| 1. |
- Allen, P Danny, et al.
(författare)
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Detecting reduced bone mineral density from dental radiographs using statistical shape models
- 2007
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Ingår i: IEEE transactions on information technology in biomedicine. - : Institute of Electrical and Electronics Engineers (IEEE). - 1089-7771 .- 1558-0032. ; 11:6, s. 601-610
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Tidskriftsartikel (refereegranskat)abstract
- We describe a novel method of estimating reduced bone mineral density (BMD) from dental panoramic tomograms (DPTs), which show the entire mandible. Careful expert width measurement of the inferior mandibular cortex has been shown to be predictive of BMD in hip and spine osteopenia and osteoporosis. We have implemented a method of automatic measurement of the width by active shape model search, using as training data 132 DPTs of female subjects whose BMD has been established by dual-energy X-ray absorptiometry. We demonstrate that widths measured after fully automatic search are significantly correlated with BMD, and exhibit less variability than manual measurements made by different experts. The correlation is highest towards the lateral region of the mandible, in a position different from that previously employed for manual width measurement. An receiver-operator characterstic (ROC) analysis for identifying osteopenia (T < -1: BMD more than one standard deviation below that of young healthy females) gives an area under curve (AUC) value of 0.64. Using a minimal interaction to initiate active shape model (ASM) search, the measurement can be made at the optimum region of the mandible, resulting in an AUC value of 0.71. Using an independent test set, AUC for detection of osteoporosis (T < -2.5) is 0.81.
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| 2. |
- Devlin, Hugh, et al.
(författare)
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Automated osteoporosis risk assessment by dentists : a new pathway to diagnosis
- 2007
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Ingår i: Bone. - : Elsevier BV. - 8756-3282 .- 1873-2763. ; 40:4, s. 835-842
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Tidskriftsartikel (refereegranskat)abstract
- General dental practitioners use a vast amount of panoramic radiography in their routine clinical work, but valuable information about patients' osteoporotic status is not collected. There are many reasons for this, but one of the prime reasons must be the disruption involved in clinical routine with lengthy manual radiographic assessment. We have developed computer software, based on active shape modeling that will automatically detect the mandibular cortex on panoramic radiographs, and then measure its width. Automatic or semi-automatic measurement of the cortical width will indicate the osteoporotic risk of the patient. The aim of our work was to assess the computer search technique's ability to measure the mandibular cortical width and to assess its potential for detection of osteoporosis of the hip, spine and femoral neck. Mandibular cortical width was measured using the manually initialized (semi-automatic) method and, when assessed for diagnosing osteoporosis at one of the three measurement sites, gave an area under the ROC curve (A(z))=0.816 (95% CI=0.784 to 0.845) and for the automatically initialized searches, A(z)=0.759 (95% CI=0.724 to 0.791). The difference between areas=0.057 (95% Confidence interval=0.025 to 0.089), p<0.0001. For diagnosing osteoporosis at the femoral neck, mandibular cortical width derived from the manually initialized fit gave an area under the ROC curve (A(z))=0.835 (95% CI=0.805 to 0.863) and for the automatically initialized searches A(z)=0.805 (95% CI=0.773 to 0.835). The difference in A(z) values between active shape modeling search methods=0.030 (95% CI=-0.010 to 0.070), and this was not significant, p=0.138. We concluded that measurement of mandibular cortical width using active shape modeling is capable of diagnosing skeletal osteoporosis with good diagnostic ability and repeatability. PMID: 17188590 [PubMed - indexed for MEDLINE]
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| 3. |
- Devlin, Hugh, et al.
