1
|
Tian J, Wang K, Wu P, Li J, Zhang X, Wang X. Development of a deep learning model for detecting lumbar vertebral fractures on CT images: An external validation. Eur J Radiol 2024; 180:111685. [PMID: 39197270 DOI: 10.1016/j.ejrad.2024.111685] [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: 03/23/2024] [Revised: 05/31/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE To develop and externally validate a binary classification model for lumbar vertebral body fractures based on CT images using deep learning methods. METHODS This study involved data collection from two hospitals for AI model training and external validation. In Cohort A from Hospital 1, CT images from 248 patients, comprising 1508 vertebrae, revealed that 20.9% had fractures (315 vertebrae) and 79.1% were non-fractured (1193 vertebrae). In Cohort B from Hospital 2, CT images from 148 patients, comprising 887 vertebrae, indicated that 14.8% had fractures (131 vertebrae) and 85.2% were non-fractured (756 vertebrae). The AI model for lumbar spine fractures underwent two stages: vertebral body segmentation and fracture classification. The first stage utilized a 3D V-Net convolutional deep neural network, which produced a 3D segmentation map. From this map, region of each vertebra body were extracted and then input into the second stage of the algorithm. The second stage employed a 3D ResNet convolutional deep neural network to classify each proposed region as positive (fractured) or negative (not fractured). RESULTS The AI model's accuracy for detecting vertebral fractures in Cohort A's training set (n = 1199), validation set (n = 157), and test set (n = 152) was 100.0 %, 96.2 %, and 97.4 %, respectively. For Cohort B (n = 148), the accuracy was 96.3 %. The area under the receiver operating characteristic curve (AUC-ROC) values for the training, validation, and test sets of Cohort A, as well as Cohort B, and their 95 % confidence intervals (CIs) were as follows: 1.000 (1.000, 1.000), 0.978 (0.944, 1.000), 0.986 (0.969, 1.000), and 0.981 (0.970, 0.992). The area under the precision-recall curve (AUC-PR) values were 1.000 (0.996, 1.000), 0.964 (0.927, 0.985), 0.907 (0.924, 0.984), and 0.890 (0.846, 0.971), respectively. According to the DeLong test, there was no significant difference in the AUC-ROC values between the test set of Cohort A and Cohort B, both for the overall data and for each specific vertebral location (all P>0.05). CONCLUSION The developed model demonstrates promising diagnostic accuracy and applicability for detecting lumbar vertebral fractures.
Collapse
Affiliation(s)
- Jingyi Tian
- Department of Radiology, Peking University First Hospital, Beijing, China; Department of Radiology, Beijing Water Conservancy Hospital, Beijing, China
| | - Kexin Wang
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Pengsheng Wu
- Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Jialun Li
- Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China.
| |
Collapse
|
2
|
Matsumoto MM, Lee CI. Realizing the Potential for Opportunistic Early Detection of Abnormalities on Medical Imaging Using Artificial Intelligence. J Am Coll Radiol 2024:S1546-1440(24)00767-1. [PMID: 39293545 DOI: 10.1016/j.jacr.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 09/12/2024] [Indexed: 09/20/2024]
Affiliation(s)
- Monica M Matsumoto
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems & Population Health, University of Washington School of Public Health, Seattle, Washington; Fred Hutchinson Cancer Center, Seattle, Washington; Director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington; and Deputy Editor of JACR
| |
Collapse
|
3
|
Cross NM, Perry J, Dong Q, Luo G, Renslo J, Chang BC, Lane NE, Marshall L, Johnston SK, Haynor DR, Jarvik JG, Heagerty PJ. Subject-level spinal osteoporotic fracture prediction combining deep learning vertebral outputs and limited demographic data. Arch Osteoporos 2024; 19:87. [PMID: 39256211 DOI: 10.1007/s11657-024-01433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/26/2024] [Indexed: 09/12/2024]
Abstract
Automated screening for vertebral fractures could improve outcomes. We achieved an AUC-ROC = 0.968 for the prediction of moderate to severe fracture using a GAM with age and three maximal vertebral body scores of fracture from a convolutional neural network. Maximal fracture scores resulted in a performant model for subject-level fracture prediction. Combining individual deep learning vertebral body fracture scores and demographic covariates for subject-level classification of osteoporotic fracture achieved excellent performance (AUC-ROC of 0.968) on a large dataset of radiographs with basic demographic data. PURPOSE Osteoporotic vertebral fractures are common and morbid. Automated opportunistic screening for incidental vertebral fractures from radiographs, the highest volume imaging modality, could improve osteoporosis detection and management. We consider how to form patient-level fracture predictions and summarization to guide management, using our previously developed vertebral fracture classifier on segmented radiographs from a prospective cohort study of US men (MrOS). We compare the performance of logistic regression (LR) and generalized additive models (GAM) with combinations of individual vertebral scores and basic demographic covariates. METHODS Subject-level LR and GAM models were created retrospectively using all fracture predictions or summary variables such as order statistics, adjacent vertebral interactions, and demographic covariates (age, race/ethnicity). The classifier outputs for 8663 vertebrae from 1176 thoracic and lumbar radiographs in 669 subjects were divided by subject to perform stratified fivefold cross-validation. Models were assessed using multiple metrics, including receiver operating characteristic (ROC) and precision-recall (PR) curves. RESULTS The best model (AUC-ROC = 0.968) was a GAM using the top three maximum vertebral fracture scores and age. Using top-ranked scores only, rather than all vertebral scores, improved performance for both model classes. Adding age, but not ethnicity, to the GAMs improved performance slightly. CONCLUSION Maximal vertebral fracture scores resulted in the highest-performing models. While combining multiple vertebral body predictions risks decreasing specificity, our results demonstrate that subject-level models maintain good predictive performance. Thresholding strategies can be used to control sensitivity and specificity as clinically appropriate.
Collapse
Affiliation(s)
- Nathan M Cross
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA.
| | - Jessica Perry
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | - Qifei Dong
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, 98195, USA
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, 98195, USA
| | - Jonathan Renslo
- Department of Medical Education, University of Southern California, Los Angeles, CA, 90042, USA
| | - Brian C Chang
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, 98195, USA
| | - Nancy E Lane
- Department of Medicine, University of California -Davis, Sacramento, CA, 95817, USA
| | - Lynn Marshall
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, 97239, USA
| | - Sandra K Johnston
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA
| | - David R Haynor
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA
| | - Jeffrey G Jarvik
- Departments of Radiology and Neurological Surgery, University of Washington, Seattle, WA, 98104-2499, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| |
Collapse
|
4
|
Liawrungrueang W, Cho ST, Kotheeranurak V, Jitpakdee K, Kim P, Sarasombath P. Osteoporotic vertebral compression fracture (OVCF) detection using artificial neural networks model based on the AO spine-DGOU osteoporotic fracture classification system. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100515. [PMID: 39188670 PMCID: PMC11345903 DOI: 10.1016/j.xnsj.2024.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 08/28/2024]
Abstract
Background Osteoporotic Vertebral Compression Fracture (OVCF) substantially reduces a person's health-related quality of life. Computer Tomography (CT) scan is currently the standard for diagnosis of OVCF. The aim of this paper was to evaluate the OVCF detection potential of artificial neural networks (ANN). Methods Models of artificial intelligence based on deep learning hold promise for quickly and automatically identifying and visualizing OVCF. This study investigated the detection, classification, and grading of OVCF using deep artificial neural networks (ANN). Techniques: Annotation techniques were used to segregate the sagittal images of 1,050 OVCF CT pictures with symptomatic low back pain into 934 CT images for a training dataset (89%) and 116 CT images for a test dataset (11%). A radiologist tagged, cleaned, and annotated the training dataset. Disc deterioration was assessed in all lumbar discs using the AO Spine-DGOU Osteoporotic Fracture Classification System. The detection and grading of OVCF were trained using the deep learning ANN model. By putting an automatic model to the test for dataset grading, the outcomes of the ANN model training were confirmed. Results The sagittal lumbar CT training dataset included 5,010 OVCF from OF1, 1942 from OF2, 522 from OF3, 336 from OF4, and none from OF5. With overall 96.04% accuracy, the deep ANN model was able to identify and categorize lumbar OVCF. Conclusions The ANN model offers a rapid and effective way to classify lumbar OVCF by automatically and consistently evaluating routine CT scans using AO Spine-DGOU osteoporotic fracture classification system.
Collapse
Affiliation(s)
| | - Sung Tan Cho
- Department of Orthopaedic Surgery, Seoul Seonam Hospital, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Pyeoungkee Kim
- Department of Computer Engineering, Silla University, Busan, South Korea
| | - Peem Sarasombath
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
5
|
Li Y, Liang Z, Li Y, Cao Y, Zhang H, Dong B. Machine learning value in the diagnosis of vertebral fractures: A systematic review and meta-analysis. Eur J Radiol 2024; 181:111714. [PMID: 39241305 DOI: 10.1016/j.ejrad.2024.111714] [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: 06/04/2024] [Revised: 07/28/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE To evaluate the diagnostic accuracy of machine learning (ML) in detecting vertebral fractures, considering varying fracture classifications, patient populations, and imaging approaches. METHOD A systematic review and meta-analysis were conducted by searching PubMed, Embase, Cochrane Library, and Web of Science up to December 31, 2023, for studies using ML for vertebral fracture diagnosis. Bias risk was assessed using QUADAS-2. A bivariate mixed-effects model was used for the meta-analysis. Meta-analyses were performed according to five task types (vertebral fractures, osteoporotic vertebral fractures, differentiation of benign and malignant vertebral fractures, differentiation of acute and chronic vertebral fractures, and prediction of vertebral fractures). Subgroup analyses were conducted by different ML models (including ML and DL) and modeling methods (including CT, X-ray, MRI, and clinical features). RESULTS Eighty-one studies were included. ML demonstrated a diagnostic sensitivity of 0.91 and specificity of 0.95 for vertebral fractures. Subgroup analysis showed that DL (SROC 0.98) and CT (SROC 0.98) performed best overall. For osteoporotic fractures, ML showed a sensitivity of 0.93 and specificity of 0.96, with DL (SROC 0.99) and X-ray (SROC 0.99) performing better. For differentiating benign from malignant fractures, ML achieved a sensitivity of 0.92 and specificity of 0.93, with DL (SROC 0.96) and MRI (SROC 0.97) performing best. For differentiating acute from chronic vertebral fractures, ML showed a sensitivity of 0.92 and specificity of 0.93, with ML (SROC 0.96) and CT (SROC 0.97) performing best. For predicting vertebral fractures, ML had a sensitivity of 0.76 and specificity of 0.87, with ML (SROC 0.80) and clinical features (SROC 0.86) performing better. CONCLUSIONS ML, especially DL models applied to CT, MRI, and X-ray, shows high diagnostic accuracy for vertebral fractures. ML also effectively predicts osteoporotic vertebral fractures, aiding in tailored prevention strategies. Further research and validation are required to confirm ML's clinical efficacy.
Collapse
Affiliation(s)
- Yue Li
- Pain Ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province 710054, PR China
| | - Zhuang Liang
- Pain Ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province 710054, PR China
| | - Yingchun Li
- Pain Ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province 710054, PR China
| | - Yang Cao
- Pain Ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province 710054, PR China
| | - Hui Zhang
- Pain Ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province 710054, PR China
| | - Bo Dong
- Pain Ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province 710054, PR China.
| |
Collapse
|
6
|
J O, S L, S G, B H, S M N. An overview of the performance of AI in fracture detection in lumbar and thoracic spine radiographs on a per vertebra basis. Skeletal Radiol 2024; 53:1563-1571. [PMID: 38413400 PMCID: PMC11194188 DOI: 10.1007/s00256-024-04626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Subtle spinal compression fractures can easily be missed. AI may help in interpreting these images. We propose to test the performance of an FDA-approved algorithm for fracture detection in radiographs on a per vertebra basis, assessing performance based on grade of compression, presence of foreign material, severity of degenerative changes, and acuity of the fracture. METHODS Thoracic and lumbar spine radiographs with inquiries for fracture were retrospectively collected and analyzed by the AI. The presence or absence of fracture was defined by the written report or cross-sectional imaging where available. Fractures were classified semi-quantitatively by the Genant classification, by acuity, by the presence of foreign material, and overall degree of degenerative change of the spine. The results of the AI were compared to the gold standard. RESULTS A total of 512 exams were included, depicting 4114 vertebra with 495 fractures. Overall sensitivity was 63.2% for the lumbar spine, significantly higher than the thoracic spine with 50.6%. Specificity was 96.7 and 98.3% respectively. Sensitivity increased with fracture grade, without a significant difference between grade 2 and 3 compression fractures (lumbar spine: grade 1, 52.5%; grade 2, 72.3%; grade 3, 75.8%; thoracic spine: grade 1, 42.4%; grade 2, 60.0%; grade 3, 60.0%). The presence of foreign material and a high degree of degenerative changes reduced sensitivity. CONCLUSION Overall performance of the AI on a per vertebra basis was degraded in clinically relevant scenarios such as for low-grade compression fractures.
