Vertebral morphometry derived from digital images.

Rosol, Michael; Cohen, Gerald; Halpern, E F; Chew, Felix S.; Kattapuram, S V; Palmer, William E.; Dupuy, Damian E.; Rosenthal, D I

doi:10.2214/ajr.167.6.8956594

Cited by 19 publications

(12 citation statements)

References 16 publications

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“…Recent improvements in hardware and software available for digital image processing have led to the development of digital imaging systems for vertebral fracture assessment in osteoporosis studies [2][3][4][5][6]. These systems have the advantage of image enhancement, high-volume throughput and ease of storage and retrieval in clinical drug trials and epidemiologic studies [7][8][9][10]. Original radiographs of the spine are converted to digital images with these systems.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Digitized Images with Original Radiography for Semiquantitative Assessment of Osteoporotic Fractures

Kuijk

et al. 2000

Osteoporosis International

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We validated a vertebral fracture assessment (VFA) workstation developed by our group for semiquantitative assessment of vertebral fractures in large-scale, multicenter osteoporosis drug trials. Baseline and follow-up spine radiographs (lateral views) of 50 patients who participated in a clinical trial were digitized and were archived on CD-ROM. Both original radiographs and the digitized images were independently assessed by three experienced radiologists. Prevalent fracture scores of vertebrae were rated in increments of 1 on a 4-point scale. Incident fractures were defined as any worsening of grade on follow-up films. Generally good to excellent agreement among the three readers was found between the two methods, with kappa scores (kappa) from 0.91 to 0.96 for prevalence of fractures, and from 0.80 to 0.90 for incidence of fractures. Reproducibility (intra-reader variability) of each method was comparable. For assessing prevalent fracture, kappa was from 0.87 to 0.96 using radiographs, and from 0.87 to 0.94 using VFA images. For incident fractures, the kappa was from 0.78 to 0.89 using radiographs, and from 0.82 to 0.88 using VFA images. Level-specific agreement between the two approaches was consistent. Overall, there is no difference between readings of digital images and readings of conventional radiographs. The quality of the new VFA for visualization of vertebral fracture is excellent.

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Section: Introductionmentioning

confidence: 99%

Comparison of Digitized Images with Original Radiography for Semiquantitative Assessment of Osteoporotic Fractures

Kuijk

et al. 2000

Osteoporosis International

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“…Wu et al [13] reported CVs for two observers of 4.2% and 3.8% for anterior heights, 3.9% and 3.1% for central heights, and 2.9% and 3.4% for posterior heights. In a study utilizing a digital technique for morphometric measurements, Rosol et al [9] reported inter-observer precision of about 2% for experienced radiologists. Nicholson et al [8], also using a digital technique, reported a range of interobserver precision for posterior heights of 2.1-5.2% for experienced observers, and 2.9-10.8% for inexperienced observers.…”

Section: Discussionmentioning

confidence: 99%

“…Digital image analysis techniques have only recently been used for vertebral morphometry in clinical trials [9,10,17], and they provide a number of advantages, such as the facility to display previously analyzed images with graphic overlays showing fiducial points. Digitizing tablet techniques have previously been widely used for morphometry, and with this technique, fiducial points for height measurements are registered to coordinates on the tablet surface, not coordinates of the image (pixels).…”

Section: Discussionmentioning

confidence: 99%

“…Digitizing tablet techniques have previously been widely used for morphometry, and with this technique, fiducial points for height measurements are registered to coordinates on the tablet surface, not coordinates of the image (pixels). Rosol et al [9] describe a number of advantages of online morphometry for clinical trials, such as digital image storage, digital display and image manipulation features, and reduced transcription errors due to increased automation. In this report we have described an additional feature of digital methods: the ability to use a computerized tutorial procedure for standardizing training in vertebral morphometry.…”

