Sanders classification of calcaneal fractures in CT images with deep learning and differential data augmentation techniques

Nurya Aghnia Farda, Jiing Yih Lai, Jia Ching Wang, Pei Yuan Lee, Jia Wei Liu, I. Hui Hsieh

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: Classification of the type of calcaneal fracture on CT images is essential in driving treatment. However, human-based classification can be challenging due to anatomical complexities and CT image constraints. The use of computer-aided classification system in standard practice is additionally hindered by the availability of training images. The aims of this study is to 1) propose a deep learning network combined with data augmentation technique to classify calcaneal fractures on CT images into the Sanders system, and 2) assess the efficiency of such approach with differential training methods. Methods: In this study, the Principle component analysis (PCA) network was selected for the deep learning neural network architecture for its superior performance. CT calcaneal images were processed through PCA filters, binary hashing, and a block-wise histogram. The Augmentor pipeline including rotation, distortion, and flips was applied to generate artificial calcaneus fractured images. Two types of training approaches and five data sample sizes were investigated to evaluate the performance of the proposed system with and without data augmentation. Results: Compared to the original performance, use of augmented images during training improved network performance accuracy by almost twofold in classifying Sanders fracture types for all dataset sizes. A fivefold increase in the number of augmented training images improved network classification accuracy by 35%. The proposed deep CNN model achieved 72% accuracy in classifying CT calcaneal images into the four Sanders categories when trained with sufficient augmented artificial images. Conclusion: The proposed deep-learning algorithm coupled with data augmentation provides a feasible and efficient approach to the use of computer-aided system in assisting physicians in evaluating calcaneal fracture types.

Original languageEnglish
Pages (from-to)616-624
Number of pages9
Issue number3
StatePublished - Mar 2021


  • Calcaneus fracture
  • Computed-tomography image
  • Computer-aided system
  • Convolutional neural network
  • Data augmentation
  • Deep learning
  • Sanders classification system


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