RibAssist 3D：基于CT衍生投影的双平面肋骨骨折检测、定位及选择性三维定位

摘要

肋骨骨折在计算机断层扫描（CT）上常见且定位耗时。我们探究了在两张正交CT投影（前后位和侧位）中独立检出的骨折能否跨视图配对并三角化为可靠的3D点，同时将假输出率控制在预设水平；我们通过一项分阶段诊断研究回答了这一问题。投影几何是精确的，且在对应关系正确的前提下，定位是准确的（中位数4.0 mm，88%在10 mm以内，93.6%肋骨定位精确）。在一个封存的55例队列中，原则上很大一部分骨折是可恢复的（61.1%具有双视图可用性，58.4%的骨折在候选图中存在正确配对），但根本限制既非几何也非定位，而是受置信度限制的跨视图对应。一项检测器×对应的受控析因分析将操作增益归因于侧位检测器质量，而非所测试的匹配方法；重新训练侧位检测器产生了首个非零的受控预算重建结果。在刻意保守的承诺策略下，预先指定的封存测试将601处骨折中的15处提升为正确的3D定位，每例0.436个假点（端到端承诺产出率为2.50%），且所承诺的点位准确（中位数1.49 mm，93%肋骨定位精确）。低产出是置信度门控弃权的结果，而非几何或检测问题：该研究建立了一个可复现的选择性3D定位框架，并确定跨视图对应是主要操作瓶颈。

English

Rib fractures are common and time-consuming to localize on computed tomography (CT). We ask whether fractures detected independently in two orthogonal CT-derived projections (anteroposterior and lateral) can be paired across views and triangulated into reliable 3D points at a controlled rate of false outputs, and we answer it with a staged diagnostic study. The projection geometry is exact, and given correct correspondence, localization is accurate (median 4.0 mm, 88% within 10 mm, 93.6% rib-exact). On a sealed 55-case cohort, a large share of fractures is in principle recoverable (61.1% dual-view availability, and a correct pair present in the candidate graph for 58.4% of fractures), yet the binding limitation is neither geometry nor localization but confidence-limited cross-view correspondence. A controlled detector-by-correspondence factorial attributes the operational gain to lateral-detector quality rather than the tested matching methods; retraining the lateral detector produces the first nonzero controlled-budget reconstructions. Under a deliberately conservative commitment policy, a pre-specified sealed pass promotes 15 of 601 fractures to correct 3D localizations at 0.436 false points per case (2.50% end-to-end commitment yield), and committed points are accurate (median 1.49 mm, 93% rib-exact). The low yield is a consequence of confidence-gated abstention, not of geometry or detection: the study establishes a reproducible framework for selective 3D localization and identifies cross-view correspondence as the dominant operational bottleneck.