1	The OsteoGram^® Measuring Bone Mineral Density Using Standard X-Rays
2	Presentation Outline: History of OsteoGram^® Evolution of the OsteoGram^® The OsteoGram^® System Scientific Validation The Clinical Trials
3	History of OsteoGram
4	Evolution of the OsteoGram^® Radiogrammetry Photo densitometry Radiographic Absorptiometry
5	Radiographic Absorptiometry Radiographic Absorptiometry (RA) is a technique that use a linear wedge to compute BMD as a function of image OD for a X-ray film. In the United States, RA was developed by CompuMed, Inc. (Los Angeles, CA).Modified forms of RA are performed in Japan, the Netherlands and Europe.
6	The OsteoGram^® System The OsteoGram^® Description The OsteoGram^® Procedure
7	OsteoGram^® description The OsteoGram^® is a stand alone system that uses RA and advanced image processing technologies to automatically measure BMD of the 2^nd, 3^rd and 4^th fingers’ middle phalangeal bones. The input to the system is a hand x-ray film from a standard x-ray equipment.
8	The OsteoGram^® System The system components include a PC with CompuMed’s analysis software, a transparency scanner, a hand positioning template and a printer
9	OsteoGram^® procedure Acquire 2-view hand x-ray (with reference wedge) Digitize the developed x-ray film Use Imaging processing technologies to extract the middle phalanges Measure phalangeal BMD pixel by pixel Calculate T-score and Z-score based on our normal database. Print the OsteoGram^® report
10	OsteoGram^® procedure
11	OsteoGram^® procedure
12	BMD Report BMD index (AU) T-score and Z-score
13	Scientific Validation Accuracy and precision Agreement with other bone mass measurements
14	Accuracy: Correlation between Ash Weight and BMC RA using OsteoGram^® : Short term precision error: <1% Accuracy error: < 5% BMC correlation: r = .983, P < .0001
15	Correlation between RA and DXA of the Forearm
16	OsteoGram^® Clinic Trials Accuracy and Precision Correlation Studies Fracture Risk Prediction Recent Studies
17	Accuracy and Precision Yang,et al. 1994. 19 cadaver studies. Correlation to ash weight was 0.983 and CV was 1.03. Ravn, et al. 1996. 68 cohorts in 1.3 weeks with duplicated RA measurements. Correlation was 0.99.
18	Correlation Studies Cosman, et al. 1991. 54 women. RA, DPA/DXA, and SPA. Yang,et al. 1994. 19 cadaver studies. Correlation to DXA was 0.887. Kleepekoper et al. RA, DXA and QCT comparison.1994. 199 postmenopausal women. Ravn et al. 1996. 308 women from the EPIC study. RA, SXA and DXA comparison. Takada, et al. 1997. 106 premenopausal and postmenopausal women. RA and DXA.
19	Fracture Risk prediction Hawaii Osteoporosis Foundation in 1997. 560 postmenopausal women. Average follow up 2.7 years. The Center for Disease Control and Prevention in 1998. 3481 white and black women. Maximum follow up 16 years.
20	Recent Studies Correlation between direct and screened exposure, 2000. Correlation between the OsteoGram^® and DXA forearm, 2000. Investigation on Chinese population, 2001
21	Direct &Screened Exposure 207 Caucasian and Asian females between the ages of 20 to 79 participated in this study at three different osteoporosis clinical centers in California, USA BMD results obtained with and without intensifying screens were very strongly correlated, the coefficient is between 0.988 ~ 0.99.
22	DXA Correlation Study BMD was measured in 40 Caucasian and Asian females between the ages of 43 and 84 using the OsteoGram^® and forearm DXA (Hologic QDR-4500W). The results were highly correlated with r = 0.87 and P<.0001
23	Investigation on a Chinese population, method 583 Chinese population between the ages of 10 to 89 participated in the study. 23 were disqualified because of diabetes or prolonged use of corticosteroid. 279 male / 281 female with an average of 35 volunteers per 10 year-span age group qualified for normal BMD measurement. Standard 8”x10” hand x-rays were acquired for the non dominant hand
24	Investigation on a Chinese population, results
25	Conclusion RA BMD using the OsteoGram: The OsteoGram^® is an accurate and precise phalangeal BMD measurement system using radiographic absorptiometry technique. The results of the OsteoGram^® are highly correlated to DXA . The OsteoGram^® can be used to predict fracture risk. The OsteoGram^® utilizes an existing standard x-ray equipment to provide osteoporosis report. The OsteoGram^® is fully automated and requires no special training .