Yves Martelli, Tristan Whitmarsh, Ludovic Humbert, François Chung, Luis M. del Río Barquero, Silvana Di Gregorio, Luigi Carotenuto, Alejandro F. Frangi; A software framework for 3D reconstruction and fracture risk assessment of the proximal femur from dual-energy x-ray absorptiometry; VPH 2012: Virtual Physiological Human - Integrative approaches to computational biomedicine, London, 2012.
In clinical routine, osteoporosis diagnosis is performed using the areal Bone Mineral Density (aBMD) computed from two-dimensional Dual-energy X-ray Absorptiometry (DXA) images. This measurement of the "projected density" gives a global marker of osteoporosis but is insufficient for an accurate quantification of non-uniform mineral deficiencies. Quantitative Computed Tomography (QCT) is one possible modality for retrieving shape and bone mineral density measurements in 3D, leading to a better characterization of the local bone quality and the fracture risk. However, due to high financial costs and a high radiation dose for the patient, this modality is rarely used in clinical routine for the follow-up of osteoporosis. In this work, we show how state-of-the-art techniques and methods for fracture risk assessment of the proximal femur using 3D analysis from single-view DXA images were brought to the research and clinical end-user, through the use of an existing open source framework for fast prototyping of clinical applications.