VerteNet -- A Multi-Context Hybrid CNN Transformer for Accurate Vertebral Landmark Localization in Lateral Spine DXA Images

Lateral Spine Image (LSI) analysis is important for medical diagnosis, treatment planning, and detailed spinal health assessments. Although modalities like Computed Tomography and Digital X-ray Imaging are commonly used, Dual Energy X-ray Absorptiometry (DXA) is often preferred due to lower radiation exposure, seamless capture, and cost-effectiveness. Accurate Vertebral Landmark Localization (VLL) on LSIs is important to detect spinal conditions like kyphosis and lordosis, as well as assessing Abdominal Aortic Calcification (AAC) using Inter-Vertebral Guides (IVGs). Nonetheless, few automated VLL methodologies have concentrated on DXA LSIs. We present VerteNet, a hybrid CNN-Transformer model featuring a novel dual-resolution attention mechanism in self and cross-attention domains, referred to as Dual Resolution Self-Attention (DRSA) and Dual Resolution Cross-Attention (DRCA). These mechanisms capture the diverse frequencies in DXA images by operating at two different feature map resolutions. Additionally, we design a Multi-Context Feature Fusion Block (MCFB) that efficiently integrates the features using DRSA and DRCA. We train VerteNet on 620 DXA LSIs from various machines and achieve superior results compared to existing methods. We also design an algorithm that utilizes VerteNet's predictions in estimating the Region of Interest (ROI) to detect potential abdominal aorta cropping, where inadequate soft tissue hinders calcification assessment. Additionally, we present a small proof-of-concept study to show that IVGs generated from VLL information can improve inter-reader correlation in AAC scoring, addressing two key areas of disagreement in expert AAC-24 scoring: IVG placement and quality control for full abdominal aorta assessment. The code for this work can be found at https://github.com/zaidilyas89/VerteNet.