Effects of dose reduction on bone strength prediction using finite element analysis

Anitha, D; Subburaj, Karupppasamy; Mei, Kai; Kopp, Felix K.; Foehr, Peter; Noël, Peter B.; Kirschke, Jan S.; Baum, Thomas

doi:10.1038/srep38441

Cited by 20 publications

(23 citation statements)

References 43 publications

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“…The whole femur CT scan protocol recommended by the CT2S service 4 involves an effective radiation dose in the range of 1.9–4.8 mSv for males and 1.3–3.2 mSv for females. A recent study on the effect of reducing the X-ray energy on the predictive accuracy of QCT-SSFE of vertebral bodies suggests that even more aggressive reductions can be adopted without any significant loss of predictive accuracy [ 40 ].…”

Section: Introductionmentioning

confidence: 99%

Are CT-Based Finite Element Model Predictions of Femoral Bone Strengthening Clinically Useful?

Viceconti

Qasim

Bhattacharya

et al. 2018

Curr Osteoporos Rep

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Purpose of ReviewThis study reviews the available literature to compare the accuracy of areal bone mineral density derived from dual X-ray absorptiometry (DXA-aBMD) and of subject-specific finite element models derived from quantitative computed tomography (QCT-SSFE) in predicting bone strength measured experimentally on cadaver bones, as well as their clinical accuracy both in terms of discrimination and prediction. Based on this information, some basic cost-effectiveness calculations are performed to explore the use of QCT-SSFE instead of DXA-aBMD in (a) clinical studies with femoral strength as endpoint, (b) predictor of the risk of hip fracture in low bone mass patients.Recent FindingsRecent improvements involving the use of smooth-boundary meshes, better anatomical referencing for proximal-only scans, multiple side-fall directions, and refined boundary conditions increase the predictive accuracy of QCT-SSFE.SummaryIf these improvements are adopted, QCT-SSFE is always preferable over DXA-aBMD in clinical studies with femoral strength as the endpoint, while it is not yet cost-effective as a hip fracture risk predictor, although pathways that combine both QCT-SSFE and DXA-aBMD are promising.

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Section: Introductionmentioning

confidence: 99%

Are CT-Based Finite Element Model Predictions of Femoral Bone Strengthening Clinically Useful?

Viceconti

Qasim

Bhattacharya

et al. 2018

Curr Osteoporos Rep

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“…Early, accurate, and efficient bone density assessment is mandatory to tailor and monitor the clinical treatment of, e.g., osteoporosis 5,6,47 . It has been shown that patient-specific FEA that utilizes QCT for material property identification is beneficial over DXA-based BMD measurement for diagnosis and medication effect assessment in osteoporotic patients 2,3,29,30 .…”

Section: Discussionmentioning

confidence: 99%

Neuro-musculoskeletal flexible multibody simulation yields a framework for efficient bone failure risk assessment

Geier

Kebbach

Soodmand

et al. 2019

Sci Rep

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Fragility fractures are a major socioeconomic problem. A non-invasive, computationally-efficient method for the identification of fracture risk scenarios under the representation of neuro-musculoskeletal dynamics does not exist. We introduce a computational workflow that integrates modally-reduced, quantitative CT-based finite-element models into neuro-musculoskeletal flexible multibody simulation (NfMBS) for early bone fracture risk assessment. Our workflow quantifies the bone strength via the osteogenic stresses and strains that arise due to the physiological-like loading of the bone under the representation of patient-specific neuro-musculoskeletal dynamics. This allows for non-invasive, computationally-efficient dynamic analysis over the enormous parameter space of fracture risk scenarios, while requiring only sparse clinical data. Experimental validation on a fresh human femur specimen together with femur strength computations that were consistent with literature findings provide confidence in the workflow: The simulation of an entire squat took only 38 s CPU-time. Owing to the loss (16% cortical, 33% trabecular) of bone mineral density (BMD), the strain measure that is associated with bone fracture increased by 31.4%; and yielded an elevated risk of a femoral hip fracture. Our novel workflow could offer clinicians with decision-making guidance by enabling the first combined in-silico analysis tool using NfMBS and BMD measurements for optimized bone fracture risk assessment.

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“…On the other hand, Anitha et al . showed that radiation dose (by tube exposure reduction) could be reduced to 64% with no impact on strength estimates obtained from finite-element- (FE-) analysis and no significant difference in volume quantification 32 . Evidence of the dose reduction potential of IR is also provided by other studies of musculoskeletal CT: Geravaise et al .…”

Section: Discussionmentioning

confidence: 99%

Bone mineral density assessment using iterative reconstruction compared with quantitative computed tomography as the standard of reference

Mann

Ziegeler

Mews

et al. 2018

Sci Rep

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This study examines the influence of iterative reconstruction on bone mineral density (BMD) measurement by comparison with standard quantitative computed tomography (QCT; reference) and two other protocols based on filtered back projection. Ten human cadaver specimens of the lumbar spine with a hydroxyapatite calibration phantom underneath, were scanned with 4 protocols: 1. standard QCT, 2. volume scan with FBP, 3. helical scan with FBP, and 4. helical scan with IR (Adaptive Iterative Dose Reduction 3D (AIDR3D)). Radiation doses were recorded as CT dose index (CTDIvol) and BMD, signal-to-noise and contrast-to-noise ratio were calculated. Mean hydroxyapatite concentration (HOA) did not differ significantly between protocols, ranging from 98.58 ± 31.09 mg cm3 (protocol 4) to 100.47 ± 30.82 mg cm3 (protocol 2). Paired sample correlations of HOA values for protocol 4 and protocols 1, 2 and 3 were nearly perfect with coefficients of 0.980, 0.979 and 0.982, respectively (p < 0.004). CTDIvol were 7.50, 5.00, 6.82 (±2.03) and 1.72 (±0.50) mGy for protocols 1, 2, 3 and 4 respectively. Objective image quality was highest for protocol 4. The use of IR for BMD assessment significantly lowers radiation exposure compared to standard QCT and protocols with FBP while not degrading BMD measurement.

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Effects of dose reduction on bone strength prediction using finite element analysis

Cited by 20 publications

References 43 publications

Are CT-Based Finite Element Model Predictions of Femoral Bone Strengthening Clinically Useful?

Are CT-Based Finite Element Model Predictions of Femoral Bone Strengthening Clinically Useful?

Neuro-musculoskeletal flexible multibody simulation yields a framework for efficient bone failure risk assessment

Bone mineral density assessment using iterative reconstruction compared with quantitative computed tomography as the standard of reference

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