Radiographic measurement of bone turnover: microfocal radiography

  • J. Chris Buckland-Wright
  • John A. Lynch


The radiograph is a shadow image of the X-ray beam as it passes through a bone. Variations in mineral content or subtle changes in the shape or contour of the tissue can indicate either an increase or loss of mineral consistent with alterations in bone turnover. The ability of standard X-ray units to detect such changes is limited by the poor image quality due to the large size of their X-ray source (0.3–1 mm), whereas microfocal X-ray units are characterized by a micron-sized X-ray source (5–100 µm) in which the object being examined is placed close to the X-ray tube, with the film at 1.5–2 m away, resulting in magnification (macroradiographs) of the image with high spatial resolution (Fig. 10.1). Such techniques have been used widely in the United States [1] and Japan [2]. The work carried out by these groups has failed largely due to limitations in the design of their X-ray machines, in which the minute size of the X-ray source could not be maintained. The macroradiographs they obtained, of either the hand or fingers, tended to be restricted in radiographic magnification (usually ×4, rarely ×6) and spatial resolution [1,3]. The design of the British tube [3, 4], based on a different approach, ensures that the micron-sized X-ray source is retained throughout the life of the machine. The present equipment is capable of producing radiographs of small specimens (post-mortem samples, animals) to most parts of the human body at higher magnifications (from ×5 to ×20) and at a spatial resolution approximating to that of histology [3]. This is clearly better than those of other non-invasive medical imaging techniques.