Collapse
Affiliation(s)
- Oppenheimer J
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany.
| | - Lüken S
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Geveshausen S
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Hamm B
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Niehues S M
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| |
Collapse
|
7
|
Nowroozi A, Salehi MA, Shobeiri P, Agahi S, Momtazmanesh S, Kaviani P, Kalra MK. Artificial intelligence diagnostic accuracy in fracture detection from plain radiographs and comparing it with clinicians: a systematic review and meta-analysis. Clin Radiol 2024; 79:579-588. [PMID: 38772766 DOI: 10.1016/j.crad.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Fracture detection is one of the most commonly used and studied aspects of artificial intelligence (AI) in medicine. In this systematic review and meta-analysis, we aimed to summarize available literature and data regarding AI performance in fracture detection on plain radiographs and various factors affecting it. METHODS We systematically reviewed studies evaluating AI algorithms in detecting bone fractures in plain radiographs, combined their performance using meta-analysis (a bivariate regression approach), and compared it with that of clinicians. We also analyzed the factors potentially affecting algorithm performance using meta-regression. RESULTS Our analysis included 100 studies. In 83 studies with confusion matrices, AI algorithms showed a sensitivity of 91.43% and a specificity of 92.12% (Area under the summary receiver operator curve = 0.968). After adjustment and false discovery rate correction, tibia/fibula (excluding ankle) fractures were associated with higher (7.0%, p=0.004) AI sensitivity, while more recent publications (5.5%, p=0.003) and Xception architecture (6.6%, p<0.001) were associated with higher specificity. Clinicians and AI showed similar specificity in fracture identification, although AI leaned to higher sensitivity (7.6%, p=0.07). Radiologists, on the other hand, were more specific than AI overall and in several subgroups, and more sensitive to hip fractures before FDR correction. CONCLUSIONS Currently available AI aids could result in a significant improvement in care where radiologists are not readily available. Moreover, identifying factors affecting algorithm performance could guide AI development teams in their process of optimizing their products.
Collapse
Affiliation(s)
- A Nowroozi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M A Salehi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - P Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Agahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - P Kaviani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - M K Kalra
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| |
Collapse
|
8
|
Dasegowda G, Sato JY, Elton DC, Garza-Frias E, Schultz T, Bridge CP, Bizzo BC, Kalra MK, Dreyer KJ. No code machine learning: validating the approach on use-case for classifying clavicle fractures. Clin Imaging 2024; 112:110207. [PMID: 38838448 DOI: 10.1016/j.clinimag.2024.110207] [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: 07/27/2023] [Revised: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE We created an infrastructure for no code machine learning (NML) platform for non-programming physicians to create NML model. We tested the platform by creating an NML model for classifying radiographs for the presence and absence of clavicle fractures. METHODS Our IRB-approved retrospective study included 4135 clavicle radiographs from 2039 patients (mean age 52 ± 20 years, F:M 1022:1017) from 13 hospitals. Each patient had two-view clavicle radiographs with axial and anterior-posterior projections. The positive radiographs had either displaced or non-displaced clavicle fractures. We configured the NML platform to automatically retrieve the eligible exams using the series' unique identification from the hospital virtual network archive via web access to DICOM Objects. The platform trained a model until the validation loss plateaus. Once the testing was complete, the platform provided the receiver operating characteristics curve and confusion matrix for estimating sensitivity, specificity, and accuracy. RESULTS The NML platform successfully retrieved 3917 radiographs (3917/4135, 94.7 %) and parsed them for creating a ML classifier with 2151 radiographs in the training, 100 radiographs for validation, and 1666 radiographs in testing datasets (772 radiographs with clavicle fracture, 894 without clavicle fracture). The network identified clavicle fracture with 90 % sensitivity, 87 % specificity, and 88 % accuracy with AUC of 0.95 (confidence interval 0.94-0.96). CONCLUSION A NML platform can help physicians create and test machine learning models from multicenter imaging datasets such as the one in our study for classifying radiographs based on the presence of clavicle fracture.
Collapse
Affiliation(s)
- Giridhar Dasegowda
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| | - James Yuichi Sato
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| | - Daniel C Elton
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| | - Emiliano Garza-Frias
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| | - Thomas Schultz
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| | - Christopher P Bridge
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| | - Bernardo C Bizzo
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA.
| | - Keith J Dreyer
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Mass General Brigham AI, USA
| |
Collapse
|
9
|
Paik S, Park J, Hong JY, Han SW. Deep learning application of vertebral compression fracture detection using mask R-CNN. Sci Rep 2024; 14:16308. [PMID: 39009647 PMCID: PMC11251057 DOI: 10.1038/s41598-024-67017-6] [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: 11/28/2023] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
Vertebral compression fractures (VCFs) of the thoracolumbar spine are commonly caused by osteoporosis or result from traumatic events. Early diagnosis of vertebral compression fractures can prevent further damage to patients. When assessing these fractures, plain radiographs are used as the primary diagnostic modality. In this study, we developed a deep learning based fracture detection model that could be used as a tool for primary care in the orthopedic department. We constructed a VCF dataset using 487 lateral radiographs, which included 598 fractures in the L1-T11 vertebra. For detecting VCFs, Mask R-CNN model was trained and optimized, and was compared to three other popular models on instance segmentation, Cascade Mask R-CNN, YOLOACT, and YOLOv5. With Mask R-CNN we achieved highest mean average precision score of 0.58, and were able to locate each fracture pixel-wise. In addition, the model showed high overall sensitivity, specificity, and accuracy, indicating that it detected fractures accurately and without misdiagnosis. Our model can be a potential tool for detecting VCFs from a simple radiograph and assisting doctors in making appropriate decisions in initial diagnosis.
Collapse
Affiliation(s)
- Seungyoon Paik
- School of Industrial and Management Engineering, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jiwon Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, South Korea
| | - Jae Young Hong
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, South Korea
| | - Sung Won Han
- School of Industrial and Management Engineering, Korea University, Anam-ro 145, Seongbuk-gu, Seoul, 02841, South Korea.
| |
Collapse
|
10
|
Awuah WA, Adebusoye FT, Wellington J, David L, Salam A, Weng Yee AL, Lansiaux E, Yarlagadda R, Garg T, Abdul-Rahman T, Kalmanovich J, Miteu GD, Kundu M, Mykolaivna NI. Recent Outcomes and Challenges of Artificial Intelligence, Machine Learning, and Deep Learning in Neurosurgery. World Neurosurg X 2024; 23:100301. [PMID: 38577317 PMCID: PMC10992893 DOI: 10.1016/j.wnsx.2024.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/23/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024] Open
Abstract
Neurosurgeons receive extensive technical training, which equips them with the knowledge and skills to specialise in various fields and manage the massive amounts of information and decision-making required throughout the various stages of neurosurgery, including preoperative, intraoperative, and postoperative care and recovery. Over the past few years, artificial intelligence (AI) has become more useful in neurosurgery. AI has the potential to improve patient outcomes by augmenting the capabilities of neurosurgeons and ultimately improving diagnostic and prognostic outcomes as well as decision-making during surgical procedures. By incorporating AI into both interventional and non-interventional therapies, neurosurgeons may provide the best care for their patients. AI, machine learning (ML), and deep learning (DL) have made significant progress in the field of neurosurgery. These cutting-edge methods have enhanced patient outcomes, reduced complications, and improved surgical planning.
Collapse
Affiliation(s)
| | | | - Jack Wellington
- Cardiff University School of Medicine, Cardiff University, Wales, United Kingdom
| | - Lian David
- Norwich Medical School, University of East Anglia, United Kingdom
| | - Abdus Salam
- Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | | | | | - Rohan Yarlagadda
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Tulika Garg
- Government Medical College and Hospital Chandigarh, India
| | | | | | | | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | | |
Collapse
|
11
|
Liawrungrueang W, Cho ST, Kotheeranurak V, Pun A, Jitpakdee K, Sarasombath P. Artificial neural networks for the detection of odontoid fractures using the Konstanz Information Miner Analytics Platform. Asian Spine J 2024; 18:407-414. [PMID: 38917858 PMCID: PMC11222894 DOI: 10.31616/asj.2023.0259] [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: 08/10/2023] [Revised: 09/30/2023] [Accepted: 10/23/2023] [Indexed: 06/27/2024] Open
Abstract
STUDY DESIGN An experimental study. PURPOSE This study aimed to investigate the potential use of artificial neural networks (ANNs) in the detection of odontoid fractures using the Konstanz Information Miner (KNIME) Analytics Platform that provides a technique for computer-assisted diagnosis using radiographic X-ray imaging. OVERVIEW OF LITERATURE In medical image processing, computer-assisted diagnosis with ANNs from radiographic X-ray imaging is becoming increasingly popular. Odontoid fractures are a common fracture of the axis and account for 10%-15% of all cervical fractures. However, a literature review of computer-assisted diagnosis with ANNs has not been made. METHODS This study analyzed 432 open-mouth (odontoid) radiographic views of cervical spine X-ray images obtained from dataset repositories, which were used in developing ANN models based on the convolutional neural network theory. All the images contained diagnostic information, including 216 radiographic images of individuals with normal odontoid processes and 216 images of patients with acute odontoid fractures. The model classified each image as either showing an odontoid fracture or not. Specifically, 70% of the images were training datasets used for model training, and 30% were used for testing. KNIME's graphic user interface-based programming enabled class label annotation, data preprocessing, model training, and performance evaluation. RESULTS The graphic user interface program by KNIME was used to report all radiographic X-ray imaging features. The ANN model performed 50 epochs of training. The performance indices in detecting odontoid fractures included sensitivity, specificity, F-measure, and prediction error of 100%, 95.4%, 97.77%, and 2.3%, respectively. The model's accuracy accounted for 97% of the area under the receiver operating characteristic curve for the diagnosis of odontoid fractures. CONCLUSIONS The ANN models with the KNIME Analytics Platform were successfully used in the computer-assisted diagnosis of odontoid fractures using radiographic X-ray images. This approach can help radiologists in the screening, detection, and diagnosis of acute odontoid fractures.
Collapse
Affiliation(s)
| | - Sung Tan Cho
- Department of Orthopaedic Surgery, Seoul Seonam Hospital, Seoul, Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok,
Thailand
| | - Alvin Pun
- Department of Neurosciences Clinical Institute, Epworth Richmond, Melbourne,
Australia
| | - Khanathip Jitpakdee
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi,
Thailand
| | - Peem Sarasombath
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai,
Thailand
| |
Collapse
|
12
|
Kuliczkowska-Płaksej J, Zdrojowy-Wełna A, Jawiarczyk-Przybyłowska A, Gojny Ł, Bolanowski M. Diagnosis and therapeutic approach to bone health in patients with hypopituitarism. Rev Endocr Metab Disord 2024; 25:513-539. [PMID: 38565758 DOI: 10.1007/s11154-024-09878-w] [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] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
The results of many studies in recent years indicate a significant impact of pituitary function on bone health. The proper function of the pituitary gland has a significant impact on the growth of the skeleton and the appearance of sexual dimorphism. It is also responsible for achieving peak bone mass, which protects against the development of osteoporosis and fractures later in life. It is also liable for the proper remodeling of the skeleton, which is a physiological mechanism managing the proper mechanical resistance of bones and the possibility of its regeneration after injuries. Pituitary diseases causing hypofunction and deficiency of tropic hormones, and thus deficiency of key hormones of effector organs, have a negative impact on the skeleton, resulting in reduced bone mass and susceptibility to pathological fractures. The early appearance of pituitary dysfunction, i.e. in the pre-pubertal period, is responsible for failure to achieve peak bone mass, and thus the risk of developing osteoporosis in later years. This argues for the need for a thorough assessment of patients with hypopituitarism, not only in terms of metabolic disorders, but also in terms of bone disorders. Early and properly performed treatment may prevent patients from developing the bone complications that are so common in this pathology. The aim of this review is to discuss the physiological, pathophysiological, and clinical insights of bone involvement in pituitary disease.
