Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.
Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea.
J Orthop Surg Res. 2022 Dec 1;17(1):520. doi: 10.1186/s13018-022-03408-7.
BACKGROUND: In the emergency room, clinicians spend a lot of time and are exposed to mental stress. In addition, fracture classification is important for determining the surgical method and restoring the patient's mobility. Recently, with the help of computers using artificial intelligence (AI) or machine learning (ML), diagnosis and classification of hip fractures can be performed easily and quickly. The purpose of this systematic review is to search for studies that diagnose and classify for hip fracture using AI or ML, organize the results of each study, analyze the usefulness of this technology and its future use value. METHODS: PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched to identify relevant studies published up to June 2022 with English language restriction. The following search terms were used [All Fields] AND (", "[MeSH Terms] OR (""[All Fields] AND "bone"[All Fields]) OR "bone fractures"[All Fields] OR "fracture"[All Fields]). The following information was extracted from the included articles: authors, publication year, study period, type of image, type of fracture, number of patient or used images, fracture classification, reference diagnosis of fracture diagnosis and classification, and augments of each studies. In addition, AI name, CNN architecture type, ROI or important region labeling, data input proportion in training/validation/test, and diagnosis accuracy/AUC, classification accuracy/AUC of each studies were also extracted. RESULTS: In 14 finally included studies, the accuracy of diagnosis for hip fracture by AI was 79.3-98%, and the accuracy of fracture diagnosis in AI aided humans was 90.5-97.1. The accuracy of human fracture diagnosis was 77.5-93.5. AUC of fracture diagnosis by AI was 0.905-0.99. The accuracy of fracture classification by AI was 86-98.5 and AUC was 0.873-1.0. The forest plot represented that the mean AI diagnosis accuracy was 0.92, the mean AI diagnosis AUC was 0.969, the mean AI classification accuracy was 0.914, and the mean AI classification AUC was 0.933. Among the included studies, the architecture based on the GoogLeNet architectural model or the DenseNet architectural model was the most common with three each. Among the data input proportions, the study with the lowest training rate was 57%, and the study with the highest training rate was 95%. In 14 studies, 5 studies used Grad-CAM for highlight important regions. CONCLUSION: We expected that our study may be helpful in making judgments about the use of AI in the diagnosis and classification of hip fractures. It is clear that AI is a tool that can help medical staff reduce the time and effort required for hip fracture diagnosis with high accuracy. Further studies are needed to determine what effect this causes in actual clinical situations.
背景:在急诊室,临床医生花费大量时间并承受精神压力。此外,骨折分类对于确定手术方法和恢复患者的活动能力非常重要。最近,借助使用人工智能(AI)或机器学习(ML)的计算机,可以轻松快速地进行髋关节骨折的诊断和分类。本系统评价的目的是搜索使用 AI 或 ML 诊断和分类髋部骨折的研究,整理每项研究的结果,分析该技术的有用性及其未来的使用价值。
方法:限制使用英语语言,在 PubMed Central、OVID Medline、Cochrane 协作图书馆、Web of Science、EMBASE 和 AHRQ 数据库中搜索截至 2022 年 6 月发表的相关研究。使用了以下搜索词[全部字段]和("[MeSH 术语]或("[全部字段]和“bone”[全部字段])或“bone fractures”[全部字段]或“fracture”[全部字段])。从纳入的文章中提取以下信息:作者、出版年份、研究期间、图像类型、骨折类型、患者或使用图像的数量、骨折分类、骨折诊断和分类的参考诊断,以及每项研究的增强信息。此外,还提取了 AI 名称、CNN 架构类型、ROI 或重要区域标记、训练/验证/测试中的数据输入比例以及每项研究的诊断准确性/AUC、分类准确性/AUC。
结果:在最终纳入的 14 项研究中,AI 对髋部骨折的诊断准确率为 79.3-98%,AI 辅助人类的骨折诊断准确率为 90.5-97.1。人类骨折诊断的准确率为 77.5-93.5。AI 骨折诊断的 AUC 为 0.905-0.99。AI 骨折分类的准确率为 86-98.5,AUC 为 0.873-1.0。森林图表示 AI 诊断的平均准确率为 0.92,AI 诊断的平均 AUC 为 0.969,AI 分类的平均准确率为 0.914,AI 分类的平均 AUC 为 0.933。在纳入的研究中,基于 GoogLeNet 架构模型或 DenseNet 架构模型的架构最常见,各有 3 个。在数据输入比例方面,训练率最低的研究为 57%,训练率最高的研究为 95%。在 14 项研究中,有 5 项研究使用 Grad-CAM 突出重要区域。
结论:我们希望我们的研究有助于对 AI 在髋部骨折诊断和分类中的使用做出判断。很明显,AI 是一种可以帮助医务人员以高精度诊断髋部骨折的工具。需要进一步的研究来确定这在实际临床情况下会产生什么影响。
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