Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic review

Abstract Purpose While several artificial intelligence (AI)‐assisted medical imaging applications are reported in the recent orthopaedic literature, comparison of the clinical efficacy and utility of these applications is currently lacking. The aim of this systematic review is to evaluate the effect...

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Main Authors: Umile Giuseppe Longo, Alberto Lalli, Guido Nicodemi, Matteo Giuseppe Pisani, Alessandro De Sire, Pieter D'Hooghe, Ara Nazarian, Jacob F. Oeding, Balint Zsidai, Kristian Samuelsson
Format: Article
Language:English
Published: Wiley 2025-04-01
Series:Journal of Experimental Orthopaedics
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Online Access:https://doi.org/10.1002/jeo2.70259
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author Umile Giuseppe Longo
Alberto Lalli
Guido Nicodemi
Matteo Giuseppe Pisani
Alessandro De Sire
Pieter D'Hooghe
Ara Nazarian
Jacob F. Oeding
Balint Zsidai
Kristian Samuelsson
author_facet Umile Giuseppe Longo
Alberto Lalli
Guido Nicodemi
Matteo Giuseppe Pisani
Alessandro De Sire
Pieter D'Hooghe
Ara Nazarian
Jacob F. Oeding
Balint Zsidai
Kristian Samuelsson
author_sort Umile Giuseppe Longo
collection DOAJ
description Abstract Purpose While several artificial intelligence (AI)‐assisted medical imaging applications are reported in the recent orthopaedic literature, comparison of the clinical efficacy and utility of these applications is currently lacking. The aim of this systematic review is to evaluate the effectiveness and reliability of AI applications in orthopaedic imaging, focusing on their impact on diagnostic accuracy, image segmentation and operational efficiency across various imaging modalities. Methods Based on the PRISMA guidelines, a comprehensive literature search of PubMed, Cochrane and Scopus databases was performed, using combinations of keywords and MeSH descriptors ('AI', 'ML', 'deep learning', 'orthopaedic surgery' and 'imaging') from inception to March 2024. Included were studies published between September 2018 and February 2024, which evaluated machine learning (ML) model effectiveness in improving orthopaedic imaging. Studies with insufficient data regarding the output variable used to assess the reliability of the ML model, those applying deterministic algorithms, unrelated topics, protocol studies, and other systematic reviews were excluded from the final synthesis. The Joanna Briggs Institute (JBI) Critical Appraisal tool and the Risk Of Bias In Non‐randomised Studies‐of Interventions (ROBINS‐I) tool were applied for the assessment of bias among the included studies. Results The 53 included studies reported the use of 11.990.643 images from several diagnostic instruments. A total of 39 studies reported details in terms of the Dice Similarity Coefficient (DSC), while both accuracy and sensitivity were documented across 15 studies. Precision was reported by 14, specificity by nine, and the F1 score by four of the included studies. Three studies applied the area under the curve (AUC) method to evaluate ML model performance. Among the studies included in the final synthesis, Convolutional Neural Networks (CNN) emerged as the most frequently applied category of ML models, present in 17 studies (32%). Conclusion The systematic review highlights the diverse application of AI in orthopaedic imaging, demonstrating the capability of various machine learning models in accurately segmenting and analysing orthopaedic images. The results indicate that AI models achieve high performance metrics across different imaging modalities. However, the current body of literature lacks comprehensive statistical analysis and randomized controlled trials, underscoring the need for further research to validate these findings in clinical settings. Level of evidence Systematic Review; Level of evidence IV.
