Diagnostic performance of ChatGPT in detecting gastrointestinal tract perforation on chest radiographs: a comparative study

Background: Gastrointestinal (GI) tract perforation is a surgical emergency requiring rapid diagnosis, often via chest radiography. Artificial intelligence (AI), including large language models like ChatGPT, has potential to enhance medical imaging but its efficacy in detecting GI perforation is unclear. We compared the diagnostic accuracy of ChatGPT 3.5 and 4 with human experts in interpreting chest radiographs for GI perforation. Methods: This retrospective study, approved by the Arel University Hospital Ethics Committee (E-52857131-050.06.04-455896), analyzed 504 chest radiographs from patients diagnosed with GI perforation between 2010 and 2021. Radiographs were classified into three groups: definite GI perforation, suspicious requiring further imaging, or no perforation. Two clinicians (emergency medicine specialist and general surgeon) independently evaluated radiographs, followed by ChatGPT 3.5 and 4 using a standardized prompt. Diagnostic accuracy was assessed with chi-square tests, and decision-making times with Student’s t-test (p