{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:19:42Z","timestamp":1786979982103,"version":"build-2736575974"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"name":"National Key Research & Development Program of Ministry of Science & Technology of China","award":["2018YFA0701703"],"award-info":[{"award-number":["2018YFA0701703"]}]},{"name":"National Key Research & Development Program of Ministry of Science & Technology of China","award":["2017YFC0108805"],"award-info":[{"award-number":["2017YFC0108805"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81871345"],"award-info":[{"award-number":["81871345"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81790653"],"award-info":[{"award-number":["81790653"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81790650"],"award-info":[{"award-number":["81790650"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81701680"],"award-info":[{"award-number":["81701680"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Key Talent Project in Jiangsu Province","award":["ZDRCA2016093"],"award-info":[{"award-number":["ZDRCA2016093"]}]},{"name":"Post-doctoral grants of China","award":["2016M603064"],"award-info":[{"award-number":["2016M603064"]}]},{"name":"Goverment of Jiangsu Province","award":["1501169B"],"award-info":[{"award-number":["1501169B"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"DOI":"10.1007\/s00330-022-08950-w","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T01:02:51Z","timestamp":1656032571000},"page":"555-565","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Lower-extremity fatigue fracture detection and grading based on deep learning models of radiographs"],"prefix":"10.1007","volume":"33","author":[{"given":"Yanping","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuexiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qirui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yefeng","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangming","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3993-7330","authenticated-orcid":false,"given":"Zhiqiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,6,24]]},"reference":[{"key":"8950_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1148\/radiology.199.1.8633129","volume":"199","author":"MW Anderson","year":"1996","unstructured":"Anderson MW, Greenspan A (1996) Stress fractures. Radiology 199:1\u201312","journal-title":"Radiology"},{"key":"8950_CR2","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s11914-996-0029-y","volume":"4","author":"SJ Warden","year":"2006","unstructured":"Warden SJ, Burr DB, Brukner PD (2006) Stress fractures: pathophysiology, epidemiology, and risk factors. Curr Osteoporos Rep 4:103\u2013109","journal-title":"Curr Osteoporos Rep"},{"key":"8950_CR3","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1148\/radiol.16142305","volume":"280","author":"MN Pathria","year":"2016","unstructured":"Pathria MN, Chung CB, Resnick DL (2016) Acute and stress-related injuries of bone and cartilage: pertinent anatomy, basic biomechanics, and imaging perspective. Radiology 280:21\u201338","journal-title":"Radiology"},{"key":"8950_CR4","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1148\/92.3.481","volume":"92","author":"ES Wilson","year":"1969","unstructured":"Wilson ES, Katz FN (1969) Stress fractures. An analysis of 250 consecutive cases. Radiology 92:481\u2013486","journal-title":"Radiology"},{"key":"8950_CR5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2511","volume":"344","author":"J Pegrum","year":"2012","unstructured":"Pegrum J, Crisp T, Padhiar N (2012) Diagnosis and management of bone stress injuries of the lower limb in athletes. BMJ 344:e2511","journal-title":"BMJ"},{"key":"8950_CR6","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.ejrad.2007.01.014","volume":"62","author":"FH Berger","year":"2007","unstructured":"Berger FH, de Jonge MC, Maas M (2007) Stress fractures in the lower extremity. The importance of increasing awareness amongst radiologists. Eur J Radiol 62:16\u201326","journal-title":"Eur J Radiol"},{"key":"8950_CR7","doi-asserted-by":"publisher","first-page":"2173","DOI":"10.1148\/rg.2018180073","volume":"38","author":"RA Marshall","year":"2018","unstructured":"Marshall RA, Mandell JC, Weaver MJ et al (2018) Imaging features and management of stress, atypical, and pathologic fractures. Radiographics 38:2173\u20132192","journal-title":"Radiographics"},{"key":"8950_CR8","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.csm.2005.08.013","volume":"25","author":"WG Raasch","year":"2006","unstructured":"Raasch WG, Hergan DJ (2006) Treatment of stress fractures: the fundamentals. Clin Sports Med 25:29\u201336","journal-title":"Clin Sports Med"},{"key":"8950_CR9","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s10140-016-1390-5","volume":"23","author":"GR Matcuk","year":"2016","unstructured":"Matcuk GR, Mahanty SR, Skalski MR et al (2016) Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol 23:365\u2013375","journal-title":"Emerg Radiol"},{"key":"8950_CR10","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1055\/s-2005-921941","volume":"9","author":"T