Artificial intelligence for lung ultrasound interpretation: a systematic review

Abstract

Context and objectives Lung ultrasound (LUS) is a safe low-cost tool that enables diagnosis, monitoring and guidance for interventional procedures at the patient's bedside. However, its expansion is hindered by a lack of training programs and the inherent difficulty of interpreting ultrasound images. In this context, Artificial Intelligence (AI) is emerging as a supportive tool for LUS interpretation, ensuring diagnostic efficacy and mitigating the shortage of experts. This systematic review aims to summarize and analyze recent advances in AI-based tools to support LUS interpretation. Methods A systematic literature search was conducted across Web of Science, IEEE Xplore, and PubMed databases to identify peer-reviewed original journal articles published between 2015 and November 2025 that employed AI for the identification and localization of lung artifacts, anatomical structures, and pathological findings. Risk of bias was assessed using PROBAST + AI. Results Twenty-four studies were included, identifying three main strategies: segmentation (10 studies), object detection (4 studies), and the generation of visual explanations through saliency maps (10 studies). All employed CNN-based architectures. The evaluation metrics used were heterogeneous. The PROBAST + AI assessment showed relevant risk-of-bias concerns, mainly concentrated in the participants and analysis domains. Conclusions The development of AI systems to support LUS interpretation shows high potential; however, current studies exhibit significant heterogeneity in their objectives, methodologies, and evaluation metrics. It is necessary to move towards solutions designed for specific clinical environments and to adopt standardized protocols and evaluations that facilitate their implementation in clinical practice. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261322517, PROSPERO CRD420261322517.