Millions of patients in England with suspected broken bones could have their X-rays checked with a £1 artificial intelligence scan to help NHS doctors avoid missing fractures. Overlooked broken bones are among the most common mistakes made in A&E units and urgent care centres, with as many as 10% of fracture cases either not spotted at all by medical professionals or diagnosed late. Missing a fracture during an initial assessment can lead to further injury or harm to the patient, worsening their condition and making it harder for hospitals to treat quickly. The NHS has now been given the green light by the National Institute for Health and Care Excellence (Nice) to use AI as a way of improving fracture detection when examining X-rays. Clinical evidence suggests that using AI may improve detection in scans, compared with a medical professional reviewing on their own, “without increasing the risk of incorrect diagnoses”, Nice said. Using AI could reduce the number of fractures missed at initial presentation, prevent further injury or harm to people during the time between the first assessment and a decision on further treatment, and “may help reduce variation in care across the country”, it added. The move could also reduce the need for follow-up checks and appointments amid the NHS workforce crisis. Mark Chapman, the director of HealthTech at Nice, said: “Every day across the NHS, thousands of images are interpreted by expert radiologists and radiographers, but there is a high vacancy rate within these departments across the country and more support is needed to manage their workload. “These AI technologies are safe to use and could spot fractures which humans might miss given the pressure and demands these professional groups work under.” In addition to a trained healthcare professional reviewing the X-ray, the NHS can use four AI platforms under draft guidance published by Nice. Those recommended are TechCare Alert, which can be used on patients of any age; Rayvolve, for adults only; and BoneView and RBfracture, for adults and children aged two and up. Chapman said: “Using AI technology to help highly skilled professionals in urgent care centres to identify which of their patients has a fracture could potentially speed up diagnosis and reduce follow-up appointments needed because of a fracture missed during an initial assessment.” Patients with suspected fractures are typically assessed by a nurse or doctor, who may request an X-ray to be carried out by a radiographer. Nice recommends that these X-rays should be reviewed by a radiologist, radiographer or other trained professional, who should provide a detailed report before a patient is discharged. Nevertheless, Nice said this was not always possible in practice, with reporting delays lasting days or weeks. During modelling, the cost for each AI scan was estimated at £1. The NHS has been advised to ensure costs remain close to that estimate. Charlotte Beardmore from the Society of Radiographers backed the plans but said that while AI might improve accuracy, it could not replace the expertise of radiographers and radiologists. A consultation on the draft recommendations will run until 5 November.