Muthukumar","year":"2005","unstructured":"Muthukumar T, Butt SH, Cassar-Pullicino VN (2005) Stress fractures and related disorders in foot and ankle: plain films, scintigraphy, CT, and MR imaging. Semin Musculoskelet Radiol 9:210\u2013226","journal-title":"Semin Musculoskelet Radiol"},{"key":"8950_CR11","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","volume":"25","author":"EJ Topol","year":"2019","unstructured":"Topol EJ (2019) High-performance medicine: the convergence of human and artificial intelligence. Nat Med 25:44\u201356","journal-title":"Nat Med"},{"key":"8950_CR12","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1038\/s41568-018-0016-5","volume":"18","author":"A Hosny","year":"2018","unstructured":"Hosny A, Parmar C, Quackenbush J et al (2018) Artificial intelligence in radiology. Nat Rev Cancer 18:500\u2013510","journal-title":"Nat Rev Cancer"},{"key":"8950_CR13","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.2021200260","volume":"3","author":"N Hendrix","year":"2021","unstructured":"Hendrix N, Scholten E, Vernhout B et al (2021) Development and validation of a convolutional neural network for automated detection of scaphoid fractures on conventional radiographs. Radiol Artif Intell 3:e200260","journal-title":"Radiol Artif Intell"},{"key":"8950_CR14","doi-asserted-by":"publisher","first-page":"11591","DOI":"10.1073\/pnas.1806905115","volume":"115","author":"R Lindsey","year":"2018","unstructured":"Lindsey R, Daluiski A, Chopra S et al (2018) Deep neural network improves fracture detection by clinicians. Proc Natl Acad Sci U S A 115:11591\u201311596","journal-title":"Proc Natl Acad Sci U S A"},{"key":"8950_CR15","doi-asserted-by":"publisher","first-page":"13694","DOI":"10.1038\/s41598-020-70660-4","volume":"10","author":"C Lee","year":"2020","unstructured":"Lee C, Jang J, Lee S et al (2020) Classification of femur fracture in pelvic X-ray images using meta-learned deep neural network. Sci Rep 10:13694","journal-title":"Sci Rep"},{"key":"8950_CR16","doi-asserted-by":"publisher","first-page":"103345","DOI":"10.1016\/j.cviu.2021.103345","volume":"216","author":"B Guan","year":"2022","unstructured":"Guan B, Yao J, Wang S et al (2022) Automatic detection and localization of thighbone fractures in X-ray based on improved deep learning method. Comput Vis Image Underst 216:103345","journal-title":"Comput Vis Image Underst"},{"key":"8950_CR17","doi-asserted-by":"publisher","first-page":"237.e1","DOI":"10.1016\/j.crad.2019.10.022","volume":"75","author":"JS Yu","year":"2020","unstructured":"Yu JS, Yu SM, Erdal BS et al (2020) Detection and localisation of hip fractures on anteroposterior radiographs with artificial intelligence: proof of concept. Clin Radiol 75:237.e1\u2013237.e9","journal-title":"Clin Radiol"},{"key":"8950_CR18","doi-asserted-by":"publisher","first-page":"109373","DOI":"10.1016\/j.ejrad.2020.109373","volume":"133","author":"L Tanzi","year":"2020","unstructured":"Tanzi L, Vezzetti E, Moreno R et al (2020) Hierarchical fracture classification of proximal femur X-ray images using a multistage deep learning approach. Eur J Radiol 133:109373","journal-title":"Eur J Radiol"},{"key":"8950_CR19","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.3390\/s22031285","volume":"22","author":"F Hardala\u00e7","year":"2022","unstructured":"Hardala\u00e7 F, Uysal F, Peker O et al (2022) Fracture detection in wrist X-ray images using deep learning-based object detection models. Sensors (Basel) 22:1285","journal-title":"Sensors (Basel)"},{"key":"8950_CR20","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1097\/RLI.0000000000000615","volume":"55","author":"JW Choi","year":"2020","unstructured":"Choi JW, Cho YJ, Lee S et al (2020) Using a dual-input convolutional neural network for automated detection of pediatric supracondylar fracture on conventional radiography. Invest Radiol 55:101\u2013110","journal-title":"Invest Radiol"},{"key":"8950_CR21","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1007\/s10278-020-00364-8","volume":"33","author":"S Mutasa","year":"2020","unstructured":"Mutasa S, Varada S, Goel A et al (2020) Advanced deep learning techniques applied to automated femoral neck fracture detection and classification. J Digit Imaging 33:1209\u20131217","journal-title":"J Digit Imaging"},{"key":"8950_CR22","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1080\/17453674.2018.1453714","volume":"89","author":"SW Chung","year":"2018","unstructured":"Chung SW, Han SS, Lee JW et al (2018) Automated detection and classification of the proximal humerus fracture by using deep learning algorithm. Acta Orthop 89:468\u2013473","journal-title":"Acta Orthop"},{"key":"8950_CR23","doi-asserted-by":"crossref","unstructured":"Kaeding CC, Miller T (2013) The comprehensive description of stress fractures: a new classification system. J Bone Joint Surg Am 95:1214\u20131220","DOI":"10.2106\/JBJS.L.00890"},{"key":"8950_CR24","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/BF00228923","volume":"24","author":"ME Mulligan","year":"1995","unstructured":"Mulligan ME (1995) The \u201cgray cortex\u201d: an early sign of stress fracture. Skeletal