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- 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. |
- Lindh, Christina, et al.
(författare)
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A comparison of manual and computer-assessed measurements of mandibular cortical width as predictiors of osteoporsis : the OSTEODENT project
- 2006
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Konferensbidrag (refereegranskat)abstract
- Objective: Manual measurement of mandibular cortical width has been shown to be significantly correlated with bone mineral density (BMD) at the hip,spine and forearm.These latter sites are fracture-prone in post-menopausal osteoporosis. We have developed computer software technology, based on active shape modelling, that will automatically detect the mandibular cortex on panoramic radiographs and then measure its width. We wanted to compare manual measurement of mandibular cortical width with semi-automated constrained fit and automated unconstrained fit methods. Material and Methods:The diagnostic ability of these different methods at detecting osteoporosis of the femoral neck was compared using dual energy X-ray absorptiometry as the “gold standard “at these sites. 671 subjects were recruited and their BMD measured at the femoral neck.143 (21.4%) subjects were osteoporotic, classified as a standardized t-score of <-2.5 at any site. The ability of one observer’s manual measurement of mandibular cortical width to act as a diagnostic test for detecting osteoporosis at the femoral neck was assessed using ROC analysis. The AUC under the ROC curve was = 0.748, (se = 0.027; 95% CI = 0.713 to 0.780). Using a previous training set of 132 DPR images, a point distribution model (PDM) was created of the inferior mandibular cortex. Two experts performed this task independently using a graphical user interface, outlining the inferior mandibular cortex by placing equally spaced points on the computer images between the mental foramen and antegonial region. In the constrained fit, four manually defined reference points were placed on the inferior mandibular surface of the images at the left and right antegonial and mental foramen regions. These points served as starting points for the active shape model and the point distribution model was stretched and positioned to match these points. Results:As a diagnostic test in detecting osteoporosis at the hip, the semi- automated constrained fit produced an AUC of 0.755 (se= 0.026; 95% CI = 0.721 – 0.788). In detecting osteoporosis at the hip, the automated unconstrained fit produced an AUC of 0.739 (se = 0.028; 95% CI = 0.704 to 0.772). There were no significant differences in AUC between the manual, and either the constrained or unconstrained fits (p>0.05).
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| 3. |
- Winning, Tracey, et al.
(författare)
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Evidence-based care and the curriculum
- 2008
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Ingår i: European journal of dental education. - : Wiley. - 1396-5883 .- 1600-0579. ; 12:Suppl 1, s. 48-63
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Forskningsöversikt (övrigt vetenskapligt/konstnärligt)abstract
- An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings for practitioners to learn and apply the principles and processes of evidence-based oral healthcare (EBOHC). Therefore, the focus of this discussion will be on ways in which EBOHC and associated research activities can be implemented into curricula, with the aim of improving patient care. This paper will initially define the scope of EBOHC and research, what these involve, why they are important, and issues that we need to manage when implementing EBOHC. This will be followed by a discussion of factors that enable successful implementation of EBOHC and research into curricula. The paper concludes with suggestions on the future of EBOHC and research in curricula. Key recommendations related to curricula include strengthening of the culture of a scientific approach to education and oral healthcare provision; complete integration of EBOHC into the curriculum at all levels; and faculty development to implement EBOHC based on their needs and evidence of effective approaches. Key recommendations to support implementation and maintenance of EBOHC include recognition and funding for high-quality systematic reviews and development of associated methodologies relevant for global environments; building global capacity of EBOHC researchers; research into improving translation of effective interventions into education and healthcare practice, including patient-reported outcomes, safety and harms, understanding and incorporation of patient values into EB decision-making, economic evaluation research specific to oral healthcare and effective methods for changing practitioner (faculty) behaviours; and extend access to synthesized research in 'user friendly' formats and languages tailored to meet users' needs. Realizing these recommendations may help to improve access to effective healthcare as a basic human right.
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