Computer-aided system for measuring the mandibular cortical width on panoramic radiographs in osteoporosis diagnosis

Osteoporotic fractures are associated with substantial morbidity, increased medical cost and high mortality risk. Several equipments of bone assessment have been developed to identify individuals, especially postmenopausal women, with hi-h risk of osteoporotic fracture; however, a large segment of women with low skeletal bone mineral density (BMD), namely women with high risk of osteoporotic fractures, cannot be identified sufficiently because osteoporosis is asymptomatic. Recent studies have been demonstrating that mandibular inferior cortical width manually measured on panoramic radiographs may be useful for the identification of women with low BNID. Automatic measurement of cortical width may enable us to identify a large number of asymptomatic women with low BNID. The purpose of this study was to develop a computer-aided system for measuring the mandibular cortical width on panoramic radiographs. Initially, oral radiologists determined the region of interest based on the position of mental foramen. Some enhancing image techniques were applied so as to measure the cortical width at the best point. Panoramic radiographs of 100 women who had BNID assessments of the lumbar spine and femoral neck were used to confirm the efficacy of our new system. Cortical width measured with our system was compared with skeletal BNID. There were significant correlation between cortical width measured with our system and skeletal BNID. These correlations were similar with those between cortical width manually measured by the dentist and skeletal BNID. Our results suggest that our new system may be useful for mass screening of osteoporosis.