scholarly journals Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians?

2018 ◽  
Vol 7 (6) ◽  
pp. 430-439 ◽  
Author(s):  
F. Eggermont ◽  
L. C. Derikx ◽  
N. Verdonschot ◽  
I. C. M. van der Geest ◽  
M. A. A. de Jong ◽  
...  
Keyword(s):  
Finite Element ◽  
Fracture Risk ◽  
Bone Disease ◽  
Failure Load ◽  
Metastatic Bone Disease ◽  
Patient Specific ◽  
Finite Element Models ◽  
Fe Model ◽  
Clinical Assessments ◽  
Number Of Patients

Objectives In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians. Methods A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians. Results In institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments. Conclusion FE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines. Cite this article: F. Eggermont, L. C. Derikx, N. Verdonschot, I. C. M. van der Geest, M. A. A. de Jong, A. Snyers, Y. M. van der Linden, E. Tanck. Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians? Towards computational modelling in daily clinical practice. Bone Joint Res 2018;7:430–439. DOI: 10.1302/2046-3758.76.BJR-2017-0325.R2.

scholarly journals Prediction of fracture risk and prophylactic intervention in metastatic bone disease: a systematic review

2018 ◽  
Vol 1 (1) ◽  
pp. 44-49
Author(s):  
Bogdan Ştefan Creţu ◽  
Călin Dragosloveanu ◽  
Dragoş Cotor ◽  
Şerban Dragosloveanu ◽  
Cristian Ioan Stoica
Keyword(s):  
Fracture Risk ◽  
Bone Disease ◽  
Meta Analysis ◽  
Metastatic Bone Disease ◽  
Bone Lesions ◽  
Pathological Fractures ◽  
Element Analysis ◽  
Actual Knowledge ◽  
Number Of Patients

AbstractPathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.

scholarly journals Effects of densitometry, material mapping and load estimation uncertainties on the accuracy of patient-specific finite-element models of the scapula

2014 ◽  
Vol 11 (93) ◽  
pp. 20131146 ◽  
Author(s):  
Gianni Campoli ◽  
Bart Bolsterlee ◽  
Frans van der Helm ◽  
Harrie Weinans ◽  
Amir A. Zadpoor
Keyword(s):  
Finite Element ◽  
Musculoskeletal Diseases ◽  
Patient Specific ◽  
Finite Element Models ◽  
Fe Model ◽  
Biomechanical Models ◽  
Step Procedure ◽  
Simulation Results ◽  
Lower Uncertainty ◽  
Average Uncertainty

Patient-specific biomechanical models including patient-specific finite-element (FE) models are considered potentially important tools for providing personalized healthcare to patients with musculoskeletal diseases. A multi-step procedure is often needed to generate a patient-specific FE model. As all involved steps are associated with certain levels of uncertainty, it is important to study how the uncertainties of individual components propagate to final simulation results. In this study, we considered a specific case of this problem where the uncertainties of the involved steps were known and the aim was to determine the uncertainty of the predicted strain distribution. The effects of uncertainties of three important components of patient-specific models, including bone density, musculoskeletal loads and the parameters of the material mapping relationship on the predicted strain distributions, were studied. It was found that the number of uncertain components and the level of their uncertainty determine the uncertainty of simulation results. The ‘average’ uncertainty values were found to be relatively small even for high levels of uncertainty in the components of the model. The ‘maximum’ uncertainty values were, however, quite high and occurred in the areas of the scapula that are of the greatest clinical relevance. In addition, the uncertainty of the simulation result was found to be dependent on the type of movement analysed, with abduction movements presenting consistently lower uncertainty values than flexion movements.

