Hand X-ray absorptiometry for measurement of bone mineral density on a slot-scanning X-ray imaging system

Includes bibliographical references.Bone mineral density (BMD) is an indicator of bone strength. While femoral and spinal BMDs are traditionally used in the management of osteoporosis, BMD at peripheral sites such as the hand has been shown to be useful in evaluating fracture risk for axial sites. These peripheral locations have been suggested as alternatives to the traditional sites for BMD measurement. Dual-energy X-ray absorptiometry (DXA) is the gold standard for measuring BMD due to low radiation dose, high accuracy and proven ability to evaluate fracture risk. Computed digital absorptiometry (CDA) has also been shown to be very effective at measuring the bone mass in hand bones using an aluminium step wedge as a calibration reference. In this project, the aim was to develop algorithm s for accurate measurement of BMD in hand bones on a slot - scanning digital radiography system. The project assess e d the feasibility of measuring bone mineral mass in hand bones using CDA on the current system. Images for CDA - based measurement were acquired using the default settings on the system for a medium sized patient. A method for automatic processing of the hand images to detect the aluminium step wedge, included in the scan for calibration, was developed and the calibration accuracy of the step wedge was evaluated. The CDA method was used for computation of bone mass with units of equivalent aluminium thickness (mmA1). The precision of the method was determined by taking three measurements in each of 1 6 volunteering subjects and computing the root - mean - square coefficient of variation (CV) of the measurements. The utility of the method was assessed by taking measurements of excised bones and assessing the correlation between the measured bone mass and ash weight obtained by incinerating the bones. The project also assessed the feasibility of implementing a DXA technique using two detectors in a slot-scanning digital radiography system to acquire dual-energy X-ray images for measuring areal and volumetric BMD of the middle phalanx of the middle finger. The dual-energy images were captured in two consecutive scans. The first scan captured the low- energy image using the detector in its normal set-up. The second scan captured the high- energy image with the detector modified to include an additional scintillator to simulate the presence of a second detector that would capture the low-energy image in a two-detector system. Scan parameters for acquisition of the dual-energy images were chosen to optimise spectral separation, entrance dose and image quality. Simulations were carried out to evaluate the spectral separation of the low- and high-energy spectra

Nanoroughness, Surface Chemistry and Drug Delivery Control by Atmospheric Plasma Jet on Implantable Devices

Implantable devices need specific tailored surface morphologies and chemistries to interact with the living systems or to actively induce a biological response also by the release of drugs or proteins. These customised requirements foster technologies that can be implemented in additive manufacturing systems. Here we present a novel approach based on spraying processes that allows to control separately topographic features in the submicron range ( 3d 60 nm - 2 \ub5m), ammine or carboxylic chemistry and fluorophore release even on temperature sensitive biodegradable polymers such as polycaprolactone (PCL). We developed a two-steps process with a first deposition of 220 nm silica and poly(lactic-co-glycolide) (PLGA) fluorescent nanoparticles by aerosol followed by the deposition of a fixing layer by atmospheric pressure plasma jet (APPJ). The nanoparticles can be used to create the nano-roughness and to include active molecule release, while the capping layer ensures stability and the chemical functionalities. The process is enabled by a novel APPJ which allows deposition rates of 10 - 20 nm\ub7s-1 at temperatures lower than 50 \ub0C using argon as process gas. This approach was assessed on titanium alloys for dental implants and on PCL films. The surfaces were characterized by FT-IR, AFM and SEM. Titanium alloys were tested with pre-osteoblasts murine cells line, while PCL film with fibroblasts. Cell behaviour was evaluated by viability and adhesion assays, protein adsorption, cell proliferation, focal adhesion formation and SEM. The release of a fluorophore molecule was assessed in the cell growing media, simulating a drug release. Osteoblast adhesion on the plasma treated materials increased by 20% with respect to commercial titanium alloys implants. Fibroblast adhesion increased by a 100% compared to smooth PCL substrate. The release of the fluorophore by the dissolution of the PLGA nanoparticles was verified and the integrity of the encapsulated drug model confirmed

