Knee arthritis severity measurement using deep learning: a publicly available algorithm with a multi-institutional validation showing radiologist-level performance

TL;DR

This paper introduces a deep learning algorithm for automatically grading knee osteoarthritis severity from X-rays, achieving radiologist-level performance and transparency, validated across multiple datasets and publicly available.

Contribution

A novel five-step deep learning method for KOA severity assessment that combines localization, classification, segmentation, and scoring, with enhanced transparency.

Findings

State-of-the-art performance on public and institutional datasets

Performs at radiologist-level accuracy

Provides transparent segmentation masks for assessment

Abstract

The assessment of knee osteoarthritis (KOA) severity on knee X-rays is a central criteria for the use of total knee arthroplasty. However, this assessment suffers from imprecise standards and a remarkably high inter-reader variability. An algorithmic, automated assessment of KOA severity could improve overall outcomes of knee replacement procedures by increasing the appropriateness of its use. We propose a novel deep learning-based five-step algorithm to automatically grade KOA from posterior-anterior (PA) views of radiographs: (1) image preprocessing (2) localization of knees joints in the image using the YOLO v3-Tiny model, (3) initial assessment of the severity of osteoarthritis using a convolutional neural network-based classifier, (4) segmentation of the joints and calculation of the joint space narrowing (JSN), and (5), a combination of the JSN and the initial assessment to determine a final Kellgren-Lawrence (KL) score. Furthermore, by displaying the segmentation masks used to make the assessment, our algorithm demonstrates a higher degree of transparency compared to typical "black box" deep learning classifiers. We perform a comprehensive evaluation using two public datasets and one dataset from our institution, and show that our algorithm reaches state-of-the art performance. Moreover, we also collected ratings from multiple radiologists at our institution and showed that our algorithm performs at the radiologist level. The software has been made publicly available at https://github.com/MaciejMazurowski/osteoarthritis-classification.