Infrared Imaging Empowered by Artificial Intelligence for Pediatric Skeletal Triage: A Narrative Review and Future Perspectives

Abstract

Background. Pediatric musculoskeletal trauma represents up to 18% of pediatric ED visits, yet diagnosis still depends on ionizing radiography. Cumulative low-dose radiation in early life raises lifetime leukemia and brain malignancy risk, motivating radiation-free triage alternatives. Objective. To synthesize evidence for a hybrid framework coupling broad-spectrum infrared (IR) imaging with deep-learning cross-modal translation to generate clinically interpretable synthetic-radiograph reconstructions from non-ionizing data. Approach. We review five IR spectral windows spanning 650 nm to 1 mm - NIR-I, NIR-II, SWIR, MIR/LWIR, and THz - and how dual-geometry (transmission/reflection) acquisition exploits wavelength-specific tissue depth and biochemical sensitivity. We summarize image-to-image translation networks (Pix2Pix, CycleGAN, Swin-Unet) and feature-matching algorithms (SuperPoint, SuperGlue, ALIKED, LightGlue) used to align and fuse IR data into radiograph-equivalent reconstructions. Implications. Pediatric anatomy - smaller cross-sections, thinner cortical bone - favors IR penetration, enabling compact, portable, non-ionizing triage hardware. Feasibility is grounded in fNIRS and transcranial photobiomodulation evidence: near-infrared light passes through skin, skull, and cortex with sufficient signal for hemodynamic monitoring - a longer, more attenuating path than through a pediatric forearm or distal leg. Key barriers: paired IR/X-ray dataset construction, AI-as-medical-device regulatory pathways, generalization across body habitus and skin pigmentation, and acquisition-protocol standardization. Conclusions. Integrated multi-spectral IR+AI imaging is a promising radiation-free complement to pediatric skeletal radiography. Progress requires multi-center paired datasets, externally validated models, and IR source safety qualification under IEC 60825-1.