Evaluation of a Weightbearing CT Artificial Intelligence-Based Automatic Measurement for the M1-M2 Intermetatarsal Angle in Hallux Valgus

Day, Jonathan; Richter, Martinus; Mansur, Nacime Salomão Barbachan; Fernando, Céline; Deland, Jonathan T.; Ellis, Scott J.; Lintz, François

doi:10.1177/10711007211015177

Cited by 20 publications

(7 citation statements)

References 25 publications

(28 reference statements)

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“…4,19,24 Although artificial intelligence-based 3-D measurements of radiographic parameters of hallux valgus are in development, these technologies are not readily available and do not appear to have been extended to flatfoot yet. 5 The Bland-Altman limits of agreement analysis, in which the DRR arch height index measurement demonstrated substantially more agreement with the WBCT measurement than did the XR measurement, suggests that DRR may offer a more accurate representation of the intrinsic anatomy of the medial arch than XR. It is possible that lesser image quality on DRRs may have contributed to difficulties in detecting anatomical landmarks, thereby contributing to the low agreement between DRR and XR.…”

Section: Discussionmentioning

confidence: 95%

“…1,2,14,17,26 Moreover, WBCT-based DRR has recently been used as a proxy for XR in hallux valgus studies. 5 Further investigation is needed to compare DRR to XR in a clinical context. In the setting of PCFD, validating DRR as an alternative to traditional weightbearing radiographs may change the diagnostic algorithm, fore going multiple traditional XR for 1 WBCT scan, thereby saving time, costs, and radiation exposure without compromising care.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Flatfoot Deformity Using Digitally Reconstructed Radiographs: Reliability and Comparison to Conventional Radiographs

Fuller

Kim

et al. 2022

Foot Ankle Int.

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Background: Digitally reconstructed radiographs (DRRs) generated from weightbearing computed tomography (WBCT) may potentially substitute for weightbearing plain radiographs (XRs) but have not been clinically validated. This study aims to test the reliability of 6 radiographic parameters of progressive collapsing foot deformity (PCFD) as measured on DRR, to investigate whether DRR represents comparably to XR through the same measurements, and to compare agreement of DRR and XR measurements of a standardized arch height parameter with reference measurements made on WBCT. Methods: DRR generated from preoperative WBCT of 71 patients (72 feet) treated surgically for PCFD were retrospectively compared with preoperative weight-bearing XR after exclusion criteria were applied. Six radiographic measurements were performed, including Meary angle, calcaneal pitch (CPA), medial cuneiform height (MCH), AP talar–first metatarsal angle (T-1MT), talonavicular coverage (TNCA), and talar incongruency (TIA). Arch height was measured on XR, DRR, and WBCT using a validated, standardized, navicular-based index. Intraclass correlation coefficients assessed DRR intraobserver and interobserver reliability. Paired samples t tests tested differences between XR and DRR. Bland-Altman limits of agreement analysis compared DRR and XR agreement with WBCT measurements. Results: Measurements were within standard PCFD ranges on XR and DRR. All measurements demonstrated excellent intrarater reliability and good to excellent interrater agreement, consistent with previous literature on XR. No differences were found for Meary, CPA, or TNCA. Minor differences were observed for MCH, T-1MT, and TIA. DRR measurements demonstrated greater agreement with WBCT than XR measurements. Conclusion: DRR from WBCT may be a promising substitute for XR in the clinical evaluation of PCFD. Radiographic measurements made on DRR demonstrated good to excellent reliability. Although small differences were found between XR and DRR for certain measurements, DRR more accurately represented medial arch anatomy compared to gold standard WBCT data than XR. If validated as a clinical substitute, DRR could eventually obviate XR where WBCT is available. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Assessment of Flatfoot Deformity Using Digitally Reconstructed Radiographs: Reliability and Comparison to Conventional Radiographs

Fuller

Kim

et al. 2022

Foot Ankle Int.

