An image processing algorithm to estimate bone

mineral density using digital X-ray images

Shiyana Sherief Khan, Archana S Jayan and Sharmila Nageswaran*
School of Electronics Engineering
VIT University
Vellore, Tamil Nadu, India
*sharmila.n@vit.ac.in

Abstract— The main idea of this paper is to test and validate an
image processing algorithm that estimates the bone mineral
density from digital X-ray (both real-time and open source)
images itself. This method can reduce cost; reduce the time for
detecting the patient status and also it is a non-invasive method.
Keywords- Bone mineral density, Specific bone density, Matlab,
Region of interest, GUI.
It is with the aim to eliminate the above two drawbacks that an
image processing algorithm was tested that estimates the
BMD from a digital X-ray image itself using MATLAB
software. This method can reduce cost; reduce the time for
detecting the patient status and also it is a non-invasive
method.

I. INTRODUCTION II. BACKGROUND

Bone mineral density (BMD) is a measure of bone density,
reflecting the strength of bones as represented by calcium
content. The BMD test detects osteopenia (mild bone loss,
usually without symptoms) and osteoporosis (more severe
bone loss, which may cause symptoms). Osteoporosis is a
medical condition in which the bones become brittle and
fragile from loss of tissue, typically as a result of hormonal
changes, or deficiency of calcium or vitamin D whereas
osteopenia is a medical condition in which the protein and
mineral content of bone tissue is reduced, but less severely
than in osteoporosis.
In the current scenario, bone mineral density is mainly
measured using the device named Bone Densitometer, which
uses lower dose of X-rays to obtain the image to calculate the
BMD level. The cost for this particular test is high and mostly
the patient has to undergo X-Ray test before bone
densitometer scanning to identify whether the patient is
detected with osteoporosis. In these cases the patient gets
exposed to X-ray radiation twice and the time consumed
becomes more.
Bone mineral density (BMD) gives a value of the average
distribution of bone mineral at the site of interest, i.e., the areal
density. It is indicative of many diseases mainly osteoporosis
which has been defined as ‘a disease characterized by low
bone mass and micro architectural deterioration of bone tissue,
leading to enhanced bone fragility and a consequent increase
in fracture risk’ (WHO-1994). BMD is calculated in the most
precise way by DEXA scanning, DXA scanning, etc. Though
DEXA scanning is more efficient in calculating BMD and
requires a lower dose of X-ray beam energy, it is more
expensive than X-ray and is often a second test followed by an
X-ray scan.
It would, therefore, be useful if one could estimate the same
from digital X-ray images itself avoiding the time taken to
conduct DEXA scanning. Moreover, the expenses could also
be reduced. The aim of this project is to estimate the Bone
Mineral Density of digital X-ray images using MATLAB
software by providing an efficient, effective and reliable
method, to reduce time consumption and to reduce cost.

978-1-5090-3239-6/17/$31.00©2017IEEE
An image processing algorithm was tested using MATLAB
software. It was initially tested with open source images and
then later validated with real-time images obtained from
Chettinad Hospital, Chennai. This code has been tested mainly
on five regions: metacarpals, proximal humerus, proximal
femur, lumbar spine and patella. Precise results were obtained
for all the regions except patella as real-time image of an
osteopenic/osteoporotic patella could not be obtained. When
the BMD values obtained using digital X-ray images were
compared with those of DEXA scan, satisfactory results were
obtained ie patients detected with osteoporosis or osteopenia
were correctly determined with the code used in this work.
III. OBJECTIVE
The objective is to identify whether a patient is normal or
osteoporotic or osteopenic based on the BMD value obtained
from the image processing algorithm and to compare the same
with the BMD value obtained from bone densitometer of the
same patient.
IV. PROJECT DESCRIPTION
BMD is calculated in the most precise way by DEXA
scanning which uses lower dose of x-rays. There are no
special methods available now to identify the patients detected
with osteoporosis from x-ray images itself. Moreover the cost
for the DEXA scan is much higher than the x-ray test.
This image processing code helps to estimate the Bone
Mineral Density from the digital x-ray image itself. The
collected image is initially re-sized to a fixed pixel dimension
and is then loaded to the MATLAB software. The re-sized
image then undergoes pre-processing which include cropping
of the image for ROI and filtering the same in order to remove
noise and other unwanted disturbances. After pre-processing, a
graph plotting intensity vs. distance is obtained. The outer
diameter and the thickness of the region is calculated from the
graph and is substituted in the formula to initially obtain the
volume per area (VPA). It is then substituted to obtain the
BMD value based on which the patient status is confirmed.
The BMD value obtained from the MATLAB code is later on
compared with the DEXA report for the validation process.
where t = Cortical thickness,
W= Outer diameter,
VPA= Volume per Area and
BMD= Bone Mineral Density
V. DESIGN APPROACH
The data collected from the hospital as X-ray images and
DEXA scan reports is used in the project for comparative
study. The X-ray images include patients suspected with
osteoporosis, osteopenia and normal person. The collected
images were resized to the dimension 200*200 pixels before
the pre-processing. Pre-processing includes cropping of the
image for ROI and filtering of the same using average filter.
Image enhancement was initially performed and later on
eliminated from pre-processing techniques, since it was
proved that the intensity of the image directly co-relate with
bone mineral density [6]. BDM report of patients suspected
with osteoporosis and osteopenia were collected. A
comparative study between the BMD values obtained from the
image processing code and from BDM report of same patient
was done.
VI. DEMONSTRATION
Region: Proximal Femur (Patient with osteoporosis)
Fig. 1: X-ray image of Patient
The image of proximal femur obtained from hospital will be
initially loaded to the MATLAB software to do image
processing and further to calculate BMD. Fig. 1 shows the
image before filtering and other pre-processing techniques.
After loading the image, it will be converted to gray scale
image.