Fractal Dimension Bone Turnover Cancellous Bone Radiographic Measurement Joint Space Width 
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  1. 1.
    Genant, H.K and Resnick, D. (1988) Magnification radiography, in Diagnosis of Bone and Joint Disorders, 2nd edn, (eds D. Resnick and G. Niwayama), W.B. Saunders, Philadelphia, pp. 84–107.Google Scholar
  2. 2.
    Takahashi, S. and Sakuma, S. (1975) Magnification Radiography, Springer, Berlin.Google Scholar
  3. 3.
    Buckland-Wright, J.C. and Bradshaw, C.R. (1989) Clinical applications of high definition microfocal radiography. British Journal of Radiology 62), 209–217.PubMedGoogle Scholar
  4. 4.
    Buckland-Wright, J.C. (1989) A new high definition microfocal X-ray unit. British Journal of Radiology 62), 201–208.PubMedGoogle Scholar
  5. 5.
    Mall, J.C., Genant, H.K., Silcox, D.C. and McCarty, D.J. (1974) The efficacy of finedetail radiography in the evaluation of patients with rheumatoid arthritis. Radiology 122), 37–42.Google Scholar
  6. 6.
    Meema, H.K. and Meema, S. (1972) Comparison of microradioscopic and morphometric findings in the hand bones with densitometric findings in the proximal radius in thyrotoxicosis and in renal osteodystrophy. Investigative Radiology 7), 88–96.PubMedCrossRefGoogle Scholar
  7. 7.
    Meema, H.K., Oreopoulos, D.G. and Meema, S. (1978) A roentgenologic study of cortical bone resorption in chronic renal failure. Radiology 126), 67–74.PubMedGoogle Scholar
  8. 8.
    Feldkamp, L.A., Goldstein, S.A., Parfitt, A.M. et al. (1989) The direct examination of three-dimensional bone architecture in-vitro by computed tomography. Journal of Bone and Mineral Research 4), 3–11.PubMedGoogle Scholar
  9. 9.
    Ruegsegger, P., Koller, B. and Muller, R. (1996) A microtomographic system for the nondestructive evaluation of bone architecture. Calcified Tissue International 58), 24–29.PubMedCrossRefGoogle Scholar
  10. 10.
    Dedrick, D.K., Goldstein, S.A., Brandt, K.D. et al. (1993) A longitudinal study of subchondral plate and trabecular bone in cruciate-deficient dogs with osteoarthritis followed up for 54 months. Arthritis and Rheumatism 36), 1460–1467.PubMedCrossRefGoogle Scholar
  11. 11.
    Benhamou, C.L., Lespessailles, E., Jacquet, G. et al. (1994) Fractal organization of trabecular bone images on calcaneus radiographs. Journal of Bone and Mineral Research 9 1909–1918.PubMedGoogle Scholar
  12. 12.
    Ruttimann, U.E., Webber, R.L. and Hazelrig, J.B. (1992) Fractal dimension from radiographs of periodontal alveolar bone-a possible diagnostic indicator of osteoporosis. Oral Surgery Oral Medicine Oral Pathology 74), 98–110.CrossRefGoogle Scholar
  13. 13.
    Caligiuri, P., Giger, M.L. and Favus, M. (1994) Multifractal radiographic analysis of osteoporosis. Medical Physics 21), 503–508.PubMedCrossRefGoogle Scholar
  14. 14.
    Lynch, J.A., Buckland-Wright, J.C. and Hawkes, D.J. (1991) Analysis of texture in macroradiographs of osteoarthritic knees using the fractal signature. Physics in Medicine and Biology 36), 709–722.PubMedCrossRefGoogle Scholar
  15. 15.
    Lynch, J.A., Buckland-Wright, J.C. and Hawkes, D.J. (1991) A robust and accurate method for calculating the fractal signature of texture in macroradiographs of osteoarthritic knees. Medical Informatics 16), 241–251.PubMedGoogle Scholar
  16. 16.
    Buckland, J.C., Lynch, J.A., Rymer, J. and Fogelman, I. (1994) Fractal signature analysis of macroradiographs measures trabecular organization in lumbar vertebrae of postmenopausal women. Calcified Tissue International 54), 106–112.CrossRefGoogle Scholar
  17. 17.
    Buckland-Wright, J.C., Lynch, J.A. and Macfarlane, D.G. (1996) Fractal signature analysis measures cancellous bone organisation in macroradiographs of patients with knee osteoarthritis. Annals of the Rheumatic Diseases 55), 749–755.PubMedGoogle Scholar
  18. 18.
    Lynch, J.A., Buckland-Wright, J.C., Hawkes, D.J. and Nair, S.V. (1996) Changes in anisotropy of modelled bone measured by simulated radiography and fractal signature analysis. Transactions of the Orthopaedic Research Society 21), 714.Google Scholar
  19. 19.
    Wilding, R.J.C., Slabbert, J.C.G., Kathree, H. et al. (1995) The use of fractal analysis to reveal remodelling in human alveolar bone following the placement of dental implants. Archives of Oral Biology 40), 61–72.PubMedCrossRefGoogle Scholar
  20. 20.
    Hall, T.A., Röckert, H.O. and Saunders, R.L. de C.H. (eds) (1972) X-Ray Microscopy in Clinical and Experimental Medicine, C.C. Thomas, Springfield, Illinois.Google Scholar
  21. 21.
    Ely, R.V. (1980) Microfocal Radiography, Academic Press, London.Google Scholar
  22. 22.