Section: Discussionmentioning

confidence: 99%

“…Vertebral height measurements obtained with rulers [1][2][3], digitizing tablets [4][5][6][7] and online digital display [8][9][10] have consistently shown intra-and inter-observer precision errors around 2-8%, which persist regardless of measurement technique [11][12][13] and mode of spine image display [8,9,11]. Since incident fracture rates, even in an osteoporotic population, are relatively low (4.0-6.5% in women with existing vertebral deformities [14]), when treatment effects further decrease incidence rates, errors of a few percent in fracture endpoints could potentially affect assessments of treatment efficacy in clinical drug trials in osteoporosis research [15].…”

Section: Introductionmentioning

confidence: 99%

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An Interactive Tutorial-Based Training Technique for Vertebral Morphometry

Gardner

Ingersleben

Heyano

et al. 2001

Osteoporosis International

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The purpose of this work was to develop a computer-based procedure for training technologists in vertebral morphometry. The utility of the resulting interactive, tutorial based training method was evaluated in this study. The training program was composed of four steps: (1) review of an online tutorial, (2) review of analyzed spine images, (3) practice in fiducial point placement and (4) testing. During testing, vertebral heights were measured from digital, lateral spine images containing osteoporotic fractures. Inter-observer measurement precision was compared between research technicians, and between technologists and radiologist. The technologists participating in this study had no prior experience in vertebral morphometry. Following completion of the online training program, good inter-observer measurement precision was seen between technologists, showing mean coefficients of variation of 2.33% for anterior, 2.87% for central and 2.65% for posterior vertebral heights. Comparisons between the technicians and radiologist ranged from 2.19% to 3.18%. Slightly better precision values were seen with height measurements compared with height ratios, and with unfractured compared with fractured vertebral bodies. The findings of this study indicate that self-directed, tutorial-based training for spine image analyses is effective, resulting in good inter-observer measurement precision. The interactive tutorial-based approach provides standardized training methods and assures consistency of instructional technique over time.

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The Radiology of Osteoporotic Vertebral Fractures Revisited

Lentle¹,

Koromani

Brown³

et al. 2019

Journal of Bone and Mineral Research

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Until recently there has been little evidence available to validate any method by which to make an accurate diagnosis of an osteoporotic vertebral fractures (OVFs) from plain radiographs. In part this reflects a lack of a completely satisfactory “gold standard,” but primarily it relates to the absence of well‐designed prospective studies in this context. Historically, OVFs were recognized by evidence of macroscopic structural failure in vertebrae using the criteria applied elsewhere in the skeleton. This comprised altered alignment, fragmentation, cortical disruptions, and breaks, among other changes. However, these morphological criteria were replaced by vertebral morphometry, referring to the use of quantitative or quasi‐quantitative measurement tools for fracture diagnosis. Vertebral morphometry emerged as an understanding of and treatment for osteoporosis evolved, mainly in response to the need for expeditious assessments of large numbers of spine images for epidemiological and pharmaceutical purposes. Although most of the descriptions of such morphometric tools have stressed that they were not to be applied to clinical diagnosis with respect to individual patients, this constraint has been widely disregarded. Here we review the major attempts to develop a diagnostic strategy for OVF and describe their characteristics in adults and children. Recent evidence suggests that morphometric (quantitative; ie, based on measurement of dimensions and shape description) criteria are inferior to morphologic (qualitative; ie, based on structural integrity) vertebral damage assessment in identifying people with low bone density and at an increased risk of future fracture. Thus there is now an evidentiary basis for suggesting that morphological assessment is the preferred strategy for use in diagnosing OVF from radiographs. © 2019 American Society for Bone and Mineral Research.

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Vertebral morphometry derived from digital images.

Cited by 19 publications

References 16 publications

Comparison of Digitized Images with Original Radiography for Semiquantitative Assessment of Osteoporotic Fractures

Comparison of Digitized Images with Original Radiography for Semiquantitative Assessment of Osteoporotic Fractures

An Interactive Tutorial-Based Training Technique for Vertebral Morphometry

The Radiology of Osteoporotic Vertebral Fractures Revisited

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