Proximal humeral bone density assessment and prediction analysis using machine learning techniques: An innovative approach in medical research

Background

Patients with fractures of the proximal humerus often local complications and failures attributed to osteoporosis. Currently, there is a lack of straight forward screening methods for assessing the extent of local osteoporosis in the proximal humerus. This study utilizes machine learning techniques to establish a diagnostic approach for evaluating local osteoporosis by analyzing the patient's demographic data, bone density, and X-ray ratio of the proximal humerus.

Methods

A cohort comprising a total of 102 hospitalized patients admitted during the period spanning from 2021 to 2023 underwent random selection procedures. Resulting in exclusion of 5 patients while enrolling 97 patients for analysis encompassing patient demographics, shoulder joint anteroposterior radiographs, and bone density information. Using the modified Tingart index methodology involving multiple measurements denoted as M1 through M4 obtained from humeral shafts. Within this cohort comprised 76 females (78.4 %) and 21 males (21.6 %), with an average age of 73.0 years (range: 43-98 years). There were 25 cases with normal bone density, 35 with osteopenia, and 37 with osteoporosis. Machine learning techniques were used to randomly divide the 97 cases into training (n = 59) and validation (n = 38) sets with a ratio of 6:4 using stratified random sampling. A decision tree model was built in the training set, and significant diagnostic indicators were selected, with the performance of the decision tree evaluated using the validation set. Multinomial logistic regression methods were used to verify the strength of the relationship between the selected indicators and osteoporosis.

Results

The decision tree identified significant diagnostic indicators as the humeral shaft medullary cavity ratio M2/M4, age, and gender. M2/M4 ≥ 1.13 can be used as an important screening criterion; M2/M4 < 1.13 was predicted as local osteoporosis; M2/M4 ≥ 1.13 and age ≥83 years were also predicted as osteoporosis. M2/M4 ≥ 1.13 and age <64 years or males aged between 64 and 83 years were predicted as the normal population; M2/M4 ≥ 1.13 and females aged between 64 and 83 years were predicted as having osteopenia. The decision tree's accuracy in the training set was 0.7627 (95 % CI (0.6341, 0.8638)), and its accuracy in the test set was 0.7895 (95 % CI (0.6268, 0.9045)). Multinomial logistic regression results showed that humeral shaft medullary cavity ratios M2/M4, age, and gender in X-ray images were significantly associated with the occurrence of osteoporosis.

Conclusion

Utilizing X-ray data of the proximal humerus in conjunction with demographic information such as gender and age enable the prediction of localized osteoporosis, facilitating physicians' rapid comprehension of osteoporosis in patients and optimization of clinical treatment plans.

Level of evidence

Level IV retrospective case study.

Intelligent Neutrosophic Diagnostic System for Cardiotocography Data

Cardiotocography data uncertainty is a critical task for the classification in biomedical field. Constructing good and efficient classifier via machine learning algorithms is necessary to help doctors in diagnosing the state of fetus heart rate. The proposed neutrosophic diagnostic system is an Interval Neutrosophic Rough Neural Network framework based on the backpropagation algorithm. It benefits from the advantages of neutrosophic set theory not only to improve the performance of rough neural networks but also to achieve a better performance than the other algorithms. The experimental results visualize the data using the boxplot for better understanding of attribute distribution. The performance measurement of the confusion matrix for the proposed framework is 95.1, 94.95, 95.2, and 95.1 concerning accuracy rate, precision, recall, and F1-score, respectively. WEKA application is used to analyse cardiotocography data performance measurement of different algorithms, e.g., neural network, decision table, the nearest neighbor, and rough neural network. The comparison with other algorithms shows that the proposed framework is both feasible and efficient classifier. Additionally, the receiver operation characteristic curve displays the proposed framework classifications of the pathologic, normal, and suspicious states by 0.93, 0.90, and 0.85 areas that are considered high and acceptable under the curve, respectively. Improving the performance measurements of the proposed framework by removing ineffective attributes via feature selection would be suitable advancement in the future. Moreover, the proposed framework can also be used in various real-life problems such as classification of coronavirus, social media, and satellite image.

