Estimating the Amount of Air Inside the Stomach for Detecting Cancers on Gastric Radiographs Using Artificial Intelligence: an Observational, Cross-sectional Study

Gastric radiography is an important tool for early detection of cancer. During gastric radiography, the stomach is monitored using barium and effervescent granules. However, stomach compression and physiological phenomena during the examination can cause air to escape the stomach. When the stomach contracts, physicians cannot accurately observe its condition, which may result in missed lesions. Notably, no research using artificial intelligence (AI) has explored the use of gastric radiography to estimate the amount of air in the stomach. Therefore, this study aimed to develop an AI system to estimate the amount of air inside the stomach using gastric radiographs. In this observational, cross-sectional study, we collected data from 300 cases who underwent medical screening and estimated the images with poor stomach air volume. We used pre-trained models of vision transformer (ViT) and convolutional neural network (CNN). Instead of retraining, dimensionality reduction was performed on the output features using principal component analysis, and LightGBM performed discriminative processing. The combination of ViT and CNN resulted in the highest accuracy (F-value 0.792, accuracy 0.943, sensitivity 0.738, specificity 0.978). High accuracy was maintained in the prone position, where air inside the stomach could be easily released. Combining ViT and CNN from gastric radiographs accurately identified cases of poor stomach air volume. The system was highly accurate in the prone position and proved clinically useful. The developed AI can be used to provide high-quality images to physicians and to prevent missed lesions.