SSP: self-supervised pertaining technique for classification of shoulder implants in x-ray medical images: a broad experimental study

Abstract

Multiple pathologic conditions can lead to a diseased and symptomatic glenohumeral joint for which total shoulder arthroplasty (TSA) replacement may be indicated. The long-term survival of implants is limited. With the increasing incidence of joint replacement surgery, it can be anticipated that joint replacement revision surgery will become more common. It can be challenging at times to retrieve the manufacturer of the in situ implant. Therefore, certain systems facilitated by AI techniques such as deep learning (DL) can help correctly identify the implanted prosthesis. Correct identification of implants in revision surgery can help reduce perioperative complications and complications. DL was used in this study to categorise different implants based on X-ray images into four classes (as a first case study of the small dataset): Cofield, Depuy, Tornier, and Zimmer. Imbalanced and small public datasets for shoulder implants can lead to poor performance of DL model training. Most of the methods in the literature have adopted the idea of transfer learning (TL) from ImageNet models. This type of TL has been proven ineffective due to some concerns regarding the contrast between features learnt from natural images (ImageNet: colour images) and shoulder implants in X-ray images (greyscale images). To address that, a new TL approach (self-supervised pertaining (SSP)) is proposed to resolve the issue of small datasets. The SSP approach is based on training the DL models (ImageNet models) on a large number of unlabelled greyscale medical images in the domain to update the features. The models are then trained on a small labelled data set of X-ray images of shoulder implants. The SSP shows excellent results in five ImageNet models, including MobilNetV2, DarkNet19, Xception, InceptionResNetV2, and EfficientNet with precision of 96.69%, 95.45%, 98.76%, 98.35%, and 96.6%, respectively. Furthermore, it has been shown that different domains of TL (such as ImageNet) do not significantly affect the performance of shoulder implants in X-ray images. A lightweight model trained from scratch achieves 96.6% accuracy, which is similar to using standard ImageNet models. The features extracted by the DL models are used to train several ML classifiers that show outstanding performance by obtaining an accuracy of 99.20% with Xception+SVM. Finally, extended experimentation has been carried out to elucidate our approach’s real effectiveness in dealing with different medical imaging scenarios. Specifically, five different datasets are trained and tested with and without the proposed SSP, including the shoulder X-ray with an accuracy of 99.47% and CT brain stroke with an accuracy of 98.60%.