Deriving Bone Density from Thoracic CT Scans

PROJECT SUMMARY ABSTRACT
As people age they steadily lose bone mass and their bones become fragile and increasingly prone to hip and
other fractures and this can prove fatal The American College of Radiology therefore recommends that
assessment of bone mineral density BMD be performed in post menopausal women and all people over the
age of every two years If indicated preventive measures and medications can effectively decrease risk of
fractures BMD is usually measured by DXA dual energy x ray absorptiometry But very often BMD is not
assessed when indicated for a variety of reasons patients do not know they need BMD assessment
health care providers have no systematic way to identify and notify patients who need BMD assessment and
BMD assessment usually requires a separate referral and reimbursement We have a solution that could
help to address this need while presenting an opportunity for both radiologists and our own company BDI
INC to profit by sharing reimbursement We created patented and published a software solution that uses an
algorithm to accurately measure BMD from previously acquired CT scans Hence if a patient is either
scheduled to undergo a chest CT scan or has had a CT scan in the last years we can measure BMD and
obviate the time trouble radiation exposure and expense of a DXA scan which would be a separate
procedure We plan to offer BMD measurement as an add on service and share the CMS reimbursement of
$ with referring radiologists Our primary target market will be individuals undergoing low radiation lung CT
scans LCS to assess risk of lung cancer New expert guidelines mandate annual scans for current or former
smokers hence the volume of CT scans will increase by an estimated million per year However our
current algorithm was created using high resolution cardiac CT scans To similarly measure BMD from LCS
used for lung cancer screening we propose to obtain DXA scans and chest CT scans using parameters
that are commonly used with low dose lung imaging develop algorithms appropriate to these acquisition
protocols Aim validate against DXA as we did previously with higher resolution cardiac CT scans Aim
and determine retest reproducibility to ensure that our method can be used for serial assessment of BMD
Aim both as a screening strategy and to evaluate the effectiveness of medications that inhibit bone loss
Recruitment and scanning will be performed by our LA BioMed subcontractor Site PI Dr Matthew Budoff
who currently operate CT scanners and a DXA scanner and image to low radiation CT scans per day
partly for research protocols Our feasibility criteria are create an algorithm for LCS identify the
thoracic vertebrae that produce the best concordance with DXA and achieve retest reproducibility of or
less A follow on Phase II application will propose to validate both algorithms in a large multi ethnic cohort the
MESA Study to ensure that our algorithms can accurately and reproducibly assess BMD from either high
resolution or low resolution serial chest CT scans in all ethnic groups and in a wide range of body sizes PROJECT NARRATIVE
BDI INC proposes to develop and validate an algorithm based method to serially measure bone mineral
density BMD from previously acquired high resolution or low resolution chest CT scans to screen for the
presence of osteoporosis that would be associated with increased risk of hip and other types of fractures in
post menopausal women and all individuals over the age of There are currently more than million chest
CT scans performed annually we particularly wish to target the million additional CT scans that estimates
indicate will be performed annually because of recent recommendations to perform annual low resolution CT
scans in current or former smokers to screen for the presence of lung cancer because the vast majority of
these individuals will be older than years or be post menopausal females and BMD assessment will
therefore be indicated if they have not had this determined in the previous two years