(författare)
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Diagnosing osteoporosis by using dental panoramic radiographs : the OSTEODENT project
- 2007
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Ingår i: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. - : Elsevier BV. - 1079-2104 .- 1528-395X. ; 104:6, s. 821-828
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Measurement of cortical thickness and subjective assessment of cortical porosity on panoramic radiographs are methods previously reported for diagnosing osteoporosis. The aims of this study were to determine the relative efficacy of the mandibular cortical index and cortical width in detecting osteoporosis, both alone and in combination, and to determine the optimal cortical width threshold for referral for additional osteoporosis investigation. STUDY DESIGN: Six hundred seventy-one postmenopausal women 45 to 70 years of age were recruited for this study. They received dual energy x-ray absorptiometry (DXA) scans of the left hip and lumbar spine (L1 to L4), and dental panoramic radiographic examinations of the teeth and jaws. Three observers separately assessed the mandibular cortical width and porosity in the mental foramen region of the mandible. Cortical width was corrected for magnification errors. Chi-squared automatic interaction detection analysis (CHAID) software was used (SPSS AnswerTree, version 3.1, SPSS Inc., Chicago, IL). RESULTS: Chi-squared automatic interaction detection analysis showed that the cortical porosity was a poorer predictor of osteoporosis than mandibular cortical width. For the 3 observers, a mandibular cortical width of <3 mm provided diagnostic odds ratios of 6.51, 6.09, and 8.04. The test is therefore only recommended in triage screening of individuals by using radiographs made for purposes other than osteoporosis. CONCLUSION: When evaluating panoramic radiographs, only those patients with the thinnest mandibular cortices (i.e., <3 mm) should be referred for further osteoporosis investigation. PMID: 17428694 [PubMed - in process]
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| 4. |
- Devlin, Hugh, et al.
(författare)
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The role of the dental surgeon in detecting osteoporosis : the OSTEODENT study
- 2008
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Ingår i: British Dental Journal. - : Springer Science and Business Media LLC. - 0007-0610 .- 1476-5373. ; 204:10
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- OBJECTIVE: To determine if thinning (<3 mm width) of the lower cortical border of the mandible on dental panoramic radiographs, as well as other clinical risk factors, may provide a useful diagnostic test for osteoporosis in young postmenopausal women. DESIGN: Six hundred and fifty-two subjects (age range 45-70 years) were involved in this multi-centre, cross-sectional study. SETTING: Patients were recruited from centres in Leuven (Belgium), Athens (Greece), Manchester (UK), and Malmo (Sweden). SUBJECTS AND METHODS: The subject's age, body weight, whether the patient took hormone replacement therapy or had a history of low trauma fracture were used to form a clinical osteoporosis risk assessment (the OSteoporosis Index of RISk or OSIRIS index). Each patient also received a dental panoramic radiographic examination. RESULTS: One hundred and forty subjects had osteoporosis involving at least one of the measurement sites (lumbar spine, femoral neck or total hip). Those with osteoporosis tended to have a low OSIRIS score and a thinned cortical mandibular border. The area under the ROC curve for using both cortical width and OSIRIS to predict osteoporosis was 0.90 (95% CI = 0.87 to 0.92). There was a significant improvement in the diagnostic ability of the combined OSIRIS and cortical width test over both tests applied separately (p <0.001). The cost effectiveness of the cortical width and OSIRIS model was improved by using a high specificity threshold rather than high sensitivity. However, this analysis ignores the costs associated with missed cases of osteoporosis. CONCLUSION: Dentists have a role to play in the detection and referral of patients at high risk of osteoporosis.
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| 5. |
- Geraets, Wil G, et al.
(författare)
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Osteoporosis and the general dental practitioner : reliability of some digital dental radiological measures
- 2007
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Ingår i: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 35:6, s. 465-471
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Dental radiographs are relatively inexpensive and are regularly made of a large fraction of the adult population; therefore, they represent an enormous potential as a screening tool for osteoporosis. Monitoring the population by means of dual X-ray absorptiometry (DXA), which is currently the most accepted method for diagnosing osteoporosis, involves enormous costs and facilities. In previous studies, it was shown that the radiographic trabecular pattern shows correlations with the bone mineral density (BMD) as measured by DXA. The objective of this study was to assess the reproducibility of the quantitative analysis of the trabecular pattern on dental radiographs. METHODS: Six regions of interest were selected manually on three digital radiographic images of 20 women. This process was performed 10 times resulting in 1200 image samples. For each image sample 26 parameters were measured. The reliability of the parameters was evaluated by means of Cronbach's alpha. RESULTS: Of the values of Cronbach's alpha 83% is at least 0.9 and 99% is at least 0.8. CONCLUSIONS: The measurements of the parameters used in this study are very reproducible. Therefore, the manual selection of the regions of interest does not introduce large amounts of noise. The imaging parameters potentially offer an accurate tool for the prediction of BMD values. PMID: 18039288 [PubMed - in process]
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| 6. |
- Geraets, Wil G, et al.
