Artificial Intelligence-based Models for Spine Malalignment Auto-analysis

Artificial Intelligence-based Models Enabling Robust and Precise Spine Malalignment Auto-analysis in China: a Multicentre, Retrospective Cohort Study

This retrospective study aimed to enhance and validate a model for diagnosing adolescent idiopathic scoliosis (AIS) across multiple medical centers. The study included 2,763 participants from prestigious hospitals in mainland China and Hong Kong. X-rays were used to develop and validate the model, with data from different hospitals to ensure robustness. Participants aged 10-18 with confirmed AIS were enrolled, and data were deidentified for privacy. The model was optimized using training data and validated internally before being deployed for real-world application. A novel data augmentation technique was used to address data heterogeneity, and a standardized analysis platform, AlignProCARE, was employed for evaluation. X-rays were annotated with vertebra landmarks, and traditional and intensity-based data augmentation methods were applied for image processing. Coronal Cobb angle was used to evaluate spinal alignment, with severity classified as normal-mild, moderate, or severe. The model's performance was statistically assessed for accuracy in predicting Cobb angle and severity grading. Overall, the study aimed to provide a reliable diagnostic tool for AIS analysis in clinical practice, improving efficiency and standardization in diagnosis and treatment.

Study Overview

• Status: Completed
• Conditions: Adolescent Idiopathic Scoliosis

Detailed Description

This retrospective study involved collecting posteroanterior whole-spine X-rays from 2,763 individuals at 5 renowned hospitals in mainland China and 2 hospitals in Hong Kong over a period from January 1, 2012, to April 4, 2021. X-rays from Queen Mary Hospital and Duchess of Kent Children's Hospital at Sandy Bay in Hong Kong, known as the QMH&DKCH cohort, were specifically used for model development. Within this cohort, 86.5% (1686 out of 1950 patients) were randomly chosen as the training set for model development, while the remaining 13.5% (264 patients) formed the internal validation set to ensure the model's performance was independently tested. Additionally, data from five prominent hospitals in mainland China were compiled into external validation datasets to assess the model's efficacy. These hospitals included Peking Union Medical College Hospital, Nanfang Hospital, Jishuitan Hospital, Ruijin Hospital, and Huashan Hospital. All data were deidentified before being utilized for model development and validation. The study enrolled participants aged 10 to 18 years with confirmed presence or absence of adolescent idiopathic scoliosis (AIS). Demographic information such as age, sex, and BMI was extracted from medical records. Exclusion criteria were applied to ensure the study's specificity, excluding individuals with other types of scoliosis, skin diseases that could impact imaging, those unable to stand, and cases where standing imaging was not feasible. The study design, illustrated in Figure 1, consisted of two main phases: model development and real-world application. The model was optimized and validated using the QMH&DKCH cohort data before being deployed on the AlignProCARE platform for clinical application across different centers. In the real-world application stage, five medical centers utilized the AlignProCARE software to upload and analyze patient X-ray images for diagnostic purposes.

• Study Type: Observational
• Enrollment (Actual): 3015

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Digital Health Laboratory, Li Ka Shing Faculty of Medicine, The University of Hong Kong

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with adolescent idiopathic scoliosis.

Description

Inclusion Criteria:

• Participants aged between 10 and 18 years old,
• A pathological confirmation of the presence or absence of AIS

Exclusion Criteria:

• Patients with other types of scoliosis, such as congenital or neuromuscular scoliosis
• Patients with skin diseases, such as acne, psoriasis, skin pigmentation and rash that can affect imaging
• Individuals that cannot stand up
• Cases where standing imaging was not feasible or other conditions that could impair image acquisition.

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort
QMH&DKCH cohort; A total of 1,950 whole spine posteroanterior X-rays collected from two local hospitals (QMH and DKCH) were utilized for the development and internal validation of our model.
PUMCH cohort; 314 whole spine posteroanterior X-rays from Peking Union Medical College Hospital, Beijing, China
NFH cohort; 94 whole spine posteroanterior X-rays from Nanfang Hospital, Guangzhou, China
JSTH cohort; 187 whole spine posteroanterior X-rays from Jishuitan Hospital, Beijing, China
RJH cohort; 294 whole spine posteroanterior X-rays from Ruijin Hospital, Shanghai, China
HSH cohort; 176 whole spine posteroanterior X-rays from Huashan Hospital, Shanghai, China

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cobb Angle prediction accuracy	Coronal Cobb angle was adopted as the standard measurement to evaluate the coronal alignment of each AIS patient. We evaluate the performance of our artificial intelligence model based on Cobb Angle prediction accuracy.	through study completion, an average of 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
AIS severity classification accuracy	Deformities with a CA exceeding 40° were deemed severe, those ranging from 20° to 40° were labelled as moderate, and angles from 0° to 20° were identified as normal to mild.	through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: The University of Hong Kong
• Collaborators: Peking Union Medical College Hospital; Huashan Hospital; Ruijin Hospital; Queen Mary Hospital, Hong Kong; Beijing Jishuitan Hospital; Nanfang Hospital, Southern Medical University; The Duchess of Kent Children's Hospital at Sandy Bay

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2022
• Primary Completion (Actual): October 5, 2024
• Study Completion (Actual): November 5, 2024

Study Registration Dates

• First Submitted: November 20, 2024
• First Submitted That Met QC Criteria: November 26, 2024
• First Posted (Estimated): December 2, 2024

Study Record Updates

• Last Update Posted (Estimated): December 2, 2024
• Last Update Submitted That Met QC Criteria: November 26, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: artificial intelligence; multi-centre cohort study; Adolescent idiopathic scoliosis; spine malalignment; data heterogeneity
• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Spinal Diseases; Spinal Curvatures; Scoliosis
• Other Study ID Numbers: UW 24-350

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No