Automated Analysis of Metacarpal Cortical Thickness in Serial Hand Radiographs

To understand the roles of various genes that influence skeletal bone accumulation and loss, accurate measurement of bone mineralization is needed. However, it is a challenging task to accurately assess bone growth over a person\u27s lifetime. Traditionally, manual analysis of hand radiographs has been used to quantify bone growth, but these measurements are tedious and may be impractical for a large-scale growth study. The aim of this project was to develop a tool to automate the measurement of metacarpal cortical bone thickness in standard hand-wrist radiographs of humans aged 3 months to 70+ years that would be more accurate, precise and efficient than manual radiograph analysis. The task was divided into two parts: development of automatic analysis software and the implementation of the routines in a Graphical User Interface (GUI). The automatic analysis was to ideally execute without user intervention, but we anticipated that not all images would be successfully analyzed. The GUI, therefore, provides the interface for the user to execute the program, review results of the automated routines, make semi-automated and manual corrections, view the quantitative results and growth trend of the participant and save the results of all analyses. The project objectives were attained. Of a test set of about 350 images from participants in a large research study, automatic analysis was successful in approximately 75% of the reasonable quality images and manual intervention allowed the remaining 25% of these images to be successfully analyzed. For images of poorer quality, including many that the Lifespan Health Research Center (LHRC) clients would not expect to be analyzed successfully, the inputs provided by the user allowed approximately 80% to be analyzed, but the remaining 20% could not be analyzed with the software. The developed software tool provides results that are more accurate and precise than those from manual analyses. Measurement accuracy, as assessed by phantom measurements, was approximately 0.5% and interobserver and intraobserver agreement were 92.1% and 96.7%, respectively. Interobserver and intraobserver correlation values for automated analysis were 0.9674 and 0.9929, respectively, versus 0.7000 and 0.7820 for manual analysis. The automated analysis process is also approximately 87.5% more efficient than manual image analysis and automatically generates an output file containing over 160 variables of interest. The software is currently being used successfully to analyze over 17,000 images in a study of human bone growth

Dosimetry tools and techniques for IMRT

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98734/1/MPH001313.pd

Radiostereometric analysis of initial femoral stem migration in cementless total hip arthroplasty of postmenopausal women : Exploring contributing factors in initial femoral stem migration