Collapse
Affiliation(s)
- Justyna Kuliczkowska-Płaksej
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Aleksandra Zdrojowy-Wełna
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Aleksandra Jawiarczyk-Przybyłowska
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland.
| | - Łukasz Gojny
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Marek Bolanowski
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| |
Collapse
|
13
|
Lee S, Jung JY, Mahatthanatrakul A, Kim JS. Artificial Intelligence in Spinal Imaging and Patient Care: A Review of Recent Advances. Neurospine 2024; 21:474-486. [PMID: 38955525 PMCID: PMC11224760 DOI: 10.14245/ns.2448388.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024] Open
Abstract
Artificial intelligence (AI) is transforming spinal imaging and patient care through automated analysis and enhanced decision-making. This review presents a clinical task-based evaluation, highlighting the specific impact of AI techniques on different aspects of spinal imaging and patient care. We first discuss how AI can potentially improve image quality through techniques like denoising or artifact reduction. We then explore how AI enables efficient quantification of anatomical measurements, spinal curvature parameters, vertebral segmentation, and disc grading. This facilitates objective, accurate interpretation and diagnosis. AI models now reliably detect key spinal pathologies, achieving expert-level performance in tasks like identifying fractures, stenosis, infections, and tumors. Beyond diagnosis, AI also assists surgical planning via synthetic computed tomography generation, augmented reality systems, and robotic guidance. Furthermore, AI image analysis combined with clinical data enables personalized predictions to guide treatment decisions, such as forecasting spine surgery outcomes. However, challenges still need to be addressed in implementing AI clinically, including model interpretability, generalizability, and data limitations. Multicenter collaboration using large, diverse datasets is critical to advance the field further. While adoption barriers persist, AI presents a transformative opportunity to revolutionize spinal imaging workflows, empowering clinicians to translate data into actionable insights for improved patient care.
Collapse
Affiliation(s)
- Sungwon Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Visual Analysis and Learning for Improved Diagnostics (VALID) Lab, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Visual Analysis and Learning for Improved Diagnostics (VALID) Lab, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Akaworn Mahatthanatrakul
- Department of Orthopaedics, Faculty of Medicine, Naresuan University Hospital, Phitsanulok, Thailand
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
14
|
Bečulić H, Begagić E, Džidić-Krivić A, Pugonja R, Softić N, Bašić B, Balogun S, Nuhović A, Softić E, Ljevaković A, Sefo H, Šegalo S, Skomorac R, Pojskić M. Sensitivity and specificity of machine learning and deep learning algorithms in the diagnosis of thoracolumbar injuries resulting in vertebral fractures: A systematic review and meta-analysis. BRAIN & SPINE 2024; 4:102809. [PMID: 38681175 PMCID: PMC11052896 DOI: 10.1016/j.bas.2024.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/13/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
Introduction Clinicians encounter challenges in promptly diagnosing thoracolumbar injuries (TLIs) and fractures (VFs), motivating the exploration of Artificial Intelligence (AI) and Machine Learning (ML) and Deep Learning (DL) technologies to enhance diagnostic capabilities. Despite varying evidence, the noteworthy transformative potential of AI in healthcare, leveraging insights from daily healthcare data, persists. Research question This review investigates the utilization of ML and DL in TLIs causing VFs. Materials and methods Employing Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) methodology, a systematic review was conducted in PubMed and Scopus databases, identifying 793 studies. Seventeen were included in the systematic review, and 11 in the meta-analysis. Variables considered encompassed publication years, geographical location, study design, total participants (14,524), gender distribution, ML or DL methods, specific pathology, diagnostic modality, test analysis variables, validation details, and key study conclusions. Meta-analysis assessed specificity, sensitivity, and conducted hierarchical summary receiver operating characteristic curve (HSROC) analysis. Results Predominantly conducted in China (29.41%), the studies involved 14,524 participants. In the analysis, 11.76% (N = 2) focused on ML, while 88.24% (N = 15) were dedicated to deep DL. Meta-analysis revealed a sensitivity of 0.91 (95% CI = 0.86-0.95), consistent specificity of 0.90 (95% CI = 0.86-0.93), with a false positive rate of 0.097 (95% CI = 0.068-0.137). Conclusion The study underscores consistent specificity and sensitivity estimates, affirming the diagnostic test's robustness. However, the broader context of ML applications in TLIs emphasizes the critical need for standardization in methodologies to enhance clinical utility.
Collapse
Affiliation(s)
- Hakija Bečulić
- Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000, Zenica, Bosnia and Herzegovina
- Department of Anatomy, School of Medicine, University of Zenica, Travnička 1, 72000, Zenica, Bosnia and Herzegovina
| | - Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Travnička 1, 72000, Zenica, Bosnia and Herzegovina
| | - Amina Džidić-Krivić
- Department of Neurology, Cantonal Hospital Zenica, Crkvice 67, 72000, Zenica, Bosnia and Herzegovina
| | - Ragib Pugonja
- Department of Anatomy, School of Medicine, University of Zenica, Travnička 1, 72000, Zenica, Bosnia and Herzegovina
| | - Namira Softić
- Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000, Zenica, Bosnia and Herzegovina
| | - Binasa Bašić
- Department of Neurology, General Hospital Travnik, Kalibunar Bb, 72270, Travnik, Bosnia and Herzegovina
| | - Simon Balogun
- Division of Neurosurgery, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ilesa Road PMB 5538, 220282, Ile-Ife, Nigeria
| | - Adem Nuhović
- Department of General Medicine, School of Medicine, University of Sarajevo, Univerzitetska 1, 71000, Sarajevo, Bosnia and Herzegovina
| | - Emir Softić
- Department of Patophysiology, School of Medicine, University of Zenica, Travnička 1, 72000, Zenica, Bosnia and Herzegovina
| | - Adnana Ljevaković
- Department of Neurology, General Hospital Travnik, Kalibunar Bb, 72270, Travnik, Bosnia and Herzegovina
| | - Haso Sefo
- Neurosurgery Clinic, University Clinical Center Sarajevo, Bolnička 25, 71000, Sarajevo, Bosnia and Herzegovina
| | - Sabina Šegalo
- Department of Laboratory Technologies, Faculty of Health Siences, University of Sarajevo, Stjepana Tomića 1, 71000, Sarajevo, Bosnia and Herzegovina
| | - Rasim Skomorac
- Department of Anatomy, School of Medicine, University of Zenica, Travnička 1, 72000, Zenica, Bosnia and Herzegovina
- Department of Surgery, School of Medicine, University of Zenica, Travnička 1, 72000, Zenica, Bosnia and Herzegovina
| | - Mirza Pojskić
- Department of Neurosurgery, University Hospital Marburg, Baldingerstr., 35033, Marburg, Germany
| |
Collapse
|
15
|
Kim YR, Yoon YS, Cha JG. Opportunistic Screening for Acute Vertebral Fractures on a Routine Abdominal or Chest Computed Tomography Scans Using an Automated Deep Learning Model. Diagnostics (Basel) 2024; 14:781. [PMID: 38611694 PMCID: PMC11011775 DOI: 10.3390/diagnostics14070781] [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: 03/13/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To develop an opportunistic screening model based on a deep learning algorithm to detect recent vertebral fractures in abdominal or chest CTs. MATERIALS AND METHODS A total of 1309 coronal reformatted images (504 with a recent fracture from 119 patients, and 805 without fracture from 115 patients), from torso CTs, performed from September 2018 to April 2022, on patients who also had a spine MRI within two months, were included. Two readers participated in image selection and manually labeled the fractured segment on each selected image with Neuro-T (version 2.3.3; Neurocle Inc.) software. We split the images randomly into the training and internal test set (labeled: unlabeled = 480:700) and the secondary interval validation set (24:105). For the observer study, three radiologists reviewed the CT images in the external test set with and without deep learning assistance and scored the likelihood of an acute fracture in each image independently. RESULTS For the training and internal test sets, the AI achieved a 99.86% test accuracy, 91.22% precision, and 89.18% F1 score for detection of recent fracture. Then, in the secondary internal validation set, it achieved 99.90%, 74.93%, and 78.30%, respectively. In the observer study, with the assistance of the deep learning algorithm, a significant improvement was observed in the radiology resident's accuracy, from 92.79% to 98.2% (p = 0.04). CONCLUSION The model showed a high level of accuracy in the test set and also the internal validation set. If this algorithm is applied opportunistically to daily torso CT evaluation, it will be helpful for the early detection of fractures that require treatment.
Collapse
Affiliation(s)
- Ye Rin Kim
- Department of Radiology, College of Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon 14584, Republic of Korea
| | - Yu Sung Yoon
- Department of Radiology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Jang Gyu Cha
- Department of Radiology, College of Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon 14584, Republic of Korea
| |
Collapse
|
16
|
Cote MP, Lubowitz JH. Recommended Requirements and Essential Elements for Proper Reporting of the Use of Artificial Intelligence Machine Learning Tools in Biomedical Research and Scientific Publications. Arthroscopy 2024; 40:1033-1038. [PMID: 38300189 DOI: 10.1016/j.arthro.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 02/02/2024]
Abstract
Essential elements required for proper use of artificial intelligence machine learning tools in biomedical research and scientific publications include (1) explanation justifying why a machine learning approach contributes to the purpose of the study; (2) description of the adequacy of the data (input) to produce the desired results (output); (3) details of the algorithmic (i.e., computational) approach including methods for organizing the data (preprocessing); the machine learning computational algorithm(s) assessed; on what data the models were trained; the presence of bias and efforts to mitigate these effects; and the methods for quantifying the variables (features) most influential in determining the results (e.g., Shapley values); (4) description of methods, and reporting of results, quantitating performance in terms of both model accuracy and model calibration (level of confidence in the model's predictions); (5) availability of the programming code (including a link to the code when available-ideally, the code should be available); (6) discussion of model internal validation (results applicable and sensitive to the population investigated and data on which the model was trained) and external validation (were the results investigated as to whether they are generalizable to different populations? If not, consideration of this limitation and discussion of plans for external validation, i.e., next steps). As biomedical research submissions using artificial intelligence technology increase, these requirements could facilitate purposeful use and comprehensive methodological reporting.
Collapse
|
17
|
Khoriati AA, Shahid Z, Fok M, Frank RM, Voss A, D'Hooghe P, Imam MA. Artificial intelligence and the orthopaedic surgeon: A review of the literature and potential applications for future practice: Current concepts. J ISAKOS 2024; 9:227-233. [PMID: 37949113 DOI: 10.1016/j.jisako.2023.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Al-Achraf Khoriati
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Zuhaib Shahid
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Margaret Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam Rd, High West, Hong Kong, China; Asia Pacific Orthopaedic Association, 57000, Malaysia.
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Joint Preservation Program, University of Colorado School of Medicine, 12631 E 17th Ave, Mail Stop B202, Aurora, CO 80045, USA.
| | - Andreas Voss
- Sporthopaedicum Regensburg, Street, Hildegard-von-Bingen-Straße 1, 93053, Regensburg, Germany.
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Aspire Zone, Sportscity Street 1, P.O. Box 29222, Doha, Qatar
| | - Mohamed A Imam
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK; Smart Health Centre, University of East London, University Way, London, E16 2RD, United Kingdom.
| |
Collapse
|
18
|
Polzer C, Yilmaz E, Meyer C, Jang H, Jansen O, Lorenz C, Bürger C, Glüer CC, Sedaghat S. AI-based automated detection and stability analysis of traumatic vertebral body fractures on computed tomography. Eur J Radiol 2024; 173:111364. [PMID: 38364589 DOI: 10.1016/j.ejrad.2024.111364] [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: 11/04/2023] [Revised: 12/29/2023] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE We developed and tested a neural network for automated detection and stability analysis of vertebral body fractures on computed tomography (CT). MATERIALS AND METHODS 257 patients who underwent CT were included in this Institutional Review Board (IRB) approved study. 463 fractured and 1883 non-fractured vertebral bodies were included, with 190 fractures unstable. Two readers identified vertebral body fractures and assessed their stability. A combination of a Hierarchical Convolutional Neural Network (hNet) and a fracture Classification Network (fNet) was used to build a neural network for the automated detection and stability analysis of vertebral body fractures on CT. Two final test settings were chosen: one with vertebral body levels C1/2 included and one where they were excluded. RESULTS The mean age of the patients was 68 ± 14 years. 140 patients were female. The network showed a slightly higher diagnostic performance when excluding C1/2. Accordingly, the network was able to distinguish fractured and non-fractured vertebral bodies with a sensitivity of 75.8 % and a specificity of 80.3 %. Additionally, the network determined the stability of the vertebral bodies with a sensitivity of 88.4 % and a specificity of 80.3 %. The AUC was 87 % and 91 % for fracture detection and stability analysis, respectively. The sensitivity of our network in indicating the presence of at least one fracture / one unstable fracture within the whole spine achieved values of 78.7 % and 97.2 %, respectively, when excluding C1/2. CONCLUSION The developed neural network can automatically detect vertebral body fractures and evaluate their stability concurrently with a high diagnostic performance.
