Diagnosis of Osteoporosis using modified U-net architecture with attention unit in DEXA and X-ray images

BACKGROUND: Osteoporosis, a silent killing disease of fracture risk, is normally determined based on the bone mineral density (BMD) and T-score values measured in bone. However, development of standard algorithms for accurate segmentation and BMD measurement from X-ray images is a challenge in the medical field. OBJECTIVE: The purpose of this work is to more accurately measure BMD from X-ray images, which can overcome the limitations of the current standard technique to measure BMD using Dual Energy X-ray Absorptiometry (DEXA) such as non-availability and inaccessibility of DEXA machines in developing countries. In addition, this work also attempts to analyze the DEXA scan images for better segmentation and measurement of BMD. METHODS: This work employs a modified U-Net with Attention unit for accurate segmentation of bone region from X-Ray and DEXA images. A linear regression model is developed to compute BMD and T-score. Based on the value of T-score, the images are then classified as normal, osteopenia or osteoporosis. RESULTS: The proposed network is experimented with the two internally collected datasets namely, DEXSIT and XSITRAY, comprised of DEXA and X-ray images, respectively. The proposed method achieved an accuracy of 88% on both datasets. The Dice score on DEXSIT and XSITRAY is 0.94 and 0.92, respectively. CONCLUSION: Our modified U-Net with attention unit achieves significantly higher results in terms of Dice score and classification accuracy. The computed BMD and T-score values of the proposed method are also compared with the respective clinical reports for validation. Hence, using the digitized X-Ray images can be used to detect osteoporosis efficiently and accurately.