1149

Femur Bone Volumetric Estimation from a Single

X-Ray Image for Osteoporosis Diagnosis
Kiattisin Supapom* and Chamnongthai Kosin* *

Faculty of Engineering
King Mongkut's University of Technology Thonburi, Prachautid Road, Bangkok, Thailand
Tel: +66-2-470-9064, Fax: +66-2-470-9070
* Email: ,** Email:

Abstract - BMD (Bone Mineral Density) is an indicator of
osteoporosis that is serious disease, particularly for elderly. To
calculate BMD, we need to measure volume by noninvasive way.
This paper proposes noninvasive bone volume measurement
method. A novel method is presented for a volumetric of femur
bone which uses a computer-based procedure to estimate
volumetric from a single x-ray image. We use an active contour
model (ACM) for 2D segmentation. Volumetric technique that the
thickness of femur region mapping to a pixels are determined
using a physical model of image acquisition and knowledge base of
the doctor. From above, we can construct a femur bone of each
pixel. Therefore we can determine a volumetric of femur bone. In
this paper, we also present a volumetric of femur bone, to evaluate
results of the proposed method by actual experiments. We
compare a BMD of the proposed method results with a BMD of
CT-SCAN results.
I. INTRODUCTION
Osteoporosis is a skeleton disorder in which bones weaken
and risk of fracture is increased. Osteoporosis is a serious and
one of the most prevalent diseases of aging. The most common
osteoporosis fractures are those of the vertebrae, hip and wrist
and their incidences increases with age. In 1994 the WHO
proposed guidelines for the diagnosis of osteoporosis based on
measurement of bone mineral density. They have been widely
used for epidemiological studies, clinical research and for
treatment strategies. An increasing awareness of osteoporosis
and the development of treatments with proven efficacy are
likely to increase the demand for management of patients with
osteoporosis. This in turn will require widespread facilities for
its diagnosis and assessment. Measurements of bone mineral
are a central component since this forms an integral component
of the definition of osteoporosis. It is the increased fracture risk
due to osteoporosis. Worldwide, the number of hip fractures
has been estimated to rise from 1.7 million in 1990 to 6.26
million by the year 2050 and this is mostly due to the
increasing life expectancy and increasing size of the population
in nearly all countries [1].
Therefore a diagnostic method able of telling whether a
patient is suffering from osteoporosis or not is very important.
Such a method makes it possible to start a treatment that can
increase the bone mineral density to a level where the risk of
fractures is reduced. Several such methods exist, some of them
being based on of absorption of X-rays. Noninvasive
assessment of bone structure in patients with osteoporosis
typically use bone mineral density (BMD). Bone mineral
density (BMD) supplemented by femoral geometry has been
shown to be more predictive of breaking strength than BMD
alone [2].Bone mineral density (BMD) measured by dual
energy X-ray absorptiometry (DXA) is a primary predictor of
osteoporosis fracture. Nowadays BMD can be measured by the
areal and volume density. Areal bone mineral density (aBMD)
is a measure relative to a two-dimensional cross-sectional area
(g/cm2), while volumetric bone mineral density (vBMD) is a
measure of bone mass, related to the three-dimensional bone
volume (g/cm3). Since aBMD is influenced by sex, body size,
geometry, quality and composition (2-7), using vBMD may
more accurately reflect bone density [3].Osteoporosis in
postmenopausal Caucasian women is defined as a value for
bone mineral density (BMD) or bone mineral content (BMC)
more than 2.5 standard deviations below the young average
value. aBMD technique is called dual x-ray absorptiometry
(DXA). vBMD technique is called quantitative CT (QCT) to
differentiate it from imaging QCT. QCT is the only
noninvasive three-dimensional bone mass measurement
technique available. QCT reports a volumetric density (g/cm3)
as opposed to the area density in (g/cm2) from other techniques.
CT scan uses a multiple images that are a cross section image,
but DXA use an only single image. Comprehensive 3-D
information about the tissues can be obtained by computerized
tomography (CT) imaging. The basic philosophy of CT is to
use a large scanner to measure an extensive set of projections
from full view angle for the 3-D reconstruction. Reconstruction
quality is extremely good, and CT scans are an indispensable
part of radiology today. However, QCT and DXA imaging has
also some disadvantages such as high radiation dose and high
cost of equipment. Therefore, the use of CT has been mainly
limited to diagnosing serious diseases and it is typically
utilized in large hospital units. Unfortunately QCT and DXA
machines are not often found in hospital equipment, while
radiographic devices are widely available. Consequently, the
applicability of the system to conventional radiographic images
was tested [1].

