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. 2025 Jul 14.
doi: 10.1007/s00247-025-06332-0. Online ahead of print.

Feasibility study of fully automatic measurement of adenoid size on lateral neck and head radiographs using deep learning

Dapeng Hao  1 , Limin Tang  1 , Da Li  2 , Sheng Miao  3 , Cheng Dong  1 , Jiufa Cui  1 , Chuanping Gao  1 , Jie Li  4
Affiliations

Feasibility study of fully automatic measurement of adenoid size on lateral neck and head radiographs using deep learning

Dapeng Hao et al. Pediatr Radiol. .

Abstract

Background: The objective and reliable quantification of adenoid size is pivotal for precise clinical diagnosis and the formulation of effective treatment strategies. Conventional manual measurement techniques, however, are often labor-intensive and time-consuming.

Objective: To develop and validate a fully automated system for measuring adenoid size using deep learning (DL) on lateral head and neck radiographs.

Materials and methods: In this retrospective study, we analyzed 711 lateral head and neck radiographs collected from two centers between February and July 2023. A DL-based adenoid size measurement system was developed, utilizing Fujioka's method. The system employed the RTMDet network and RTMPose networks for accurate landmark detection, and mathematical formulas were applied to determine adenoid size. To evaluate consistency and reliability of the system, we employed the intra-class correlation coefficient (ICC), mean absolute difference (MAD), and Bland-Altman plots as key assessment metrics.

Results: The DL-based system exhibited high reliability in the prediction of adenoid, nasopharynx, and adenoid-nasopharyngeal ratio measurements, showcasing strong agreement with the reference standard. The results indicated an ICC for adenoid measurements of 0.902 [95%CI, 0.872-0.925], with a MAD of 1.189 and a root mean square (RMS) of 1.974. For nasopharynx measurements, the ICC was 0.868 [95%CI, 0.828-0.899], with a MAD of 1.671 and an RMS of 1.916. Additionally, the adenoid-nasopharyngeal ratio measurements yielded an ICC of 0.911 [95%CI, 0.883-0.932], a MAD of 0.054, and an RMS of 0.076.

Conclusions: The developed DL-based system effectively automates the measurement of the adenoid-nasopharyngeal ratio, adenoid, and nasopharynx on lateral neck or head radiographs, showcasing high reliability.

Keywords: Adenoid; Child; Deep learning; Nasopharynx; Radiograph; Retrospective studies.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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