Dual-energy X-ray absorptiometry derived structural geometry for stress fracture prediction in male U.S. Marine Corps recruits.

A total of 626 U.S. male Marine Corps recruits underwent anthropometric measurements and dual-energy X-ray absorptiometry (DXA) scans of the femoral midshaft and the distal third of the tibia prior to a 12 week physical training program. Conventionally obtained frontal plane DXA scan data were used to measure the bone mineral density (BMD) as well as to derive the cross-sectional area, moment of inertia, section modulus, and bone width in the femur, tibia, and fibula. During training, 23 recruits (3.7%) presented with a total of 27 radiologically confirmed stress fractures in various locations in the lower extremity. After excluding 16 cases of shin splints, periostitis, and other stress reactions that did not meet fracture definition criteria, we compared anthropometric and bone structural geometry measurements between fracture cases and the remaining 587 normals. There was no significant difference in age (p = 0.8), femur length (p = 0.2), pelvic width (p = 0.08), and knee width at the femoral condyles (p = 0.06), but fracture cases were shorter (p = 0.01), lighter (p = 0.0006), and smaller in most anthropometric girth dimensions (p < 0.04). Fracture case bone cross-sectional areas (p < 0.001), moments of inertia (p < 0.001), section moduli (p < 0.001), and widths (p < 0.001) as well as BMD (p < 0.03) were significantly smaller in the tibia and femur. After correcting for body weight differences, the tibia cross-sectional area (p = 0.03), section modulus (p = 0.05), and width (p = 0.03) remained significantly smaller in fracture subjects. We conclude that both small body weight and small diaphyseal dimensions relative to body weight are factors predisposing to the development of stress fractures in this population. These results suggest that bone structural geometry measurements derived from DXA data may provide a simple noninvasive methodology for assessing the risk of stress fracture.

Hydrogel embolic agents. Theory and practice of adding radio-opacity.

RATIONALE AND OBJECTIVES: Spheres of hydrogel have been developed as embolic material with the ability to incorporate radio-opaque materials. To optimize particle design for radiographic or fluoroscopic visualization, we have examined the theoretical determinants of particle contrast. In addition, loaded hydrogel particles were tested in a rabbit model. METHODS: Computer simulations of particle subject contrast were examined regarding particle composition, particle size, patient thickness, and x-ray beam kilovoltage. Embolizations in the rabbit kidney were used to test the practical aspects of the materials. RESULTS: Tantalum and tungsten offer some theoretical and practical advantages over other materials. With this particular hydrogel preparation, contrast material loading was limited to 20% of the volume as loaded contrast agent. The soft particles passed through catheters as small as 3 French; they were usually injected as a suspension of saline/contrast material. Tantalum/hydrogel particles as large as 2 mm could be forced through the 140 cm/3-Fr catheter with a guide wire. CONCLUSIONS: Radio-opacity of embolic material should add an element of control in embolization procedures that is lacking with the current agents. The heavy metals, tungsten and tantalum, are suitable additives for radiopaque material for hydrogel emboli. The input relationship appears predictable with computer monitoring techniques. Initial results in a study of these radiopaque particles are very encouraging. Further studies are underway to evaluate the long-term effects in renal and hepatic circulations.

Curved beam model of the proximal femur for estimating stress using dual-energy X-ray absorptiometry derived structural geometry.

The investigation of individual differences in hip strength requires a method to measure structural geometry in vivo and a valid analytical approach to calculate mechanical stress. We developed a method for deriving structural geometry of the femur from the proximal shaft through the femoral neck, using data from dual energy X-ray absorptiometry. The geometric properties are employed in a two-dimensional curved beam model of the proximal femur to estimate stresses on the lateral and medial bone surfaces. Stresses calculated by this method are compared with those from the conventional flexure formula and with results produced from a cadaver femur with use of three-dimensional finite element analysis of computed tomography data. Loading conditions simulating a one-legged stance and a fall on the greater trochanter are employed. Stresses calculated by curved beam theory are in much better agreement with three-dimensional finite element analysis than are those for which the conventional straight beam formula was used. In simulation of a fall on the greater trochanter, all three methods show peaks of stress at the femoral neck but only the curved beam and finite element analysis methods show an additional peak at the medial intertrochanteric margin. Both neck and trochanter regions correspond to common failure sites for hip fractures in the elderly. The curved beam treatment of hip structure derived from dual-energy X-ray absorptiometry provides an approach for the in vivo engineering analysis of hip structure that is not practical by other methods.

