Increasing radiologist workloads and increasing primary care radiology services make it relevant to explore the use of artificial intelligence (AI) and particularly deep learning to provide diagnostic assistance to radiologists and primary care physicians in improving the quality of patient care. This study investigates new model architectures and deep transfer learning to improve the performance in detecting abnormalities of upper extremities while training with limited data. DenseNet-169, DenseNet-201, and InceptionResNetV2 deep learning models were implemented and evaluated on the humerus and finger radiographs from MURA, a large public dataset of musculoskeletal radiographs. These architectures were selected because of their high recognition accuracy in a benchmark study. The DenseNet-201 and InceptionResNetV2 models, employing deep transfer learning to optimize training on limited data, detected abnormalities in the humerus radiographs with 95% CI accuracies of 8392% and high sensitivities greater than 0.9, allowing for these models to serve as useful initial screening tools to prioritize studies for expedited review. The performance in the case of finger radiographs was not as promising, possibly due to the limitations of large inter-radiologist variation. It is suggested that the causes of this variation be further explored using machine learning approaches, which may lead to appropriate remediation.
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