The use of artificial intelligence (AI) is a powerful tool for image analysis that is increasingly being evaluated by radiology professionals. However, due to the fact that these methods have been developed for the analysis of nonmedical image data and data structure in radiology departments is not “AI ready”, implementing AI in radiology is not straightforward. The purpose of this review is to guide the reader through the pipeline of an AI project for automated image analysis in radiology and thereby encourage its implementation in radiology departments. At the same time, this review aims to enable readers to critically appraise articles on AI-based software in radiology.

Highlights It is feasible to develop clinically useful AI-based software for quantification of pulmonary opacities in COVID-19 in just 10 days. An established pipeline for fast transition of prototypes to full clinical implementation is an important key to success. Human-level performance, even in the presence of advanced disease, was achieved with less than 200 chest CT scans for training of the AI algorithm.

Pancreatic cystic lesions (PCL) are a frequent and underreported incidental finding on CT scans and can transform into neoplasms with devastating consequences. We developed and evaluated an algorithm based on a two-step nnU-Net architecture for automated detection of PCL on CTs. A total of 543 cysts on 221 abdominal CTs were manually segmented in 3D by a radiology resident in consensus with a board-certified radiologist specialized in abdominal radiology. This information was used to train a two-step nnU-Net for detection with the performance assessed depending on lesions’ volume and location in comparison to three human readers of varying experience. Mean sensitivity was 78.8 ± 0.1%. The sensitivity was highest for large lesions with 87.8% for cysts ≥220 mm3 and for lesions in the distal pancreas with up to 96.2%. The number of false-positive detections for cysts ≥220 mm3 was 0.1 per case. The algorithm’s performance was comparable to human readers. To conclude, automated detection of PCL on CTs is feasible. The proposed model could serve radiologists as a second reading tool. All imaging data and code used in this study are freely available online.