Shin, Nan-Young
(Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University)
,
Lee, Byoung-Dai
(Center for Artificial Intelligence in Medicine and Imaging)
,
Kang, Ju-Hee
(Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University)
,
Kim, Hye-Rin
(Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University)
,
Oh, Dong Hyo
(Center for Artificial Intelligence in Medicine and Imaging)
,
Lee, Byung Il
(Center for Artificial Intelligence in Medicine and Imaging)
,
Kim, Sung Hyun
(Center for Artificial Intelligence in Medicine and Imaging)
,
Lee, Mu Sook
(Department of Radiology, Keimyung University, Dongsan Hospital)
,
Heo, Min-Suk
(Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University)
Purpose: The aim of this study was to evaluate the clinical efficacy of a Tanner-Whitehouse 3 (TW3)-based fully automated bone age assessment system on hand-wrist radiographs of Korean children and adolescents. Materials and Methods: Hand-wrist radiographs of 80 subjects (40 boys and 40 girls, 7-15 ...
Purpose: The aim of this study was to evaluate the clinical efficacy of a Tanner-Whitehouse 3 (TW3)-based fully automated bone age assessment system on hand-wrist radiographs of Korean children and adolescents. Materials and Methods: Hand-wrist radiographs of 80 subjects (40 boys and 40 girls, 7-15 years of age) were collected. The clinical efficacy was evaluated by comparing the bone ages that were determined using the system with those from the reference standard produced by 2 oral and maxillofacial radiologists. Comparisons were conducted using the paired t-test and simple regression analysis. Results: The bone ages estimated with this bone age assessment system were not significantly different from those obtained with the reference standard (P>0.05) and satisfied the equivalence criterion of 0.6 years within the 95% confidence interval (-0.07 to 0.22), demonstrating excellent performance of the system. Similarly, in the comparisons of gender subgroups, no significant difference in bone age between the values produced by the system and the reference standard was observed (P>0.05 for both boys and girls). The determination coefficients obtained via regression analysis were 0.962, 0.945, and 0.952 for boys, girls, and overall, respectively (P=0.000); hence, the radiologist-determined bone ages and the system-determined bone ages were strongly correlated. Conclusion: This TW3-based system can be effectively used for bone age assessment based on hand-wrist radiographs of Korean children and adolescents.
Purpose: The aim of this study was to evaluate the clinical efficacy of a Tanner-Whitehouse 3 (TW3)-based fully automated bone age assessment system on hand-wrist radiographs of Korean children and adolescents. Materials and Methods: Hand-wrist radiographs of 80 subjects (40 boys and 40 girls, 7-15 years of age) were collected. The clinical efficacy was evaluated by comparing the bone ages that were determined using the system with those from the reference standard produced by 2 oral and maxillofacial radiologists. Comparisons were conducted using the paired t-test and simple regression analysis. Results: The bone ages estimated with this bone age assessment system were not significantly different from those obtained with the reference standard (P>0.05) and satisfied the equivalence criterion of 0.6 years within the 95% confidence interval (-0.07 to 0.22), demonstrating excellent performance of the system. Similarly, in the comparisons of gender subgroups, no significant difference in bone age between the values produced by the system and the reference standard was observed (P>0.05 for both boys and girls). The determination coefficients obtained via regression analysis were 0.962, 0.945, and 0.952 for boys, girls, and overall, respectively (P=0.000); hence, the radiologist-determined bone ages and the system-determined bone ages were strongly correlated. Conclusion: This TW3-based system can be effectively used for bone age assessment based on hand-wrist radiographs of Korean children and adolescents.
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문제 정의
1 years. It was aimed to utilize the BAA system to provide more efficient evaluation of skeletal maturity in clinical practice.
제안 방법
The software was trained to use the TW3 method to automatically analyze hand-wrist radiographs entered in the form of image files and to present bone ages in 0.1 years. It was aimed to utilize the BAA system to provide more efficient evaluation of skeletal maturity in clinical practice.
Accordingly, this study was performed to evaluate the clinical efficacy of this TW3-based BAA system by comparing bone ages measured with the system with those measured by 2 oral and maxillofacial radiologists.
This study complied with the management standards of medical device clinical trials and the fundamental principles of the Declaration of Helsinki in conducting the test and evaluating and recording its results. The institutional review board of Seoul National University Dental Hospital approved this retrospective study and waived the requirement to obtain informed consent.
The images were obtained and visualized without patient information using Infinitt® PACS software (Infinitt Healthcare Co. Ltd., Seoul, South Korea) with tools such as window width/level adjustment and zoom.
