Significant inherent extra-articular varus angulation is associated with abnormal postoperative hip-knee-ankle (HKA) angle. At present, HKA is manually measured by orthopedic surgeons and it increases the doctors' workload. To automatically determine HKA, a deep learning-based automated method for measuring HKA on the unilateral lower limb X-rays was developed and validated. This study retrospectively selected 398 double lower limbs X-rays during 2018 and 2020 from Jilin University Second Hospital. The images (n = 398) were cropped into unilateral lower limb images (n = 796). The deep neural network was used to segment the head of hip, the knee, and the ankle in the same image, respectively. Then, the mean square error of distance between each internal point of each organ and the organ's boundary was calculated. The point with the minimum mean square error was set as the central point of the organ. HKA was determined using the coordinates of three organs' central points according to the law of cosines. In a quantitative analysis, HKA was measured manually by three orthopedic surgeons with a high consistency (176.90 ° ± 12.18°, 176.95 ° ± 12.23°, 176.87 ° ± 12.25°) as evidenced by the Kandall's W of 0.999 (p < 0.001). Of note, the average measured HKA by them (176.90 ° ± 12.22°) served as the ground truth. The automatically measured HKA by the proposed method (176.41 ° ± 12.08°) was close to the ground truth, showing no significant difference. In addition, intraclass correlation coefficient (ICC) between them is 0.999 (p < 0.001). The average of difference between prediction and ground truth is 0.49°. The proposed method indicates a high feasibility and reliability in clinical practice.
Program under Grant 20180519008JH, and in part by the Foundation of Jilin Provincial Department of Finance (Establishment of standardized database for colorectal cancer and exploration of new diagnosis and treatment model based on big data analysis).
In this study, we aim to provide a deep convolutional network based femoral neck fracture detection system on radiographs for emergency patients. We retrospectively collected 1,491 frontal pelvic radiographs from three institutions and assigned them to the following data sets: primary dataset (710 radiographs, to fine-tune and validate the initial model called the Digital Radiography Fracture Detection System [DR-FDS]), internal test set 1 (189 radiographs) and 2 (235 radiographs), and external test set 1 (189 radiographs) and 2 (168 radiographs). Per-bounding box recall and precision and per-image sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC) were computed. We randomly extracted 300 radiographs from the above test sets and compared their effect on the diagnostic accuracy and efficiency of fine-tuned model-assisted and unassisted clinicians. The fine-tuned DR-FDS showed a better overall performance in detecting femoral neck fractures than did the initial DR-FDS. The fine-tuned DR-FDS achieved AUC values of 0.9526 (95%CI, 0.9048-0.9767) and 0.9633(95%CI, 0.9346-0.9797) in internal test sets 1 and 2. In external test sets 1 and 2, this model also achieved promising results with AUC values of 0.9231 (95%CI, 0.8779-0.9520), and 0.9937 (95%CI 0.9739-0.9985), respectively. The clinicians showed a statistically significant increase in specificity, sensitivity, and accuracy for the identification of minimal/undisplaced fracture and a decrease in the average reading time. The object detection model that is fine-tuned has high sensitivity and specificity and the universal ability to detect and locate femoral neck fractures on pelvic radiographs. INDEX TERMSFemoral neck fractures, Convolutional neural network, Radiographs, Small sample, Finetuning
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