Multi-level fuzzy min-max neural network classifier

In this paper a multi-level fuzzy min-max neural network classifier (MLF), which is a supervised learning method, is described. MLF uses basic concepts of the fuzzy min-max (FMM) method in a multi-level structure to classify patterns. This method uses separate classifiers with smaller hyperboxes in different levels to classify the samples that are located in overlapping regions. The final output of the network is formed by combining the outputs of these classifiers. MLF is capable of learning nonlinear boundaries with a single pass through the data. According to the obtained results, the MLF method, compared to the other FMM networks, has the highest performance and the lowest sensitivity to maximum size of the hyperbox parameter (θ), with a training accuracy of 100% in most cases.

UNSUPERVISED FUZZY CLUSTERING USING WEIGHTED INCREMENTAL NEURAL NETWORKS

A new more efficient variant of a recently developed algorithm for unsupervised fuzzy clustering is introduced. A Weighted Incremental Neural Network (WINN) is introduced and used for this purpose. The new approach is called FC-WINN (Fuzzy Clustering using WINN). The WINN algorithm produces a net of nodes connected by edges, which reflects and preserves the topology of the input data set. Additional weights, which are proportional to the local densities in input space, are associated with the resulting nodes and edges to store useful information about the topological relations in the given input data set. A fuzziness factor, proportional to the connectedness of the net, is introduced in the system. A watershed-like procedure is used to cluster the resulting net. The number of the resulting clusters is determined by this procedure. Only two parameters must be chosen by the user for the FC-WINN algorithm to determine the resolution and the connectedness of the net. Other parameters that must be specified are those which are necessary for the used incremental neural network, which is a modified version of the Growing Neural Gas algorithm (GNG). The FC-WINN algorithm is computationally efficient when compared to other approaches for clustering large high-dimensional data sets.

Fuzzy associative conjuncted maps network

The fuzzy associative conjuncted maps (FASCOM) is a fuzzy neural network that associates data of nonlinearly related inputs and outputs. In the network, each input or output dimension is represented by a feature map that is partitioned into fuzzy or crisp sets. These fuzzy sets are then conjuncted to form antecedents and consequences, which are subsequently associated to form if-then rules. The associative memory is encoded through an offline batch mode learning process consisting of three consecutive phases. The initial unsupervised membership function initialization phase takes inspiration from the organization of sensory maps in our brains by allocating membership functions based on uniform information density. Next, supervised Hebbian learning encodes synaptic weights between input and output nodes. Finally, a supervised error reduction phase fine-tunes the network, which allows for the discovery of the varying levels of influence of each input dimension across an output feature space in the encoded memory. In the series of experiments, we show that each phase in the learning process contributes significantly to the final accuracy of prediction. Further experiments using both toy problems and real-world data demonstrate significant superiority in terms of accuracy of nonlinear estimation when benchmarked against other prominent architectures and exhibit the network's suitability to perform analysis and prediction on real-world applications, such as traffic density prediction as shown in this paper.

A Fuzzy Min-Max Neural Network Classifier With Compensatory Neuron Architecture

This paper proposes a fuzzy min-max neural network classifier with compensatory neurons (FMCNs). FMCN uses hyperbox fuzzy sets to represent the pattern classes. It is a supervised classification technique with new compensatory neuron architecture. The concept of compensatory neuron is inspired from the reflex system of human brain which takes over the control in hazardous conditions. Compensatory neurons (CNs) imitate this behavior by getting activated whenever a test sample falls in the overlapped regions amongst different classes. These neurons are capable to handle the hyperbox overlap and containment more efficiently. Simpson used contraction process based on the principle of minimal disturbance, to solve the problem of hyperbox overlaps. FMCN eliminates use of this process since it is found to be erroneous. FMCN is capable to learn the data online in a single pass through with reduced classification and gradation errors. One of the good features of FMCN is that its performance is less dependent on the initialization of expansion coefficient, i.e., maximum hyperbox size. The paper demonstrates the performance of FMCN by comparing it with fuzzy min-max neural network (FMNN) classifier and general fuzzy min-max neural network (GFMN) classifier, using several examples.

