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      Computerized Bone Age Estimation Using Deep Learning Based Program: Evaluation of the Accuracy and Efficiency

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          Most cited references 16

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          Is Open Access

          Root mean square error (RMSE) or mean absolute error (MAE)? – Arguments against avoiding RMSE in the literature

           T. Chai,  R. Draxler (2014)
          Both the root mean square error (RMSE) and the mean absolute error (MAE) are regularly employed in model evaluation studies. Willmott and Matsuura (2005) have suggested that the RMSE is not a good indicator of average model performance and might be a misleading indicator of average error, and thus the MAE would be a better metric for that purpose. While some concerns over using RMSE raised by Willmott and Matsuura (2005) and Willmott et al. (2009) are valid, the proposed avoidance of RMSE in favor of MAE is not the solution. Citing the aforementioned papers, many researchers chose MAE over RMSE to present their model evaluation statistics when presenting or adding the RMSE measures could be more beneficial. In this technical note, we demonstrate that the RMSE is not ambiguous in its meaning, contrary to what was claimed by Willmott et al. (2009). The RMSE is more appropriate to represent model performance than the MAE when the error distribution is expected to be Gaussian. In addition, we show that the RMSE satisfies the triangle inequality requirement for a distance metric, whereas Willmott et al. (2009) indicated that the sums-of-squares-based statistics do not satisfy this rule. In the end, we discussed some circumstances where using the RMSE will be more beneficial. However, we do not contend that the RMSE is superior over the MAE. Instead, a combination of metrics, including but certainly not limited to RMSEs and MAEs, are often required to assess model performance.
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            Fully Automated Deep Learning System for Bone Age Assessment

            Skeletal maturity progresses through discrete phases, a fact that is used routinely in pediatrics where bone age assessments (BAAs) are compared to chronological age in the evaluation of endocrine and metabolic disorders. While central to many disease evaluations, little has changed to improve the tedious process since its introduction in 1950. In this study, we propose a fully automated deep learning pipeline to segment a region of interest, standardize and preprocess input radiographs, and perform BAA. Our models use an ImageNet pretrained, fine-tuned convolutional neural network (CNN) to achieve 57.32 and 61.40% accuracies for the female and male cohorts on our held-out test images. Female test radiographs were assigned a BAA within 1 year 90.39% and within 2 years 98.11% of the time. Male test radiographs were assigned 94.18% within 1 year and 99.00% within 2 years. Using the input occlusion method, attention maps were created which reveal what features the trained model uses to perform BAA. These correspond to what human experts look at when manually performing BAA. Finally, the fully automated BAA system was deployed in the clinical environment as a decision supporting system for more accurate and efficient BAAs at much faster interpretation time (<2 s) than the conventional method.
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              The BoneXpert method for automated determination of skeletal maturity.

              Bone age rating is associated with a considerable variability from the human interpretation, and this is the motivation for presenting a new method for automated determination of bone age (skeletal maturity). The method, called BoneXpert, reconstructs, from radiographs of the hand, the borders of 15 bones automatically and then computes "intrinsic" bone ages for each of 13 bones (radius, ulna, and 11 short bones). Finally, it transforms the intrinsic bone ages into Greulich Pyle (GP) or Tanner Whitehouse (TW) bone age. The bone reconstruction method automatically rejects images with abnormal bone morphology or very poor image quality. From the methodological point of view, BoneXpert contains the following innovations: 1) a generative model (active appearance model) for the bone reconstruction; 2) the prediction of bone age from shape, intensity, and texture scores derived from principal component analysis; 3) the consensus bone age concept that defines bone age of each bone as the best estimate of the bone age of the other bones in the hand; 4) a common bone age model for males and females; and 5) the unified modelling of TW and GP bone age. BoneXpert is developed on 1559 images. It is validated on the Greulich Pyle atlas in the age range 2-17 years yielding an SD of 0.42 years [0.37; 0.47] 95% conf, and on 84 clinical TW-rated images yielding an SD of 0.80 years [0.68; 0.93] 95% conf. The precision of the GP bone age determination (its ability to yield the same result on a repeated radiograph) is inferred under suitable assumptions from six longitudinal series of radiographs. The result is an SD on a single determination of 0.17 years [0.13; 0.21] 95% conf.
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                Author and article information

                Journal
                American Journal of Roentgenology
                American Journal of Roentgenology
                American Roentgen Ray Society
                0361-803X
                1546-3141
                December 2017
                December 2017
                : 209
                : 6
                : 1374-1380
                Affiliations
                [1 ]Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
                [2 ]Vuno Research Center, Vuno Inc., Seoul, South Korea.
                Article
                10.2214/AJR.17.18224
                © 2017
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