Collapse
Affiliation(s)
- Constanze Polzer
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Eren Yilmaz
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Carsten Meyer
- Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany; Department of Computer Science, Faculty of Engineering, Kiel University, Kiel, Germany
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, USA
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Claus-Christian Glüer
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sam Sedaghat
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
| |
Collapse
|
19
|
Wang YN, Liu G, Wang L, Chen C, Wang Z, Zhu S, Wan WT, Weng YZ, Lu WW, Li ZY, Wang Z, Ma XL, Yang Q. A Deep-Learning Model for Diagnosing Fresh Vertebral Fractures on Magnetic Resonance Images. World Neurosurg 2024; 183:e818-e824. [PMID: 38218442 DOI: 10.1016/j.wneu.2024.01.035] [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: 12/09/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The accurate diagnosis of fresh vertebral fractures (VFs) was critical to optimizing treatment outcomes. Existing studies, however, demonstrated insufficient accuracy, sensitivity, and specificity in detecting fresh fractures using magnetic resonance imaging (MRI), and fall short in localizing the fracture sites. METHODS This prospective study comprised 716 patients with fresh VFs. We obtained 849 Short TI Inversion Recovery (STIR) image slices for training and validation of the AI model. The AI models employed were yolov7 and resnet50, to detect fresh VFs. RESULTS The AI model demonstrated a diagnostic accuracy of 97.6% for fresh VFs, with a sensitivity of 98% and a specificity of 97%. The performance of the model displayed a high degree of consistency when compared to the evaluations by spine surgeons. In the external testing dataset, the model exhibited a classification accuracy of 92.4%, a sensitivity of 93%, and a specificity of 92%. CONCLUSIONS Our findings highlighted the potential of AI in diagnosing fresh VFs, offering an accurate and efficient way to aid physicians with diagnosis and treatment decisions.
Collapse
Affiliation(s)
- Yan-Ni Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Gang Liu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lei Wang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, School of Health Sciences & Biomedical Engineering, Hebei University of Technology, Tianjin, China
| | - Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zhi Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Shan Zhu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Wen-Tao Wan
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yuan-Zhi Weng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Weijia William Lu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Zhao-Yang Li
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin, China
| | - Zheng Wang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin-Long Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
| |
Collapse
|
20
|
Bharadwaj UU, Chin CT, Majumdar S. Practical Applications of Artificial Intelligence in Spine Imaging: A Review. Radiol Clin North Am 2024; 62:355-370. [PMID: 38272627 DOI: 10.1016/j.rcl.2023.10.005] [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] [Indexed: 01/27/2024]
Abstract
Artificial intelligence (AI), a transformative technology with unprecedented potential in medical imaging, can be applied to various spinal pathologies. AI-based approaches may improve imaging efficiency, diagnostic accuracy, and interpretation, which is essential for positive patient outcomes. This review explores AI algorithms, techniques, and applications in spine imaging, highlighting diagnostic impact and challenges with future directions for integrating AI into spine imaging workflow.
Collapse
Affiliation(s)
- Upasana Upadhyay Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 1700 4th Street, Byers Hall, Suite 203, Room 203D, San Francisco, CA 94158, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA.
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 1700 4th Street, Byers Hall, Suite 203, Room 203D, San Francisco, CA 94158, USA
| |
Collapse
|
21
|
Nguyen HG, Nguyen HT, Nguyen LT, Tran TS, Ho-Pham LT, Ling SH, Nguyen TV. Development of a shape-based algorithm for identification of asymptomatic vertebral compression fractures: A proof-of-principle study. Osteoporos Sarcopenia 2024; 10:22-27. [PMID: 38690543 PMCID: PMC11056464 DOI: 10.1016/j.afos.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/25/2023] [Accepted: 01/14/2024] [Indexed: 05/02/2024] Open
Abstract
Objectives Vertebral fracture is both common and serious among adults, yet it often goes undiagnosed. This study aimed to develop a shape-based algorithm (SBA) for the automatic identification of vertebral fractures. Methods The study included 144 participants (50 individuals with a fracture and 94 without a fracture) whose plain thoracolumbar spine X-rays were taken. Clinical diagnosis of vertebral fracture (grade 0 to 3) was made by rheumatologists using Genant's semiquantitative method. The SBA algorithm was developed to determine the ratio of vertebral body height loss. Based on the ratio, SBA classifies a vertebra into 4 classes: 0 = normal, 1 = mild fracture, 2 = moderate fracture, 3 = severe fracture). The concordance between clinical diagnosis and SBA-based classification was assessed at both person and vertebra levels. Results At the person level, the SBA achieved a sensitivity of 100% and specificity of 62% (95% CI, 51%-72%). At the vertebra level, the SBA achieved a sensitivity of 84% (95% CI, 72%-93%), and a specificity of 88% (95% CI, 85%-90%). On average, the SBA took 0.3 s to assess each X-ray. Conclusions The SBA developed here is a fast and efficient tool that can be used to systematically screen for asymptomatic vertebral fractures and reduce the workload of healthcare professionals.
Collapse
Affiliation(s)
- Huy G. Nguyen
- School of Biomedical Engineering, University of Technology Sydney, Australia
- Bone and Muscle Research Group, Ton Duc Thang University, Ho Chi Minh City, Viet Nam
- Saigon Precision Medicine Research Center, Ho Chi Minh City, Viet Nam
| | - Hoa T. Nguyen
- Can Tho University of Medicine and Pharmacy, Can Tho City, Viet Nam
| | | | - Thach S. Tran
- School of Biomedical Engineering, University of Technology Sydney, Australia
| | - Lan T. Ho-Pham
- Bone and Muscle Research Group, Ton Duc Thang University, Ho Chi Minh City, Viet Nam
- Saigon Precision Medicine Research Center, Ho Chi Minh City, Viet Nam
- BioMedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Sai H. Ling
- School of Biomedical Engineering, University of Technology Sydney, Australia
| | - Tuan V. Nguyen
- School of Biomedical Engineering, University of Technology Sydney, Australia
- Tam Anh Research Institute, Tam Anh Hospital at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| |
Collapse
|
22
|
Rahmaniar W, Suzuki K, Lin TL. Auto-CA: Automated Cobb Angle Measurement Based on Vertebrae Detection for Assessment of Spinal Curvature Deformity. IEEE Trans Biomed Eng 2024; 71:640-649. [PMID: 37682652 DOI: 10.1109/tbme.2023.3313126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
An accurate identification and localization of vertebrae in X-ray images can assist doctors in measuring Cobb angles for treating patients with adolescent idiopathic scoliosis. It is useful for clinical decision support systems for diagnosis, surgery planning, and spinal health analysis. Currently, publicly available annotated datasets on spinal vertebrae are small, making deep-learning-based detection methods that are highly data-dependent less accurate. In this article, we propose an algorithm based on convolutional neural networks that can be trained to detect vertebrae from a small set of images. This method can display critical information on a patient's spine, display vertebrae and their labels on the thoracic and lumbar, calculate the Cobb angle, and evaluate the severity of spinal deformities. The proposed achieved an average accuracy of 0.958 and 0.962 for classifying spinal deformities (i.e., C-shaped, S-shaped type 1, and S-shaped type 2) and severity of Cobb angle (i.e., normal, mild, moderate, and severe), respectively. The Cobb angle measurement had a median difference of less than 5° from the ground-truth with SMAPE of 5.27% and an error on landmark detection of 19.73. In addition, Lenke classification is used to analyze spinal deformities as types A, B, and C, which have an average accuracy of 0.924. Physicians can use the proposed system in clinical practice by providing X-ray images via the user interface.
Collapse
|
23
|
Maki S, Furuya T, Inoue M, Shiga Y, Inage K, Eguchi Y, Orita S, Ohtori S. Machine Learning and Deep Learning in Spinal Injury: A Narrative Review of Algorithms in Diagnosis and Prognosis. J Clin Med 2024; 13:705. [PMID: 38337399 PMCID: PMC10856760 DOI: 10.3390/jcm13030705] [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: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
Spinal injuries, including cervical and thoracolumbar fractures, continue to be a major public health concern. Recent advancements in machine learning and deep learning technologies offer exciting prospects for improving both diagnostic and prognostic approaches in spinal injury care. This narrative review systematically explores the practical utility of these computational methods, with a focus on their application in imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), as well as in structured clinical data. Of the 39 studies included, 34 were focused on diagnostic applications, chiefly using deep learning to carry out tasks like vertebral fracture identification, differentiation between benign and malignant fractures, and AO fracture classification. The remaining five were prognostic, using machine learning to analyze parameters for predicting outcomes such as vertebral collapse and future fracture risk. This review highlights the potential benefit of machine learning and deep learning in spinal injury care, especially their roles in enhancing diagnostic capabilities, detailed fracture characterization, risk assessments, and individualized treatment planning.
Collapse
Affiliation(s)
- Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| |
Collapse
|
24
|
Jung J, Dai J, Liu B, Wu Q. Artificial intelligence in fracture detection with different image modalities and data types: A systematic review and meta-analysis. PLOS DIGITAL HEALTH 2024; 3:e0000438. [PMID: 38289965 PMCID: PMC10826962 DOI: 10.1371/journal.pdig.0000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/25/2023] [Indexed: 02/01/2024]
Abstract
Artificial Intelligence (AI), encompassing Machine Learning and Deep Learning, has increasingly been applied to fracture detection using diverse imaging modalities and data types. This systematic review and meta-analysis aimed to assess the efficacy of AI in detecting fractures through various imaging modalities and data types (image, tabular, or both) and to synthesize the existing evidence related to AI-based fracture detection. Peer-reviewed studies developing and validating AI for fracture detection were identified through searches in multiple electronic databases without time limitations. A hierarchical meta-analysis model was used to calculate pooled sensitivity and specificity. A diagnostic accuracy quality assessment was performed to evaluate bias and applicability. Of the 66 eligible studies, 54 identified fractures using imaging-related data, nine using tabular data, and three using both. Vertebral fractures were the most common outcome (n = 20), followed by hip fractures (n = 18). Hip fractures exhibited the highest pooled sensitivity (92%; 95% CI: 87-96, p< 0.01) and specificity (90%; 95% CI: 85-93, p< 0.01). Pooled sensitivity and specificity using image data (92%; 95% CI: 90-94, p< 0.01; and 91%; 95% CI: 88-93, p < 0.01) were higher than those using tabular data (81%; 95% CI: 77-85, p< 0.01; and 83%; 95% CI: 76-88, p < 0.01), respectively. Radiographs demonstrated the highest pooled sensitivity (94%; 95% CI: 90-96, p < 0.01) and specificity (92%; 95% CI: 89-94, p< 0.01). Patient selection and reference standards were major concerns in assessing diagnostic accuracy for bias and applicability. AI displays high diagnostic accuracy for various fracture outcomes, indicating potential utility in healthcare systems for fracture diagnosis. However, enhanced transparency in reporting and adherence to standardized guidelines are necessary to improve the clinical applicability of AI. Review Registration: PROSPERO (CRD42021240359).
Collapse
Affiliation(s)
- Jongyun Jung
- Department of Biomedical Informatics (Dr. Qing Wu, Jongyun Jung, and Jingyuan Dai), College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Jingyuan Dai
- Department of Biomedical Informatics (Dr. Qing Wu, Jongyun Jung, and Jingyuan Dai), College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Bowen Liu
- Department of Mathematics and Statistics, Division of Computing, Analytics, and Mathematics, School of Science and Engineering (Bowen Liu), University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Qing Wu
- Department of Biomedical Informatics (Dr. Qing Wu, Jongyun Jung, and Jingyuan Dai), College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| |
Collapse
|
25
|
Kolasa K, Admassu B, Hołownia-Voloskova M, Kędzior KJ, Poirrier JE, Perni S. Systematic reviews of machine learning in healthcare: a literature review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:63-115. [PMID: 37955147 DOI: 10.1080/14737167.2023.2279107] [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: 07/17/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The increasing availability of data and computing power has made machine learning (ML) a viable approach to faster, more efficient healthcare delivery. METHODS A systematic literature review (SLR) of published SLRs evaluating ML applications in healthcare settings published between1 January 2010 and 27 March 2023 was conducted. RESULTS In total 220 SLRs covering 10,462 ML algorithms were reviewed. The main application of AI in medicine related to the clinical prediction and disease prognosis in oncology and neurology with the use of imaging data. Accuracy, specificity, and sensitivity were provided in 56%, 28%, and 25% SLRs respectively. Internal and external validation was reported in 53% and less than 1% of the cases respectively. The most common modeling approach was neural networks (2,454 ML algorithms), followed by support vector machine and random forest/decision trees (1,578 and 1,522 ML algorithms, respectively). EXPERT OPINION The review indicated considerable reporting gaps in terms of the ML's performance, both internal and external validation. Greater accessibility to healthcare data for developers can ensure the faster adoption of ML algorithms into clinical practice.
