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      Multiclass datasets expand neural network utility: an example on ankle radiographs

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          Abstract

          Purpose

          Artificial intelligence in computer vision has been increasingly adapted in clinical application since the implementation of neural networks, potentially providing incremental information beyond the mere detection of pathology. As its algorithmic approach propagates input variation, neural networks could be used to identify and evaluate relevant image features. In this study, we introduce a basic dataset structure and demonstrate a pertaining use case.

          Methods

          A multidimensional classification of ankle x-rays ( n = 1493) rating a variety of features including fracture certainty was used to confirm its usability for separating input variations. We trained a customized neural network on the task of fracture detection using a state-of-the-art preprocessing and training protocol. By grouping the radiographs into subsets according to their image features, the influence of selected features on model performance was evaluated via selective training.

          Results

          The models trained on our dataset outperformed most comparable models of current literature with an ROC AUC of 0.943. Excluding ankle x-rays with signs of surgery improved fracture classification performance (AUC 0.955), while limiting the training set to only healthy ankles with and without fracture had no consistent effect.

          Conclusion

          Using multiclass datasets and comparing model performance, we were able to demonstrate signs of surgery as a confounding factor, which, following elimination, improved our model. Also eliminating pathologies other than fracture in contrast had no effect on model performance, suggesting a beneficial influence of feature variability for robust model training. Thus, multiclass datasets allow for evaluation of distinct image features, deepening our understanding of pathology imaging.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s11548-023-02839-9.

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          Most cited references14

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          ImageNet Large Scale Visual Recognition Challenge

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            Deep neural network improves fracture detection by clinicians

            Significance Historically, computer-assisted detection (CAD) in radiology has failed to achieve improvements in diagnostic accuracy, decreasing clinician sensitivity and leading to unnecessary further diagnostic tests. With the advent of deep learning approaches to CAD, there is great excitement about its application to medicine, yet there is little evidence demonstrating improved diagnostic accuracy in clinically-relevant applications. We trained a deep learning model to detect fractures on radiographs with a diagnostic accuracy similar to that of senior subspecialized orthopedic surgeons. We demonstrate that when emergency medicine clinicians are provided with the assistance of the trained model, their ability to accurately detect fractures significantly improves.
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              Automated detection and classification of the proximal humerus fracture by using deep learning algorithm

              Background and purpose — We aimed to evaluate the ability of artificial intelligence (a deep learning algorithm) to detect and classify proximal humerus fractures using plain anteroposterior shoulder radiographs. Patients and methods — 1,891 images (1 image per person) of normal shoulders (n = 515) and 4 proximal humerus fracture types (greater tuberosity, 346; surgical neck, 514; 3-part, 269; 4-part, 247) classified by 3 specialists were evaluated. We trained a deep convolutional neural network (CNN) after augmentation of a training dataset. The ability of the CNN, as measured by top-1 accuracy, area under receiver operating characteristics curve (AUC), sensitivity/specificity, and Youden index, in comparison with humans (28 general physicians, 11 general orthopedists, and 19 orthopedists specialized in the shoulder) to detect and classify proximal humerus fractures was evaluated. Results — The CNN showed a high performance of 96% top-1 accuracy, 1.00 AUC, 0.99/0.97 sensitivity/specificity, and 0.97 Youden index for distinguishing normal shoulders from proximal humerus fractures. In addition, the CNN showed promising results with 65–86% top-1 accuracy, 0.90–0.98 AUC, 0.88/0.83–0.97/0.94 sensitivity/specificity, and 0.71–0.90 Youden index for classifying fracture type. When compared with the human groups, the CNN showed superior performance to that of general physicians and orthopedists, similar performance to orthopedists specialized in the shoulder, and the superior performance of the CNN was more marked in complex 3- and 4-part fractures. Interpretation — The use of artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs. Further studies are necessary to determine the feasibility of applying artificial intelligence in the clinic and whether its use could improve care and outcomes compared with current orthopedic assessments.
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                Author and article information

                Contributors
                suam.kim@uniklinik-freiburg.de
                Journal
                Int J Comput Assist Radiol Surg
                Int J Comput Assist Radiol Surg
                International Journal of Computer Assisted Radiology and Surgery
                Springer International Publishing (Cham )
                1861-6410
                1861-6429
                2 February 2023
                2 February 2023
                2023
                : 18
                : 5
                : 819-826
                Affiliations
                [1 ]GRID grid.7708.8, ISNI 0000 0000 9428 7911, Department of Diagnostic and Interventional Radiology, Faculty of Medicine, , Medical Center–University of Freiburg, ; Hugstetter Str. 55, 79106 Freiburg, Germany
                [2 ]GRID grid.5963.9, Department of Medical Physics, Faculty of Medicine, , Medical Center–University of Freiburg, University of Freiburg, ; Freiburg, Germany
                [3 ]GRID grid.7708.8, ISNI 0000 0000 9428 7911, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, , Medical Center–University of Freiburg, ; Freiburg, Germany
                [4 ]Department of Trauma and Orthopaedic Surgery, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
                Author information
                http://orcid.org/0000-0001-8940-4076
                Article
                2839
                10.1007/s11548-023-02839-9
                10113347
                36729290
                31d9222e-2370-45a4-9a4d-071ddd7f0f79
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 April 2022
                : 18 January 2023
                Funding
                Funded by: Universitätsklinikum Freiburg (8975)
                Categories
                Original Article
                Custom metadata
                © CARS 2023

                neural network,deep learning,radiographs,musculoskeletal

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