The effect of deep convolutional neural networks on radiologists' performance in the detection of hip fractures on digital pelvic radiographs

Mawatari, Tsubasa; Hayashida, Yoshiko; Katsuragawa, Shigehiko; Yoshimatsu, Yuta; Hamamura, Toshihiko; Anai, Kenta; Ueno, Midori; Yamaga, Satoru; Ueda, Issei; Terasawa, Takashi; Fujisaki, Akitaka; Chihara, Chihiro; Miyagi, Tsuyoshi; Aoki, Takatoshi; Korogi, Yukunori

doi:10.1016/j.ejrad.2020.109188

Cited by 28 publications

(36 citation statements)

References 26 publications

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“…( 77 ) Twelve studies compared ML model performance versus human experts. ( 66,71,78–83,85,91,93,94 ) In four of these studies, ML outperformed human experts significantly. ( 80,83,85,91 ) Thirteen studies applied transfer learning based on pre‐defined CNN architectures, pre‐trained on the ImageNet data set ( 77,79–83,85,90,91,93,95 ) or on a radiography image database.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 32 studies that investigated fracture detection (Table 3), (66–97 ) 11 were on vertebral fractures, ( 66–76 ) 17 hip fractures, ( 74–90 ) and 10 other fracture sites such as humerus or wrist. ( 75,76,90–97 ) Nineteen studies developed CNN models for image analysis.…”

Section: Resultsmentioning

confidence: 99%

“…( 80,83,85,91 ) Thirteen studies applied transfer learning based on pre‐defined CNN architectures, pre‐trained on the ImageNet data set ( 77,79–83,85,90,91,93,95 ) or on a radiography image database. ( 78,94 ) Some of these were fine‐tuned on the last layers, ( 82 ) on the penultimate layer, (77,79,83,93,95 ) or were unclear. ( 78,80,81,85,90,91,94 ) Model decision‐making was highlighted using heat maps such as Grad‐CAM.…”

Section: Resultsmentioning

confidence: 99%

“…( 75,76,90–97 ) Nineteen studies developed CNN models for image analysis. ( 66,67,71,72,77–86,90,91,93–95 ) Others used features extracted from images or collected from non‐imaging data. ( 68–70,73–77,87–89,92,96,97 ) Studies reported average best AUC of 0.92 (range 0.63 to 1.00) and average best accuracy of 89.8% (range 78.4% to 99.1%].…”

Section: Resultsmentioning

confidence: 99%

“…( 66,67,78,79,84,90,94 ) However, several studies did not use techniques that allowed for adequate understanding of the models' decision‐making (eg, data visualization). ( 68,70–76,80,82,83,85–89,92,93,95,97 ) In some studies, class unbalancing was handled using sampling methods, ( 74,97 ) and overfitting was controlled with data augmentation. ( 80,83,84,95 ) Mutasa and colleagues demonstrated how data augmentation using digitally reconstructed and generated images was able to improve the test AUC from 0.80 (95% CI, not reported) to 0.92 (95% CI, not reported).…”

Section: Resultsmentioning

confidence: 99%

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Machine Learning Solutions for Osteoporosis—A Review

Smets

Shevroja

Hügle

et al. 2020

Journal of Bone and Mineral Research

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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).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Machine Learning Solutions for Osteoporosis—A Review

Smets

Shevroja

Hügle

et al. 2020

Journal of Bone and Mineral Research

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Artificial Intelligence for Hip Fracture Detection and Outcome Prediction

et al. 2023

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ImportanceArtificial intelligence (AI) enables powerful models for establishment of clinical diagnostic and prognostic tools for hip fractures; however the performance and potential impact of these newly developed algorithms are currently unknown.ObjectiveTo evaluate the performance of AI algorithms designed to diagnose hip fractures on radiographs and predict postoperative clinical outcomes following hip fracture surgery relative to current practices.Data SourcesA systematic review of the literature was performed using the MEDLINE, Embase, and Cochrane Library databases for all articles published from database inception to January 23, 2023. A manual reference search of included articles was also undertaken to identify any additional relevant articles.Study SelectionStudies developing machine learning (ML) models for the diagnosis of hip fractures from hip or pelvic radiographs or to predict any postoperative patient outcome following hip fracture surgery were included.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses and was registered with PROSPERO. Eligible full-text articles were evaluated and relevant data extracted independently using a template data extraction form. For studies that predicted postoperative outcomes, the performance of traditional predictive statistical models, either multivariable logistic or linear regression, was recorded and compared with the performance of the best ML model on the same out-of-sample data set.Main Outcomes and MeasuresDiagnostic accuracy of AI models was compared with the diagnostic accuracy of expert clinicians using odds ratios (ORs) with 95% CIs. Areas under the curve for postoperative outcome prediction between traditional statistical models (multivariable linear or logistic regression) and ML models were compared.ResultsOf 39 studies that met all criteria and were included in this analysis, 18 (46.2%) used AI models to diagnose hip fractures on plain radiographs and 21 (53.8%) used AI models to predict patient outcomes following hip fracture surgery. A total of 39 598 plain radiographs and 714 939 hip fractures were used for training, validating, and testing ML models specific to diagnosis and postoperative outcome prediction, respectively. Mortality and length of hospital stay were the most predicted outcomes. On pooled data analysis, compared with clinicians, the OR for diagnostic error of ML models was 0.79 (95% CI, 0.48-1.31; P = .36; I2 = 60%) for hip fracture radiographs. For the ML models, the mean (SD) sensitivity was 89.3% (8.5%), specificity was 87.5% (9.9%), and F1 score was 0.90 (0.06). The mean area under the curve for mortality prediction was 0.84 with ML models compared with 0.79 for alternative controls (P = .09).Conclusions and RelevanceThe findings of this systematic review and meta-analysis suggest that the potential applications of AI to aid with diagnosis from hip radiographs are promising. The performance of AI in diagnosing hip fractures was comparable with that of expert radiologists and surgeons. However, current implementations of AI for outcome prediction do not seem to provide substantial benefit over traditional multivariable predictive statistics.

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