Comparing ChatGPT 4.0’s Performance in Interpreting Thyroid Nodule Ultrasound Reports Using ACR-TI-RADS 2017: Analysis Across Different Levels of Ultrasound User Experience

<b>Background/Objectives:</b> This study evaluates ChatGPT 4.0's ability to interpret thyroid ultrasound (US) reports using ACR-TI-RADS 2017 criteria, comparing its performance with different levels of US users. <b>Methods:</b> A team of medical experts, an inexperienced US user, and ChatGPT 4.0 analyzed 100 fictitious thyroid US reports. ChatGPT's performance was assessed for accuracy, consistency, and diagnostic recommendations, including fine-needle aspirations (FNA) and follow-ups. <b>Results:</b> ChatGPT demonstrated substantial agreement with experts in assessing echogenic foci, but inconsistencies in other criteria, such as composition and margins, were evident in both its analyses. Interrater reliability between ChatGPT and experts ranged from moderate to almost perfect, reflecting AI's potential but also its limitations in achieving expert-level interpretations. The inexperienced US user outperformed ChatGPT with a nearly perfect agreement with the experts, highlighting the critical role of traditional medical training in standardized risk stratification tools such as TI-RADS. <b>Conclusions:</b> ChatGPT showed high specificity in recommending FNAs but lower sensitivity and specificity for follow-ups compared to the medical student. These findings emphasize ChatGPT's potential as a supportive diagnostic tool rather than a replacement for human expertise. Enhancing AI algorithms and training could improve ChatGPT's clinical utility, enabling better support for clinicians in managing thyroid nodules and improving patient care. This study highlights both the promise and current limitations of AI in medical diagnostics, advocating for its refinement and integration into clinical workflows. However, it emphasizes that traditional clinical training must not be compromised, as it is essential for identifying and correcting AI-driven errors.