Assessment of Bone Health via Digital Wrist Tomosynthesis in Mammography Setting
Abstract
The proposed project relates to the Topic Area “Musculoskeletal Health” because it aims at improving diagnosis of bone fragility and assessment of fracture risk. The encouragement area of research on measures to improve diagnosis and prevention of chronic disorders is addressed. Bone fractures attributable to osteoporosis are a significant problem. Though preventative treatment options are available for individuals who are at risk of a fracture, a substantial number of at-risk individuals are never identified due to lack of adherence to bone screening recommendations. The issue is further complicated because bone mineral density (BMD) derived from dual energy x-ray absorptiometry (DXA), the current standard diagnosis of osteoporosis, has limited accuracy in predicting risk of fracture. This proposal aims to improve both prevalence of osteoporosis screening and accuracy of fracture prediction in a single solution. The long-term goal of this research program is to help prevent osteoporotic fractures through development of effective means for bone assessment. Digital tomosynthesis (DTS) is a technique that allows for a 3D examination of an object using a series of detailed images, each of which is focused on a different plane of the object and acquired during a single scan. DTS scanners are widely available in mammography clinics because this technique has become a standard for breast cancer screening. Our preliminary data indicate that density, microstructural and geometric properties of the wrist bones can be measured using DTS with high precision and strongly correlate with reference measurements from DXA and high-resolution laboratory imaging methods. Our preliminary data with human subjects further demonstrate that digital wrist tomosynthesis (DWT) is straightforward and safe in the clinic, and the measurements are consistent with the expected trends in bone properties that occur with aging. Given the high adherence to breast cancer screening, the technical feasibility of the method, and the readily available nature of DWT in the clinic, our overall hypothesis is that bone assessment via DWT in a mammography setting will provide effective means to improve bone screening, if offered together with breast screening. The overall objective of the current proposal is to identify the technical and systemic implementation steps needed for this readily translatable approach through three aims. In the first aim of this project, we will measure bone density using DWT, identify measurements that are equivalent to DXA-based bone density in terms of diagnostic accuracy, and determine cutoff values for diagnosis of osteoporosis. These results will be important to determine the extent to which current screening practices for osteoporosis can be performed in the mammography environment where screening adherence can be maintained at recommended levels. In the second aim, we will determine the extent to which DWT can separate subjects with established osteoporotic fractures from those subjects without a fracture, independently from BMD. Since we can measure bone microstructure and geometry in addition to bone quantity using DWT, we expect these measurements will be more accurate than BMD alone in predicting who is likely to have an osteoporotic fracture. These results are important in making decisions regarding whether to adapt the existing BMD-based diagnostic practices to the mammography and women’s health clinics (i.e., apply those established in the first aim) vs. implement newer diagnostic criteria that will include measurements other than bone density. The decision whether to extend the method to populations other than women scheduled to receive mammography will also largely depend on the results of this aim. These populations include men (who would normally never receive services in the mammography clinic) and individuals who are not receiving mammography but have disorders where BMD is insufficient for fracture assessmen
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110530
Entities
People
- Yener Yeni
Organizations
- Henry Ford Health
- United States Army