Composite Attention Residual U-Net for Rib Fracture Detection

Applications of Artificial Intelligence in Acute Thoracic Imaging

The applications of artificial intelligence (AI) in radiology are rapidly advancing with AI algorithms being used in a wide range of disease pathologies and clinical settings. Acute thoracic pathologies including rib fractures, pneumothoraces, and acute PE are associated with significant morbidity and mortality and their identification is crucial for prompt treatment. AI models which increase diagnostic accuracy, improve radiologist efficiency and reduce time to diagnosis of acute abnormalities in the thorax have the potential to significantly improve patient outcomes. The purpose of this review is to summarize the current applications of AI in acute thoracic imaging, highlighting their strengths, limitations, and future research opportunities.

Diagnostic Accuracy of Artificial Intelligence for Detection of Rib Fracture on X-ray and Computed Tomography Imaging: A Systematic Review

Rib pathology is uniquely difficult and time-consuming for radiologists to diagnose. AI can reduce radiologist workload and serve as a tool to improve accurate diagnosis. To date, no reviews have been performed synthesizing identification of rib fracture data on AI and its diagnostic performance on X-ray and CT scans of rib fractures and its comparison to physicians. The objectives of this study are to analyze the performance of artificial intelligence in diagnosing rib fracture on X-ray and computed tomography (CT) scan using multiple clinical studies and to compare it to that of physicians findings of rib fracture. A literature search was conducted on PubMed and Embase for articles regarding the use of artificial intelligence for the detection of rib fractures up until July 2024. AI model, number of cases, sensitivity, and comparison to physicians data was collected. A total of 29 studies, comprising 125,364 cases, were included in this review. The pooled sensitivity of AI models was 0.853. Nineteen of these studies compared their results to radiologists, orthopedic surgeons, or anesthesiologists, totalling 61 physicians. Of these 19 studies, the radiologists had a pooled sensitivity of 0.750. The sensitivity of AI in these studies by comparison was 0.840. The results suggest that artificial intelligence has a promising role in detecting rib fractures on X-ray and CT scans. In our interpretation, the performance of artificial intelligence is similar to, or better than, that of physicians, alluding to its encouraging potential in a clinical setting as it may reduce physician workload, improve reading efficiency, and lead to better patient outcomes.

Classification of rib fracture types from postmortem computed tomography images using deep learning

Human or time resources can sometimes fall short in medical image diagnostics, and analyzing images in full detail can be a challenging task. With recent advances in artificial intelligence, an increasing number of systems have been developed to assist clinicians in their work. In this study, the objective was to train a model that can distinguish between various fracture types on different levels of hierarchical taxonomy and detect them on 2D-image representations of volumetric postmortem computed tomography (PMCT) data. We used a deep learning model based on the ResNet50 architecture that was pretrained on ImageNet data, and we used transfer learning to fine-tune it to our specific task. We trained our model to distinguish between "displaced," "nondisplaced," "ad latus," "ad longitudinem cum contractione," and "ad longitudinem cum distractione" fractures. Radiographs with no fractures were correctly predicted in 95-99% of cases. Nondisplaced fractures were correctly predicted in 80-86% of cases. Displaced fractures of the "ad latus" type were correctly predicted in 17-18% of cases. The other two displaced types of fractures, "ad longitudinem cum contractione" and "ad longitudinem cum distractione," were correctly predicted in 70-75% and 64-75% of cases, respectively. The model achieved the best performance when the level of hierarchical taxonomy was high, while it had more difficulties when the level of hierarchical taxonomy was lower. Overall, deep learning techniques constitute a reliable solution for forensic pathologists and medical practitioners seeking to reduce workload.

Deep learning for acute rib fracture detection in CT data: a systematic review and meta-analysis

OBJECTIVES

To review studies on deep learning (DL) models for classification, detection, and segmentation of rib fractures in CT data, to determine their risk of bias (ROB), and to analyse the performance of acute rib fracture detection models.

METHODS

Research articles written in English were retrieved from PubMed, Embase, and Web of Science in April 2023. A study was only included if a DL model was used to classify, detect, or segment rib fractures, and only if the model was trained with CT data from humans. For the ROB assessment, the Quality Assessment of Diagnostic Accuracy Studies tool was used. The performance of acute rib fracture detection models was meta-analysed with forest plots.

RESULTS

A total of 27 studies were selected. About 75% of the studies have ROB by not reporting the patient selection criteria, including control patients or using 5-mm slice thickness CT scans. The sensitivity, precision, and F1-score of the subgroup of low ROB studies were 89.60% (95%CI, 86.31%-92.90%), 84.89% (95%CI, 81.59%-88.18%), and 86.66% (95%CI, 84.62%-88.71%), respectively. The ROB subgroup differences test for the F1-score led to a p-value below 0.1.

CONCLUSION

ROB in studies mostly stems from an inappropriate patient and data selection. The studies with low ROB have better F1-score in acute rib fracture detection using DL models.

ADVANCES IN KNOWLEDGE

This systematic review will be a reference to the taxonomy of the current status of rib fracture detection with DL models, and upcoming studies will benefit from our data extraction, our ROB assessment, and our meta-analysis.