Mr. Nikolaos Tsaousis Profile

Nikolaos Tsaousis

at Univ of Cambridge

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Proceedings Article | 28 February 2013 Paper

Cortical thickness estimation of the proximal femur from multi-view dual-energy X-ray absorptiometry (DXA)

N. Tsaousis, A. Gee, G. Treece, K.E.S. Poole

Proceedings Volume 8670, 86700B (2013) https://doi.org/10.1117/12.2006389

KEYWORDS: Dual energy x-ray absorptiometry, X-rays, X-ray computed tomography, Error analysis, Bone, Gold, Reconstruction algorithms, Standards development, Computed tomography, Statistical analysis

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Hip fracture is the leading cause of acute orthopaedic hospital admission amongst the elderly, with around a third of patients not surviving one year post-fracture. Although various preventative therapies are available, patient selection is difficult. The current state-of-the-art risk assessment tool (FRAX) ignores focal structural defects, such as cortical bone thinning, a critical component in characterizing hip fragility. Cortical thickness can be measured using CT, but this is expensive and involves a significant radiation dose. Instead, Dual-Energy X-ray Absorptiometry (DXA) is currently the preferred imaging modality for assessing hip fracture risk and is used routinely in clinical practice. Our ambition is to develop a tool to measure cortical thickness using multi-view DXA instead of CT. In this initial study, we work with digitally reconstructed radiographs (DRRs) derived from CT data as a surrogate for DXA scans: this enables us to compare directly the thickness estimates with the gold standard CT results. Our approach involves a model-based femoral shape reconstruction followed by a data-driven algorithm to extract numerous cortical thickness point estimates. In a series of experiments on the shaft and trochanteric regions of 48 proximal femurs, we validated our algorithm and established its performance limits using 20 views in the range 0°–171°: estimation errors were 0:19 ± 0:53mm (mean +/- one standard deviation). In a more clinically viable protocol using four views in the range 0°–51°, where no other bony structures obstruct the projection of the femur, measurement errors were −0:07 ± 0:79 mm.

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