Collapse
Affiliation(s)
- Katarzyna Kolasa
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
| | - Bisrat Admassu
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
| | | | | | | | | |
Collapse
|
26
|
Dong Q, Luo G, Lane NE, Lui LY, Marshall LM, Johnston SK, Dabbous H, O'Reilly M, Linnau KF, Perry J, Chang BC, Renslo J, Haynor D, Jarvik JG, Cross NM. Generalizability of Deep Learning Classification of Spinal Osteoporotic Compression Fractures on Radiographs Using an Adaptation of the Modified-2 Algorithm-Based Qualitative Criteria. Acad Radiol 2023; 30:2973-2987. [PMID: 37438161 PMCID: PMC10776803 DOI: 10.1016/j.acra.2023.04.023] [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: 02/16/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 07/14/2023]
Abstract
RATIONALE AND OBJECTIVES Spinal osteoporotic compression fractures (OCFs) can be an early biomarker for osteoporosis but are often subtle, incidental, and underreported. To ensure early diagnosis and treatment of osteoporosis, we aimed to build a deep learning vertebral body classifier for OCFs as a critical component of our future automated opportunistic screening tool. MATERIALS AND METHODS We retrospectively assembled a local dataset, including 1790 subjects and 15,050 vertebral bodies (thoracic and lumbar). Each vertebral body was annotated using an adaption of the modified-2 algorithm-based qualitative criteria. The Osteoporotic Fractures in Men (MrOS) Study dataset provided thoracic and lumbar spine radiographs of 5994 men from six clinical centers. Using both datasets, five deep learning algorithms were trained to classify each individual vertebral body of the spine radiographs. Classification performance was compared for these models using multiple metrics, including the area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, and positive predictive value (PPV). RESULTS Our best model, built with ensemble averaging, achieved an AUC-ROC of 0.948 and 0.936 on the local dataset's test set and the MrOS dataset's test set, respectively. After setting the cutoff threshold to prioritize PPV, this model achieved a sensitivity of 54.5% and 47.8%, a specificity of 99.7% and 99.6%, and a PPV of 89.8% and 94.8%. CONCLUSION Our model achieved an AUC-ROC>0.90 on both datasets. This testing shows some generalizability to real-world clinical datasets and a suitable performance for a future opportunistic osteoporosis screening tool.
Collapse
Affiliation(s)
- Qifei Dong
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington (Q.D., G.L., B.C.C.)
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington (Q.D., G.L., B.C.C.)
| | - Nancy E Lane
- Department of Medicine, University of California - Davis, Sacramento, California (N.E.L.)
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco, California (L.-Y.L.)
| | - Lynn M Marshall
- Epidemiology Programs, Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon (L.M.M.)
| | - Sandra K Johnston
- Department of Radiology, University of Washington, Seattle, Washington (S.K.J., K.F.L., D.H., N.M.C)
| | - Howard Dabbous
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia (H.D.)
| | - Michael O'Reilly
- Department of Radiology, University of Limerick Hospital Group, Limerick, Ireland (M.O.)
| | - Ken F Linnau
- Department of Radiology, University of Washington, Seattle, Washington (S.K.J., K.F.L., D.H., N.M.C)
| | - Jessica Perry
- Department of Biostatistics, University of Washington, Seattle, Washington (J.P.)
| | - Brian C Chang
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington (Q.D., G.L., B.C.C.)
| | - Jonathan Renslo
- Keck School of Medicine, University of Southern California, Los Angeles, California (J.R.)
| | - David Haynor
- Department of Radiology, University of Washington, Seattle, Washington (S.K.J., K.F.L., D.H., N.M.C)
| | - Jeffrey G Jarvik
- Departments of Radiology and Neurological Surgery, University of Washington, Seattle, Washington (J.G.J)
| | - Nathan M Cross
- Department of Radiology, University of Washington, Seattle, Washington (S.K.J., K.F.L., D.H., N.M.C).
| |
Collapse
|
27
|
Shen L, Gao C, Hu S, Kang D, Zhang Z, Xia D, Xu Y, Xiang S, Zhu Q, Xu G, Tang F, Yue H, Yu W, Zhang Z. Using Artificial Intelligence to Diagnose Osteoporotic Vertebral Fractures on Plain Radiographs. J Bone Miner Res 2023; 38:1278-1287. [PMID: 37449775 DOI: 10.1002/jbmr.4879] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Osteoporotic vertebral fracture (OVF) is a risk factor for morbidity and mortality in elderly population, and accurate diagnosis is important for improving treatment outcomes. OVF diagnosis suffers from high misdiagnosis and underdiagnosis rates, as well as high workload. Deep learning methods applied to plain radiographs, a simple, fast, and inexpensive examination, might solve this problem. We developed and validated a deep-learning-based vertebral fracture diagnostic system using area loss ratio, which assisted a multitasking network to perform skeletal position detection and segmentation and identify and grade vertebral fractures. As the training set and internal validation set, we used 11,397 plain radiographs from six community centers in Shanghai. For the external validation set, 1276 participants were recruited from the outpatient clinic of the Shanghai Sixth People's Hospital (1276 plain radiographs). Radiologists performed all X-ray images and used the Genant semiquantitative tool for fracture diagnosis and grading as the ground truth data. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were used to evaluate diagnostic performance. The AI_OVF_SH system demonstrated high accuracy and computational speed in skeletal position detection and segmentation. In the internal validation set, the accuracy, sensitivity, and specificity with the AI_OVF_SH model were 97.41%, 84.08%, and 97.25%, respectively, for all fractures. The sensitivity and specificity for moderate fractures were 88.55% and 99.74%, respectively, and for severe fractures, they were 92.30% and 99.92%. In the external validation set, the accuracy, sensitivity, and specificity for all fractures were 96.85%, 83.35%, and 94.70%, respectively. For moderate fractures, the sensitivity and specificity were 85.61% and 99.85%, respectively, and 93.46% and 99.92% for severe fractures. Therefore, the AI_OVF_SH system is an efficient tool to assist radiologists and clinicians to improve the diagnosing of vertebral fractures. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Li Shen
- Department of Osteoporosis and Bone Disease, Shanghai Clinical Research Center of Bone Disease, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Gao
- Department of Osteoporosis and Bone Disease, Shanghai Clinical Research Center of Bone Disease, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shundong Hu
- Department of Radiology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Kang
- Shanghai Jiyinghui Intelligent Technology Co, Shanghai, China
| | - Zhaogang Zhang
- Shanghai Jiyinghui Intelligent Technology Co, Shanghai, China
| | - Dongdong Xia
- Department of Orthopaedics, Ning Bo First Hospital, Zhejiang, China
| | - Yiren Xu
- Department of Radiology, Ning Bo First Hospital, Zhejiang, China
| | - Shoukui Xiang
- Department of Endocrinology and Metabolism, The First People's Hospital of Changzhou, Changzhou, China
| | - Qiong Zhu
- Kangjian Community Health Service Center, Shanghai, China
| | - GeWen Xu
- Kangjian Community Health Service Center, Shanghai, China
| | - Feng Tang
- Jinhui Community Health Service Center, Shanghai, China
| | - Hua Yue
- Department of Osteoporosis and Bone Disease, Shanghai Clinical Research Center of Bone Disease, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Zhenlin Zhang
- Department of Osteoporosis and Bone Disease, Shanghai Clinical Research Center of Bone Disease, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
28
|
Wagner DT, Tilmans L, Peng K, Niedermeier M, Rohl M, Ryan S, Yadav D, Takacs N, Garcia-Fraley K, Koso M, Dikici E, Prevedello LM, Nguyen XV. Artificial Intelligence in Neuroradiology: A Review of Current Topics and Competition Challenges. Diagnostics (Basel) 2023; 13:2670. [PMID: 37627929 PMCID: PMC10453240 DOI: 10.3390/diagnostics13162670] [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: 05/16/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
There is an expanding body of literature that describes the application of deep learning and other machine learning and artificial intelligence methods with potential relevance to neuroradiology practice. In this article, we performed a literature review to identify recent developments on the topics of artificial intelligence in neuroradiology, with particular emphasis on large datasets and large-scale algorithm assessments, such as those used in imaging AI competition challenges. Numerous applications relevant to ischemic stroke, intracranial hemorrhage, brain tumors, demyelinating disease, and neurodegenerative/neurocognitive disorders were discussed. The potential applications of these methods to spinal fractures, scoliosis grading, head and neck oncology, and vascular imaging were also reviewed. The AI applications examined perform a variety of tasks, including localization, segmentation, longitudinal monitoring, diagnostic classification, and prognostication. While research on this topic is ongoing, several applications have been cleared for clinical use and have the potential to augment the accuracy or efficiency of neuroradiologists.
Collapse
Affiliation(s)
- Daniel T. Wagner
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Luke Tilmans
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Kevin Peng
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | | | - Matt Rohl
- College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Sean Ryan
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Divya Yadav
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Noah Takacs
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Krystle Garcia-Fraley
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Mensur Koso
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Engin Dikici
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Xuan V. Nguyen
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| |
Collapse
|
29
|
Salimi M, Parry JA, Shahrokhi R, Mosalamiaghili S. Application of artificial intelligence in trauma orthopedics: Limitation and prospects. World J Clin Cases 2023; 11:4231-4240. [PMID: 37449222 PMCID: PMC10337008 DOI: 10.12998/wjcc.v11.i18.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 06/26/2023] Open
Abstract
The varieties and capabilities of artificial intelligence and machine learning in orthopedic surgery are extensively expanding. One promising method is neural networks, emphasizing big data and computer-based learning systems to develop a statistical fracture-detecting model. It derives patterns and rules from outstanding amounts of data to analyze the probabilities of different outcomes using new sets of similar data. The sensitivity and specificity of machine learning in detecting fractures vary from previous studies. AI may be most promising in the diagnosis of less-obvious fractures that are more commonly missed. Future studies are necessary to develop more accurate and effective detection models that can be used clinically.
Collapse
Affiliation(s)
- Maryam Salimi
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, CO 80215, United States
| | - Joshua A Parry
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, CO 80215, United States
| | - Raha Shahrokhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7138433608, Iran
| | | |
Collapse
|
30
|
Uygur MM, Frara S, di Filippo L, Giustina A. New tools for bone health assessment in secreting pituitary adenomas. Trends Endocrinol Metab 2023; 34:231-242. [PMID: 36869001 DOI: 10.1016/j.tem.2023.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 03/05/2023]
Abstract
Pituitary hormones regulate skeletal physiology, and excess levels affect bone remodeling and alter bone microstructure. Vertebral fractures (VFs) are an early phenomenon of impaired bone health in secreting pituitary adenomas. However, they are not accurately predicted by areal bone mineral density (BMD). Emerging data demonstrate that a morphometric approach is essential for evaluating bone health in this clinical setting and is considered to be the gold standard method in acromegaly. Several novel tools have been proposed as alternative or additional methods for the prediction of fractures, particularly in pituitary-driven osteopathies. This review highlights the novel potential biomarkers and diagnostic methods for bone fragility, including their pathophysiological, clinical, radiological, and therapeutic implications in acromegaly, prolactinomas, and Cushing's disease.
Collapse
Affiliation(s)
- Meliha Melin Uygur
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy; Department of Endocrinology and Metabolism Disease, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy
| | - Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Opportunistic screening is a combination of techniques to identify subjects of high risk for osteoporotic fracture using routine clinical CT scans prescribed for diagnoses unrelated to osteoporosis. The two main components are automated detection of vertebral fractures and measurement of bone mineral density (BMD) in CT scans, in which a phantom for calibration of CT to BMD values is not used. This review describes the particular challenges of opportunistic screening and provides an overview and comparison of current techniques used for opportunistic screening. The review further outlines the performance of opportunistic screening. RECENT FINDINGS A wide range of technologies for the automatic detection of vertebral fractures have been developed and successfully validated. Most of them are based on artificial intelligence algorithms. The automated differentiation of osteoporotic from traumatic fractures and vertebral deformities unrelated to osteoporosis, the grading of vertebral fracture severity, and the detection of mild vertebral fractures is still problematic. The accuracy of automated fracture detection compared to classical radiological semi-quantitative Genant scoring is about 80%. Accuracy errors of alternative BMD calibration methods compared to simultaneous phantom-based calibration used in standard quantitative CT (QCT) range from below 5% to about 10%. The impact of contrast agents, frequently administered in clinical CT on the determination of BMD and on fracture risk determination is still controversial. Opportunistic screening, the identification of vertebral fracture and the measurement of BMD using clinical routine CT scans, is feasible but corresponding techniques still need to be integrated into the clinical workflow and further validated with respect to the prediction of fracture risk.
Collapse
Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany.
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
| | - Stefan Bartenschlager
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
| |
Collapse
|
32
|
York TJ, Raj S, Ashdown T, Jones G. Clinician and computer: a study on doctors' perceptions of artificial intelligence in skeletal radiography. BMC MEDICAL EDUCATION 2023; 23:16. [PMID: 36627640 PMCID: PMC9830124 DOI: 10.1186/s12909-022-03976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Traumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians' confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography. METHODS A novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review. RESULTS The responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice. Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20). CONCLUSIONS This study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.
