Can Deep Learning Using Weight Bearing Knee Anterio-Posterior Radiograph Alone Replace a Whole-Leg Radiograph in the Interpretation of Weight Bearing Line Ratio?

Weight bearing whole-leg radiograph (WLR) is essential to assess lower limb alignment such as weight bearing line (WBL) ratio. The purpose of this study was to develop a deep learning (DL) model that predicts the WBL ratio using knee standing AP alone. Total of 3997 knee AP & WLRs were used. WBL ratio was used for labeling and analysis of prediction accuracy. The WBL ratio was divided into seven categories (0, 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6). After training, performance of the DL model was evaluated. Final performance was evaluated using 386 subjects as a test set. Cumulative score (CS) within error range 0.1 was set with showing maximum CS in the validation set (95% CI, 0.924-0.970). In the test set, mean absolute error was 0.054 (95% CI, 0.048-0.061) and CS was 0.951 (95% CI, 0.924-0.970). Developed DL algorithm could predict the WBL ratio on knee standing AP alone with comparable accuracy as the degree primary physician can assess the alignment. It can be the basis for developing an automated lower limb alignment assessment tool that can be used easily and cost-effectively in primary clinics.