# Automatic hip osteoarthritis grading with uncertainty estimation from computed tomography using digitally-reconstructed radiographs

arXiv: https://arxiv.org/abs/2401.00159 · HTML: https://mlsanity.com/paper/2401.00159/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 15 of its 33 references that are in the map.
- First posted on arXiv 30 Dec 2023.

## Builds on (most cited first, 15 of 15)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Dropout as a Bayesian Approximation: Representing Model Uncertainty in Deep Learning](https://mlsanity.com/paper/1506.02142/) (2015)
- [UMAP: Uniform Manifold Approximation and Projection for Dimension Reduction](https://mlsanity.com/paper/1802.03426/) (2018)
- [3D U-Net: Learning Dense Volumetric Segmentation from Sparse Annotation](https://mlsanity.com/paper/1606.06650/) (2016)
- [Albumentations: fast and flexible image augmentations](https://mlsanity.com/paper/1809.06839/) (2018)
- [Concurrent Spatial and Channel Squeeze & Excitation in Fully Convolutional Networks](https://mlsanity.com/paper/1803.02579/) (2018)
- [Transformers in Medical Image Analysis: A Review](https://mlsanity.com/paper/2202.12165/) (2022)
- [Automated Muscle Segmentation from Clinical CT using Bayesian U-Net for Personalized Musculoskeletal Modeling](https://mlsanity.com/paper/1907.08915/) (2019)
- [Temporal Context Matters: Enhancing Single Image Prediction with Disease Progression Representations](https://mlsanity.com/paper/2203.01933/) (2022)
- [Reconciling Feature-Reuse and Overfitting in DenseNet with Specialized Dropout](https://mlsanity.com/paper/1810.00091/) (2018)

## Built on by (most cited first, 2 of 2)

- [3DDX: Bone Surface Reconstruction from a Single Standard-Geometry Radiograph via Dual-Face Depth Estimation](https://mlsanity.com/paper/2409.16702/) (2024)
- [Validation of musculoskeletal segmentation model with uncertainty estimation for bone and muscle assessment in hip-to-knee clinical CT images](https://mlsanity.com/paper/2409.02770/) (2024)

## Abstract (arXiv)

Progression of hip osteoarthritis (hip OA) leads to pain and disability, likely leading to surgical treatment such as hip arthroplasty at the terminal stage. The severity of hip OA is often classified using the Crowe and Kellgren-Lawrence (KL) classifications. However, as the classification is subjective, we aimed to develop an automated approach to classify the disease severity based on the two grades using digitally-reconstructed radiographs (DRRs) from CT images. Automatic grading of the hip OA severity was performed using deep learning-based models. The models were trained to predict the disease grade using two grading schemes, i.e., predicting the Crowe and KL grades separately, and predicting a new ordinal label combining both grades and representing the disease progression of hip OA. The models were trained in classification and regression settings. In addition, the model uncertainty was estimated and validated as a predictor of classification accuracy. The models were trained and validated on a database of 197 hip OA patients, and externally validated on 52 patients. The model accuracy was evaluated using exact class accuracy (ECA), one-neighbor class accuracy (ONCA), and balanced accuracy.The deep learning models produced a comparable accuracy of approximately 0.65 (ECA) and 0.95 (ONCA) in the classification and regression settings. The model uncertainty was significantly larger in cases with large classification errors (P<6e-3). In this study, an automatic approach for grading hip OA severity from CT images was developed. The models have shown comparable performance with high ONCA, which facilitates automated grading in large-scale CT databases and indicates the potential for further disease progression analysis. Classification accuracy was correlated with the model uncertainty, which would allow for the prediction of classification errors.