI model to estimate the pneumothorax amount on a chest radiograph and applied it to a treatment algorithm developed by experienced thoracic surgeons. U-net performed semantic segmentation and classification of pneumothorax and non-pneumothorax areas. The pneumothorax amount was measured using chest computed tomography (volume ratio, gold standard) and chest radiographs (area ratio, true label) and calculated using the AI model (area ratio, predicted label). Each value was compared and analyzed based on clinical outcomes. The study included 96 patients, of which 67 comprised the training set and the others the test set. The AI model showed an accuracy of 97.8%, sensitivity of 69.2%, a negative predictive value of 99.1%, and a dice similarity coefficient of 61.8%. In the test set, the average amount of pneumothorax was 15%, 16%, and 13% in the gold standard, predicted, and true labels, respectively. The predicted label was not significantly different from the gold standard (p = 0.11) but inferior to the true label (difference in MAE: 3.03%). The amount of pneumothorax in thoracostomy patients was 21.6% in predicted cases and 18.5% in true cases.<\/jats:p>","DOI":"10.3390\/diagnostics12081823","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T01:41:16Z","timestamp":1659058876000},"page":"1823","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Quantitative Measurement of Pneumothorax Using Artificial Intelligence Management Model and Clinical Application"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8304-0232","authenticated-orcid":false,"given":"Dohun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4406-0940","authenticated-orcid":false,"given":"Jae-Hyeok","family":"Lee","sequence":"additional","affiliation":[{"name":"Deepnoid, Inc., Seoul 08376, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si-Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Myeon","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6546-7918","authenticated-orcid":false,"given":"Minji","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Radiology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Mun","family":"Choi","sequence":"additional","affiliation":[{"name":"Deepnoid, Inc., Seoul 08376, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun-Yeop","family":"Lee","sequence":"additional","affiliation":[{"name":"Deepnoid, Inc., Seoul 08376, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Deepnoid, Inc., Seoul 08376, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0007-1960","authenticated-orcid":false,"given":"Jin-Young","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Radiology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.4306\/pi.2017.14.6.795","article-title":"Psychological Problems of Pneumothorax According to Resilience, Stress, and Post-Traumatic Stress","volume":"14","author":"Kim","year":"2017","journal-title":"Psychiatry Investig."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4782","DOI":"10.21037\/jtd.2019.10.30","article-title":"Fate of Spontaneous Pneumothorax from Middle to Old Age: How to Overcome an Irritating Recurrence?","volume":"11","author":"Nam","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1093\/icvts\/ivz290","article-title":"Epidemiology and Management of Primary Spontaneous Pneumothorax: A Systematic Review","volume":"30","author":"Mendogni","year":"2020","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"253","DOI":"10.5090\/kjtcs.2011.44.3.253","article-title":"Life-Threatening Simultaneous Bilateral Spontaneous Tension Pneumothorax\u2014A Case Report","volume":"44","author":"Rim","year":"2011","journal-title":"Korean J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"424","DOI":"10.5090\/kjtcs.2017.50.6.424","article-title":"Location of Ruptured Bullae in Secondary Spontaneous Pneumothorax","volume":"50","author":"Choi","year":"2017","journal-title":"Korean J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/j.athoracsur.2013.12.066","article-title":"Four Cases of Contralateral Pneumothorax After Pneumonectomy","volume":"98","author":"Matsuoka","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s00101-019-0579-x","article-title":"Catheterization of the Subclavian Vein and the Risk of Pneumothorax: Mechanical Ventilation Increases the Risk of Pneumothorax During Infraclavicular Landmark-Guided Subclavian Vein Puncture: A Prospective Randomized Study","volume":"68","author":"Palmaers","year":"2019","journal-title":"Anaesthesist"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1213\/ANE.0000000000001431","article-title":"Influence of Mechanical Ventilation on the Incidence of Pneumothorax During Infraclavicular Subclavian Vein Catheterization: A Prospective Randomized Noninferiority Trial","volume":"123","author":"Kim","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.clp.2007.11.004","article-title":"Pulmonary Complications of Mechanical Ventilation in Neonates","volume":"35","author":"Miller","year":"2008","journal-title":"Clin. Perinatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/0735-6757(95)90164-7","article-title":"Delayed Tension Penumothorax Complicating Central Venous Catheterization and Positive Pressure Ventilation","volume":"13","author":"Plewa","year":"1995","journal-title":"Am. J. Emerg. Med."