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Cheng CT, Ooyang CH, Kang SC, Liao CH. Applications of Deep Learning in Trauma Radiology: A Narrative Review. Biomed J 2024:100743. [PMID: 38679199 DOI: 10.1016/j.bj.2024.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 05/01/2024] Open
Abstract
Diagnostic imaging is essential in modern trauma care for initial evaluation and identifying injuries requiring intervention. Deep learning (DL) has become mainstream in medical image analysis and has shown promising efficacy for classification, segmentation, and lesion detection. This narrative review provides the fundamental concepts for developing DL algorithms in trauma imaging and presents an overview of current progress in each modality. DL has been applied to detect free fluid on Focused Assessment with Sonography for Trauma (FAST), traumatic findings on chest and pelvic X-rays, and computed tomography (CT) scans, identify intracranial hemorrhage on head CT, detect vertebral fractures, and identify injuries to organs like the spleen, liver, and lungs on abdominal and chest CT. Future directions involve expanding dataset size and diversity through federated learning, enhancing model explainability and transparency to build clinician trust, and integrating multimodal data to provide more meaningful insights into traumatic injuries. Though some commercial artificial intelligence products are Food and Drug Administration-approved for clinical use in the trauma field, adoption remains limited, highlighting the need for multi-disciplinary teams to engineer practical, real-world solutions. Overall, DL shows immense potential to improve the efficiency and accuracy of trauma imaging, but thoughtful development and validation are critical to ensure these technologies positively impact patient care.
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Affiliation(s)
- Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Taiwan
| | - Chun-Hsiang Ooyang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Taiwan
| | - Shih-Ching Kang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Taiwan.
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Taiwan
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Liu XS, Nie R, Duan AW, Yang L, Li X, Zhang LT, Guo GK, Guo QS, Zhao DC, Li Y, Zhang HH. YOLOX-SwinT algorithm improves the accuracy of AO/OTA classification of intertrochanteric fractures by orthopedic trauma surgeons. Chin J Traumatol 2024:S1008-1275(24)00051-8. [PMID: 38762418 DOI: 10.1016/j.cjtee.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 05/20/2024] Open
Abstract
PURPOSE Intertrochanteric fracture (ITF) classification is crucial for surgical decision-making. However, orthopedic trauma surgeons have shown lower accuracy in ITF classification than expected. The objective of this study was to utilize an artificial intelligence (AI) method to improve the accuracy of ITF classification. METHODS We trained a network called YOLOX-SwinT, which is based on the You Only Look Once X (YOLOX) object detection network with Swin Transformer (SwinT) as the backbone architecture, using 762 radiographic ITF examinations as the training set. Subsequently, we recruited 5 senior orthopedic trauma surgeons (SOTS) and 5 junior orthopedic trauma surgeons (JOTS) to classify the 85 original images in the test set, as well as the images with the prediction results of the network model in sequence. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) 20.0 (IBM Corp., Armonk, NY, USA) to compare the differences among the SOTS, JOTS, SOTS + AI, JOTS + AI, SOTS + JOTS, and SOTS + JOTS + AI groups. All images were classified according to the AO/OTA 2018 classification system by 2 experienced trauma surgeons and verified by another expert in this field. Based on the actual clinical needs, after discussion, we integrated 8 subgroups into 5 new subgroups, and the dataset was divided into training, validation, and test sets by the ratio of 8:1:1. RESULTS The mean average precision at the intersection over union (IoU) of 0.5 (mAP50) for subgroup detection reached 90.29%. The classification accuracy values of SOTS, JOTS, SOTS + AI, and JOTS + AI groups were 56.24% ± 4.02%, 35.29% ± 18.07%, 79.53% ± 7.14%, and 71.53% ± 5.22%, respectively. The paired t-test results showed that the difference between the SOTS and SOTS + AI groups was statistically significant, as well as the difference between the JOTS and JOTS + AI groups, and the SOTS + JOTS and SOTS + JOTS + AI groups. Moreover, the difference between the SOTS + JOTS and SOTS + JOTS + AI groups in each subgroup was statistically significant, with all p < 0.05. The independent samples t-test results showed that the difference between the SOTS and JOTS groups was statistically significant, while the difference between the SOTS + AI and JOTS + AI groups was not statistically significant. With the assistance of AI, the subgroup classification accuracy of both SOTS and JOTS was significantly improved, and JOTS achieved the same level as SOTS. CONCLUSION In conclusion, the YOLOX-SwinT network algorithm enhances the accuracy of AO/OTA subgroups classification of ITF by orthopedic trauma surgeons.
