Improving radiograph analysis throughput through transfer learning and object detection

Abstract

SIGN Fracture Care International partners with surgeons in low-resource hospitals worldwide to provide access to effective orthopedic care by donating educational materials and innovatively designed surgical implants. Over two decades, SIGN’s Online Surgical Database (SOSD) has grown to contain over 500,000 medical images, with radiographs holding the majority share. One challenge in working with hospitals worldwide is that both the radiographs uploaded to the SOSD and the data entry accompanying the uploads vary in quality. To improve the accuracy of data in the SOSD, we trained a model to detect surgical implants in radiographs. We first developed a tool to automatically detect radiographs, then trained an object detection model to determine the number and placement of surgical implants visible in the radiograph. Active learning was used to generate a training set containing 2,510 radiographs with screws, nails, and plates labeled by bounding boxes. Training a model to simultaneously recognize all three classes of implants gave a low average precision (AP) for the plate class, likely due to the low number of plate instances in our training set and the large variety of surgical plates used by SIGN-partnered surgeons. Applying standard image augmentation techniques to increase the plate count in our training set did not appreciably increase the AP of plate detection. To improve plate detection, we redrew the bounding boxes to account for correlations between the screw and plate classes. Training one model to detect nails and screws and a separate model to detect plates increased the AP of plate detection by 78.8 percentage points. The AP of each class was 80.7% for screws, 93.6% for nails, and 92.6% for plates; meanwhile, the sensitivity was 92% for screws, 86% for nails, and 81% for plates. We show that object detection methods can be used to detect surgical implants in radiographs of varying quality; however, the detection ability is dependent on the type of implant, and some implants, in our case plates, must be treated differently than others. Such tools can improve the throughput of radiograph analysis, assisting physicians and surgeons with the treatment of bone fractures.