Deep Learning-based End-to-end Diagnosis System for Avascular Necrosis of Femoral Head

As the first diagnostic imaging modality of avascular necrosis of the femoral head (AVNFH), accurately staging AVNFH from a plain radiograph is critical yet challenging for orthopedists. Thus, we propose a deep learning-based AVNFH diagnosis system (AVN-net). The proposed AVN-net reads plain radiographs of the pelvis, conducts diagnosis, and visualizes results automatically. Deep convolutional neural networks are trained to provide an end-to-end diagnosis solution, covering tasks of femoral head detection, exam-view identification, side classification, AVNFH diagnosis, and key clinical notes generation. AVN-net is able to obtain state-of-the-art testing AUC of 0.97 (95% CI: 0.97-0.98) in AVNFH detection and significantly greater F1 scores than less-to-moderately experienced orthopedists in all diagnostic tests (p<0.01). Furthermore, two real-world pilot studies were conducted for diagnosis support and education assistance, respectively, to assess the utility of AVN-net. The experimental results are promising. With the AVN-net diagnosis as a reference, the diagnostic accuracy and consistency of all orthopedists considerably improved while requiring only 1/4 of the time. Students self-studying the AVNFH diagnosis using AVN-net can learn better and faster than the control group. To the best of our knowledge, this study is the first research on the prospective use of a deep learning-based diagnosis system for AVNFH by conducting two pilot studies representing real-world application scenarios. We have demonstrated that the proposed AVN-net achieves expert-level AVNFH diagnosis performance, provides efficient support in clinical decision-making, and effectively passes clinical experience to students.