0-7803-9740-X/06/$20.00 e2006 IEEE F4A-3 ISCIT 2006

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11. ATTENUATION X-RAY ANALYSIS

The X-ray intensity transmitted through a dense material isa .

RA i V
given by equation 1:

where I is the transmitted X-ray intensity, Io is the incident

X-ray intensity, p,is the linear attenuation coefficient (in cm)C
and t is the thickness of the material (in cm). This equation
shows that the X-ray intensity depends on the density of the
material the thickness of the material. For composite materials,
the intensity is given by adding the individual contributions of
each chemical element:

I= IO eXP - E, it, (2)

When an X-ray beam penetrates for instance the forearm it is

attenuated by soft tissue with linear attenuation coefficient /,t as
well as by bone mineral with linear attenuation coefficient pb
[3].
TTI. METHODS Dn
r r

The goal of this research is the estimate volume of femur

human for BMD (g/cm3) value. From the figure 2 shown all
process of the system. First of all we get the x-ray image. The
first step, we are going enhance image for detect boundary of
femur. Therefore we can extract only femur bone out of hip.
After that we get the shape of femur. Then we determine a
diameter of center point at femur head for the depth of femur
bone. This is knowledge of medical research. The second step
is determines a depth of each point from a depth of a center
point of femur head. That method relative with an attenuation
of x-ray. Then we can estimate a volume from a multiply a Plot d
boundary femur with a depth of each point. The last step is PM
calculates a vBMD value for osteoporosis diagnosis.

| ~*t Fig. 2. Shown the system of process

A. Preprocessing. Modified Canny Edge Detection

0
_ The-1 Canny edge detector [4] takes as input a gray image and
produces as output an image that showing the position of the
edges. It works as follows. The image is first smoothed by
Gaussian convolution. Next, a simple 2D first derivative
Fig. 1. Illustration of a section of bone within tissue irradiated with an operator is applied to the smoothed image to highlight regions
incident beam of intensity, Io, to give transmitted intensities of I1 and 12. of the image with high first derivatives.
 1151
B. Contour Extraction Active Contour and Gradient Vector
Flow
The contour extraction module makes use of snake to snap tbp2 I1nn 2]+tbpl =
(7)
onto the contour of the femur. Snakes are formulated as
energy-minimizing contours controlled by two forces:
1) Internal contour forces which enforce the smoothness
constraint. - Volumetric and Bone Mineral Density
2) Image forces which attracts the contour to the desired
features, in this case, edges [5,6]. Volume is the last step of the entire process. All the
reconstruction result can be viewed directly in three-
dimensional and in an interactive way. User can change the
Esrnke = / t(v(fihI) ± Lmge(V ))tlS (3) surface geometry in three dimensional. Fig. 3 shown the result
of volume of femur bone.
Representing the position of the snake parametrically by v(s)
(x(s); y(s)), the energy of a snake Esnke (Eqn 1) is a sum of the
internal energy Eint of the snake and the image energy Eimage.
The GVF was created to overcome two shortcomings of the
original active contour formulationGVF is computed as a
diffusion of the gradient vectors of a gray-level edge map
derived from the image. The GVF field is defined as the vector
field G(x; y) = (q(x,y),r(x,y)) that minimizes the energy
functional

I a/[d(4') ±912 + 2i±IE12 ±+VE12VdXdy (4)

Where £ is an edge map E(x, y) derived from the image.

Using calculus of variations.
C. Estimating Volumetric
- Depth Extraction. Relative Depth of Femur
After that, we get a diameter of femur head that assume a
sphere. Therefore a diameter is a depth at center point of femuwr Fig. 3. Shown a volumetric of femur.
head. We want to relative depth between two points.

