Previously submitted to: JMIR Research Protocols (no longer under consideration since Jun 30, 2026)
Date Submitted: Jun 17, 2025
Open Peer Review Period: Jun 17, 2025 - Aug 12, 2025
(closed for review but you can still tweet)
Identifying Right Ventricular Dysfunction from Chest X-Ray Using Deep Learning: Protocol for a Feasibility Trial
Background:
Right ventricular dysfunction (RVD) is an important predictor of outcomes in patients with heart disease, which has significant prognostic implications for a range of diseases, including ischaemic and non-ischaemic cardiomyopathy, valvular heart disease, congenital heart disease, and pulmonary hypertension. The routine diagnosis of right heart structural abnormalities at an earlier stage, ideally when only structural abnormalities are present but patients are not yet symptomatic, represents an elusive but critical goal in the field of cardiology.
Objective:
The objective of this study is to apply deep learning (DL) analysis to chest X-rays (CXRs) in order to accurately detect specific structural abnormalities, thus facilitating the early identification of patients exhibiting RVD and improving outcomes.
Methods:
A total of 10,000 paired CXR-echocardiogram data will be assembled, including a retrospective dataset (2015–2024) and a prospective feasibility subset (January 2025–December 2025). The data includes adult CXRs with corresponding echocardiographic labels of right ventricular function, including right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and right ventricular myocardial performance index (RVMPI). The study will employ DenseNet-121 for the interpretation of CXRs with the objective of identifying the presence of RVD. The DL model will be evaluated against independently collected and labelled sets of CXRs, Subsequently, three main assessments of the model will be performed: validation of the trained model on a separate dataset of patients who have been treated in the emergency department, validation on another independent test dataset obtained from healthy volunteers, and comparison of the model's performance against that of five radiologists on a sample of CXRs will be conducted. The primary objective of the study protocol is the creation of a DL model that is capable of accurately identifying RVD from inexpensive and prevalent examinations of CXRs.
Results:
The collected data will be synthesized to evaluate the program's acceptability and the feasibility of study procedures. Ethical approval was obtained in November 2024, followed by the initiation of participant recruitment. Data collection is scheduled to continue through December 2025.
Conclusions:
This feasibility trial may confirm DL can identify RVD from CXRs.
ClinicalTrial:
Chinese Clinical Trial Registry ChiCTR2500095838; https://www.chictr.org.cn/showprojEN.html?proj=250189
International Registered Report:
PRR1-10.2196/79197
Citation
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