Reproducibility analysis of automated deep learning based localisation of mandibular canals on a temporal CBCT dataset.

Preoperative radiological identification of mandibular canals is essential for maxillofacial surgery. This study demonstrates the reproducibility of a deep learning system (DLS) by evaluating its localisation performance on 165 heterogeneous cone beam computed tomography (CBCT) scans from 72 patients in comparison to an experienced radiologist's annotations. We evaluated the performance of the DLS using the symmetric mean curve distance (SMCD), the average symmetric surface distance (ASSD), and the Dice similarity coefficient (DSC). The reproducibility of the SMCD was assessed using the within-subject coefficient of repeatability (RC). Three other experts rated the diagnostic validity twice using a 0-4 Likert scale. The reproducibility of the Likert scoring was assessed using the repeatability measure (RM). The RC of SMCD was 0.969 mm, the median (interquartile range) SMCD and ASSD were 0.643 (0.186) mm and 0.351 (0.135) mm, respectively, and the mean (standard deviation) DSC was 0.548 (0.138). The DLS performance was most affected by postoperative changes. The RM of the Likert scoring was 0.923 for the radiologist and 0.877 for the DLS. The mean (standard deviation) Likert score was 3.94 (0.27) for the radiologist and 3.84 (0.65) for the DLS. The DLS demonstrated proficient qualitative and quantitative reproducibility, temporal generalisability, and clinical validity.

Comparison of deep learning segmentation and multigrader-annotated mandibular canals of multicenter CBCT scans.

Deep learning approach has been demonstrated to automatically segment the bilateral mandibular canals from CBCT scans, yet systematic studies of its clinical and technical validation are scarce. To validate the mandibular canal localization accuracy of a deep learning system (DLS) we trained it with 982 CBCT scans and evaluated using 150 scans of five scanners from clinical workflow patients of European and Southeast Asian Institutes, annotated by four radiologists. The interobserver variability was compared to the variability between the DLS and the radiologists. In addition, the generalisation of DLS to CBCT scans from scanners not used in the training data was examined to evaluate its out-of-distribution performance. The DLS had a statistically significant difference (p < 0.001) with lower variability to the radiologists with 0.74 mm than the interobserver variability of 0.77 mm and generalised to new devices with 0.63 mm, 0.67 mm and 0.87 mm (p < 0.001). For the radiologists' consensus segmentation, used as a gold standard, the DLS showed a symmetric mean curve distance of 0.39 mm, which was statistically significantly different (p < 0.001) compared to those of the individual radiologists with values of 0.62 mm, 0.55 mm, 0.47 mm, and 0.42 mm. These results show promise towards integration of DLS into clinical workflow to reduce time-consuming and labour-intensive manual tasks in implantology.

Deep Learning Method for Mandibular Canal Segmentation in Dental Cone Beam Computed Tomography Volumes.

Accurate localisation of mandibular canals in lower jaws is important in dental implantology, in which the implant position and dimensions are currently determined manually from 3D CT images by medical experts to avoid damaging the mandibular nerve inside the canal. Here we present a deep learning system for automatic localisation of the mandibular canals by applying a fully convolutional neural network segmentation on clinically diverse dataset of 637 cone beam CT volumes, with mandibular canals being coarsely annotated by radiologists, and using a dataset of 15 volumes with accurate voxel-level mandibular canal annotations for model evaluation. We show that our deep learning model, trained on the coarsely annotated volumes, localises mandibular canals of the voxel-level annotated set, highly accurately with the mean curve distance and average symmetric surface distance being 0.56 mm and 0.45 mm, respectively. These unparalleled accurate results highlight that deep learning integrated into dental implantology workflow could significantly reduce manual labour in mandibular canal annotations.