    Buckland-Wright, J.C. (1980) Qualitative and quantitative assessment of tissue organisation in normal and diseased organs, in Microfocal Radiography, (ed. R.V. Ely), Academic Press, London, pp. 147–195.Google Scholar
  23. 23.
    Buckland-Wright, J.C. (1977) The microfocal X-ray unit: a demonstration of its potential. Medical and Biological Illustration 27), 163–168.Google Scholar
  24. 24.
    Buckland-Wright, J.C., Macfarlane, D.G., Lynch, J.A. and Clark, B. (1990) Quantitative microfocal radiographic assessment of progression in osteoarthritis of the hand. Arthritis and Rheumatism 33), 57–65.PubMedCrossRefGoogle Scholar
  25. 25.
    Buckland-Wright, J.C., Macfarlane, D.G. and Lynch, J.A. (1992) Relationship between joint space width and subchondral sclerosis in the osteoarthritic hand: a quantitative microfocal study. Journal of Rheumatology 19), 788–795.PubMedGoogle Scholar
  26. 26.
    Buckland-Wright J.C., Macfarlane, D.G., Jasani, M.K. and Lynch, J.A. (1994) Quantitative microfocal radiographic assessment of osteoarthritis of the knee from weight bearing tunnel and semi-flexed standing views. Journal of Rheumatology 21), 1734–1741.PubMedGoogle Scholar
  27. 27.
    Lynch, J.A., Buckland-Wright, J.C. and Macfarlane, D.G. (1993) Precision of joint space width measurement in knee osteoarthritis from digital image analysis of high definition macroradiographs. Osteoarthritis and Cartilage 1), 209–218.PubMedCrossRefGoogle Scholar
  28. 28.
    Buckland-Wright, J.C. (1983) X-ray assessment of activity in rheumatoid disease. British Journal of Rheumatology 22), 3–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Buckland-Wright, J.C. (1984) Microfocal radiographic examination of erosions in the wrist and hand of patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 43), 160–171.PubMedGoogle Scholar
  30. 30.
    Bellman S. (1953) Microangiography. Acta Radiologica 102 (Suppl.), 1–104.Google Scholar
  31. 31.
    Hobdell, M.H. (1970) The relationship between the functional and structural organisation of bone in the jaws of mammals. PhD Thesis, London University.Google Scholar
  32. 32.
    Doi, K. and Imhof, H. (1977) Noise reduction by radiographie magnification. Radiology 122), 479–487.PubMedGoogle Scholar
  33. 33.
    Buckland-Wright, J.C. (1994) Quantitative radiography of osteoarthritis. Annals of the Rheumatic Diseases 53), 268–275.PubMedGoogle Scholar
  34. 34.
    Buckland-Wright, J.C, Carmichael, I. and Walker, S.R.(1986) Quantitative microfocal radiography accurately detects joint changes in rheumatoid arthritis. Annals of the Rheumatic Diseases 45), 379–383.PubMedGoogle Scholar
  35. 35.
    Buckland-Wright, J.C., Clarke, G.S., Chikanza, I.C and Grahame, R.(1993) Quantitative microfocal radiography detects changes in erosion area in patients with early rheumatoid arthritis treated with myocrisine. Journal of Rheumatology 20), 243–247.PubMedCrossRefGoogle Scholar
  36. 36.
    Buckland-Wright, J.C. (1981) Microfocal radiography in the quantitative assessment of experimentally induced inflammatory arthritis in guinea pigs. Journal of Pathology 135), 127–145.PubMedCrossRefGoogle Scholar
  37. 37.
    Buckland-Wright, J.C, Spring, M.W., Mak, R.H.K. et al. (1990) Quantitative microfocal radiography of children with renal osteodystrophy; comparison with laboratory and histological findings. British Journal of Radiology 63), 609–614.PubMedCrossRefGoogle Scholar
  38. 38.
    Wou, P.C.S., Lima, E., Turner, C. et al. (1993) Quantitative macroradiography with biochemical correlation of children with renal osteodystrophy: short communication. British Journal of Radiology 66), 743–747.PubMedGoogle Scholar
  39. 39.
    Buckland-Wright, J.C. and Walker, S.R. (1987) Incidence and size of erosions in the wrist and hand of rheumatoid patients: a quantitative microfocal radiographic study. Annals of the Rheumatic Diseases 46), 463–467.PubMedGoogle Scholar
  40. 40.
    Buckland-Wright, J.C., Clarke, G.S. and Walker, S.R. (1989) Erosion number and area progression in the wrist and hand of rheumatoid patients: a quantitative microfocal radiographie study. Annals of the Rheumatic Diseases 48), 25–29.PubMedCrossRefGoogle Scholar
  41. 41.
    Buckland-Wright, J.C., Macfarlane, D.G. and Lynch, J.A. (1995) Sensitivity of radiographie features and specificity of scintigraphic imaging in hand osteoarthritis. Revue du Rhumatisme [English Edition] 62(Suppl. 1), 14S–26S.Google Scholar
  42. 42.
    Buckland-Wright, J.C., Macfarlane, D.G., Lynch, J.A. and Jasani, M.K. (1995) Quantitative microfocal radiography detects changes in OA knee joint space width in patients in placebo-controlled trial of NSAID therapy. Journal of Rheumatology 22), 937–943.PubMedGoogle Scholar
  43. 43.
