The Artificial Intelligence Motion Study (AIM): A Feasibility Study of AI-Assisted Image Recognition of Cervical Spine Vertebrae in Dynamic X-Ray Recordings

Background: Qualitative motion analysis revealed that the cervical spine moves according to a consistent pattern. This analysis calculates the relative rotation between vertebral segments to determine the sequence in which they contribute to extension, demonstrating high sensitivity and specificity. However, the extensive time required limits its applicability. This study investigated the feasibility of implementing a deep-learning model to analyze qualitative cervical motion. Methods: A U-Net architecture was implemented as 2D and 2D+t models. Dice similarity coefficient (DSC) and Intersection over Union (IoU) were used to assess the performance of the models. Intraclass Correlation Coefficient (ICC) was used to compare the relative rotation of individual vertebrae and segments to the ground truth. Results: IoU ranged from 0.37 to 0.74 and DSC ranged from 0.53 to 0.80. The ICC scores for relative rotation ranged from 0.62 to 0.96 for individual vertebrae and from 0.28 to 0.72 for vertebral segments. For segments, 2D+t models presented higher ICC scores compared to 2D models. Conclusion: This study showed the feasibility of implementing deep-learning models to analyze qualitative cervical motion in dynamic X-ray recordings. Future research should focus on improving model segmentation by enhancing recording contrast and applying post-processing methods.