Collapse
Affiliation(s)
- Thomas James York
- Alexander Fleming Building, Imperial College London, South Kensington Campus, London, UK.
| | | | | | - Gareth Jones
- Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
33
|
Iyer S, Blair A, White C, Dawes L, Moses D, Sowmya A. Vertebral compression fracture detection using imitation learning, patch based convolutional neural networks and majority voting. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
|
34
|
Aaltonen HL, O'Reilly MK, Linnau KF, Dong Q, Johnston SK, Jarvik JG, Cross NM. m2ABQ-a proposed refinement of the modified algorithm-based qualitative classification of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:137-145. [PMID: 36336755 PMCID: PMC10246552 DOI: 10.1007/s00198-022-06546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
Currently, there is no reproducible, widely accepted gold standard to classify osteoporotic vertebral body fractures (OVFs). The purpose of this study is to refine a method with clear rules to classify OVFs for machine learning purposes. The method was found to have moderate interobserver agreement that improved with training. INTRODUCTION The current methods to classify osteoporotic vertebral body fractures are considered ambiguous; there is no reproducible, accepted gold standard. The purpose of this study is to refine classification methodology by introducing clear, unambiguous rules and a refined flowchart to allow consistent classification of osteoporotic vertebral body fractures. METHODS We developed a set of rules and refinements that we called m2ABQ to classify vertebrae into five categories. A fracture-enriched database of thoracic and lumbar spine radiographs of patients 65 years of age and older was retrospectively obtained from clinical institutional radiology records using natural language processing. Five raters independently classified each vertebral body using the m2ABQ system. After each annotation round, consensus sessions that included all raters were held to discuss and finalize a consensus annotation for each vertebral body where individual raters' evaluations differed. This process led to further refinement and development of the rules. RESULTS Each annotation round showed increase in Fleiss kappa both for presence vs absence of fracture 0.62 (0.56-0.68) to 0.70 (0.65-0.75), as well as for the whole m2ABQ scale 0.29 (0.25-0.33) to 0.54 (0.51-0.58). CONCLUSION The m2ABQ system demonstrates moderate interobserver agreement and practical feasibility for classifying osteoporotic vertebral body fractures. Future studies to compare the method to existing studies are warranted, as well as further development of its use in machine learning purposes.
Collapse
Affiliation(s)
- H L Aaltonen
- Department of Radiology, University of Washington, Seattle, WA, USA.
- Department of Medical Imaging and Physiology, Lund University, Malmo, Sweden.
| | - M K O'Reilly
- Department of Radiology, University of Washington, Seattle, WA, USA
- Department of Radiology, University of Limerick Hospital Group, Limerick, Ireland
- Clinical Learning, Evidence, And Research [CLEAR] Center for Musculoskeletal Disorders, Seattle, USA
| | - K F Linnau
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Q Dong
- Clinical Learning, Evidence, And Research [CLEAR] Center for Musculoskeletal Disorders, Seattle, USA
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - S K Johnston
- Department of Radiology, University of Washington, Seattle, WA, USA
- Clinical Learning, Evidence, And Research [CLEAR] Center for Musculoskeletal Disorders, Seattle, USA
| | - J G Jarvik
- Department of Radiology, University of Washington, Seattle, WA, USA
- Clinical Learning, Evidence, And Research [CLEAR] Center for Musculoskeletal Disorders, Seattle, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - N M Cross
- Department of Radiology, University of Washington, Seattle, WA, USA
- Clinical Learning, Evidence, And Research [CLEAR] Center for Musculoskeletal Disorders, Seattle, USA
| |
Collapse
|
35
|
Dong Q, Luo G, Lane NE, Lui LY, Marshall LM, Kado DM, Cawthon P, Perry J, Johnston SK, Haynor D, Jarvik JG, Cross NM. Deep Learning Classification of Spinal Osteoporotic Compression Fractures on Radiographs using an Adaptation of the Genant Semiquantitative Criteria. Acad Radiol 2022; 29:1819-1832. [PMID: 35351363 PMCID: PMC10249440 DOI: 10.1016/j.acra.2022.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVES Osteoporosis affects 9% of individuals over 50 in the United States and 200 million women globally. Spinal osteoporotic compression fractures (OCFs), an osteoporosis biomarker, are often incidental and under-reported. Accurate automated opportunistic OCF screening can increase the diagnosis rate and ensure adequate treatment. We aimed to develop a deep learning classifier for OCFs, a critical component of our future automated opportunistic screening tool. MATERIALS AND METHODS The dataset from the Osteoporotic Fractures in Men Study comprised 4461 subjects and 15,524 spine radiographs. This dataset was split by subject: 76.5% training, 8.5% validation, and 15% testing. From the radiographs, 100,409 vertebral bodies were extracted, each assigned one of two labels adapted from the Genant semiquantitative system: moderate to severe fracture vs. normal/trace/mild fracture. GoogLeNet, a deep learning model, was trained to classify the vertebral bodies. The classification threshold on the predicted probability of OCF outputted by GoogLeNet was set to prioritize the positive predictive value (PPV) while balancing it with the sensitivity. Vertebral bodies with the top 0.75% predicted probabilities were classified as moderate to severe fracture. RESULTS Our model yielded a sensitivity of 59.8%, a PPV of 91.2%, and an F1 score of 0.72. The areas under the receiver operating characteristic curve (AUC-ROC) and the precision-recall curve were 0.99 and 0.82, respectively. CONCLUSION Our model classified vertebral bodies with an AUC-ROC of 0.99, providing a critical component for our future automated opportunistic screening tool. This could lead to earlier detection and treatment of OCFs.
Collapse
Affiliation(s)
- Qifei Dong
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Nancy E Lane
- Department of Medicine, University of California - Davis, Sacramento, California
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Lynn M Marshall
- Epidemiology Programs, Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon
| | - Deborah M Kado
- Department of Medicine, Stanford University, Stanford, California; Geriatric Research Education and Clinical Center (GRECC), Veterans Administration Health System, Palo Alto, CA 94304, USA
| | - Peggy Cawthon
- California Pacific Medical Center Research Institute, Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California
| | - Jessica Perry
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Sandra K Johnston
- Department of Radiology, University of Washington, Seattle, Washington
| | - David Haynor
- Department of Radiology, University of Washington, Seattle, Washington
| | - Jeffrey G Jarvik
- Departments of Radiology and Neurological Surgery, University of Washington, Seattle, Washington
| | - Nathan M Cross
- Department of Radiology, University of Washington, 1959 NE Pacific Street Box 357115, Seattle, Washington 98195-7115.
| |
Collapse
|
36
|
Artificial Intelligence in Orthopedic Radiography Analysis: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12092235. [PMID: 36140636 PMCID: PMC9498096 DOI: 10.3390/diagnostics12092235] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Artificial intelligence (AI) in medicine is a rapidly growing field. In orthopedics, the clinical implementations of AI have not yet reached their full potential. Deep learning algorithms have shown promising results in computed radiographs for fracture detection, classification of OA, bone age, as well as automated measurements of the lower extremities. Studies investigating the performance of AI compared to trained human readers often show equal or better results, although human validation is indispensable at the current standards. The objective of this narrative review is to give an overview of AI in medicine and summarize the current applications of AI in orthopedic radiography imaging. Due to the different AI software and study design, it is difficult to find a clear structure in this field. To produce more homogeneous studies, open-source access to AI software codes and a consensus on study design should be aimed for.
Collapse
|
37
|
Boonrod A, Boonrod A, Meethawolgul A, Twinprai P. Diagnostic accuracy of deep learning for evaluation of C-spine injury from lateral neck radiographs. Heliyon 2022; 8:e10372. [PMID: 36061007 PMCID: PMC9433686 DOI: 10.1016/j.heliyon.2022.e10372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/01/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Traumatic spinal cord injury (TSI) is a leading cause of morbidity and mortality worldwide, with the cervical spine being the most affected. Delayed diagnosis carries a risk of morbidity and mortality. However, cervical spine CT scans are time-consuming, costly, and not always available in general care. In this study, deep learning was used to assess and improve the detection of cervical spine injuries on lateral radiographs, the most widely used screening method to help physicians triage patients quickly and avoid unnecessary CT scans. Materials and methods Lateral neck or lateral cervical spine radiographs were obtained for patients who underwent CT scan of cervical spine. Ground truth was determined based on CT reports. CiRA CORE, a codeless deep learning program, was used as a training and testing platform. YOLO network models, including V2, V3, and V4, were trained to detect cervical spine injury. The diagnostic accuracy, sensitivity, and specificity of the model were calculated. Results A total of 229 radiographs (129 negative and 100 positive) were selected for inclusion in our study from a list of 625 patients with cervical spine CT scans, 181 (28.9%) of whom had cervical spine injury. The YOLO V4 model performed better than the V2 or V3 (AUC = 0.743), with sensitivity, specificity, and accuracy of 80%, 72% and 75% respectively. Conclusion Deep learning can improve the accuracy of lateral c-spine or neck radiographs. We anticipate that this will assist clinicians in quickly triaging patients and help to minimize the number of unnecessary CT scans.
Collapse
Affiliation(s)
- Arunnit Boonrod
- Department of Radiology, Khon Kaen University, Khon Kaen, 40002, Thailand
- AI and Informatics in Medical Imaging (AIIMI) Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Artit Boonrod
- Department of Orthopedics, Khon Kaen University, Khon Kaen, 40002, Thailand
- AI and Informatics in Medical Imaging (AIIMI) Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | | | - Prin Twinprai
- Department of Radiology, Khon Kaen University, Khon Kaen, 40002, Thailand
| |
Collapse
|
38
|
Xiao BH, Zhu MSY, Du EZ, Liu WH, Ma JB, Huang H, Gong JS, Diacinti D, Zhang K, Gao B, Liu H, Jiang RF, Ji ZY, Xiong XB, He LC, Wu L, Xu CJ, Du MM, Wang XR, Chen LM, Wu KY, Yang L, Xu MS, Diacinti D, Dou Q, Kwok TYC, Wáng YXJ. A software program for automated compressive vertebral fracture detection on elderly women's lateral chest radiograph: Ofeye 1.0. Quant Imaging Med Surg 2022; 12:4259-4271. [PMID: 35919046 PMCID: PMC9338385 DOI: 10.21037/qims-22-433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
Background Because osteoporotic vertebral fracture (OVF) on chest radiographs is commonly missed in radiological reports, we aimed to develop a software program which offers automated detection of compressive vertebral fracture (CVF) on lateral chest radiographs, and which emphasizes CVF detection specificity with a low false positivity rate. Methods For model training, we retrieved 3,991 spine radiograph cases and 1,979 chest radiograph cases from 16 sources, with among them in total 1,404 cases had OVF. For model testing, we retrieved 542 chest radiograph cases and 162 spine radiograph cases from four independent clinics, with among them 215 cases had OVF. All cases were female subjects, and except for 31 training data cases which were spine trauma cases, all the remaining cases were post-menopausal women. Image data included DICOM (Digital Imaging and Communications in Medicine) format, hard film scanned PNG (Portable Network Graphics) format, DICOM exported PNG format, and PACS (Picture Archiving and Communication System) downloaded resolution reduced DICOM format. OVF classification included: minimal and mild grades with <20% or ≥20-25% vertebral height loss respectively, moderate grade with ≥25-40% vertebral height loss, severe grade with ≥40%-2/3 vertebral height loss, and collapsed grade with ≥2/3 vertebral height loss. The CVF detection base model was mainly composed of convolution layers that include convolution kernels of different sizes, pooling layers, up-sampling layers, feature merging layers, and residual modules. When the model loss function could not be further decreased with additional training, the model was considered to be optimal and termed 'base-model 1.0'. A user-friendly interface was also developed, with the synthesized software termed 'Ofeye 1.0'. Results Counting cases and with minimal and mild OVFs included, base-model 1.0 demonstrated a specificity of 97.1%, a sensitivity of 86%, and an accuracy of 93.9% for the 704 testing cases. In total, 33 OVFs in 30 cases had a false negative reading, which constituted a false negative rate of 14.0% (30/215) by counting all OVF cases. Eighteen OVFs in 15 cases had OVFs of ≥ moderate grades missed, which constituted a false negative rate of 7.0% (15/215, i.e., sensitivity 93%) if only counting cases with ≥ moderate grade OVFs missed. False positive reading was recorded in 13 vertebrae in 13 cases (one vertebra in each case), which constituted a false positivity rate of 2.7% (13/489). These vertebrae with false positivity labeling could be readily differentiated from a true OVF by a human reader. The software Ofeye 1.0 allows 'batch processing', for example, 100 radiographs can be processed in a single operation. This software can be integrated into hospital PACS, or installed in a standalone personal computer. Conclusions A user-friendly software program was developed for CVF detection on elderly women's lateral chest radiographs. It has an overall low false positivity rate, and for moderate and severe CVFs an acceptably low false negativity rate. The integration of this software into radiological practice is expected to improve osteoporosis management for elderly women.