In cementless total hip arthroplasty (THA), femoral stems rely on the initial press‐fit fixation against the cortical bone to achieve osseointegration. In aging women, structural changes of the proximal femur may jeopardize the stem stability. Preoperative screening of bone quality and exploring the factors that cause stem migration may help in the selection process of patients for the use of cementless fixation techniques. Antiresorptive denosumab therapy might be efficient in preventing periprosthetic bone loss and reducing femoral stem migration in postmenopausal women. Sixty-five postmenopausal women with primary hip osteoarthritis (60 to 85 years old and Dorr A-type or B-type femur morphology) underwent cementless THA with implantation of a parallel-sided femoral component in a randomized double-blind placebo-controlled trial. The patients randomly received denosumab or a placebo 1 month before and 5 months after the surgery. The three-dimensional stem migration was measured using model-based radiostereometric analysis (RSA). Patient’s baseline characteristics, local and systemic bone mineral density (BMD) values measured by dual-energy X-ray absorptiometry (DXA), cortical-bone thicknes measured by pulse-echo ultrasonometry, surgery-related factors, and postoperative walking activity were examined for the association with stem migration. The accuracy and clinical precision of model-based RSA were comparable to those of marker-based RSA. Denosumab significantly decreased periprosthetic bone loss but did not reduce stem migration which occurred predominately during the first 3 months. DXA and pulse-echo ultrasonometry of the distal radius helped to identify patients at high risk of stem subsidence of more than 2 mm. Walking activity and local BMD dictated the direction and magnitude of stem rotation around y-axis. Femoral stem stability is sensitive to adequate bone stock. In postmenopausal women, stem migration is predominantly due to impaired bone quality. Inhibition of periprosthetic bone resorption did not prevent stem migration. Preoperative evaluation of the skeletal status is recommended for all postmenopausal women with hip osteoarthritis before scheduling cementless THA.Lonkan tekonivelen biologinen kiinnittyminen ikääntyvillä naisilla: varsiosan liikkeen radiostereometrinen analyysi Sementitön lonkan tekonivelleikkaus perustuu implantin biologiseen kiinnittymiseen. Kantavan varsiosan luutuminen edellyttää, että implantti saadaan leikkauksessa tukevasti paikoilleen kuoriluuta vasten. Tämän saavuttaminen voi olla vaikeaa naisilla, joille on kehittynyt vaihdevuosien jälkeen reisiluun kuoriluun ohentumista ja huokoistumista. Tästä johtuen on tärkeää selvittää ennen leikkausta potilaan luuston kunto. On myös arvioitava muita tekijöitä, jotka voivat lisätä varsiosan liikettä. Ennen leikkausta aloitettu luukatoa estävä lääkitys voi vahvistaa kuoriluuta ja näin parantaa varsiosan tukevuutta. Satunnaistettuun kliiniseen potilastutkimukseen osallistui 65 lonkan nivelrikkoa sairastavaa naispotilasta (keski-ikä 69 vuotta). Potilaille tehtiin sementitön lonkan tekonivelleikkaus. Ennen leikkausta aloitettiin luulääkitys (denosumabi), jonka tiedetään vahvistavan reisiluun kuoriluuta osteoporoosia sairastavilla naisilla. Potilaiden subjektiivista toipumista seurattiin kuvaavilla kyselykaavakkeilla ja myös objektiivisilla mittauksilla (kävelynopeus, kävelyaktiviteetti, luuntiheysmittaus, kuoriluun ultraäänimittaus ja luuaineenvaihdunnan merkkiaineet). Varsiosan kolmiulotteista liikettä seurattiin 3D-mallinnukseen perustuvalla radiostereometrisellä analyysillä. Menetelmän tarkkuus ja toistettavuus varmistettiin prekliinisessä kokeessa muoviluumalleilla. Lääkehoito esti reisiluun yläosan paikallisen luukadon varsiosan ympärillä, mutta se ei vähentänyt varsiosan painumista ja kiertymistä. Liikettä tapahtui ensimmäisten kuukausien aikana leikkauksesta. Varsiosat luutuivat ja hoitoryhmien välillä ei ollut eroa kliinisessä toipumisessa. Ennen leikkausta tehty ranteen kuoriluun paksuuden ultraäänimittaus (Bindex®) ja luuntiheysmittaus auttoivat tunnistamaan kohtalaisen hyvin ne potilaat, joille kehittyi varsiosan yli 2 mm painuminen leikkauksen jälkeen. Varsiosan kiertymisen suunta ja määrä heijastivat kävelyaktiivisuutta leikkauksen jälkeen. Tulokset vahvistivat aiempia tuloksia, että biologisesti kiinnittyvä lonkan tekonivelen varsiosa vaatii hyvää luuainesta. Luulääkkeellä (denosumabi) voidaan estää paikallista luukatoa, mutta luuresorption esto ei vähennä varsiosan alkuvaiheen liikettä. Luuston kunnon seulontaa suositellaan kaikille vaihevuosi-iän ohittaneille naisille, joille suunnitellaan sementitöntä lonkan tekonivelleikkausta

The relevance of biomaterials to the prevention and treatment of osteoporosis

Osteoporosis is a worldwide disease with a very high prevalence in humans older than 50. The main clinical consequences are bone fractures, which often lead to patient disability or even death. A number of commercial biomaterials are currently used to treat osteoporotic bone fractures, but most of these have not been specifically designed for that purpose. Many drug- or cell-loaded biomaterials have been proposed in research laboratories, but very few have received approval for commercial use. In order to analyze this scenario and propose alternatives to overcome it, the Spanish and European Network of Excellence for the Prevention and Treatment of Osteoporotic Fractures, ‘‘Ageing’’, was created. This network integrates three communities, e.g. clinicians, materials scientists and industrial advisors, tackling the same problem from three different points of view. Keeping in mind the premise ‘‘living longer, living better’’, this commentary is the result of the thoughts, proposals and conclusions obtained after one year working in the framework of this network