Granular self-organizing map (grSOM) for structure identification

This work presents a useful extension of Kohonen's Self-Organizing Map (KSOM) for structure identification in linguistic (fuzzy) system modeling applications. More specifically the granular SOM neural model is presented for inducing a distribution of nonparametric fuzzy interval numbers (FINs) from the data. A FIN can represent a local probability distribution function and/or a conventional fuzzy set; moreover, a FIN is interpreted as an information granule. Learning is based on a novel metric distance d(K)(.,.) between FINs. The metric d(K)(.,.) can be tuned nonlinearly by a mass function m(x), the latter attaches a weight of significance to a real number 'x' in a data dimension. Rigorous analysis is based on mathematical lattice theory. A grSOM can cope with ambiguity by processing linguistic (fuzzy) input data and/or intervals. This work presents a simple grSOM variant, namely greedy grSOM, for classification. A genetic algorithm (GA) introduces tunable nonlinearities during training. Extensive comparisons are shown with related work from the literature. The practical effectiveness of the greedy grSOM is demonstrated comparatively in three benchmark classification problems. Statistical evidence strongly suggests that the proposed techniques improve classification performance. In addition, the greedy grSOM induces descriptive decision-making knowledge (fuzzy rules) from the training data.

Data-partitioning using the Hilbert space filling curves: effect on the speed of convergence of Fuzzy ARTMAP for large database problems

The Fuzzy ARTMAP algorithm has been proven to be one of the premier neural network architectures for classification problems. One of the properties of Fuzzy ARTMAP, which can be both an asset and a liability, is its capacity to produce new nodes (templates) on demand to represent classification categories. This property allows Fuzzy ARTMAP to automatically adapt to the database without having to a priori specify its network size. On the other hand, it has the undesirable side effect that large databases might produce a large network size (node proliferation) that can dramatically slow down the training speed of the algorithm. To address the slow convergence speed of Fuzzy ARTMAP for large database problems, we propose the use of space-filling curves, specifically the Hilbert space-filling curves (HSFC). Hilbert space-filling curves allow us to divide the problem into smaller sub-problems, each focusing on a smaller than the original dataset. For learning each partition of data, a different Fuzzy ARTMAP network is used. Through this divide-and-conquer approach we are avoiding the node proliferation problem, and consequently we speedup Fuzzy ARTMAP's training. Results have been produced for a two-class, 16-dimensional Gaussian data, and on the Forest database, available at the UCI repository. Our results indicate that the Hilbert space-filling curve approach reduces the time that it takes to train Fuzzy ARTMAP without affecting the generalization performance attained by Fuzzy ARTMAP trained on the original large dataset. Given that the resulting smaller datasets that the HSFC approach produces can independently be learned by different Fuzzy ARTMAP networks, we have also implemented and tested a parallel implementation of this approach on a Beowulf cluster of workstations that further speeds up Fuzzy ARTMAP's convergence to a solution for large database problems.

Estimation of the stapes-bone thickness in the stapedotomy surgical procedure using a machine-learning technique

Stapedotomy is a surgical procedure aimed at the treatment of hearing impairment due to otosclerosis. The treatment consists of drilling a hole through the stapes bone in the inner ear in order to insert a prosthesis. Safety precautions require knowledge of the nonmeasurable stapes thickness. The technical goal herein has been the design of high-level controls for an intelligent mechatronics drilling tool in order to enable the estimation of stapes thickness from measurable drilling data. The goal has been met by learning a map between drilling features, hence no model of the physical system has been necessary. Learning has been achieved as explained in this paper by a scheme, namely the d-sigma Fuzzy Lattice Neurocomputing (d sigma-FLN) scheme for classification, within the framework of fuzzy lattices. The successful application of the d sigma-FLN scheme is demonstrated in estimating the thickness of a stapes bone "on-line" using drilling data obtained experimentally in the laboratory.