Osteoporosis Prescreening using Panoramic Radiographs through a Deep Convolutional Neural Network with Attention Mechanism

Objectives. The aim of this study was to investigate whether a deep convolutional neural network (CNN) with an attention module can detect osteoporosis on panoramic radiographs. Study Design. A dataset of 70 panoramic radiographs (PRs) from 70 different subjects of age between 49 to 60 was used, including 49 subjects with osteoporosis and 21 normal subjects. We utilized the leave-one-out cross-validation approach to generate 70 training and test splits. Specifically, for each split, one image was used for testing and the remaining 69 images were used for training. A deep convolutional neural network (CNN) using the Siamese architecture was implemented through a fine-tuning process to classify an PR image using patches extracted from eight representative trabecula bone areas (Figure 1). In order to automatically learn the importance of different PR patches, an attention module was integrated into the deep CNN. Three metrics, including osteoporosis accuracy (OPA), non-osteoporosis accuracy (NOPA) and overall accuracy (OA), were utilized for performance evaluation. Results. The proposed baseline CNN approach achieved the OPA, NOPA and OA scores of 0.667, 0.878 and 0.814, respectively. With the help of the attention module, the OPA, NOPA and OA scores were further improved to 0.714, 0.939 and 0.871, respectively. Conclusions. The proposed method obtained promising results using deep CNN with an attention module, which might be applied to osteoporosis prescreening.