Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Deep Learning-Enabled Detection of Pneumoperitoneum in Supine and Erect Abdominal Radiography: Modeling Using Transfer Learning and Semi-Supervised Learning

  • Sangjoon Park (Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology) ;
  • Jong Chul Ye (Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology) ;
  • Eun Sun Lee (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Gyeongme Cho (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Jin Woo Yoon (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Joo Hyeok Choi (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Ijin Joo (Department of Radiology, Seoul National University Hospital) ;
  • Yoon Jin Lee (Department of Radiology, Seoul National University Bundang Hospital)
  • Received : 2022.07.25
  • Accepted : 2023.04.11
  • Published : 2023.06.01
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Abstract

Objective: Detection of pneumoperitoneum using abdominal radiography, particularly in the supine position, is often challenging. This study aimed to develop and externally validate a deep learning model for the detection of pneumoperitoneum using supine and erect abdominal radiography. Materials and Methods: A model that can utilize "pneumoperitoneum" and "non-pneumoperitoneum" classes was developed through knowledge distillation. To train the proposed model with limited training data and weak labels, it was trained using a recently proposed semi-supervised learning method called distillation for self-supervised and self-train learning (DISTL), which leverages the Vision Transformer. The proposed model was first pre-trained with chest radiographs to utilize common knowledge between modalities, fine-tuned, and self-trained on labeled and unlabeled abdominal radiographs. The proposed model was trained using data from supine and erect abdominal radiographs. In total, 191212 chest radiographs (CheXpert data) were used for pre-training, and 5518 labeled and 16671 unlabeled abdominal radiographs were used for fine-tuning and self-supervised learning, respectively. The proposed model was internally validated on 389 abdominal radiographs and externally validated on 475 and 798 abdominal radiographs from the two institutions. We evaluated the performance in diagnosing pneumoperitoneum using the area under the receiver operating characteristic curve (AUC) and compared it with that of radiologists. Results: In the internal validation, the proposed model had an AUC, sensitivity, and specificity of 0.881, 85.4%, and 73.3% and 0.968, 91.1, and 95.0 for supine and erect positions, respectively. In the external validation at the two institutions, the AUCs were 0.835 and 0.852 for the supine position and 0.909 and 0.944 for the erect position. In the reader study, the readers' performances improved with the assistance of the proposed model. Conclusion: The proposed model trained with the DISTL method can accurately detect pneumoperitoneum on abdominal radiography in both the supine and erect positions.

Keywords

Acknowledgement

This study was supported by research grant from Biomedical Research Institute, Chung-Ang University Hospital (2022).

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