Low bone mass estimation: The exhibition of semi-automated approach over the manual method in a comparative perspective with DXA

Abstract

Background: Osteoporosis is an ailment with decremented quality and density of the bone. Bone mineral density measurements were performed by dual energy x-ray absorptiometry (DXA) which is used in the diagnosis of osteoporosis. Objective: The main objectives of the study are (i) To evaluate low bone mass in South Indian women by means of Fuzzy Local Information Clustering Means (FLICM) with respect to diagnosis of low BMD in a comparative perspective with DXA. (ii) To Assess the capability of manual as well as CAD measurements in the evaluation of osteoporosis. Methodology: In this study an semi-automated Computer Aided Diagnosis (CAD) system for osteoporotic risk detection using digital radiographs was presented. The radiograph was intensified, the measured bone indicies such as periosteal and endosteal width were measured and the femur shaft cortical thickness (FS-CCTSA) and percentage cortical thickness of femur shaft FS-CCTSA (%) was calculated. Combined cortical thickness of femur shaft has been used in the derived regression formula to predict total hip BMD (T.BMD) and compared with T.BMD by DXA. Results: The combined cortical thickness of femur shaft of total studied population and the old aged population was strongly correlated (p<0.01) with DXA femur T.BMD measurements. The empirical formula was identified as a better tool for predicting low bone mass in total population and old-aged population with a sensitivity (85.7 and 94.7%), specificity (86.6 and 87.5%), positive predictive value (90 and 94.7%) and negative predictive value (81.2 and 87.5%), respectively. Conclusion: The results suggest that the derived empirical formula is useful and better index than other simple radiogrammetry measurements in the evaluation of low bone mass. An automated CAD tool could be implemented by involving standard conventional digital x-rays of other skeletal sites, namely clavicle and forearm will be useful as a cost effective mass screening tool in the evaluation of low bone mass.