A New Method To Determine Volumetric Bone Mineral Density From Bi-Planar Dual Energy Radiographs Using A Finite Element Model: An Ex-Vivo Study

Finite element models (FEMs) derived from QCT-scans were developed to evaluate vertebral strength but QCT scanners limitations are restrictive for routine osteoporotic diagnosis. A new approach considers using bi-planar dual energy (BP2E) X-rays absorptiometry to build vertebral FEM. The purpose was to propose a FEM based on BP2E absorptiometry and to compare the vertebral strength predicted from this model to a QCT-based FEM. About 46 vertebrae were QCT scanned and imaged with BP2E X-rays. Subject-specific vertebral geometry and bone material properties were obtained from both medical imaging techniques to build FEM for each vertebra. Vertebral body volumetric bone mineral density (vBMD) distribution and vertebral strength prediction from the BP2E-based FEM and the QCT-based FEM were compared. A statistical error of 7[Formula: see text]mg/cm3 with a RMSE of 9.6% and a [Formula: see text] of 0.83 were found in the vBMD distribution differences between the BP2E-based and qCT-based FEM. The average vertebral strength was 3321[Formula: see text][Formula: see text] and 3768[Formula: see text][Formula: see text][Formula: see text for the qCT-based and BP2E-based FEM, respectively, with a RMSE of 641[Formula: see text]N and [Formula: see text] of 0.92. This method was developed to estimate vBMD distribution in lumbar vertebrae from a pair of 2D-BMD images and demonstrated to be accurate to personalize the mechanical properties in vitro

Vertebral strength prediction from Bi-Planar dual energy x-ray absorptiometry under anterior compressive force using a finite element model: An in vitro study

Finite element models (FEM) derived from qCT-scans were developed as a clinical tool to evaluate vertebral strength. However, the high dose, time and cost of qCT-scanner are limitations for routine osteoporotic diagnosis. A new approach considers using bi-planar dual energy (BP2E) X-rays absorptiometry to build vertebral FEM using synchronized sagittal and frontal plane radiographs. The purpose of this study was to compare the performance of the areal bone mineral density (aBMD) measured from DXA, qCT-based FEM and BP2E-based FEM in predicting experimental vertebral strength. Twenty eight vertebrae from eleven lumbar spine segments were imaged with qCT, DXA and BP2E X-rays before destructively tested in anterior compression. FEM were built based on qCT and BP2E images for each vertebra. Subject-specific FEM were built based on 1) the BP2E images using 3D reconstruction and volumetric BMD distribution estimation and 2) the qCT scans using slice by slice segmentation and voxel based calibration. Linear regression analysis was performed to find the best predictor for experimental vertebral strength (Fexpe); aBMD, modeled vertebral strength and vertebral stiffness. Areal BMD was moderately correlated with Fexpe (R2 = 0.74). FEM calculations of vertebral strength were highly to strongly correlated with Fexpe (R2 = 0.84, p < 0.001 for BP2E model and R2 = 0.95, p < 0.001 for qCT model). The results of this study suggest that aBMD accounted for only 74% of Fexpe variability while FE models accounted for at least 84%. For anterior compressive loading on isolated vertebral bodies, simplistic loading condition aimed to replicate anterior wedge fractures, both FEM were good predictors of Fexpe. Therefore FEM based on BP2E X-rays absorptiometry could be a good alternative to replace qCT-based models in the prediction of vertebral strength. However future work should investigate the performance of the BP2E-based model in vivo in discriminating patients with and without vertebral fracture in a prospective study.The authors would like to thank S. Persohn and M. Jeyasankar for contributing to mechanical testing. The authors would also thank Anabela Darbon, advanced research engineer at EOS Imaging, for EOS® dual energy acquisition and calibration. This work was supported by the Banque Publique d’Investissement through the dexEOS project part of the FUI14. The funding agencies had no role in the design and conduct of the study, in the collection, management, analysis and interpretation of the data, or in the preparation, review, or approval of the manuscript

Subject Specific Finite Element Mesh Generation of the Pelvis from Biplanar X-ray Images: Application to 120 clinical cases