    Buckland-Wright, J.C, Macfarlane, D.G. and Lynch, J.A. (1991) Osteophytes in the arthritic hand: their incidence, size, distribution and progression. Annals of the Rheumatic Diseases 50), 627–630.PubMedGoogle Scholar
  44. 44.
    Buckland-Wright, J.C., Macfarlane, D.G., Fogelman, I. et al. (1991) Technetium 99m methylene diphosphonate bone scanning in osteoarthritic hands. European Journal of Nuclear Medicine 18), 12–16.PubMedCrossRefGoogle Scholar
  45. 45.
    Macfarlane, D.G., Buckland-Wright, J.C., Emery, P. et al. (1991) Comparison of clinical, radionuclide and radiographie features osteoarthritis of the hands. Annals of the Rheumatic Diseases 50), 623–626.PubMedGoogle Scholar
  46. 46.
    Machin, K. and Webb, S. (1994) Cone-beam x-ray microtomography of small specimens. Physics in Medicine and Biology, 39), 1639–1657.PubMedCrossRefGoogle Scholar
  47. 47.
    Holdsworth, D.W., Drangova, M. and Fenster, A. (1993) A highresolution XRII-based quantitative volume CT scanner. Medical Physics 20), 449–462.PubMedCrossRefGoogle Scholar
  48. 48.
    Feldkamp, L.A., Davis, L.C. and Kress, J.W. (1984) Practical cone-beam algorithm. Journal of the Optical Society of America A-Optics and Image Science 1), 612–619.Google Scholar
  49. 49.
    Kuhn, J.L., Goldstein, S.A., Feldkamp, L.A. et al. (1990) Evaluation of a microcomputed tomography system to study trabecular bone-structure. Journal of Orthopaedic Research 8), 833–842.PubMedCrossRefGoogle Scholar
  50. 50.
    Croucher, P.I., Garrahan, N.J. and Compston, J.E. (1996) Assessment of cancellous bone-structure-comparison of strut analysis, trabecular bone pattern factor, and marrow space star volume. Journal of Bone and Mineral Research 11), 955–961.PubMedGoogle Scholar
  51. 51.
    Turner, C.H., Cowin, S.C., Rho, J.Y. et al. (1990) The fabric dependence of the orthotropic elastic-constants of cancellous bone. Journal of Biomechanics 23), 549–561.PubMedCrossRefGoogle Scholar
  52. 52.
    Harrigan, T.P. and Mann, R.W. (1984) Characterization of microstructural anisotropy in orthotropic materials using a 2nd rank tensor. Journal of Materials Science 19), 761–767.CrossRefGoogle Scholar
  53. 53.
    Ham, Y.S., Russ, J.C., Gardner, R.P. and Verghese, K. (1993) 3-dimensional differential absorption x-ray cone-beam microtomography using balanced filters and algebraic reconstruction. Applied Radiation and Isotopes 44), 1313–1320.CrossRefGoogle Scholar
  54. 54.
    Goldstein, S.A., Goulet, R. and McCubbrey, D. (1993) Measurement and significance of three-dimensional architecture to the mechanical integrity of trabecular bone. Calcified Tissue International 53(Suppl. 1), S127–S133.PubMedCrossRefGoogle Scholar
  55. 55.
    Singh, M., Nagrath, A.R. and Maini, P.S. (1970) Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. Journal of Bone and Joint Surgery, 52A), 457–467.Google Scholar
  56. 56.
    Gluer, C.C., Cummings, S.R., Pressman, A. et al. (1994) Prediction of hip-fractures from pelvic radiographs-the study of osteoporotic fractures. Journal of Bone and Mineral Research 9), 671–677.PubMedCrossRefGoogle Scholar
  57. 57.
    Masud, T., Jawed, S., Doyle, D.V. and Spector, T.D. (1995) A population study of the screening potential of assessment of trabecular pattern of the femoral-neck (Singh index)-the Chingford study. British Journal of Radiology 68), 389–393.PubMedCrossRefGoogle Scholar
  58. 58.
    Caldwell, C.B., Rosson, J., Surowiak, J. and Hearn, T. (1993) Use of fractal dimension to characterize the structure of cancellous bone in radiographs of the proximal femur, in Fractals in Biology and Medicine (eds T.F. Nonnenmacher, G. A. Losa and E.R. Weibel), Birkhäser-Verlag, Basel, pp. 300–306.Google Scholar
  59. 59.
    Saupe, D. (1988) Algorithms for random fractals, in The Science of Fractal Images (eds H.O. Peitgen and D. Saupe), Springer-Verlag, New York, pp. 71–133.Google Scholar
  60. 60.
    Pentland, A.P. (1984) Fractal-based descriptions of natural scenes. IEEE Transactions on Pattern Analysis and Machine Intelligence 6), 661–674.Google Scholar
  61. 61.
    Voss, R.F. (1988) Random fractal forgeries, in The Science of Fractal Images (eds H.O. Peitgen and D. Saupe), Springer-Verlag, New York, pp. 805–836.Google Scholar
  62. 62.
    Peleg, S., Naor, J., Hartley, R. and Avnir, D. (1984) Multiple resolution texture analysis and classification. IEEE Transactions on Pattern Analysis and Machine Intelligence 6), 518–523.CrossRefGoogle Scholar
  63. 63.
    Sternberg, S.R. (1986) Greyscale morphology. Computer Vision Graphics and Image Processing 35), 333–355.CrossRefGoogle Scholar

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© Chapman and Hall Ltd 1998

Authors and Affiliations

  • J. Chris Buckland-Wright
  • John A. Lynch

There are no affiliations available

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