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“…Day et al 9 aimed to assess the performance of an AI-based software that automatically measures the M1-M2 IMA from weightbearing cone beam computed tomography (WBCT) scans in hallux valgus patients. The AI-based software was faster than manual measurements, correlated well with manual measurements, and had higher and nearly perfect test-retest reliability (0.99 intrasoftware intraclass correlation coefficient for both 3D and 2D IMA).…”

Section: Resultsmentioning

confidence: 99%

“…The AI-based software was faster than manual measurements, correlated well with manual measurements, and had higher and nearly perfect test-retest reliability (0.99 intrasoftware intraclass correlation coefficient for both 3D and 2D IMA). 9 …”

Section: Resultsmentioning

confidence: 99%

Advancements in Artificial Intelligence for Foot and Ankle Surgery: A Systematic Review

Gupta

Kingston

O’Malley

et al. 2023

Foot & Ankle Orthopaedics

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Background: There has been a rapid increase in research applying artificial intelligence (AI) to various subspecialties of orthopaedic surgery, including foot and ankle surgery. The purpose of this systematic review is to (1) characterize the topics and objectives of studies using AI in foot and ankle surgery, (2) evaluate the performance of their models, and (3) evaluate their validity (internal or external validation). Methods: A systematic literature review was conducted using PubMed/MEDLINE and Embase databases in December 2022. All studies that used AI or its subsets machine learning (ML) and deep learning (DL) in the setting of foot and ankle surgery relevant to orthopaedic surgeons were included. Studies were evaluated for their demographics, subject area, outcomes of interest, model(s) tested, model(s)’ performance, and validity (internal or external). Results: A total of 31 studies met inclusion criteria: 14 studies investigated AI for image interpretation, 13 studies investigated AI for clinical predictions, and 4 studies were grouped as “other.” Studies commonly explored AI for ankle fractures, calcaneus fractures, hallux valgus, Achilles tendon pathologies, plantar fasciitis, and sports injuries. For studies reporting the area under the receiver operating characteristic curve (AUC), AUCs ranged from 0.64 (poor) to 0.99 (excellent). Two studies (6.45%) reported external validation. Conclusion: Applications of AI in the field of foot and ankle surgery are expanding, particularly for image interpretation and clinical predictions. Current model performances range from poor to excellent, and most studies lack external validation, demonstrating a need for further research prior to deploying AI-based clinical applications. Level of Evidence: Level III, retrospective cohort study.

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“…A potential future application of WBCT 3D measurements may be to implement software tools to aid in the process of taking complex measurements. 6…”

Section: Discussionmentioning

confidence: 99%

A Case-Control Study of 3D vs 2D Weightbearing CT Measurements of the M1-M2 Intermetatarsal Angle in Hallux Valgus

et al. 2022

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Background: Weightbearing computed tomography (WBCT) 3-dimensional measurements may be reliable in assessing hallux valgus (HV). The objective of this study was to compare 2D and 3D WBCT measurements of the M1-M2 intermetatarsal angle (IMA) in patients with HV and in healthy controls. We hypothesized that 2D and 3D IMA measurements would correlate and have similar reliability in both HV and controls. Methods: Retrospective multicenter comparative study included WBCT scans from 83 feet (41 HV, 42 controls). IMA was measured on digitally reconstructed radiographs (DRR-IMA). 3D angle (3D-IMA) and its projection on the weightbearing plane (2D-IMA) were calculated from 3D coordinates of the first and second metatarsals. Intraobserver reliability and intermethod correlations were calculated using intraclass correlation coefficients (ICCs). Results: Intraobserver reliability was very strong for DRR-IMA (0.95) and 3D-IMA (0.99). Intermethod correlation between the 3 modalities in HV patients ranged from moderate (DRR vs 2D, 0.48; DRR vs 3D, 0.48) to very strong (2D vs 3D, 0.91). Similarly, intermethod correlation in the control group ranged from moderate (DRR vs 2D, 0.56; DRR vs 3D, 0.60) to very strong (2D vs 3D, 0.92). Conclusion: Measurements for IMA are similar using DRR, 3D and 2D projected angles, with very strong intraobserver reliability and moderate to very strong intermethod correlations. This is the first head-to-head comparison between these measurement modalities in HV. Further investigations are warranted before formulating guidelines for the clinical use of 3D angles. Level of Evidence: Level III, case-control study.

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Evaluation of a Weightbearing CT Artificial Intelligence-Based Automatic Measurement for the M1-M2 Intermetatarsal Angle in Hallux Valgus

Cited by 20 publications

References 25 publications

Assessment of Flatfoot Deformity Using Digitally Reconstructed Radiographs: Reliability and Comparison to Conventional Radiographs

Assessment of Flatfoot Deformity Using Digitally Reconstructed Radiographs: Reliability and Comparison to Conventional Radiographs

Advancements in Artificial Intelligence for Foot and Ankle Surgery: A Systematic Review

A Case-Control Study of 3D vs 2D Weightbearing CT Measurements of the M1-M2 Intermetatarsal Angle in Hallux Valgus

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