Radiol 24:201\u2013203","journal-title":"Skeletal Radiol"},{"key":"8950_CR25","doi-asserted-by":"crossref","unstructured":"Png MA, Koh JSB, Goh SK et al (2012) Bisphosphonate-related femoral periosteal stress reactions: scoring system based on radiographic and MRI findings. AJR Am J Roentgenol 198:869\u2013877","DOI":"10.2214\/AJR.11.6794"},{"key":"8950_CR26","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1111\/sms.13466","volume":"29","author":"J Schilcher","year":"2019","unstructured":"Schilcher J, Bernhardsson M, Aspenberg P (2019) Chronic anterior tibial stress fractures in athletes: no crack but intense remodeling. Scand J Med Sci Sport 29:1521\u20131528","journal-title":"Scand J Med Sci Sport"},{"key":"8950_CR27","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1097\/RMR.0b013e3180421c8c","volume":"17","author":"M Fredericson","year":"2006","unstructured":"Fredericson M, Jennings F, Beaulieu C, Matheson GO (2006) Stress fractures in athletes. Top Magn Reson Imaging 17:309\u2013325","journal-title":"Top Magn Reson Imaging"},{"key":"8950_CR28","doi-asserted-by":"crossref","unstructured":"He K, Zhang X, Ren S, Sun J (2016) Deep residual learning for image recognition. In: 2016 IEEE Conference on Computer Vision and Pattern Recognition (CVPR). IEEE, pp 770\u2013778","DOI":"10.1109\/CVPR.2016.90"},{"key":"8950_CR29","doi-asserted-by":"crossref","unstructured":"Li Y, Wang Y, Lin G, et al (2021) Triplet-branch network with prior-knowledge embedding for fatigue fracture grading. In: Medical Image Computing and Computer Assisted Intervention-MICCAI 2021. pp 449\u2013458","DOI":"10.1007\/978-3-030-87240-3_43"},{"key":"8950_CR30","doi-asserted-by":"crossref","unstructured":"Zhou B, Cui Q, Wei X-S, Chen Z-M (2020) BBN: bilateral-branch network with cumulative learning for long-tailed visual recognition. In: 2020 IEEE\/CVF Conference on Computer Vision and Pattern Recognition (CVPR). IEEE, pp 9716\u20139725","DOI":"10.1109\/CVPR42600.2020.00974"},{"key":"8950_CR31","doi-asserted-by":"crossref","unstructured":"Cao Z, Qin T, Liu T-Y, et al (2007) Learning to rank. In: Proceedings of the 24th international conference on Machine learning - ICML \u201907. ACM Press, New York, New York, USA, pp 129\u2013136","DOI":"10.1145\/1273496.1273513"},{"key":"8950_CR32","doi-asserted-by":"publisher","unstructured":"Fu R, Hu Q, Dong X, et al (2020) Axiom-based Grad-CAM: towards accurate visualization and explanation of CNNs. arXiv e-prints arXiv:2008.02312 https:\/\/doi.org\/10.48550\/arXiv.2008.02312","DOI":"10.48550\/arXiv.2008.02312"},{"key":"8950_CR33","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.carj.2018.02.002","volume":"69","author":"A Tang","year":"2018","unstructured":"Tang A, Tam R, Cadrin-Ch\u00eanevert A et al (2018) Canadian Association of Radiologists white paper on artificial intelligence in radiology. Can Assoc Radiol J 69:120\u2013135","journal-title":"Can Assoc Radiol J"},{"key":"8950_CR34","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1007\/s00256-017-2640-7","volume":"46","author":"JC Mandell","year":"2017","unstructured":"Mandell JC, Khurana B, Smith SE (2017) Stress fractures of the foot and ankle, part 1: biomechanics of bone and principles of imaging and treatment. Skeletal Radiol 46:1021\u20131029","journal-title":"Skeletal Radiol"},{"key":"8950_CR35","doi-asserted-by":"crossref","unstructured":"Lefere M, Demeyere A, Vanhoenacker F (2021) Overuse bone trauma and stress fractures. Imaging of Orthopedic Sports Injuries. Springer, Cham, pp 135\u2013150","DOI":"10.1007\/174_2020_240"},{"key":"8950_CR36","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1007\/s00256-017-2632-7","volume":"46","author":"JC Mandell","year":"2017","unstructured":"Mandell JC, Khurana B, Smith SE (2017) Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol 46:1165\u20131186","journal-title":"Skeletal Radiol"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-022-08950-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-022-08950-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-022-08950-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T07:09:31Z","timestamp":1671088171000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-022-08950-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,24]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["8950"],"URL":"https:\/\/doi.org\/10.1007\/s00330-022-08950-w","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,24]]},"assertion":[{"value":"2 January 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2022","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2022","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The scientific guarantor of this publication is Zhiqiang Zhang from the Department of Diagnostic Radiology, Jinling Hospital, Medicine School of Nanjing University.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"Y.L., K.M., and Y.Z. are employees of Tencent Jarvis Lab. All other authors disclosed no relevant relationships.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"\u2022 retrospective\u2022 multicenter study","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}