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  4. Automated Segmentation and Diagnostic Measurement for the Evaluation of Cervical Spine Injuries Using X‑Rays

Automated Segmentation and Diagnostic Measurement for the Evaluation of Cervical Spine Injuries Using X‑Rays

Journal of Imaging Informatics in Medicine, 2024 · DOI: https://doi.org/10.1007/s10278-024-01006-z · Published: February 20, 2024

Spinal Cord InjuryMedical ImagingBioinformatics

Simple Explanation

The study focuses on using machine learning to automatically analyze cervical spine X-ray images. This is done by identifying and outlining (segmenting) different parts of the spine and skull on the X-rays. The automated system then measures key distances and angles on the segmented images, which are important for diagnosing injuries. These measurements are compared to manual measurements to see how accurate the automated system is. The goal is to create a tool that can help doctors quickly and accurately assess cervical spine injuries using widely available X-ray technology.

Study Duration
2009 to 2022
Participants
852 cervical X-rays
Evidence Level
Not specified

Key Findings

  • 1
    The study achieved high average dice coefficient values for cervical spine segmentation (C1-C7), indicating accurate automated identification of these regions on X-rays.
  • 2
    Comparison of automatically measured metrics and manually measured metrics showed high Pearson’s correlation coefficients in McGregor’s line, space available cord, cervical sagittal vertical axis, and cervical lordosis.
  • 3
    No metric showed adjusted significant differences at P < 0.05 between manual and automatic metric measuring methods.

Research Summary

This study implemented multiclass segmentation of the cervical regions (hard palate, basion, opisthion, C1–C7) using U-Net architectures with EfficientNet-B4, DenseNet201, and InceptionResNetV2 backbones trained on X-ray images of normal and pre/postoperative patients. The study developed algorithms to automatically measure diagnostic metrics McGregor line (MG), basion-dens interval (BDI), basion-atlas interval (BAI), Powers ratio, space-available-cord (SAC), cervical sagittal vertical axis (cSVA), and cervical lordosis (CL) using the multiclass segmentations. The automatically generated measurements were compared with manual measurements obtained from manually segmented regions to verify its performance, demonstrating the reliability and efficiency of the automated approach.

Practical Implications

Clinical Decision Support

Automated measurements can assist clinicians in making faster and more consistent diagnoses of cervical spine injuries.

Surgical Planning

Accurate automated segmentation and measurement can aid in pre-surgical planning and post-operative evaluation.

Improved Efficiency

Automating the measurement process reduces the time and resources required for cervical spine injury assessment.

Study Limitations

  • 1
    Lower segmentation performance for craniofacial bones due to indistinct boundaries.
  • 2
    Potential bias due to the imbalanced dataset with more normal subjects than those with cervical injuries.
  • 3
    Generalizability to different X-ray imaging machines and populations needs further validation.

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