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Affiliation(s)
- Xue-Si Liu
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Rui Nie
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Ao-Wen Duan
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Li Yang
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xiang Li
- Department of Information, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Le-Tian Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Guang-Kuo Guo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Qing-Shan Guo
- Division of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, 400042, China
| | - Dong-Chu Zhao
- Division of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, 400042, China
| | - Yang Li
- Division of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, 400042, China.
| | - He-Hua Zhang
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Cheng CT, Kuo LW, Ouyang CH, Hsu CP, Lin WC, Fu CY, Kang SC, Liao CH. Development and evaluation of a deep learning-based model for simultaneous detection and localization of rib and clavicle fractures in trauma patients' chest radiographs. Trauma Surg Acute Care Open 2024; 9:e001300. [PMID: 38646620 PMCID: PMC11029226 DOI: 10.1136/tsaco-2023-001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Purpose To develop a rib and clavicle fracture detection model for chest radiographs in trauma patients using a deep learning (DL) algorithm. Materials and methods We retrospectively collected 56 145 chest X-rays (CXRs) from trauma patients in a trauma center between August 2008 and December 2016. A rib/clavicle fracture detection DL algorithm was trained using this data set with 991 (1.8%) images labeled by experts with fracture site locations. The algorithm was tested on independently collected 300 CXRs in 2017. An external test set was also collected from hospitalized trauma patients in a regional hospital for evaluation. The receiver operating characteristic curve with area under the curve (AUC), accuracy, sensitivity, specificity, precision, and negative predictive value of the model on each test set was evaluated. The prediction probability on the images was visualized as heatmaps. Results The trained DL model achieved an AUC of 0.912 (95% CI 87.8 to 94.7) on the independent test set. The accuracy, sensitivity, and specificity on the given cut-off value are 83.7, 86.8, and 80.4, respectively. On the external test set, the model had a sensitivity of 88.0 and an accuracy of 72.5. While the model exhibited a slight decrease in accuracy on the external test set, it maintained its sensitivity in detecting fractures. Conclusion The algorithm detects rib and clavicle fractures concomitantly in the CXR of trauma patients with high accuracy in locating lesions through heatmap visualization.
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Affiliation(s)
- Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chun-Hsiang Ouyang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chi-Po Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Wei-Cheng Lin
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
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Sarkar N, Kumagai M, Meyr S, Pothapragada S, Unberath M, Li G, Ahmed SR, Smith EB, Davis MA, Khatri GD, Agrawal A, Delproposto ZS, Chen H, Caballero CG, Dreizin D. An ASER AI/ML expert panel formative user research study for an interpretable interactive splenic AAST grading graphical user interface prototype. Emerg Radiol 2024; 31:167-178. [PMID: 38302827 DOI: 10.1007/s10140-024-02202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE The AAST Organ Injury Scale is widely adopted for splenic injury severity but suffers from only moderate inter-rater agreement. This work assesses SpleenPro, a prototype interactive explainable artificial intelligence/machine learning (AI/ML) diagnostic aid to support AAST grading, for effects on radiologist dwell time, agreement, clinical utility, and user acceptance. METHODS Two trauma radiology ad hoc expert panelists independently performed timed AAST grading on 76 admission CT studies with blunt splenic injury, first without AI/ML assistance, and after a 2-month washout period and randomization, with AI/ML assistance. To evaluate user acceptance, three versions of the SpleenPro user interface with increasing explainability were presented to four independent expert panelists with four example cases each. A structured interview consisting of Likert scales and free responses was conducted, with specific questions regarding dimensions of diagnostic utility (DU); mental support (MS); effort, workload, and frustration (EWF); trust and reliability (TR); and likelihood of future use (LFU). RESULTS SpleenPro significantly decreased interpretation times for both raters. Weighted Cohen's kappa increased from 0.53 to 0.70 with AI/ML assistance. During user acceptance interviews, increasing explainability was associated with improvement in Likert scores for MS, EWF, TR, and LFU. Expert panelists indicated the need for a combined early notification and grading functionality, PACS integration, and report autopopulation to improve DU. CONCLUSIONS SpleenPro was useful for improving objectivity of AAST grading and increasing mental support. Formative user research identified generalizable concepts including the need for a combined detection and grading pipeline and integration with the clinical workflow.
