Opportunistic tool for immediate assessment of bone mineral density

BACKGROUND CONTEXT: While the role of several spinal radiographic measurements on patients’ spinal health, surgical planning, and outcome prediction has been investigated, the role of BMD values in treatment of spinal condition is not well documented. A hindering factor in systematically including BMD in patients’ clinical care is additional imaging requirements, increasing operational burden and insurance policies associated with increased costs. A BMD measurement technology integrated in clinical a radiography system can alleviate this shortcoming. PURPOSE: Bone mineral density (BMD) values of lumbar spine, calculated using stereoradiography dual energy system, are significantly correlated with DXA BMD measurements. STUDY DESIGN/SETTING: Cadaveric study. PATIENT SAMPLE: N/A OUTCOME MEASURES: N/A METHODS: A total of 36 adult cadaveric torsos were scanned twice with a low dose stereoradiography system (72 scans) and once with DXA. An automated segmentation method identified vertebral bodies in the radiography system, while a technician manually adjusted the pre-determined boundary of the vertebrae in DXA. Stereoradiography frontal (L1-L4) BMD value in mono (only PA view) and bi-plane images (both PA and lateral images) and DXA images were calculated for both systems and compared statistically. The repeatability of the BMD measured in the stereoradiography system was evaluated. RESULTS: There were 22 male and 14 female specimens were included. A total of 222 vertebral bodies were segmented. A significant correlation was observed for both mono- and bi-plane acquisition modes compared to DXA scans, R2=0.92 and R2=0.90, p<0.05, respectively. ANOVA analysis for repeatability assessment resulted in F=0.001 and p=0.977, showing no statistically significant differences between the repeated measurements. The mean and standard deviation of the differences between repeated BMD values measured in the stereoradiography system were 0.001 (g/cm2) and 0.058 (g/cm2) respectively. CONCLUSIONS: The dual energy stereoradiography system offers opportunistic monitoring of BMD as part of routine clinical evaluation of spine. The BMD measurements of the stereoradiography system were strongly comparable to the DXA BMD measurements. The repeatability of the stereoradiography system showed minimal differences between multiple measurements of the same dataset. FDA Device/Drug Status: Stereoradiography with dual energy (Investigational/Not Approved).

Duke Scholars

Author Christopher Ignatius Shaffrey Orthopaedic Surgery