Strengths and Limitations
The strength of this study is the evaluation of consecutively enrolled individuals in the clinical practice setting. There are some limitations of the study. First, since the residents and radiologists were from the same country, although they are fully qualified specialists, their findings might not be representative of clinicians elsewhere. Although we used the final reports of experienced radiologists as the reference, nonstandard terms in their reports may reduce the BLEU score. Second, we did not include data on ethnicity and patient demographic characteristics beyond age and sex. Future work should be to study the generalizability of this system in different geographic settings. Third, although the current 23 abnormal signs on CXR are common, other abnormal signs need further study to improve the scope and generalizability of the system.