Several Finite Element (FE) models of the pelvis have been developed to comprehensively assess the onset of pathologies and for clinical and industrial applications. However, because of the difficulties associated with the creation of subject-specific FE mesh from CT scan and MR images, most of the existing models rely on the data of one given individual. Moreover, although several fast and robust methods have been developed for automatically generating tetrahedral meshes of arbitrary geometries, hexahedral meshes are still preferred today because of their distinct advantages but their generation remains an open challenge. Recently, approaches have been proposed for fast 3D reconstruction of bones based on X-ray imaging. In this study, we adapted such an approach for the fast and automatic generation of all-hexahedral subject-specific FE models of the pelvis based on the elastic registration of a generic mesh to the subject-specific target in conjunction with element regularity and quality correction. The technique was successfully tested on a database of 120 3D reconstructions of pelvises from biplanar X-ray images. For each patient, a full hexahedral subject-specific FE mesh was generated with an accurate surface representation

Vertebral strength prediction under anterior compressive force using a finite element model for osteoporosis assessment

Vertebral fractures are one of the most common clinical manifestations with the major adverse consequences of osteoporosis as they usually occur under non-traumatic loading conditions. Height loss, back pain and func-tional disability are the most encountered consequences of vertebral fractures with repetitive fracture experience more likely occurring within a year after the first fracture. Early diagnosis of osteoporosis is therefore important for vertebral fracture prevention as drug treatments are more effective before perforation of the trabeculae (Mc Donnell et al. 2007). Bone mineral density (BMD) measured by dual energy X-ray absorptiometry (DXA) is the most clinically used method to diagnose osteopo-rosis. However this technique can only predict 40–70% of vertebral fractures as it only measures areal BMD which does not account for three dimensional (3D) geometry and BMD distribution (Sornay-Rendu et al. 2005). The combination of patient-specific 3D geometry and 3D BMD distribution is necessary to predict vertebral strength. Finite element models (FEM) derived from quantitative computed tomography (qCT) images are used to predict failure strength of vertebral bodies (Crawford et al. 2003; Imai et al. 2006; Buckley et al. 2007). Most of these models were validated under axial compressive forces to the vertebral body while vertebral fractures are more associated with eccentric compres-sion (Lunt et al. 2003). The purpose of this study was to compare the performance of the aBMD from DXA and qCT-based FEM in predicting experimen-tal vertebral strength. The experimental set up allowed for anterior compression testing on isolated vertebral bodies to ensure repeatable loading condition simulat-ing an anterior wedge-shape fracture

A 3D reconstruction method of the body envelope from biplanar X-rays: Evaluation of its accuracy and reliability

The aim of this study was to propose a novel method for reconstructing the external body envelope from the low dose biplanar X-rays of a person. The 3D body envelope was obtained by deforming a template to match the surface profiles in two X-rays images in three successive steps: global morphing to adopt the position of a person and scale the template׳s body segments, followed by a gross deformation and a fine deformation using two sets of pre-defined control points. To evaluate the method, a biplanar X-ray acquisition was obtained from head to foot for 12 volunteers in a standing posture. Up to 172 radio-opaque skin markers were attached to the body surface and used as reference positions. Each envelope was reconstructed three times by three operators. Results showed a bias lower than 7 mm and a confidence interval (95%) of reproducibility lower than 6 mm for all body parts, comparable to other existing methods matching a template onto stereographic photographs. The proposed method offers the possibility of reconstructing body shape in addition to the skeleton using a low dose biplanar X-rays system.The authors thank the ParisTech BiomecAM chair program on subject-specific musculoskeletal modeling, and in particular COVEA and Société Générale. A part of the evaluation was also performed within the support of the dexEOS project part of the FUI14 program. The authors thank Sonia Simoes, Thomas Joubert and Christophe Gatt for their technical assistance

The Athena X-ray Integral Field Unit (X-IFU)

