Effective Feature Extraction for Knee Osteoarthritis Detection on X-ray Images Using Convolutional Neural Networks

Background: Knee osteoarthritis (KOA) is a degenerative joint disease commonly assessed using X-ray images based on the Kellgren-Lawrence (KL) criteria. Although the KL standard exists, its ambiguity often causes patients to misunderstand their condition, leading to overtreatment or delayed treatment and challenges in guiding precise surgical decisions. Moreover, the data-driven technology has been impeded by low resolution and feature distribution inconsistency of knee X-ray images. The imbalances between positive and negative samples further degrade detection accuracy. Objective: The objective of this study was to develop a deep learning-based model, namely Task-aligned Path Aggregation Feature Fusion For Knee Osteoarthritis Detection (TPAFFKnee), to improve KOA detection accuracy by addressing limitations in traditional methods. Its more accurate detection could help in terms of proper treatment for patients and precision in surgery by physicians. Methods: We proposed the TPAFFKnee model based on the EfficientNetB4 network, which introduced a path aggregation network for better feature extraction and replaced Fully Convolutional Network (FCN) with task-aligned detection as the head. Additionally, the loss function was improved by replacing the original loss function with Efficient Intersection over Union Loss (EIoU Loss) to address the imbalance between positive and negative samples. Results: The results showed that the model could accurately detect KOA categories and lesion locations based on the KL classification criteria, with a Mean Average Precision (mAP) of 93% on the Mendeley KOA dataset of 1650 knee osteoarthritis X-ray images from several hospitals. The mAP for the K2, K3, and K4 categories were 98.6%, 98.5%, and 99.6%, respectively. Compared with Faster R-CNN, SSD, RetinaNet, EfficientNetB4, and YOLOX, the proposed algorithm improved detection mAP by 14.3%, 12.4%, 15.3%, 22.7%, and 4.3%. Conclusion: This study emphasizes the importance of the EfficientNetB4 network in KOA detection. The TPAFFKnee model provides an effective solution for improving the accuracy of KOA detection and offers a promising approach for standardized KL classification in medical applications. Future research can integrate more clinical data while improving the overall landscape of healthcare delivery through data-driven automation solutions.