Computer-Aided Diagnosis (CAD) systems for chest radiographs using artificial intelligence (AI) have recently shown a great potential as a second opinion for radiologists. The performances of such systems, however, were mostly evaluated on a fixed dataset in a retrospective manner and, thus, far from the real performances in clinical practice. In this work, we demonstrate a mechanism for validating an AI-based system for detecting abnormalities on X-ray scans, VinDr-CXR, at the Phu Tho General Hospital - a provincial hospital in the North of Vietnam. The AI system was directly integrated into the Picture Archiving and Communication System (PACS) of the hospital after being trained on a fixed annotated dataset from other sources. The performance of the system was prospectively measured by matching and comparing the AI results with the radiology reports of 6,285 chest X-ray examinations extracted from the Hospital Information System (HIS) over the last two months of 2020. The normal/abnormal status of a radiology report was determined by a set of rules and served as the ground truth. Our system achieves an F1 score - the harmonic average of the recall and the precision - of 0.653 (95% CI 0.635, 0.671) for detecting any abnormalities on chest X-rays. Despite a significant drop from the in-lab performance, this result establishes a high level of confidence in applying such a system in real-life situations.
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