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Affiliation(s)
- Nathan Sarkar
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Mitsuo Kumagai
- University of Maryland College Park, 4603 Calvert Rd, College Park, MD, 20740, USA
| | - Samantha Meyr
- University of Maryland College Park, 4603 Calvert Rd, College Park, MD, 20740, USA
| | - Sriya Pothapragada
- University of Maryland College Park, 4603 Calvert Rd, College Park, MD, 20740, USA
| | - Mathias Unberath
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | - Guang Li
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Sagheer Rauf Ahmed
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
- R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Elana Beth Smith
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
- R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | | | | | - Anjali Agrawal
- Teleradiology Solutions, 22 Lianfair Road Unit 6, Ardmore, PA, 19003, USA
| | | | - Haomin Chen
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | | | - David Dreizin
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA.
- R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, USA.
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Nho WY. Validation of the 35-mm rule in traumatic pneumothorax in an Asian population. Postgrad Med 2024; 136:60-66. [PMID: 38294228 DOI: 10.1080/00325481.2024.2313449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/30/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Thoracic injury crucially threatens human health. Recent studies have suggested using computed tomography (CT) to observe traumatic pneumothorax (PTX). However, cross-ethnic validation is required to overcome potential barriers for the global application of this method. This study aimed to validate the 35-mm rule in traumatic PTX in a Korean population. METHODS Data from the institutional registry were analyzed, and chest CT images were reviewed. Factors for observation failure were evaluated via logistic regression analysis, and a receiver-operating curve was created to calculate the optimal cutoff value. RESULTS In total, 286 participants were included in this study. The average PTX size was 8.2 (3.2-26.5) mm, and 210 of 213 (95.3%) initially observed patients with a PTX size of ≤35 mm successfully completed the safety observation. Multivariate regression analysis revealed that a PTX size of >35 mm is associated with observation failure and suggested a cutoff of 24.5 mm. CONCLUSION Most patients with traumatic PTX of ≤35 mm on CT had undergone successful 4-h observation without thoracostomy. Additionally, PTX of >35 mm was an independent risk factor for observation failure. Considering the lower optimal cutoff value and high failure rates observed in this study, the current guidelines need modifications.
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Affiliation(s)
- Woo Young Nho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
- Regional Trauma Center, Kyungpook National University Hospital, Daegu, South Korea
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6
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Zeng B, Wang H, Xu J, Tu P, Joskowicz L, Chen X. Two-Stage Structure-Focused Contrastive Learning for Automatic Identification and Localization of Complex Pelvic Fractures. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:2751-2762. [PMID: 37030821 DOI: 10.1109/tmi.2023.3264298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Pelvic fracture is a severe trauma with a high rate of morbidity and mortality. Accurate and automatic diagnosis and surgical planning of pelvic fracture require effective identification and localization of the fracture zones. This is a challenging task due to the complexity of pelvic fractures, which often exhibit multiple fragments and sites, large fragment size differences, and irregular morphology. We have developed a novel two-stage method for the automatic identification and localization of complex pelvic fractures. Our method is unique in that it allows to combine the symmetry properties of the pelvic anatomy and capture the symmetric feature differences caused by the fracture on both the left and right sides, thereby overcoming the limitations of existing methods which consider only image or geometric features. It implements supervised contrastive learning with a novel Siamese deep neural network, which consists of two weight-shared branches with a structural attention mechanism, to minimize the confusion of local complex structures of the pelvic bones with the fracture zones. A structure-focused attention (SFA) module is designed to capture the spatial structural features and enhances the recognition ability of fracture zones. Comprehensive experiments on 103 clinical CT scans from the publicly available dataset CTPelvic1K show that our method achieves a mean accuracy and sensitivity of 0.92 and 0.93, which are superior to those reported with three SOTA contrastive learning methods and five advanced classification networks, demonstrating the effectiveness of identifying and localizing various types of complex pelvic fractures from clinical CT images.