(författare)
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Prediction of bone mineral density with dental radiographs
- 2007
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Ingår i: Bone. - : Elsevier BV. - 8756-3282 .- 1873-2763. ; 40:5, s. 1217-1221
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Tidskriftsartikel (refereegranskat)abstract
- There is consensus to use the bone mineral density (BMD) for the operational definition of the degree of osteoporosis and the risk of osteoporotic fractures. Dual X-ray absorptiometry (DXA) is the common technique to determine BMD. Because of high costs and limited availability of DXA equipment it is worthwhile to look for alternative diagnostic techniques. As part of a larger study, the Osteodent project, we investigated if the trabecular pattern on dental radiographs can be used to predict BMD and to identify the subjects with osteoporosis and increased risk of osteoporotic fractures. In four clinical centers 671 women with an average age of 55 years were recruited. BMD values were measured by DXA equipment at the femoral neck, total hip, and spine. One panoramic and two intraoral radiographs were made. From 525 women a complete set of BMD values and radiographs was obtained. Four regions of interest on the radiographs were selected manually and then processed automatically. On all regions of interest mean and standard deviation of the gray values were measured and several features describing the shape of the binarized trabecular pattern. Multiple regression was used to predict BMD of total hip and spine by means of the radiographic measurements combined with age. It was found that age accounts for 10% of the variation in total hip BMD and 14% of the variation in spinal BMD. When all measurements on the dental radiographs are used the explained variation increases to 22% and 23%. The areas under the ROC curves are comparable to those of commonly used screening instruments for osteoporosis. It is concluded that prediction of DXA measurements of BMD by means of quantitative analysis of the trabecular pattern on dental radiographs is feasible. PMID: 17317351 [PubMed - indexed for MEDLINE]
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| 7. |
- Geraets, Wil GM, et al.
(författare)
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Selecting regions of interest on intraoral radiographs for the prediction of bone mineral density
- 2008
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Ingår i: Dento-Maxillo-Facial Radiology. - : Oxford University Press (OUP). - 0250-832X .- 1476-542X. ; 37:7, s. 375-379
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: A previous study showed that the trabecular pattern on dental radiographs correlates with femoral and spinal bone mineral density (BMD). The objective of this study was to determine if the correlation is affected by the size and location of the region of interest (ROI). METHODS: In a European research project on osteoporosis, BMD was measured at the left hip and the lumbar spine of 525 women. From all subjects, intraoral radiographs were made of the premolar region in the upper and lower jaws. Two ROIs were indicated manually on each scanned image. The smallest region involved only trabecular bone and the largest also included parts of the neighbouring teeth. The ROIs were subjected to automatic image analysis, yielding 26 measurements per ROI. Stepwise linear regression was used to predict femoral and spinal BMD. RESULTS: Inner and outer regions predicted BMD equally well. The radiographs of lower and upper jaw also predicted BMD equally well. Combining inner and outer regions did not improve the prediction of femoral and spinal BMD, but combining lower and upper jaws did. CONCLUSIONS: This study shows that it is possible to include parts of neighbouring teeth in the ROI used to assess the trabecular pattern and predict BMD. This simplifies the process of selecting the ROIs because no efforts have to be made to exclude neighbouring teeth. Combining ROIs of lower and upper jaws significantly improves the prediction of BMD.
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| 8. |
- Gullberg, Joanna, et al.