Experimental testing of a DEXA-derived curved beam model of the proximal femur.

This study was designed to test whether, using curved beam theory, a structural model of the proximal femur derived from two-dimensional dual energy x-ray absorptiometry could be used to predict femoral strength in an experimental simulation of a fall on the greater trochanter. A set of 22 fresh cadaveric femoral specimens were scanned with use of two-dimensional dual energy x-ray absorptiometry and then were tested to failure in a materials testing system, under three-point loading, with the ground impact vector aligned within the plane and along the bisector of the femoral neck-shaft angle. Failure locations generally corresponded to stress peak locations predicted by the curved beam model. Predicted failure loads correlated well with measured failure loads for femoral neck fractures (r=0.89; percent SE of estimate=23%) and some-what less well for intertrochanteric fractures (r=0.83; percent SE of estimate=29%). Overall predictions for failure load calculated from the maximum stress peak value over both locations corresponded to measured failure loads with an r value of 0.91 (percent SE of estimate=21%). This kind of structural approach to the analysis of data for hip bone mass has the potential to provide mechanistic interpretations of the statistical associations frequently shown between conventional bone mineral measures and either hip fracture risk in vivo or bone strength in vitro.

Dose rate table for a 32P intravascular brachytherapy source from Monte Carlo calculations.

Studies of intravascular brachytherapy to prevent restenosis following angioplasty have shown many promising results. Accurate dose rate tables based on detailed models of the brachytherapy sources are necessary for treatment planning. This work will present an away and along dose rate table for a 27 mm long catheter based 32P beta source. MD-55-2 radiochromic film has been exposed at five different depths (0.5 mm-4 mm) in a polystyrene phantom using a 27 mm long Guidant 32P beta source. The total dose to the active region of the film was determined using the absolute detector response of the MD-55-2 radiochromic film. The Monte Carlo code MCNP4B2 was also used to calculate the dose to the active region of the film using a detailed model of the source, encapsulation, and radiochromic film. The dose to film calculations showed good agreement with the measurements presented in this work with an average difference of 7%. The Monte Carlo calculations were also verified against previously published depth dose in water measurements determined using radiochromic film and plastic scintillator. The depth dose calculations in water showed good agreement with the previously published measurements with the calculations being about 2.5% lower than the film measurements and about 2.5% higher than the scintillator measurements. This work then uses the verified Monte Carlo code to present a dose rate table for the 32P intravascular beta source.

Theoretical analysis of error propagation in triple-energy absorptiometry: application to measurement of lead in bone in vivo.

We propose a three component tissue decomposition for quantifying lead in bone from a mixture of bone and muscle in vivo using a triple-energy absorptiometric method. The theoretical optimization of this method, by relating signal uncertainty to radiation dose, requires an expression of the signal variance. The error propagation was therefore theoretically modeled for a counting detector, assuming noise dominance by quantum statistics and neglecting covariance between energy levels. A final expression for the lead signal variance at each energy level was obtained via a Jacobian matrix. The Jacobian was maximized by choosing the first energy as low as permissible by dose constraints below the lead K edge. A second optimum was achieved when the upper energy was just above and the middle energy was just below the lead K edge. While the signal-to-noise ratio (SNR) had similar behavior to that of the Jacobian as a function of middle and upper energies, the SNR was almost constant as a function of lower energy in the 40-60 keV range. Hence, dose could be reduced without SNR loss. A simulated clinical measurement on an adult tibia using a 50 mCi 155Eu source and a 10 min acquisition time resulted in a standard deviation of 4 micrograms Pb/g bone mass. This approach can be applied to other systems containing three components, provided there is a K edge within the counting energy range.