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Dreizin D, Staziaki PV, Khatri GD, Beckmann NM, Feng Z, Liang Y, Delproposto ZS, Klug M, Spann JS, Sarkar N, Fu Y. Artificial intelligence CAD tools in trauma imaging: a scoping review from the American Society of Emergency Radiology (ASER) AI/ML Expert Panel. Emerg Radiol 2023; 30:251-265. [PMID: 36917287 PMCID: PMC10640925 DOI: 10.1007/s10140-023-02120-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AI/ML CAD tools can potentially improve outcomes in the high-stakes, high-volume model of trauma radiology. No prior scoping review has been undertaken to comprehensively assess tools in this subspecialty. PURPOSE To map the evolution and current state of trauma radiology CAD tools along key dimensions of technology readiness. METHODS Following a search of databases, abstract screening, and full-text document review, CAD tool maturity was charted using elements of data curation, performance validation, outcomes research, explainability, user acceptance, and funding patterns. Descriptive statistics were used to illustrate key trends. RESULTS A total of 4052 records were screened, and 233 full-text articles were selected for content analysis. Twenty-one papers described FDA-approved commercial tools, and 212 reported algorithm prototypes. Works ranged from foundational research to multi-reader multi-case trials with heterogeneous external data. Scalable convolutional neural network-based implementations increased steeply after 2016 and were used in all commercial products; however, options for explainability were narrow. Of FDA-approved tools, 9/10 performed detection tasks. Dataset sizes ranged from < 100 to > 500,000 patients, and commercialization coincided with public dataset availability. Cross-sectional torso datasets were uniformly small. Data curation methods with ground truth labeling by independent readers were uncommon. No papers assessed user acceptance, and no method included human-computer interaction. The USA and China had the highest research output and frequency of research funding. CONCLUSIONS Trauma imaging CAD tools are likely to improve patient care but are currently in an early stage of maturity, with few FDA-approved products for a limited number of uses. The scarcity of high-quality annotated data remains a major barrier.
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Affiliation(s)
- David Dreizin
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Pedro V Staziaki
- Cardiothoracic Imaging, Department of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Garvit D Khatri
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Nicholas M Beckmann
- Memorial Hermann Orthopedic & Spine Hospital, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Zhaoyong Feng
- Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yuanyuan Liang
- Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zachary S Delproposto
- Division of Emergency Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - J Stephen Spann
- Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Nathan Sarkar
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yunting Fu
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Baltimore, MD, USA
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Artificial Intelligence (AI) for Fracture Diagnosis: An Overview of Current Products and Considerations for Clinical Adoption, From the AJR Special Series on AI Applications. AJR Am J Roentgenol 2022; 219:869-878. [PMID: 35731103 DOI: 10.2214/ajr.22.27873] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fractures are common injuries that can be difficult to diagnose, with missed fractures accounting for most misdiagnoses in the emergency department. Artificial intelligence (AI) and, specifically, deep learning have shown a strong ability to accurately detect fractures and augment the performance of radiologists in proof-of-concept research settings. Although the number of real-world AI products available for clinical use continues to increase, guidance for practicing radiologists in the adoption of this new technology is limited. This review describes how AI and deep learning algorithms can help radiologists to better diagnose fractures. The article also provides an overview of commercially available U.S. FDA-cleared AI tools for fracture detection as well as considerations for the clinical adoption of these tools by radiology practices.
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Baumann F, Becker C, Freigang V, Alt V. Imaging, post-processing and navigation: Surgical applications in pelvic fracture treatment. Injury 2022; 53 Suppl 3:S16-S22. [PMID: 36028373 DOI: 10.1016/j.injury.2022.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 02/02/2023]
Abstract
Technical advancements of the past decade have led to massive improvements regarding imaging and visualization in trauma care. Digital imaging technology has fundamentally changed most processes in fracture management. However, the digital revolution in trauma surgery has just begun. Optical tracking navigation is currently the gold standard for positioning of implants for advanced applications in trauma surgery. Digital technology may enable the surgeon to achieve the same level of safety even in non-navigated placement of screws: We developed a new planning tool to transcript a preoperative into a semi-transparent "fluoroscopic like" image that can be identified intraoperatively and used as a map for the safe placement of sacro-iliac screws based on the "vestibule concept". In the future, development of artificial intelligence algorithms may provide features like automated segmentation of bone-fragments and other applications for a systematic fracture analysis to improve the standard of care in trauma surgery. Digital transformation has massive impact on diagnostics and surgical management of pelvic fractures. Improved visualization technology provides a better understanding of the surgical anatomy of the pelvis and may enable the surgeon to achieve greatest safety in percutaneous placement of screws even without using optical tracking navigation tools. The "para-axial fusion technique" is a useful tool to plan fluoroscopic views based on a 3D dataset prior to the surgery.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
| | - Claus Becker
- Institute of Diagnostic Radiology, Regensburg University Medical Center, Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
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Dankelman LHM, Schilstra S, IJpma FFA, Doornberg JN, Colaris JW, Verhofstad MHJ, Wijffels MME, Prijs J. Artificial intelligence fracture recognition on computed tomography: review of literature and recommendations. Eur J Trauma Emerg Surg 2022; 49:681-691. [PMID: 36284017 PMCID: PMC10175338 DOI: 10.1007/s00068-022-02128-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/02/2022] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose
The use of computed tomography (CT) in fractures is time consuming, challenging and suffers from poor inter-surgeon reliability. Convolutional neural networks (CNNs), a subset of artificial intelligence (AI), may overcome shortcomings and reduce clinical burdens to detect and classify fractures. The aim of this review was to summarize literature on CNNs for the detection and classification of fractures on CT scans, focusing on its accuracy and to evaluate the beneficial role in daily practice.