Collapse
Affiliation(s)
- Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Er-Zhu Du
- Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, China
| | - Wei-Hong Liu
- Department of Radiology, General Hospital of China Resources & Wuhan Iron and Steel Corporation, Wuhan, China
| | - Jian-Bing Ma
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hua Huang
- Department of Radiology, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Jing-Shan Gong
- Department of Radiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Davide Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy
- Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Kun Zhang
- Department of Radiology, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ri-Feng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhong-You Ji
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiao-Bao Xiong
- Department of Radiology, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Lai-Chang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Wu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chuan-Jun Xu
- Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mei-Mei Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Li-Mei Chen
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kong-Yang Wu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- College of Electrical and Information Engineering, Jinan University, Guangzhou, China
| | - Liu Yang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mao-Sheng Xu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy
| | - Qi Dou
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Y. C. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
39
|
Artificial Intelligence Accurately Detects Traumatic Thoracolumbar Fractures on Sagittal Radiographs. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58080998. [PMID: 35893113 PMCID: PMC9330443 DOI: 10.3390/medicina58080998] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Commonly being the first step in trauma routine imaging, up to 67% fractures are missed on plain radiographs of the thoracolumbar (TL) spine. The aim of this study was to develop a deep learning model that detects traumatic fractures on sagittal radiographs of the TL spine. Identifying vertebral fractures in simple radiographic projections would have a significant clinical and financial impact, especially for low- and middle-income countries where computed tomography (CT) and magnetic resonance imaging (MRI) are not readily available and could help select patients that need second level imaging, thus improving the cost-effectiveness. Materials and Methods: Imaging studies (radiographs, CT, and/or MRI) of 151 patients were used. An expert group of three spinal surgeons reviewed all available images to confirm presence and type of fractures. In total, 630 single vertebra images were extracted from the sagittal radiographs of the 151 patients—302 exhibiting a vertebral body fracture, and 328 exhibiting no fracture. Following augmentation, these single vertebra images were used to train, validate, and comparatively test two deep learning convolutional neural network models, namely ResNet18 and VGG16. A heatmap analysis was then conducted to better understand the predictions of each model. Results: ResNet18 demonstrated a better performance, achieving higher sensitivity (91%), specificity (89%), and accuracy (88%) compared to VGG16 (90%, 83%, 86%). In 81% of the cases, the “warm zone” in the heatmaps correlated with the findings, suggestive of fracture within the vertebral body seen in the imaging studies. Vertebras T12 to L2 were the most frequently involved, accounting for 48% of the fractures. A4, A3, and A1 were the most frequent fracture types according to the AO Spine Classification. Conclusions: ResNet18 could accurately identify the traumatic vertebral fractures on the TL sagittal radiographs. In most cases, the model based its prediction on the same areas that human expert classifiers used to determine the presence of a fracture.
Collapse
|
40
|
Feng C, Zhou X, Wang H, He Y, Li Z, Tu C. Research hotspots and emerging trends of deep learning applications in orthopedics: A bibliometric and visualized study. Front Public Health 2022; 10:949366. [PMID: 35928480 PMCID: PMC9343683 DOI: 10.3389/fpubh.2022.949366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background As a research hotspot, deep learning has been continuously combined with various research fields in medicine. Recently, there is a growing amount of deep learning-based researches in orthopedics. This bibliometric analysis aimed to identify the hotspots of deep learning applications in orthopedics in recent years and infer future research trends. Methods We screened global publication on deep learning applications in orthopedics by accessing the Web of Science Core Collection. The articles and reviews were collected without language and time restrictions. Citespace was applied to conduct the bibliometric analysis of the publications. Results A total of 822 articles and reviews were finally retrieved. The analysis showed that the application of deep learning in orthopedics has great prospects for development based on the annual publications. The most prolific country is the USA, followed by China. University of California San Francisco, and Skeletal Radiology are the most prolific institution and journal, respectively. LeCun Y is the most frequently cited author, and Nature has the highest impact factor in the cited journals. The current hot keywords are convolutional neural network, classification, segmentation, diagnosis, image, fracture, and osteoarthritis. The burst keywords are risk factor, identification, localization, and surgery. The timeline viewer showed two recent research directions for bone tumors and osteoporosis. Conclusion Publications on deep learning applications in orthopedics have increased in recent years, with the USA being the most prolific. The current research mainly focused on classifying, diagnosing and risk predicting in osteoarthritis and fractures from medical images. Future research directions may put emphasis on reducing intraoperative risk, predicting the occurrence of postoperative complications, screening for osteoporosis, and identification and classification of bone tumors from conventional imaging.
Collapse
Affiliation(s)
- Chengyao Feng
- The Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaowen Zhou
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Hua Wang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yu He
- The Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhihong Li
- The Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chao Tu
- The Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Chao Tu
| |
Collapse
|
41
|
D’Antoni F, Russo F, Ambrosio L, Bacco L, Vollero L, Vadalà G, Merone M, Papalia R, Denaro V. Artificial Intelligence and Computer Aided Diagnosis in Chronic Low Back Pain: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105971. [PMID: 35627508 PMCID: PMC9141006 DOI: 10.3390/ijerph19105971] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022]
Abstract
Low Back Pain (LBP) is currently the first cause of disability in the world, with a significant socioeconomic burden. Diagnosis and treatment of LBP often involve a multidisciplinary, individualized approach consisting of several outcome measures and imaging data along with emerging technologies. The increased amount of data generated in this process has led to the development of methods related to artificial intelligence (AI), and to computer-aided diagnosis (CAD) in particular, which aim to assist and improve the diagnosis and treatment of LBP. In this manuscript, we have systematically reviewed the available literature on the use of CAD in the diagnosis and treatment of chronic LBP. A systematic research of PubMed, Scopus, and Web of Science electronic databases was performed. The search strategy was set as the combinations of the following keywords: “Artificial Intelligence”, “Machine Learning”, “Deep Learning”, “Neural Network”, “Computer Aided Diagnosis”, “Low Back Pain”, “Lumbar”, “Intervertebral Disc Degeneration”, “Spine Surgery”, etc. The search returned a total of 1536 articles. After duplication removal and evaluation of the abstracts, 1386 were excluded, whereas 93 papers were excluded after full-text examination, taking the number of eligible articles to 57. The main applications of CAD in LBP included classification and regression. Classification is used to identify or categorize a disease, whereas regression is used to produce a numerical output as a quantitative evaluation of some measure. The best performing systems were developed to diagnose degenerative changes of the spine from imaging data, with average accuracy rates >80%. However, notable outcomes were also reported for CAD tools executing different tasks including analysis of clinical, biomechanical, electrophysiological, and functional imaging data. Further studies are needed to better define the role of CAD in LBP care.
Collapse
Affiliation(s)
- Federico D’Antoni
- Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128 Rome, Italy; (F.D.); (L.B.); (L.V.)
| | - Fabrizio Russo
- Department of Orthopaedic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 200, 00128 Rome, Italy; (L.A.); (G.V.); (R.P.); (V.D.)
- Correspondence: (F.R.); (M.M.)
| | - Luca Ambrosio
- Department of Orthopaedic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 200, 00128 Rome, Italy; (L.A.); (G.V.); (R.P.); (V.D.)
| | - Luca Bacco
- Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128 Rome, Italy; (F.D.); (L.B.); (L.V.)
- ItaliaNLP Lab, Istituto di Linguistica Computazionale “Antonio Zampolli”, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Webmonks S.r.l., Via del Triopio, 5, 00178 Rome, Italy
| | - Luca Vollero
- Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128 Rome, Italy; (F.D.); (L.B.); (L.V.)
| | - Gianluca Vadalà
- Department of Orthopaedic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 200, 00128 Rome, Italy; (L.A.); (G.V.); (R.P.); (V.D.)
| | - Mario Merone
- Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128 Rome, Italy; (F.D.); (L.B.); (L.V.)
- Correspondence: (F.R.); (M.M.)
| | - Rocco Papalia
- Department of Orthopaedic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 200, 00128 Rome, Italy; (L.A.); (G.V.); (R.P.); (V.D.)
| | - Vincenzo Denaro
- Department of Orthopaedic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 200, 00128 Rome, Italy; (L.A.); (G.V.); (R.P.); (V.D.)
| |
Collapse
|
42
|
Ground truth generalizability affects performance of the artificial intelligence model in automated vertebral fracture detection on plain lateral radiographs of the spine. Spine J 2022; 22:511-523. [PMID: 34737066 DOI: 10.1016/j.spinee.2021.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/23/2021] [Accepted: 10/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Computer-aided diagnosis with artificial intelligence (AI) has been used clinically, and ground truth generalizability is important for AI performance in medical image analyses. The AI model was trained on one specific group of older adults (aged≧60) has not yet been shown to work equally well in a younger adult group (aged 18-59). PURPOSE To compare the performance of the developed AI model with ensemble method trained with the ground truth for those aged 60 years or older in identifying vertebral fractures (VFs) on plain lateral radiographs of spine (PLRS) between younger and older adult populations. STUDY DESIGN/SETTING Retrospective analysis of PLRS in a single medical institution. OUTCOME MEASURES Accuracy, sensitivity, specificity, and interobserver reliability (kappa value) were used to compare diagnostic performance of the AI model and subspecialists' consensus between the two groups. METHODS Between January 2016 and December 2018, the ground truth of 941 patients (one PLRS per person) aged 60 years and older with 1101 VFs and 6358 normal vertebrae was used to set up the AI model. The framework of the developed AI model includes: object detection with You Only Look Once Version 3 (YOLOv3) at T0-L5 levels in the PLRS, data pre-preprocessing with image-size and quality processing, and AI ensemble model (ResNet34, DenseNet121, and DenseNet201) for identifying or grading VFs. The reported overall accuracy, sensitivity and specificity were 92%, 91% and 93%, respectively, and external validation was also performed. Thereafter, patients diagnosed as VFs and treated in our institution during October 2019 to August 2020 were the study group regardless of age. In total, 258 patients (339 VFs and 1725 normal vertebrae) in the older adult population (mean age 78±10.4; range, 60-106) were enrolled. In the younger adult population (mean age 36±9.43; range, 20-49), 106 patients (120 VFs and 728 normal vertebrae) were enrolled. After identification and grading of VFs based on the Genant method with consensus between two subspecialists', VFs in each PLRS with human labels were defined as the testing dataset. The corresponding CT or MRI scan was used for labeling in the PLRS. The bootstrap method was applied to the testing dataset. RESULTS The model for clinical application, Digital Imaging and Communications in Medicine (DICOM) format, is uploaded directly (available at: http://140.113.114.104/vght_demo/svf-model (grading) and http://140.113.114.104/vght demo/svf-model2 (labeling). Overall accuracy, sensitivity and specificity in the older adult population were 93.36% (95% CI 93.34%-93.38%), 88.97% (95% CI 88.59%-88.99%) and 94.26% (95% CI 94.23%-94.29%), respectively. Overall accuracy, sensitivity and specificity in the younger adult population were 93.75% (95% CI 93.7%-93.8%), 65.00% (95% CI 64.33%-65.67%) and 98.49% (95% CI 98.45%-98.52%), respectively. Accuracy reached 100% in VFs grading once the VFs were labeled accurately. The unique pattern of limbus-like VFs, 43 (35.8%) were investigated only in the younger adult population. If limbus-like VFs from the dataset were not included, the accuracy increased from 93.75% (95% CI 93.70%-93.80%) to 95.78% (95% CI 95.73%-95.82%), sensitivity increased from 65.00% (95% CI 64.33%-65.67%) to 70.13% (95% CI 68.98%-71.27%) and specificity remained unchanged at 98.49% (95% CI 98.45%-98.52%), respectively. The main causes of false negative results in older adults were patients' lung markings, diaphragm or bowel airs (37%, n=14) followed by type I fracture (29%, n=11). The main causes of false negatives in younger adults were limbus-like VFs (45%, n=19), followed by type I fracture (26%, n=11). The overall kappa between AI discrimination and subspecialists' consensus in the older and younger adult populations were 0.77 (95% CI, 0.733-0.805) and 0.72 (95% CI, 0.6524-0.80), respectively. CONCLUSIONS The developed VF-identifying AI ensemble model based on ground truth of older adults achieved better performance in identifying VFs in older adults and non-fractured thoracic and lumbar vertebrae in the younger adults. Different age distribution may have potential disease diversity and implicate the effect of ground truth generalizability on the AI model performance.
