• Jianming Xian, Jingwei Sun, Ruimou Xie, Fei Yang, Jiaqi Huang, Kehong Yuan, Yu Pan, and Zhendong Luo.
• Tsinghua Shenzhen International Graduate School, Shenzhen, Guangdong Province.
• Spine. 2024 Oct 15; 49 (20): 145614641456-1464.

Study DesignDiagnostics.ObjectivesBased on deep learning semantic segmentation model, we sought to assess pelvic tilt by area ratio of the lesser pelvic and the obturator foramen in anteroposterior (AP) radiographs.BackgroundPelvic tilt is a critical factor in hip and spinal surgery, commonly evaluated by medical professionals through sagittal pelvic radiographs. The inherent pelvic asymmetry, as well as potential obstructions from clothing and musculature in roentgenography, may result in ghosting and blurring artifacts, thereby complicating precise measurement.MethodsPT directly affects the area ratio of the lesser pelvis to the obturator foramen in AP radiographs. An exponential regression analysis of simulated radiographs from ten male and ten female pelvises in specific tilt positions derived a formula correlating this area ratio with PT. Two blinded investigators evaluated this formula using 161 simulated AP pelvic radiographs. A deep learning semantic segmentation model was then fine-tuned to automatically calculate the area ratio, enabling intelligent PT evaluation. This model and the regression function were integrated for automated PT measurement and tested on a dataset of 231 clinical cases.ResultsWe observed no disparity between men and women in the aforementioned area ratio. The test results from two blinded investigators analyzing 161 simulated radiographs revealed a mean absolute error of 0.19° (SD ±4.71°), with a correlation coefficient between them reaching 0.96. In addition, the mean absolute error obtained from testing 231 clinical AP radiographs using the fine-tuned semantic segmentation model mentioned earlier is -0.58° (SD ±5.97°).ConclusionsWe found that using deep learning neural networks enabled a more accurate and robust automatic measurement of PT through the area ratio of the lesser pelvis and obturator foramen.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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