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Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs

The assessment of the knee alignment using standing weight-bearing full-leg radiographs (FLR) is a standardized method. Determining the load-bearing axis of the leg requires time-consuming manual measurements. The aim of this study is to develop and validate a novel algorithm based on artificial int...

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Autores principales: Erne, Felix, Grover, Priyanka, Dreischarf, Marcel, Reumann, Marie K., Saul, Dominik, Histing, Tina, Nüssler, Andreas K., Springer, Fabian, Scholl, Carolin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689840/
https://www.ncbi.nlm.nih.gov/pubmed/36359520
http://dx.doi.org/10.3390/diagnostics12112679
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author Erne, Felix
Grover, Priyanka
Dreischarf, Marcel
Reumann, Marie K.
Saul, Dominik
Histing, Tina
Nüssler, Andreas K.
Springer, Fabian
Scholl, Carolin
author_facet Erne, Felix
Grover, Priyanka
Dreischarf, Marcel
Reumann, Marie K.
Saul, Dominik
Histing, Tina
Nüssler, Andreas K.
Springer, Fabian
Scholl, Carolin
author_sort Erne, Felix
collection PubMed
description The assessment of the knee alignment using standing weight-bearing full-leg radiographs (FLR) is a standardized method. Determining the load-bearing axis of the leg requires time-consuming manual measurements. The aim of this study is to develop and validate a novel algorithm based on artificial intelligence (AI) for the automated assessment of lower limb alignment. In the first stage, a customized mask-RCNN model was trained to automatically detect and segment anatomical structures and implants in FLR. In the second stage, four region-specific neural network models (adaptations of UNet) were trained to automatically place anatomical landmarks. In the final stage, this information was used to automatically determine five key lower limb alignment angles. For the validation dataset, weight-bearing, antero-posterior FLR were captured preoperatively and 3 months postoperatively. Preoperative images were measured by the operating orthopedic surgeon and an independent physician. Postoperative images were measured by the second rater only. The final validation dataset consisted of 95 preoperative and 105 postoperative FLR. The detection rate for the different angles ranged between 92.4% and 98.9%. Human vs. human inter-(ICCs: 0.85–0.99) and intra-rater (ICCs: 0.95–1.0) reliability analysis achieved significant agreement. The ICC-values of human vs. AI inter-rater reliability analysis ranged between 0.8 and 1.0 preoperatively and between 0.83 and 0.99 postoperatively (all p < 0.001). An independent and external validation of the proposed algorithm on pre- and postoperative FLR, with excellent reliability for human measurements, could be demonstrated. Hence, the algorithm might allow for the objective and time saving analysis of large datasets and support physicians in daily routine.
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spelling pubmed-96898402022-11-25 Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs Erne, Felix Grover, Priyanka Dreischarf, Marcel Reumann, Marie K. Saul, Dominik Histing, Tina Nüssler, Andreas K. Springer, Fabian Scholl, Carolin Diagnostics (Basel) Article The assessment of the knee alignment using standing weight-bearing full-leg radiographs (FLR) is a standardized method. Determining the load-bearing axis of the leg requires time-consuming manual measurements. The aim of this study is to develop and validate a novel algorithm based on artificial intelligence (AI) for the automated assessment of lower limb alignment. In the first stage, a customized mask-RCNN model was trained to automatically detect and segment anatomical structures and implants in FLR. In the second stage, four region-specific neural network models (adaptations of UNet) were trained to automatically place anatomical landmarks. In the final stage, this information was used to automatically determine five key lower limb alignment angles. For the validation dataset, weight-bearing, antero-posterior FLR were captured preoperatively and 3 months postoperatively. Preoperative images were measured by the operating orthopedic surgeon and an independent physician. Postoperative images were measured by the second rater only. The final validation dataset consisted of 95 preoperative and 105 postoperative FLR. The detection rate for the different angles ranged between 92.4% and 98.9%. Human vs. human inter-(ICCs: 0.85–0.99) and intra-rater (ICCs: 0.95–1.0) reliability analysis achieved significant agreement. The ICC-values of human vs. AI inter-rater reliability analysis ranged between 0.8 and 1.0 preoperatively and between 0.83 and 0.99 postoperatively (all p < 0.001). An independent and external validation of the proposed algorithm on pre- and postoperative FLR, with excellent reliability for human measurements, could be demonstrated. Hence, the algorithm might allow for the objective and time saving analysis of large datasets and support physicians in daily routine. MDPI 2022-11-03 /pmc/articles/PMC9689840/ /pubmed/36359520 http://dx.doi.org/10.3390/diagnostics12112679 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Erne, Felix
Grover, Priyanka
Dreischarf, Marcel
Reumann, Marie K.
Saul, Dominik
Histing, Tina
Nüssler, Andreas K.
Springer, Fabian
Scholl, Carolin
Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs
title Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs
title_full Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs
title_fullStr Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs
title_full_unstemmed Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs
title_short Automated Artificial Intelligence-Based Assessment of Lower Limb Alignment Validated on Weight-Bearing Pre- and Postoperative Full-Leg Radiographs
title_sort automated artificial intelligence-based assessment of lower limb alignment validated on weight-bearing pre- and postoperative full-leg radiographs
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689840/
https://www.ncbi.nlm.nih.gov/pubmed/36359520
http://dx.doi.org/10.3390/diagnostics12112679
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