Fig. 5: Final result displays the patient status

The final output will be displayed on the command window
Fig. 2: Cropped image for ROI
from which the patient status is confirmed.
The interest region of image will be cropped which is then
used in consecutive steps in measuring the bone mineral VII. RESULTS
density. The region of interest here is the shaft of the proximal
TABLE 1: SUMMARY O F RESULTS
femur. Fig. 2 shows the cropped image.
S. Region Specific BMD Patient
No. density, ρ value Status
(g/cm3) (g/cm2)
1. Metacarpals 1.2 3.63561 Normal
2. Metacarpals 1.2 0.544768 Osteoporosis
3. Proximal Humerus 0.255±0.091 1.7397 Normal
4. Proximal Humerus 0.255±0.091 0.478918 Osteoporosis
5. Proximal Femur 0.35±0.19 1.27608 Normal
Fig. 3: Filtered image using average filter
6. Proximal Femur 0.35±0.19 0.764249 Osteoporosis
The cropped image will undergo average filtering process in
7. Proximal Femur 0.35±0.19 0.887669 Osteopenia
order to remove noise and other unwanted disturbances in the 8. Lumbar Spine 0.242±0.096 1.20718 Normal
image. Fig. 3 shows the filtered image. 9. Lumbar Spine 0.242±0.096 0.97714 Osteopenia
10. Patella 0.731±0.222 7.13309 Normal

TABLE 2: C OMPARISON O F RESULTS

Intensity

S. Region Ag DEXA Scan MATLAB Code

No. e BMD Patient BMD Patient
value Status value Status
(g/cm2) (g/cm2)
1) Proximal 85 0.490 Osteoporosis 0.764249 Osteoporosis
Fig. 4: Result after using ‘improfile’ command
Femur
The ‘improfile’ command will be used to obtain the profile
(ROI:
graph. The figure will show the intensity of image according Shaft)
to the number of pixels. Fig. 4 shows the profile graph. The 2) Lumbar 63 0.877 Osteopenia 0.97714 Osteopenia

parameters such as diameter and thickness of shaft needed in Spine

(ROI:
the equation will be measured from the profile figure.
L2-L4)
 VIII. CONCLUSION
Table 1 shows the summary of observations wherein 10 X-ray
images were tested on the code out of which 7 were real-time
and 3 were open source. The patient status has been
determined according to the BMD value obtained for each.
The code works well on four regions: metacarpals, proximal
humerus, proximal femur and lumbar spine.
Table 2 gives a comparison of the results wherein one can
clearly see that the patient status is accurately determined in
both cases even though the BMD value slightly differs. This
proves the code to be useful in further experimentation to be
used as an alternative to bone densitometer scan for detecting
patients with osteoporosis.
In computer science, a graphical user interface or GUI is a
type of interface that allows users to interact with electronic
devices through graphical icons and visual indicators such as
secondary notation, as opposed to text-based interfaces, typed
command labels or text navigation. Further work would be to
create a GUI to make it user-friendly and interactive so that it
further decreases the time taken to execute the code.
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