, Seoul, South Korea) with tools such as window width/level adjustment and zoom. All radiographs were evaluated on a diagnostic display screen (Nio Color 2MP LED 21.3-inch monitor with 1200-1600 resolution; BARCO, Kortrijk, Belgium) in a quiet room under dim lighting conditions.
Two observers, oral and maxillofacial radiologists with 4 and 7 years of experience, assessed the bone ages from the 80 selected hand-wrist radiographs using the TW3 method. The estimation was performed twice by each observer, with estimates separated by a 3-week interval.
In contrast, the TW3 method outperforms the GP method in accuracy and reproducibility, since it is more complex and elaborative to evaluate the skeletal maturity levels of specific bones from the hand and wrist area, compute the score based on maturity levels, and convert the score to a bone age using a correlation matrix between maturity scores and bone ages. The BAA system in this study is the first TW3-based fully automated system using deep CNNs for ROI extraction and skeletal maturity evaluation.
05). In addition, correlations between the bone ages from the reference standard and those estimated with the BAA system were evaluated using simple regression analysis. For statistical calculations, IBM SPSS Statistics version 23 (SPSS Corp.
대상 데이터
A total of 80 radiographs (40 from boys and 40 from girls) were collected for this study. The sample size required to satisfy conditions set for the consistency test was calculated using PASS 2019 software (NCSS, LLC, Kaysville, UT, USA).
The TW3-based fully automated BAA system was developed based on 2 CNNs: Faster-R-CNN, which is the region-based CNN for the extraction of actual ROIs from bounding ROIs, and VGGNet-BA CNN, used for classification of the skeletal maturity level of an ROI. Hand-wrist radiographs of 3,027 Korean male and female children and adolescents under 18 years old, labeled by 2 radiologists based on the TW3 method, were used to train the system. The details of the system have been previously described.
This study had some limitations. First, this study was retrospective, involving 80 radiographs from a single institution. Since the conditions (such as hand positioning) under which the radiographs were taken were not strictly controlled, it was sometimes difficult to observe the developmental status of specific regions, such as the middle phalanges of the fingers, due to overlapping or superimposition.
데이터처리
The secondary efficacy evaluation was performed by comparison between the bone ages from the reference standard and those estimated with the BAA system in the gender subgroups, also using the paired t-test (P<0.05).
Using the paired t-test, the primary efficacy of the developed BAA system was evaluated via a comparison between the bone ages from the reference standard and those estimated with the BAA system (P<0.05).
Cohen kappa coefficients were calculated to evaluate the reliability of the reference standard. These coefficients were interpreted according to the definitions shown in Table 2.
Table 4 shows the difference between the bone ages from the reference standard and those obtained with the BAA system. This difference was assessed using the paired t-test. No statistically significant difference was found between the bone ages from the reference standard and those obtained with the BAA system for the gender subgroups or for the overall group.
성능/효과
The chronological age of the subjects ranged from 7 to 15 years old; this age was calculated by subtracting the birth date of the subject from the date on which the radiograph was taken. Considering that the maximum bone age interpretable with the TW3 method is 15 years (for girls) and 16.5 years (for boys) and that the prediction could be unreliable in cases of complete fusion of the radius and ulna, the upper limit of the sample chronological age was set at 15 years.
17 years in girls. Given that existing TW3-based BAA systems that were not fully automated have produced estimation errors of 0.8-0.9 years6, and that 0.42 years is the lowest value that has been reported among GP-based fully automated BAA systems,17 the system in this study can be concluded to be reliable and have excellent accuracy for BAA. The regression analysis also showed excellent determination coefficients and linear regression equations with significant probability, demonstrating a statistically significant and very high correlation between bone ages obtained with the system and those from the reference standard.
42 years is the lowest value that has been reported among GP-based fully automated BAA systems,17 the system in this study can be concluded to be reliable and have excellent accuracy for BAA. The regression analysis also showed excellent determination coefficients and linear regression equations with significant probability, demonstrating a statistically significant and very high correlation between bone ages obtained with the system and those from the reference standard.
In conclusion, this study demonstrated that this BAA system can be effectively used for TW3-based BAA from hand-wrist radiographs of Korean children and adolescents aged 7-15 years.
후속연구
Additionally, since the test subjects consisted of individuals of a single race only, future research should be conducted in multiple institutions and include a multi-racial sample of subjects. Second, since X-ray images in infants aged 0-6 years are not commonly obtained in non-emergency situations due to concerns about radiation exposure, further studies will be needed to expand the range of automated bone age prediction.
참고문헌 (17)
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