Improved Productivity Using Deep Learning-Assisted Major Coronal Curve Measurement on Scoliosis Radiographs

Background: Deep learning models have the potential to enable fast and consistent interpretations of scoliosis radiographs. This study aims to assess the impact of deep learning assistance on the speed and accuracy of clinicians in measuring major coronal curves on scoliosis radiographs. Methods: We utilized a deep learning model (Context Axial Reverse Attention Network, or CaraNet) to assist in measuring Cobb’s angles on scoliosis radiographs in a simulated clinical setting. Four trainee radiologists with no prior experience and four trainee orthopedists with four to six months of prior experience analyzed the radiographs retrospectively, both with and without deep learning assistance, using a six-week washout period. We recorded the interpretation time and mean angle differences, with a consultant spine surgeon providing the reference standard. The dataset consisted of 640 radiographs from 640 scoliosis patients, aged 10–18 years; we divided the dataset into 75% for training, 16% for validation, and 9% for testing. Results: Deep learning assistance achieved non-statistically significant improvements in mean accuracy of 0.32 for trainee orthopedists (95% CI −1.4 to 0.8, p > 0.05) and 0.43 degrees (95% CI −1.6 to 0.8, p > 0.05) for trainee radiologists (non-inferior across all readers). Mean interpretation time decreased by 13.25 s for trainee radiologists, but increased by 3.85 s for trainee orthopedists (p = 0.005). Conclusions: Deep learning assistance for measuring Cobb’s angles was as accurate as unaided interpretation and slightly improved measurement accuracy. It increased the interpretation speeds of trainee radiologists but slightly slowed trainee orthopedists, suggesting that its effect on speed depended on prior experience.