Methods
Literature search was performed according to the PRISMA statement, and Embase, Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Google Scholar databases were searched. Studies were eligible when the use of AI for the detection of fractures on CT scans was described. Quality assessment was done with a modified version of the methodologic index for nonrandomized studies (MINORS), with a seven-item checklist. Performance of AI was defined as accuracy, F1-score and area under the curve (AUC).
Results
Of the 1140 identified studies, 17 were included. Accuracy ranged from 69 to 99%, the F1-score ranged from 0.35 to 0.94 and the AUC, ranging from 0.77 to 0.95. Based on ten studies, CNN showed a similar or improved diagnostic accuracy in addition to clinical evaluation only.
Conclusions
CNNs are applicable for the detection and classification fractures on CT scans. This can improve automated and clinician-aided diagnostics. Further research should focus on the additional value of CNN used for CT scans in daily clinics.
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Affiliation(s)
- Lente H. M. Dankelman
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sanne Schilstra
- Department of Orthopedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
| | - Frank F. A. IJpma
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
| | - Job N. Doornberg
- Department of Orthopedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Orthopedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Joost W. Colaris
- Department of Orthopedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Mathieu M. E. Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jasper Prijs
- Department of Orthopedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Orthopedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia
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Niiya A, Murakami K, Kobayashi R, Sekimoto A, Saeki M, Toyofuku K, Kato M, Shinjo H, Ito Y, Takei M, Murata C, Ohgiya Y. Development of an artificial intelligence-assisted computed tomography diagnosis technology for rib fracture and evaluation of its clinical usefulness. Sci Rep 2022; 12:8363. [PMID: 35589847 PMCID: PMC9119970 DOI: 10.1038/s41598-022-12453-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
Artificial intelligence algorithms utilizing deep learning are helpful tools for diagnostic imaging. A deep learning-based automatic detection algorithm was developed for rib fractures on computed tomography (CT) images of high-energy trauma patients. In this study, the clinical effectiveness of this algorithm was evaluated. A total of 56 cases were retrospectively examined, including 46 rib fractures and 10 control cases from our hospital, between January and June 2019. Two radiologists annotated the fracture lesions (complete or incomplete) for each CT image, which is considered the “ground truth.” Thereafter, the algorithm’s diagnostic results for all cases were compared with the ground truth, and the sensitivity and number of false positive (FP) results per case were assessed. The radiologists identified 199 images with a fracture. The sensitivity of the algorithm was 89.8%, and the number of FPs per case was 2.5. After additional learning, the sensitivity increased to 93.5%, and the number of FPs was 1.9 per case. FP results were found in the trabecular bone with the appearance of fracture, vascular grooves, and artifacts. The sensitivity of the algorithm used in this study was sufficient to aid the rapid detection of rib fractures within the evaluated validation set of CT images.