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spelling doaj-art-218bbe8e06ef47b38e79a905de8ab4c82025-08-20T04:03:13ZengWileyJournal of Experimental Orthopaedics2197-11532025-04-01122n/an/a10.1002/jeo2.70259Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic reviewUmile Giuseppe Longo0Alberto Lalli1Guido Nicodemi2Matteo Giuseppe Pisani3Alessandro De Sire4Pieter D'Hooghe5Ara Nazarian6Jacob F. Oeding7Balint Zsidai8Kristian Samuelsson9Fondazione Policlinico Universitario Campus Bio‐Medico Roma ItalyFondazione Policlinico Universitario Campus Bio‐Medico Roma ItalyFondazione Policlinico Universitario Campus Bio‐Medico Roma ItalyFondazione Policlinico Universitario Campus Bio‐Medico Roma ItalyDepartment of Medical and Surgical Sciences University of Catanzaro “Magna Grecia” Catanzaro ItalyDepartment of Orthopaedic Surgery and Sportsmedicine Aspetar Hospital Doha QatarCarl J. Shapiro Department of Orthopaedic Surgery Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School Boston Massachusetts USASchool of Medicine, Mayo Clinic Alix School of Medicine Rochester Minnesota USADepartment of Orthopaedics Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg SwedenDepartment of Orthopaedics Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg SwedenAbstract Purpose While several artificial intelligence (AI)‐assisted medical imaging applications are reported in the recent orthopaedic literature, comparison of the clinical efficacy and utility of these applications is currently lacking. The aim of this systematic review is to evaluate the effectiveness and reliability of AI applications in orthopaedic imaging, focusing on their impact on diagnostic accuracy, image segmentation and operational efficiency across various imaging modalities. Methods Based on the PRISMA guidelines, a comprehensive literature search of PubMed, Cochrane and Scopus databases was performed, using combinations of keywords and MeSH descriptors ('AI', 'ML', 'deep learning', 'orthopaedic surgery' and 'imaging') from inception to March 2024. Included were studies published between September 2018 and February 2024, which evaluated machine learning (ML) model effectiveness in improving orthopaedic imaging. Studies with insufficient data regarding the output variable used to assess the reliability of the ML model, those applying deterministic algorithms, unrelated topics, protocol studies, and other systematic reviews were excluded from the final synthesis. The Joanna Briggs Institute (JBI) Critical Appraisal tool and the Risk Of Bias In Non‐randomised Studies‐of Interventions (ROBINS‐I) tool were applied for the assessment of bias among the included studies. Results The 53 included studies reported the use of 11.990.643 images from several diagnostic instruments. A total of 39 studies reported details in terms of the Dice Similarity Coefficient (DSC), while both accuracy and sensitivity were documented across 15 studies. Precision was reported by 14, specificity by nine, and the F1 score by four of the included studies. Three studies applied the area under the curve (AUC) method to evaluate ML model performance. Among the studies included in the final synthesis, Convolutional Neural Networks (CNN) emerged as the most frequently applied category of ML models, present in 17 studies (32%). Conclusion The systematic review highlights the diverse application of AI in orthopaedic imaging, demonstrating the capability of various machine learning models in accurately segmenting and analysing orthopaedic images. The results indicate that AI models achieve high performance metrics across different imaging modalities. However, the current body of literature lacks comprehensive statistical analysis and randomized controlled trials, underscoring the need for further research to validate these findings in clinical settings. Level of evidence Systematic Review; Level of evidence IV.https://doi.org/10.1002/jeo2.70259artificial intelligence (AI)imagingmultimodality
spellingShingle Umile Giuseppe Longo
Alberto Lalli
Guido Nicodemi
Matteo Giuseppe Pisani
Alessandro De Sire
Pieter D'Hooghe
Ara Nazarian
Jacob F. Oeding
Balint Zsidai
Kristian Samuelsson
Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic review
Journal of Experimental Orthopaedics
artificial intelligence (AI)
imaging
multimodality
title Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic review
title_full Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic review
title_fullStr Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic review
title_full_unstemmed Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic review
title_short Artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities: A systematic review
title_sort artificial intelligence demonstrates potential to enhance orthopaedic imaging across multiple modalities a systematic review
topic artificial intelligence (AI)
imaging
multimodality
url https://doi.org/10.1002/jeo2.70259
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