(författare)
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Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists
- 2020
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Ingår i: Gerodontology. - : John Wiley & Sons. - 0734-0664 .- 1741-2358. ; 37:2, s. 208-216
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. Background Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. Materials and methods A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. Results From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. Conclusion Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.
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| 9. |
- Gustafsson, Pernilla, et al.
(författare)
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Will image quality influence diagnostic accuracy efficacy when diagnosing osteoporosis by intraoral radiography?
- 2009
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Ingår i: Programme and abstract book. ; , s. 67-67
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction In 2003-2005, the OSTEODENT study was performed with the aim of identifying the most valid and effective radiographic index for diagnosis of osteoporosis to be used in oral health care. One of the proposed indices was based on visual assessment of the trabecular pattern in intraoral periapical radiographs. Although strict quality criteria were used, the quality of the intraoral radiographs differed due to film placement and projection errors (Lindh et al 2008). Objectives To investigate if the diagnostic accuracy of visual assessment of the trabecular pattern to diagnose osteoporosis in intraoral radiography increased for images with optimal image quality. Material and methods One hundred intraoral radiographs of the upper and lower premolar regions with optimal image quality were chosen from the original sample of 600 images. The trabecular pattern was assessed by four observers and classified into one of three groups (i) dense homogenous trabecular patter, (ii) heterogeneous trabecular pattern, or (iii) sparse homogenous trabecular pattern. The criterion standard was comprised of osteoporosis as measured by DXA. Sensitivity, specificity, odds ratio, and inter- and intra-observer agreement for the assessment of the 100 images with optimal quality were compared to the values obtained from the assessment of the original sample. Results Sensitivity of images of optimal quality increased in the upper jaw as compared to that of the original sample. The odds ratios of images with optimal image quality were higher for both the upper and the lower jaw. The median intraobserver agreement (weighted Kappa) was also slightly higher for both jaws whilst the median interobserver agreement was comparable for the two samples. Conclusions and discussion Although image quality of intraoral radiography influenced the diagnostic accuracy efficacy in osteoporosis diagnosis to some extent, optimal image quality might not be necessary for the usability of the proposed classification in clinical practice. Reference: Lindh C, Horner K, Jonasson G, Olsson P, Rohlin M, Jacobs R , Karayianni K, van der Stelt P, Adams J, Marjanovic E, Pavitt S, Devlin H. The use of visual assessment of dental radiographs for identifying women at risk of having osteoporosis: the OSTEODENT project. Oral Surg, Oral Med, Oral Pathol, Oral Radiol Endod 2008;106:285- 93
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| 10. |
- Horner, Keith, et al.
(författare)
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The mandibular cortex on radiographs as a tool for osteoporosis risk assessment : the OSTEODENT Project
- 2007
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Ingår i: Journal of clinical densitometry. - : Elsevier BV. - 1094-6950 .- 1559-0747. ; 10:2, s. 138-146
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to measure the accuracy of porosity of the mandibular cortex on dental panoramic radiographs (DPRs) in diagnosis of osteoporosis, alone and in combination with a clinical risk index. Six hundred seventy-one women (45-70yr) were recruited in the study, and dual-energy X-ray absorptiometry of the hip and lumbar spine was performed. A clinical index of osteoporosis risk (OSIRIS) and a DPR were obtained for each subject. The cortical appearance on the DPR was classified using the mandibular cortical index (MCI) by 5 observers. receiver operating characteristic (ROC) curve analysis was performed with calculation of area under the ROC curve (AUC) and sensitivity and specificity at various thresholds. Complete data were available for 653 subjects, of whom 21.6% had osteoporosis. The AUC for OSIRIS was 0.838. When used alone as the diagnostic test, MCI AUC for the 5 observers ranged from 0.560 to 0.670, significantly less than OSIRIS. Intraobserver and interobserver repeatability of MCI assessment was inconsistent. We conclude that MCI has limited value for osteoporosis diagnosis, being most appropriate as a method of fortuitous case-finding. PMID: 17449308 [PubMed - in process]
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