The X-ray Integral Field Unit (X-IFU) is the high resolution X-ray spectrometer of the ESA Athena X-ray observatory. Over a field of view of 5' equivalent diameter, it will deliver X-ray spectra from 0.2 to 12 keV with a spectral resolution of 2.5 eV up to 7 keV on similar to 5 '' pixels. The X-IFU is based on a large format array of super-conducting molybdenum-gold Transition Edge Sensors cooled at similar to 90 mK, each coupled with an absorber made of gold and bismuth with a pitch of 249 mu m. A cryogenic anti-coincidence detector located underneath the prime TES array enables the non X-ray background to be reduced. A bath temperature of similar to 50 mK is obtained by a series of mechanical coolers combining 15K Pulse Tubes, 4K and 2K Joule-Thomson coolers which pre-cool a sub Kelvin cooler made of a He-3 sorption cooler coupled with an Adiabatic Demagnetization Refrigerator. Frequency domain multiplexing enables to read out 40 pixels in one single channel. A photon interacting with an absorber leads to a current pulse, amplified by the readout electronics and whose shape is reconstructed on board to recover its energy with high accuracy. The defocusing capability offered by the Athena movable mirror assembly enables the X-IFU to observe the brightest X-ray sources of the sky (up to Crab-like intensities) by spreading the telescope point spread function over hundreds of pixels. Thus the X-IFU delivers low pile-up, high throughput (> 50%), and typically 10 eV spectral resolution at 1 Crab intensities, i.e. a factor of 10 or more better than Silicon based X-ray detectors. In this paper, the current X-IFU baseline is presented, together with an assessment of its anticipated performance in terms of spectral resolution, background, and count rate capability. The X-IFU baseline configuration will be subject to a preliminary requirement review that is scheduled at the end of 2018. The X-IFU will be provided by an international consortium led by France, the Netherlands and Italy, with further ESA member state contributions from Belgium, Czech Republic, Finland, Germany, Ireland, Poland, Spain, Switzerland and contributions from Japan and the United States.Peer reviewe

Thoraco-lumbar vertebral osteoporotic fracture risk estimation with a patient specific finite element model

L'ostéoporose est une maladie du squelette caractérisée par une perte de la qualité osseuse qui entraîne un risque de fracture accru, notamment au niveau vertébral. Des modèles en éléments finis basés sur la tomodensitométrie permettent d'estimer la résistance vertébrale, et donc le risque de fracture, mais leur utilisation en routine clinique est limitée par le coût et l'irradiation engendrée par la tomodensitométrie. L'estimation la résistance vertébrale à partir d'un modèle en éléments finis basés sur l'imagerie basse dose, telle que l'absorptiométrie biphotonique à rayons X, ou la stéréo-radiographie EOS en double énergie, permettrait une utilisation en routine clinique. Cette thèse contribue au développement de la modélisation à partir de l'imagerie basse dose pour la prédiction du risque de fracture. Un modèle en éléments finis de résistance vertébrale y est évalué par rapport à un modèle basé sur la tomodensitométrie, et une étude de sensibilité identifie les facteurs importants du modèle sont analysés. Des méthodes de maillage hexaédrique morpho-réalistes à partir de la reconstruction 3D, et d'estimation de la distribution de densité à partir d'image 2D de densité y sont développées. De plus, profitant des possibilités du système EOS qui permet de radiographier le patient de la tête aux pieds, une méthode préliminaire est proposée pour estimer l'effort exercé sur les vertèbres in vivo. Nous espérons que nos méthodes pourront être utilisées très prochainement in vivo, et contribuer à l'estimation du risque de fracture ostéoporotique, et à la prise en charge des patients à risque de fracture.Osteoporosis is a bone disease which decreases bone quantity and quality, and increases fracture risk, notably at the vertebral level. CT-scan-based finite element models allow predicting vertebral strength, and thus fracture risk, but their use in routine clinical practice is limited by the cost and accessibility of CT-scan. However, vertebral strength prediction from a finite element model based on low dose images, such as dual X-ray absorptiometry or EOS stereo-radiography in dual energy, would allow a wider use. This PhD thesis contributes to develop fracture risk estimation by such a model. The low dose approach is evaluated in comparison to CT-based finite element model, and a sensitivity study is performed to identify the most important parameters of the model. Hexahedral morpho-realistic meshing techniques from 3D reconstruction and estimation methods for the 3D bone mineral density distribution from low dose images are developed and evaluated. Moreover, taking advantage of EOS system's possibility to take full body radiographs in standing position, a preliminary method is proposed to estimate the load applied to vertebra in vivo. We hope those methods will be used soon in vivo, and will contribute to estimating osteoporotic fracture risk estimation in clinical situations