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Affiliation(s)
- Akifumi Niiya
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
| | - Kouzou Murakami
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Rei Kobayashi
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Atsuhito Sekimoto
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Miho Saeki
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Kosuke Toyofuku
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Masako Kato
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Hidenori Shinjo
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Yoshinori Ito
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Mizuki Takei
- Fujifilm Corporation, Nishiazabu 2-Chome, Minato-ku, Tokyo, 26-30, Japan
| | - Chiori Murata
- Fujifilm Corporation, Nishiazabu 2-Chome, Minato-ku, Tokyo, 26-30, Japan
| | - Yoshimitsu Ohgiya
- Department of Radiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
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Yu TJ, Bangura A, Bodanapally U, Nascone J, O'Toole R, Liang Y, Dreizin D. Dual-Energy CT and Cinematic Rendering to Improve Assessment of Pelvic Fracture Instability. Radiology 2022; 304:353-362. [PMID: 35438566 PMCID: PMC9340240 DOI: 10.1148/radiol.211679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Grading of pelvic fracture instability is challenging in patients with pelvic binders. Dual-energy CT (DECT) and cinematic rendering can provide ancillary information regarding osteoligamentous integrity, but the utility of these tools remains unknown. Purpose To assess the added diagnostic value of DECT and cinematic rendering, with respect to single-energy CT (SECT), for discriminating any instability and translational instability in patients with pelvic binders. Materials and Methods In this retrospective analysis, consecutive adult patients (age ≥18 years) were stabilized with pelvic binders and scanned in dual-energy mode using a 128-section CT scanner at one level I trauma center between August 2016 and January 2019. Young-Burgess grading by orthopedists served as the reference standard. Two radiologists performed blinded consensus grading with the Young-Burgess system in three reading sessions (session 1, SECT; session 2, SECT plus DECT; session 3, SECT plus DECT and cinematic rendering). Lateral compression (LC) type 1 (LC-1) and anteroposterior compression (APC) type 1 (APC-1) injuries were considered stable; LC type 2 and APC type 2, rotationally unstable; and LC type 3, APC type 3, and vertical shear, translationally unstable. Diagnostic performance for any instability and translational instability was compared between reading sessions using the McNemar and DeLong tests. Radiologist agreement with the orthopedic reference standard was calculated with the weighted κ statistic. Results Fifty-four patients (mean age, 41 years ± 16 [SD]; 41 men) were analyzed. Diagnostic performance was greater with SECT plus DECT and cinematic rendering compared with SECT alone for any instability, with an area under the receiver operating characteristic curve (AUC) of 0.67 for SECT alone and 0.82 for SECT plus DECT and cinematic rendering (P = .04); for translational instability, the AUCs were 0.80 for SECT alone and 0.95 for SECT plus DECT and cinematic rendering (P = .01). For any instability, corresponding sensitivities were 61% (22 of 36 patients) for SECT alone and 86% (31 of 36 patients) for SECT plus DECT and cinematic rendering (P < .001). The corresponding specificities were 72% (13 of 18 patients) and 78% (14 of 18 patients), respectively (P > .99). Agreement (κ value) between radiologists and orthopedist reference standard improved from 0.44 to 0.76 for SECT versus the combination of SECT, DECT, and cinematic rendering. Conclusion Combined use of single-energy CT, dual-energy CT, and cinematic rendering improved instability assessment over that with single-energy CT alone. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Theresa J Yu
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Abdulai Bangura
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Uttam Bodanapally
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Jason Nascone
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Robert O'Toole
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Yuanyuan Liang
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
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Zapaishchykova A, Dreizin D, Li Z, Wu JY, Roohi SF, Unberath M. An Interpretable Approach to Automated Severity Scoring in Pelvic Trauma. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2021; 12903:424-433. [PMID: 37483538 PMCID: PMC10362989 DOI: 10.1007/978-3-030-87199-4_40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Pelvic ring disruptions result from blunt injury mechanisms and are often found in patients with multi-system trauma. To grade pelvic fracture severity in trauma victims based on whole-body CT, the Tile AO/OTA classification is frequently used. Due to the high volume of whole-body trauma CTs generated in busy trauma centers, an automated approach to Tile classification would provide substantial value, e. g., to prioritize the reading queue of the attending trauma radiologist. In such scenario, an automated method should perform grading based on a transparent process and based on interpretable features to enable interaction with human readers and lower their workload by offering insights from a first automated read of the scan. This paper introduces an automated yet interpretable pelvic trauma decision support system to assist radiologists in fracture detection and Tile grade classification. The method operates similarly to human interpretation of CT scans and first detects distinct pelvic fractures on CT with high specificity using a Faster-RCNN model that are then interpreted using a structural causal model based on clinical best practices to infer an initial Tile grade. The Bayesian causal model and finally, the object detector are then queried for likely co-occurring fractures that may have been rejected initially due to the highly specific operating point of the detector, resulting in an updated list of detected fractures and corresponding final Tile grade. Our method is transparent in that it provides finding location and type using the object detector, as well as information on important counterfactuals that would invalidate the system's recommendation and achieves an AUC of 83.3%/85.1% for translational/rotational instability. Despite being designed for human-machine teaming, our approach does not compromise on performance compared to previous black-box approaches.
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