Dosimetry characterization of 32P catheter-based vascular brachytherapy source wire.

Dosimetry measurements and Monte Carlo simulations for a catheter-based 32P endovascular brachytherapy source wire are described. The measured dose rates were obtained using both radiochromic dye film and an automated plastic scintillator. The investigated source has dimensions of 27 mm in length and 0.24 mm in diameter, and is encapsulated in NiTi. For the radiochromic film measurements, calibrated radiochromic dye film was irradiated at distances between 1 and 5 mm from the source axis in A-150 plastic, and read out with a high-resolution scanning densitometer. The depth-dose curve measured in A-150 is then converted to that in water using correction factors obtained from Monte Carlo calculations. For the scintillator system, direct measurements in water were acquired at distances between 1 and 6 mm from the center of the source, along the perpendicular bisector of the source axis. The scintillator was calibrated in terms of absorbed-dose rate in a reference beta-particle field at multiple depths. The measured dose rates obtained from the film and scintillator measurements were then normalized to the measured source activity, i.e., to convert the measured data to units of cGy/s/mCi. Theoretical dosimetry calculations of the catheter-based 32P wire geometry were also obtained from Monte Carlo simulations using the Electron Gamma Shower code (EGS4), the Monte Carlo N-particle transport code (MCNP4B), and CYLTRAN from the Integrated Tiger Series codes (ITS v.3) and found to be in good agreement. The results of both measurements and calculations are expressed as absorbed-dose rate in water per unit of contained activity (cGy/s/mCi). Comparisons indicate that the measured and calculated dosimetry are in good agreement (<10%) within the relevant treatment distances (1-5 mm). This work fully characterizes the radiation field around a novel 32P beta brachytherapy source in water. The depth-dose curve can be used to calculate the dose to the vessel wall from a 27 mm 32P source wire centered within the vessel lumen.

Dosimetry of beta-ray ophthalmic applicators: comparison of different measurement methods.

An international intercomparison of the dosimetry of three beta particle emitting ophthalmic applicators was performed, which involved measurements with radiochromic film, thermoluminescence dosimeters (TLDs), alanine pellets, plastic scintillators, extrapolation ionization chambers, a small fixed-volume ionization chambers, a diode detector and a diamond detector. The sources studied were planar applicators of 90Sr-90Y and 106Ru-106Rh, and a concave applicator of 106Ru-106Rh. Comparisons were made of absolute dosimetry determined at 1 mm from the source surface in water or water-equivalent plastic, and relative dosimetry along and perpendicular to the source axes. The results of the intercomparison indicate that the various methods yield consistent absolute dosimetry results at the level of 10%-14% (one standard deviation) depending on the source. For relative dosimetry along the source axis at depths of 5 mm or less, the agreement was 3%-9% (one standard deviation) depending on the source and the depth. Crucial to the proper interpretation of the measurement results is an accurate knowledge of the detector geometry, i.e., sensitive volume and amount of insensitive covering material. From the results of these measurements, functions which describe the relative dose rate along and perpendicular to the source axes are suggested.

Brachytherapy optimal planning with application to intravascular radiation therapy.

We have been studying brachytherapy planning with the objective of minimizing the maximum deviation of the delivered dose from prescribed dose bounds for treatment volumes. A general framework for optimal treatment planning is presented and the minmax optimization is formulated as a linear program. Dose rate calculations are based on the dosimetry formulation of the American Association of Physicists in Medicine, Task Group 43. We apply the technique to optimal planning for intravascular brachytherapy of intimal hyperplasia using ultrasound data and 192Ir seeds. The planning includes determination of an optimal dwell-time sequence for a train of seeds that deliver radiation while stepping through the vessel lesion. The results illustrate the advantage of this strategy over the common approach of delivering radiation by positioning a single train of seeds along the whole lesion.