SEA model for structural acoustic coupling by means of periodic finite element models of the structural subsystems

2021 ◽  
Vol 263 (1) ◽  
pp. 5301-5309
Author(s):  
Luca Alimonti ◽  
Abderrazak Mejdi ◽  
Andrea Parrinello
Keyword(s):  
Finite Element ◽  
Numerical Approach ◽  
Unit Cell ◽  
Analytical Models ◽  
Finite Element Models ◽  
Fe Model ◽  
Acoustic Coupling ◽  
Representative Unit Cell ◽  
Definition Of ◽  
Acoustic Treatment

Statistical Energy Analysis (SEA) often relies on simplified analytical models to compute the parameters required to build the power balance equations of a coupled vibro-acoustic system. However, the vibro-acoustic of modern structural components, such as thick sandwich composites, ribbed panels, isogrids and metamaterials, is often too complex to be amenable to analytical developments without introducing further approximations. To overcome this limitation, a more general numerical approach is considered. It was shown in previous publications that, under the assumption that the structure is made of repetitions of a representative unit cell, a detailed Finite Element (FE) model of the unit cell can be used within a general and accurate numerical SEA framework. In this work, such framework is extended to account for structural-acoustic coupling. Resonant as well as non-resonant acoustic and structural paths are formulated. The effect of any acoustic treatment applied to coupling areas is considered by means of a Generalized Transfer Matrix (TM) approach. Moreover, the formulation employs a definition of pressure loads based on the wavenumber-frequency spectrum, hence allowing for general sources to be fully represented without simplifications. Validations cases are presented to show the effectiveness and generality of the approach.

scholarly journals Skeletal Microstructure and Estimated Bone Strength Improve Following Parathyroidectomy in Primary Hyperparathyroidism

2017 ◽  
Vol 103 (1) ◽  
pp. 196-205 ◽  
Author(s):  
Natalie E Cusano ◽  
Mishaela R Rubin ◽  
Barbara C Silva ◽  
Yu-Kwang Donovan Tay ◽  
John M Williams ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Bone Density ◽  
Primary Hyperparathyroidism ◽  
Fracture Risk ◽  
Bone Strength ◽  
Failure Load ◽  
Mineral Density ◽  
Element Analysis ◽  
Volumetric Bone Density

Abstract Context High-resolution peripheral quantitative computed tomography (HRpQCT) is a noninvasive imaging technology that can provide insight into skeletal microstructure and strength. In asymptomatic primary hyperparathyroidism (PHPT), HRpQCT imaging has demonstrated both decreased cortical and trabecular indices, consistent with evidence for increased fracture risk. There are limited data regarding changes in HRpQCT parameters postparathyroidectomy. Objective To evaluate changes in skeletal microstructure by HRpQCT in subjects with PHPT after parathyroidectomy. Design We studied 29 subjects with PHPT (21 women, 8 men) with HRpQCT at baseline and 6, 12, 18, and 24 months postparathyroidectomy. Main Outcome Measures Volumetric bone mineral density, microarchitectural indices, and finite element analysis at the distal radius and tibia. Results At both the radius and tibia, there were significant improvements in total, cortical, and trabecular volumetric bone density as early as 6 months postparathyroidectomy (24-month values for total volumetric bone density, radius: +2.8 ± 4%, tibia: +4.4 ± 4%; P < 0.0001 for both), cortical thickness (radius: +1.1 ± 2%, tibia: +2.0 ± 3%; P < 0.01 for both), and trabecular bone volume (radius: +3.8 ± 5%, tibia: +3.2 ± 4%; P < 0.0001 for both). At both sites, by finite element analysis, stiffness and failure load were improved starting at 6 months postparathyroidectomy (24-month values for failure load, radius: +6.2 ± 6%, tibia: +4.8 ± 7%; P < 0.0001 for both). Conclusions These results provide information about skeletal microarchitecture in subjects with PHPT followed through 2 years after parathyroidectomy. Estimated bone strength is improved, consistent with data showing decreased fracture risk postparathyroidectomy.

Fracture risk assessment in metastatic femurs: a patient-specific CT-based finite-element approach

Meccanica ◽  
2019 ◽  
Vol 55 (4) ◽  
pp. 861-881 ◽  
Author(s):  
Cristina Falcinelli ◽  
Alberto Di Martino ◽  
Alessio Gizzi ◽  
Giuseppe Vairo ◽  
Vincenzo Denaro
Keyword(s):  
Risk Assessment ◽  
Finite Element ◽  
Fracture Risk ◽  
Fracture Risk Assessment ◽  
Patient Specific ◽  
Finite Element Approach ◽  
Element Approach
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