},{"key":"ref_11","first-page":"170","article-title":"Delayed Pneumothorax: A Potential Complication of Transbronchial Lung Biopsy","volume":"23","author":"Narula","year":"2018","journal-title":"Respir. Med. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jclinane.2017.11.023","article-title":"Delayed Diagnosis of Contralateral Tension Pneumothorax During Robotic Lung Wedge Resection","volume":"45","author":"Huang","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/nature14236","article-title":"Human-Level Control Through Deep Reinforcement Learning","volume":"518","author":"Mnih","year":"2015","journal-title":"Nature"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1038\/s41568-018-0016-5","article-title":"Artificial Intelligence in Radiology","volume":"18","author":"Hosny","year":"2018","journal-title":"Nat. Rev. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"ii18","DOI":"10.1136\/thx.2010.136986","article-title":"Management of Spontaneous Pneumothorax: British Thoracic Society Pleural Disease Guideline 2010","volume":"65","author":"MacDuff","year":"2010","journal-title":"Thorax"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1378\/chest.119.2.590","article-title":"Management of Spontaneous Pneumothorax: An American College of Chest Physicians Delphi Consensus Statement","volume":"119","author":"Baumann","year":"2001","journal-title":"Chest"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.thorsurg.2016.08.009","article-title":"Errors and Complications in Chest Tube Placement","volume":"27","author":"Filosso","year":"2017","journal-title":"Thorac. Surg. Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/S2213-2600(15)00220-9","article-title":"Spontaneous Pneumothorax: Time to Rethink Management?","volume":"3","author":"Bintcliffe","year":"2015","journal-title":"Lancet Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s11548-019-02115-9","article-title":"Contour-Aware Multi-Label Chest X-Ray Organ Segmentation","volume":"15","author":"Kholiavchenko","year":"2020","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1109\/TMI.2018.2806086","article-title":"Fully Convolutional Architectures for Multiclass Segmentation in Chest Radiographs","volume":"37","author":"Novikov","year":"2018","journal-title":"IEEE Trans. Med. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8821697","DOI":"10.1155\/2021\/8821697","article-title":"Risk Factors and a Scoring System to Predict ARDS in Patients with COVID-19 Pneumonia in Korea: A Multicenter Cohort Study","volume":"2021","author":"Seo","year":"2021","journal-title":"Dis. Markers"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e200172","DOI":"10.1148\/ryai.2021200172","article-title":"Detection and Semiquantitative Analysis of Cardiomegaly, Pneumothorax, and Pleural Effusion on Chest Radiographs","volume":"3","author":"Zhou","year":"2021","journal-title":"Radiol. Artif. Intell."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000135932","article-title":"Pneumothorax","volume":"76","author":"Noppen","year":"2008","journal-title":"Respiration"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1001\/jama.1954.03690190030009","article-title":"Spontaneous Pneumothorax and Its Treatment","volume":"155","author":"Kircher","year":"1954","journal-title":"J. Am. Med. Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Islam, S., Rehana, H., Asaduzzaman, S., Hossen, S.M., Hossain, R., Bhuiyan, T., Uddin, M.S., and Akter, N. (2020, January 5\u20137). Automated Risk Prediction by Measuring Pneumothorax Size Using Deep Learning. Proceedings of the 2020 IEEE Region 10 Symposium (TENSYMP), Dhaka, Bangladesh.","DOI":"10.1109\/TENSYMP50017.2020.9230840"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s41747-020-00152-7","article-title":"Deep Learning Detection and Quantification of Pneumothorax in Heterogeneous Routine Chest Computed Tomography","volume":"4","author":"Schlegl","year":"2020","journal-title":"Eur. Radiol. Exp."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s13054-020-2785-y","article-title":"Artificial Intelligence in the Intensive Care Unit","volume":"24","author":"Gutierrez","year":"2020","journal-title":"Crit. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1056\/NEJM200003233421207","article-title":"Spontaneous Pneumothorax","volume":"342","author":"Sahn","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1111\/j.1440-1673.2007.01705.x","article-title":"How Accurate Is the Light Index for Estimating Pneumothorax Size?","volume":"51","author":"Hoi","year":"2007","journal-title":"Australas. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/8\/1823\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:58:47Z","timestamp":1760140727000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/8\/1823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,29]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["diagnostics12081823"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12081823","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,29]]}}}