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Proximal femur segmentation and quantification in dual-energy subtraction tomosynthesis: A novel approach to fracture risk assessment.

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Title: Proximal femur segmentation and quantification in dual-energy subtraction tomosynthesis: A novel approach to fracture risk assessment.
Authors: Matsushima, Akari1 (AUTHOR) matsushima_a@med.teikyo-u.ac.jp, Chen, Tai-Been1 (AUTHOR), Kimura, Koharu1 (AUTHOR), Sato, Mizuki2 (AUTHOR), Hsu, Shih-Yen3 (AUTHOR), Okamoto, Takahide1 (AUTHOR) matsushima_a@med.teikyo-u.ac.jp
Source: Journal of X-Ray Science & Technology. Mar2025, Vol. 33 Issue 2, p405-419. 15p.
Subjects: Convolutional neural networks, Bone densitometry, Bone density, Tomosynthesis, Older people, Femur, Dual-energy X-ray absorptiometry
Abstract: Background: Osteoporosis is a major public health concern, especially among older adults, due to its association with an increased risk of fractures, particularly in the proximal femur. These fractures severely impact mobility and quality of life, leading to significant economic and health burdens. Objective: This study aims to enhance bone density assessment in the proximal femur by addressing the limitations of conventional dual-energy X-ray absorptiometry through the integration of tomosynthesis with dual-energy applications and advanced segmentation models. Methods and Materials: The imaging capability of a radiography/fluoroscopy system with dual-energy subtraction was evaluated. Two phantoms were included in this study: a tomosynthesis phantom (PH-56) was used to measure the quality of the tomosynthesis images, and a torso phantom (PH-4) was used to obtain proximal femur images. Quantification of bone images was achieved by optimizing the energy subtraction (ene-sub) and scale factors to isolate bone pixel values while nullifying soft tissue pixel values. Both the faster region-based convolutional neural network (Faster R-CNN) and U-Net were used to segment the proximal femoral region. The performance of these models was then evaluated using the intersection-over-union (IoU) metric with a torso phantom to ensure controlled conditions. Results: The optimal ene-sub-factor ranged between 1.19 and 1.20, and a scale factor of around 0.1 was found to be suitable for detailed bone image observation. Regarding segmentation performance, a VGG19-based Faster R-CNN model achieved the highest mean IoU, outperforming the U-Net model (0.865 vs. 0.515, respectively). Conclusions: These findings suggest that the integration of tomosynthesis with dual-energy applications significantly enhances the accuracy of bone density measurements in the proximal femur, and that the Faster R-CNN model provides superior segmentation performance, thereby offering a promising tool for bone density and osteoporosis management. Future research should focus on refining these models and validating their clinical applicability to improve patient outcomes. [ABSTRACT FROM AUTHOR]
Copyright of Journal of X-Ray Science & Technology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Proximal femur segmentation and quantification in dual-energy subtraction tomosynthesis: A novel approach to fracture risk assessment.
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  Data: <searchLink fieldCode="AR" term="%22Matsushima%2C+Akari%22">Matsushima, Akari</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> matsushima_a@med.teikyo-u.ac.jp</i><br /><searchLink fieldCode="AR" term="%22Chen%2C+Tai-Been%22">Chen, Tai-Been</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kimura%2C+Koharu%22">Kimura, Koharu</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sato%2C+Mizuki%22">Sato, Mizuki</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hsu%2C+Shih-Yen%22">Hsu, Shih-Yen</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Okamoto%2C+Takahide%22">Okamoto, Takahide</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> matsushima_a@med.teikyo-u.ac.jp</i>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+X-Ray+Science+%26+Technology%22">Journal of X-Ray Science & Technology</searchLink>. Mar2025, Vol. 33 Issue 2, p405-419. 15p.
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  Data: <searchLink fieldCode="DE" term="%22Convolutional+neural+networks%22">Convolutional neural networks</searchLink><br /><searchLink fieldCode="DE" term="%22Bone+densitometry%22">Bone densitometry</searchLink><br /><searchLink fieldCode="DE" term="%22Bone+density%22">Bone density</searchLink><br /><searchLink fieldCode="DE" term="%22Tomosynthesis%22">Tomosynthesis</searchLink><br /><searchLink fieldCode="DE" term="%22Older+people%22">Older people</searchLink><br /><searchLink fieldCode="DE" term="%22Femur%22">Femur</searchLink><br /><searchLink fieldCode="DE" term="%22Dual-energy+X-ray+absorptiometry%22">Dual-energy X-ray absorptiometry</searchLink>
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  Group: Ab
  Data: Background: Osteoporosis is a major public health concern, especially among older adults, due to its association with an increased risk of fractures, particularly in the proximal femur. These fractures severely impact mobility and quality of life, leading to significant economic and health burdens. Objective: This study aims to enhance bone density assessment in the proximal femur by addressing the limitations of conventional dual-energy X-ray absorptiometry through the integration of tomosynthesis with dual-energy applications and advanced segmentation models. Methods and Materials: The imaging capability of a radiography/fluoroscopy system with dual-energy subtraction was evaluated. Two phantoms were included in this study: a tomosynthesis phantom (PH-56) was used to measure the quality of the tomosynthesis images, and a torso phantom (PH-4) was used to obtain proximal femur images. Quantification of bone images was achieved by optimizing the energy subtraction (ene-sub) and scale factors to isolate bone pixel values while nullifying soft tissue pixel values. Both the faster region-based convolutional neural network (Faster R-CNN) and U-Net were used to segment the proximal femoral region. The performance of these models was then evaluated using the intersection-over-union (IoU) metric with a torso phantom to ensure controlled conditions. Results: The optimal ene-sub-factor ranged between 1.19 and 1.20, and a scale factor of around 0.1 was found to be suitable for detailed bone image observation. Regarding segmentation performance, a VGG19-based Faster R-CNN model achieved the highest mean IoU, outperforming the U-Net model (0.865 vs. 0.515, respectively). Conclusions: These findings suggest that the integration of tomosynthesis with dual-energy applications significantly enhances the accuracy of bone density measurements in the proximal femur, and that the Faster R-CNN model provides superior segmentation performance, thereby offering a promising tool for bone density and osteoporosis management. Future research should focus on refining these models and validating their clinical applicability to improve patient outcomes. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Journal of X-Ray Science & Technology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1177/08953996241312594
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        Text: English
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      – SubjectFull: Convolutional neural networks
        Type: general
      – SubjectFull: Bone densitometry
        Type: general
      – SubjectFull: Bone density
        Type: general
      – SubjectFull: Tomosynthesis
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      – SubjectFull: Older people
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      – SubjectFull: Femur
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      – SubjectFull: Dual-energy X-ray absorptiometry
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      – TitleFull: Proximal femur segmentation and quantification in dual-energy subtraction tomosynthesis: A novel approach to fracture risk assessment.
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              M: 03
              Text: Mar2025
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