Sex determination from lateral cephalometric radiographs using an automated deep learning convolutional neural network

Purpose: Despite the proliferation of numerous morphometric and anthropometric methods for sex identification based on linear, angular, and regional measurements of various parts of the body, these methods are subject to error due to the observer's knowledge and expertise. This study aimed to explore the possibility of automated sex determination using convolutional neural networks(CNNs) based on lateral cephalometric radiographs. Materials and Methods: Lateral cephalometric radiographs of 1,476 Iranian subjects (794 women and 682 men) from 18 to 49 years of age were included. Lateral cephalometric radiographs were considered as a network input and output layer including 2 classes(male and female). Eighty percent of the data was used as a training set and the rest as a test set. Hyperparameter tuning of each network was done after preprocessing and data augmentation steps. The predictive performance of different architectures (DenseNet, ResNet, and VGG) was evaluated based on their accuracy in test sets. Results: The CNN based on the DenseNet121 architecture, with an overall accuracy of 90%, had the best predictive power in sex determination. The prediction accuracy of this model was almost equal for men and women. Furthermore, with all architectures, the use of transfer learning improved predictive performance. Conclusion: The results confirmed that a CNN could predict a person's sex with high accuracy. This prediction was independent of human bias because feature extraction was done automatically. However, for more accurate sex determination on a wider scale, further studies with larger sample sizes are desirable.