Ip2 - ioe(ps -b )tbpl IV. EXPERIMENT RESULTS

Il e(Ps-Ph )tb,2 (5) The most common method of measuring bone mass is X-ray
diagrams, often used in clinical and research has also been the
most thoroughly studied. The resulting are usually represented
If we assume a center point of femur head is a point (pi). So as BMD (volume grams/cm3). Since CT-Scan measurements
diameter is tbp] and intensity is I'p. Each point is a point (P2) are by a volumetric density (grams/cm3). In the result we
and intensity (Ip2). classify into two groups. The first group, testing is a geometry
shape, such as a sphere, cylinder and cubic for determination a
volume. The figure 4. shown the relation of result. The second
group, testing is a BMD of X-Ray image (g/cm3) compare with
'p2 (Ps Yb )tbpl(I-s b )tbp2 (6)
a BMD DEXA(g/cm2). Altogether, 50 X-ray images were
digitally recorded. Table 1 shown the result of this group case.
Ipl It use a BMC value of DEXA. The finally of this group, we can
find a correlation between them. The last group, testing is a
(I BMD of X-Ray image (g/cm3) compare with a BMD CT-Scan
in: p2 (Ps /b )Qbp2 tb)pl (g/cm3).
YIp1 )
 1152

Gi pli: coiapiiiag b etwee a p lasic 6 rip h: C m aibal il g b1 twema a plastic

ball aditi s amid lesti I aditis b all volti nl ic amad resiv It vo kimlmltic
00
0
E E 40 --PB
(mm)Ra dius
A
s0 _ .-4-PB Volume
.0 (cm3)
| 3j-20 Radius Result
E 30
20
2il.0 -
(c2 m3)
---Volm3)
(D
ume Result

1 2 3 4 5 6 7 8 1 2 3 4 5 0 7 8
subject subject

(a) (b)
Grap h: p eri eiitag e o f vo ltiiie eior
10.00% e

45~
:3.00% j
25.00%
0 .00%A

1 2 3 4 5 0 7 8

(c)
Fig. 41. Grapgh of Group 1 testing. (a) Comparing between plastic ball radius and result.
(b) Comparing between plastic ball volumetric and result.
(c) Comparing percentage of volume error between plastic ball and result.

TABLE I. Group 2 testing. Descriptive statistics for DEXA and QCT measurements of the femur (n=50)
phalanges presented as mean (standard deviation). *p < 0.0001 for comparison of middle vs. proximal BMD.

V. CONCLUSSION REFERENCES

[1] JA. Kanis. P. Delmas, P. Burckhardt,C. Cooper and D.

A novel method is presented for a volumetric of femur bone
which uses a computer-based procedure to estimate a BMD for
osteoporosis diagnosis from a single x-ray image. Therefore
the thickness of femur region mapping to a pixels are
determined using a physical model of image acquisition and
knowledge base of the doctor. The processing scheme
consisted of the following three steps. 1) Preprocessing, we
modified Canny edge detector is used to compute the edges. 2)
The contour extraction, we used an automatic segmentation
femur. We applied an active contour model with gradient
vector flow for finding boundary of femur. And we use
knowledge that is a geometry model. 3) Estimating volumetric.
This model is based on the assumption that the region of
interest (ROI), which is composed of two types of tissue and
bone. Effective linear attenuation coefficients of these parts are
derived from empirical data. To evaluate performance of the
proposed method, experiment with 50 subjects have been
performance, the BMD results reveal 4.53O difference volume
correlation comparing BMD of CT- scan.
Torgerson, "Guidelines for diagnosis and management of osteoporosis,"
The European Foundation for Osteoporosis and Bone Disease.
Osteoporos Int, vol. 7, pp. 590-406, 1997.
[2] "WWW.WHO.INT.".
[3] E. Saskia van, S. Peter R., H. Henkjan, et al: "Volumetric Breast Density
Estimation From Full-Field Digital Mammograms " IEEE Transactions
on Medical Imaging, vol. 25, No. 3, March 2006.
[4] J. Canny, "A computational approach to edge detection," IEEE
Transactions on Pattern Analysis and Machine Intelligence, vol. 8, no. 6,
pp. 679-698, 1986.
[5] G.Behiels, F. Maes, D.Vandermeulen, and P. Suetens, "Evaluation of
image features and search strategies for segmentation of bone structures
in radiographs using active shape models," Medical Image Analysis, vol.
6, no. 1, 2002.
[6] M. Andrzej and C. Piotr: "Texture Analysis of X-ray Images for Detection
of Changes in Bone Mass and Structure," IEEE on Biomedical
Engineering, No. 2, pp. 103-108, 2001.
[7] J. Lin, S. Grampp and T. Link: "Fracture Analysis of Proximal Femur
Radiographs: Correlation with Biomechanical Properties and Bone
mineral Density," International Osteoporosis Foundation and National
Osteoporosis Foundation, No. 9, pp. 516-524, 2002.