Collapse
|
43
|
Karandikar P, Massaad E, Hadzipasic M, Kiapour A, Joshi RS, Shankar GM, Shin JH. Machine Learning Applications of Surgical Imaging for the Diagnosis and Treatment of Spine Disorders: Current State of the Art. Neurosurgery 2022; 90:372-382. [PMID: 35107085 DOI: 10.1227/neu.0000000000001853] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/10/2021] [Indexed: 01/18/2023] Open
Abstract
Recent developments in machine learning (ML) methods demonstrate unparalleled potential for application in the spine. The ability for ML to provide diagnostic faculty, produce novel insights from existing capabilities, and augment or accelerate elements of surgical planning and decision making at levels equivalent or superior to humans will tremendously benefit spine surgeons and patients alike. In this review, we aim to provide a clinically relevant outline of ML-based technology in the contexts of spinal deformity, degeneration, and trauma, as well as an overview of commercial-level and precommercial-level surgical assist systems and decisional support tools. Furthermore, we briefly discuss potential applications of generative networks before highlighting some of the limitations of ML applications. We conclude that ML in spine imaging represents a significant addition to the neurosurgeon's armamentarium-it has the capacity to directly address and manifest clinical needs and improve diagnostic and procedural quality and safety-but is yet subject to challenges that must be addressed before widespread implementation.
Collapse
Affiliation(s)
- Paramesh Karandikar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- T.H. Chan School of Medicine, University of Massachusetts, Worcester, Massachusetts, USA
| | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhamed Hadzipasic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Kiapour
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rushikesh S Joshi
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
44
|
Kuo RYL, Harrison C, Curran TA, Jones B, Freethy A, Cussons D, Stewart M, Collins GS, Furniss D. Artificial Intelligence in Fracture Detection: A Systematic Review and Meta-Analysis. Radiology 2022; 304:50-62. [PMID: 35348381 DOI: 10.1148/radiol.211785] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Patients with fractures are a common emergency presentation and may be misdiagnosed at radiologic imaging. An increasing number of studies apply artificial intelligence (AI) techniques to fracture detection as an adjunct to clinician diagnosis. Purpose To perform a systematic review and meta-analysis comparing the diagnostic performance in fracture detection between AI and clinicians in peer-reviewed publications and the gray literature (ie, articles published on preprint repositories). Materials and Methods A search of multiple electronic databases between January 2018 and July 2020 (updated June 2021) was performed that included any primary research studies that developed and/or validated AI for the purposes of fracture detection at any imaging modality and excluded studies that evaluated image segmentation algorithms. Meta-analysis with a hierarchical model to calculate pooled sensitivity and specificity was used. Risk of bias was assessed by using a modified Prediction Model Study Risk of Bias Assessment Tool, or PROBAST, checklist. Results Included for analysis were 42 studies, with 115 contingency tables extracted from 32 studies (55 061 images). Thirty-seven studies identified fractures on radiographs and five studies identified fractures on CT images. For internal validation test sets, the pooled sensitivity was 92% (95% CI: 88, 93) for AI and 91% (95% CI: 85, 95) for clinicians, and the pooled specificity was 91% (95% CI: 88, 93) for AI and 92% (95% CI: 89, 92) for clinicians. For external validation test sets, the pooled sensitivity was 91% (95% CI: 84, 95) for AI and 94% (95% CI: 90, 96) for clinicians, and the pooled specificity was 91% (95% CI: 81, 95) for AI and 94% (95% CI: 91, 95) for clinicians. There were no statistically significant differences between clinician and AI performance. There were 22 of 42 (52%) studies that were judged to have high risk of bias. Meta-regression identified multiple sources of heterogeneity in the data, including risk of bias and fracture type. Conclusion Artificial intelligence (AI) and clinicians had comparable reported diagnostic performance in fracture detection, suggesting that AI technology holds promise as a diagnostic adjunct in future clinical practice. Clinical trial registration no. CRD42020186641 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Cohen and McInnes in this issue.
Collapse
Affiliation(s)
- Rachel Y L Kuo
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - Conrad Harrison
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - Terry-Ann Curran
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - Benjamin Jones
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - Alexander Freethy
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - David Cussons
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - Max Stewart
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - Gary S Collins
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| | - Dominic Furniss
- From the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Old Road Headington, Oxford OX3 7LD, UK (R.Y.L.K., C.H., M.S., G.S.C., D.F.); Department of Plastic Surgery, John Radcliffe Hospital, Oxford, UK (T.A.C., A.F.); Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK (B.J.); Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK (D.C.); and UK EQUATOR Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Centre for Statistics in Medicine, Oxford UK (G.S.C.)
| |
Collapse
|
45
|
Somma T, DE Rosa A, Mastantuoni C, Esposito F, Meglio V, Romano F, Ricciardi L, DE Divitiis O, DI Somma C. Multidisciplinary management of osteoporotic vertebral fractures. An overview. Minerva Endocrinol (Torino) 2021; 47:189-202. [PMID: 34881854 DOI: 10.23736/s2724-6507.21.03515-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vertebral fractures represent the most frequent complication associated with osteoporosis. Patients harboring a vertebral fracture complain physical impairment including low back pain and spine balance alteration, i.e., kyphosis, leading to subsequent systemic complication, with an increase in morbidity and mortality risk. Different strategies are available in the management of osteoporotic vertebral fractures: medical therapy acts as a prevention strategy while surgical vertebral augmentation procedures, when correctly indicated, aim to reduce pain and to restore the physiological vertebral height. Considering the growing prevalence and incidence of this condition and its socio-economic burden, prevention, diagnosis and treatment of osteoporotic vertebral fractures are of utmost importance. Our aim is to review the current strategies for the management of osteoporotic vertebral fractures providing an integrated multidisciplinary endocrinological, radiological and neurosurgical point of view.
Collapse
Affiliation(s)
- Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Andrea DE Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy -
| | - Ciro Mastantuoni
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Vincenzo Meglio
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Fiammetta Romano
- Unit of Endocrinology, Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Luca Ricciardi
- Neurosurgery, Department NESMOS, Sapienza University of Rome, Rome, Italy
| | - Oreste DE Divitiis
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Carolina DI Somma
- Unit of Endocrinology, Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW In this paper, we discuss how recent advancements in image processing and machine learning (ML) are shaping a new and exciting era for the osteoporosis imaging field. With this paper, we want to give the reader a basic exposure to the ML concepts that are necessary to build effective solutions for image processing and interpretation, while presenting an overview of the state of the art in the application of machine learning techniques for the assessment of bone structure, osteoporosis diagnosis, fracture detection, and risk prediction. RECENT FINDINGS ML effort in the osteoporosis imaging field is largely characterized by "low-cost" bone quality estimation and osteoporosis diagnosis, fracture detection, and risk prediction, but also automatized and standardized large-scale data analysis and data-driven imaging biomarker discovery. Our effort is not intended to be a systematic review, but an opportunity to review key studies in the recent osteoporosis imaging research landscape with the ultimate goal of discussing specific design choices, giving the reader pointers to possible solutions of regression, segmentation, and classification tasks as well as discussing common mistakes.
Collapse
Affiliation(s)
- Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94158, USA.
| | - Francesco Caliva
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94158, USA
| | - Galateia Kazakia
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94158, USA
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94158, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94158, USA
| |
Collapse
|
47
|
Kong SH, Shin CS. Applications of Machine Learning in Bone and Mineral Research. Endocrinol Metab (Seoul) 2021; 36:928-937. [PMID: 34674509 PMCID: PMC8566132 DOI: 10.3803/enm.2021.1111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/23/2021] [Accepted: 09/09/2021] [Indexed: 12/26/2022] Open
Abstract
In this unprecedented era of the overwhelming volume of medical data, machine learning can be a promising tool that may shed light on an individualized approach and a better understanding of the disease in the field of osteoporosis research, similar to that in other research fields. This review aimed to provide an overview of the latest studies using machine learning to address issues, mainly focusing on osteoporosis and fractures. Machine learning models for diagnosing and classifying osteoporosis and detecting fractures from images have shown promising performance. Fracture risk prediction is another promising field of research, and studies are being conducted using various data sources. However, these approaches may be biased due to the nature of the techniques or the quality of the data. Therefore, more studies based on the proposed guidelines are needed to improve the technical feasibility and generalizability of artificial intelligence algorithms.
Collapse
Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| |
Collapse
|
48
|
Coppola F, Faggioni L, Gabelloni M, De Vietro F, Mendola V, Cattabriga A, Cocozza MA, Vara G, Piccinino A, Lo Monaco S, Pastore LV, Mottola M, Malavasi S, Bevilacqua A, Neri E, Golfieri R. Human, All Too Human? An All-Around Appraisal of the "Artificial Intelligence Revolution" in Medical Imaging. Front Psychol 2021; 12:710982. [PMID: 34650476 PMCID: PMC8505993 DOI: 10.3389/fpsyg.2021.710982] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
Artificial intelligence (AI) has seen dramatic growth over the past decade, evolving from a niche super specialty computer application into a powerful tool which has revolutionized many areas of our professional and daily lives, and the potential of which seems to be still largely untapped. The field of medicine and medical imaging, as one of its various specialties, has gained considerable benefit from AI, including improved diagnostic accuracy and the possibility of predicting individual patient outcomes and options of more personalized treatment. It should be noted that this process can actively support the ongoing development of advanced, highly specific treatment strategies (e.g., target therapies for cancer patients) while enabling faster workflow and more efficient use of healthcare resources. The potential advantages of AI over conventional methods have made it attractive for physicians and other healthcare stakeholders, raising much interest in both the research and the industry communities. However, the fast development of AI has unveiled its potential for disrupting the work of healthcare professionals, spawning concerns among radiologists that, in the future, AI may outperform them, thus damaging their reputations or putting their jobs at risk. Furthermore, this development has raised relevant psychological, ethical, and medico-legal issues which need to be addressed for AI to be considered fully capable of patient management. The aim of this review is to provide a brief, hopefully exhaustive, overview of the state of the art of AI systems regarding medical imaging, with a special focus on how AI and the entire healthcare environment should be prepared to accomplish the goal of a more advanced human-centered world.
Collapse
Affiliation(s)
- Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- SIRM Foundation, Italian Society of Medical and Interventional Radiology, Milan, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Michela Gabelloni
- Academic Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Fabrizio De Vietro
- Academic Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Vincenzo Mendola
- Academic Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Arrigo Cattabriga
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alberto Piccinino
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Silvia Lo Monaco
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Luigi Vincenzo Pastore
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Margherita Mottola
- Department of Computer Science and Engineering, University of Bologna, Bologna, Italy
| | - Silvia Malavasi
- Department of Computer Science and Engineering, University of Bologna, Bologna, Italy
| | - Alessandro Bevilacqua
- Department of Computer Science and Engineering, University of Bologna, Bologna, Italy
| | - Emanuele Neri
- SIRM Foundation, Italian Society of Medical and Interventional Radiology, Milan, Italy
- Academic Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
49
|
Smets J, Shevroja E, Hügle T, Leslie WD, Hans D. Machine Learning Solutions for Osteoporosis-A Review. J Bone Miner Res 2021; 36:833-851. [PMID: 33751686 DOI: 10.1002/jbmr.4292] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/04/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
Osteoporosis and its clinical consequence, bone fracture, is a multifactorial disease that has been the object of extensive research. Recent advances in machine learning (ML) have enabled the field of artificial intelligence (AI) to make impressive breakthroughs in complex data environments where human capacity to identify high-dimensional relationships is limited. The field of osteoporosis is one such domain, notwithstanding technical and clinical concerns regarding the application of ML methods. This qualitative review is intended to outline some of these concerns and to inform stakeholders interested in applying AI for improved management of osteoporosis. A systemic search in PubMed and Web of Science resulted in 89 studies for inclusion in the review. These covered one or more of four main areas in osteoporosis management: bone properties assessment (n = 13), osteoporosis classification (n = 34), fracture detection (n = 32), and risk prediction (n = 14). Reporting and methodological quality was determined by means of a 12-point checklist. In general, the studies were of moderate quality with a wide range (mode score 6, range 2 to 11). Major limitations were identified in a significant number of studies. Incomplete reporting, especially over model selection, inadequate splitting of data, and the low proportion of studies with external validation were among the most frequent problems. However, the use of images for opportunistic osteoporosis diagnosis or fracture detection emerged as a promising approach and one of the main contributions that ML could bring to the osteoporosis field. Efforts to develop ML-based models for identifying novel fracture risk factors and improving fracture prediction are additional promising lines of research. Some studies also offered insights into the potential for model-based decision-making. Finally, to avoid some of the common pitfalls, the use of standardized checklists in developing and sharing the results of ML models should be encouraged. © 2021 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Julien Smets
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Enisa Shevroja
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Didier Hans
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|