Estimation du risque de fracture ostéoporotique du rachis thoraco-lombaire par un modèle en élément finis personnalisé

Osteoporosis is a bone disease which decreases bone quantity and quality, and increases fracture risk, notably at the vertebral level. CT-scan-based finite element models allow predicting vertebral strength, and thus fracture risk, but their use in routine clinical practice is limited by the cost and accessibility of CT-scan. However, vertebral strength prediction from a finite element model based on low dose images, such as dual X-ray absorptiometry or EOS stereo-radiography in dual energy, would allow a wider use. This PhD thesis contributes to develop fracture risk estimation by such a model. The low dose approach is evaluated in comparison to CT-based finite element model, and a sensitivity study is performed to identify the most important parameters of the model. Hexahedral morpho-realistic meshing techniques from 3D reconstruction and estimation methods for the 3D bone mineral density distribution from low dose images are developed and evaluated. Moreover, taking advantage of EOS system's possibility to take full body radiographs in standing position, a preliminary method is proposed to estimate the load applied to vertebra in vivo. We hope those methods will be used soon in vivo, and will contribute to estimating osteoporotic fracture risk estimation in clinical situations.L'ostéoporose est une maladie du squelette caractérisée par une perte de la qualité osseuse qui entraîne un risque de fracture accru, notamment au niveau vertébral. Des modèles en éléments finis basés sur la tomodensitométrie permettent d'estimer la résistance vertébrale, et donc le risque de fracture, mais leur utilisation en routine clinique est limitée par le coût et l'irradiation engendrée par la tomodensitométrie. L'estimation la résistance vertébrale à partir d'un modèle en éléments finis basés sur l'imagerie basse dose, telle que l'absorptiométrie biphotonique à rayons X, ou la stéréo-radiographie EOS en double énergie, permettrait une utilisation en routine clinique. Cette thèse contribue au développement de la modélisation à partir de l'imagerie basse dose pour la prédiction du risque de fracture. Un modèle en éléments finis de résistance vertébrale y est évalué par rapport à un modèle basé sur la tomodensitométrie, et une étude de sensibilité identifie les facteurs importants du modèle sont analysés. Des méthodes de maillage hexaédrique morpho-réalistes à partir de la reconstruction 3D, et d'estimation de la distribution de densité à partir d'image 2D de densité y sont développées. De plus, profitant des possibilités du système EOS qui permet de radiographier le patient de la tête aux pieds, une méthode préliminaire est proposée pour estimer l'effort exercé sur les vertèbres in vivo. Nous espérons que nos méthodes pourront être utilisées très prochainement in vivo, et contribuer à l'estimation du risque de fracture ostéoporotique, et à la prise en charge des patients à risque de fracture

Effect of postural alignment alteration with age on vertebral strength

International audiencePurpose. The purpose of this study was to analyze the impact of postural alignment changes with age on vertebral strength using finite element analysis and barycentremetry.Methods. A total of 117 subjects from 20 to 83 years were divided in three age groups: young, (20 to 40 years, 62 subjects), intermediate (40 to 60 years, 26 subjects) and elderly (60 years and over, 29 subjects). EOS biplane radiographs were acquired, allowing 3D reconstruction of the spine and body envelope as well as spinal, pelvic and sagittal alignment parameters measurements. A barycentremetry method allowed estimating of the mass and center of mass (CoM) position of the upper body above L1, relatively to the center of the L1 vertebra (lever arm). To investigate the effect of this lever arm, vertebral strength of a generic finite element models (with constant geometry and mechanical properties for all subjects) was successively computed applying the personalized lever arm of each subject. Results. A combination of an increase in thoracic kyphosis, cervical lordosis and pelvic tilt with a loss of lumbar lordosis was observed between the young and the older groups. Sagittal alignment parameters indicated a more forward position as age increased. The lever arm of the CoM above L1 varied from an average of 1 mm backward for the young group, to averages of 7 and 24 mm forward, respectively for the intermediate and elderly group. As a result, vertebral strength decreased from 2527 N for the young group to 1820 N for the elderly group. Conclusion. The global sagittal alignment modifications observed with age were consistent with the literature. Posture alteration with age reduced vertebral strength significantly in this simplified loading model. Postural alignment seems essential to be considered in the evaluation of osteoporotic patients