Evaluation of an artificial intelligence system for diagnosing scaphoid fracture on direct radiography
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ORIGINAL ARTICLE
Evaluation of an artificial intelligence system for diagnosing scaphoid fracture on direct radiography Emre Ozkaya1 · Fatih Esad Topal1 · Tugrul Bulut2 · Merve Gursoy3 · Mustafa Ozuysal4 · Zeynep Karakaya1 Received: 30 June 2020 / Accepted: 21 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of this study is to determine the diagnostic performance of artificial intelligence with the use of convolutional neural networks (CNN) for detecting scaphoid fractures on anteroposterior wrist radiographs. The performance of the deep learning algorithm was also compared with that of the emergency department (ED) physician and two orthopaedic specialists (less experienced and experienced in the hand surgery). Methods A total 390 patients with AP wrist radiographs were included in the study. The presence/absence of the fracture on radiographs was confirmed via CT. The diagnostic performance of the CNN, ED physician and two orthopaedic specialists (less experienced and experienced) as measured by AUC, sensitivity, specificity, F-Score and Youden index, to detect scaphoid fractures was evaluated and compared between the groups. Results The CNN had 76% sensitivity and 92% specificity, 0.840 AUC, 0.680 Youden index and 0.826 F score values in identifying scaphoid fractures. The experienced orthopaedic specialist had the best diagnostic performance according to AUC. While CNN’s performance was similar to a less experienced orthopaedic specialist, it was better than the ED physician. Conclusion The deep learning algorithm has the potential to be used for diagnosing scaphoid fractures on radiographs. Artificial intelligence can be useful for scaphoid fracture diagnosis particularly in the absence of an experienced orthopedist or hand surgeon. Keywords Scaphoid · Fracture · Deep learning · Artificial intelligence · Radiography
Introduction Approximately 29% of all injuries treated in emergency departments are hand and wrist injuries. Fractures account for 42% of these injuries [1]. Scaphoid fractures are the most common carpal bone fractures [2]. Although scaphoid fractures are not life-threatening, early diagnosis is very * Tugrul Bulut [email protected] 1
Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
2
Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basin Sitesi Karabağlar, Izmir, Turkey
3
Department of Radiology, Faculty of Medicine, Izmir Democracy University, Izmir, Turkey
4
Department of Computer Engineering, Izmir Institute of Technology, Izmir, Turkey
important to start appropriate treatment as early as possible. The initial assessment of these fractures is usually done in emergency departments (EDs). The first-line imaging method for diagnosis is plain radiographs, which is a simple, inexpensive, and easily accessible imaging method. It is quite possible to miss the scaphoid fracture on these
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