Can use of Artificial Intelligence improve Osteoporosis Detection and Bone Health Assessment?

This study is about using Artificial Intelligence (AI) to predict bone health from chest X-rays. Normally, osteoporosis is diagnosed using a DEXA scan, which measures bone mineral density (BMD). However, DEXA scans are not always available to everyone, so researchers are testing whether an AI model can estimate bone density just from a chest X-ray. Researchers will use Deep Learning AI model designed for image classification. The AI model will be trained using ~80,000 X-rays and ~15,000 DEXA scans from real patients to find patterns in X-rays that relate to bone strength. The model was tested on a retrospective subset of X-rays that were not used during training with 80% sensitivity and 80% specificity for diagnosis of osteoporosis. The goal is to see how close the AI's predictions are to the real bone density measurements. The chest x-ray and BMD scans will be delivered by accredited radiographers. BMD scan radiation doses are significantly less than a typical chest x-ray and around 1% of the radiation dose of a chest x-ray. The processing of the deep learning model could be done on-premises (local-server within the hospital) or cloud-based AI system. Correlating BMD scan to the chest x-ray will only be done once and will be within a period of 3 months. The setting for this intervention will occur within accredited Radiology practices with Flinders University staff ensuring that BMD appointments occurs within the stipulated 3 months as defined in the protocol. The prospective portion of this study will evaluate this deep learning AI system for opportunistic detection of osteoporosis on chest radiographs in a community setting. Patients referred to a radiology clinic for a chest-x ray will be screened for eligibility. At regular intervals, representatives from the clinic will provide the investigator and delegated staff with a listing of patients who have had chest x-rays performed within the last 2 weeks. Patients will then be contacted by the research team via phone and assessed if they are eligible and willing to participate in the study. Patient consent will be obtained at the time of performing the DEXA scan. Patients flagged for a follow-up DEXA study will be contacted by designated research staff and referred to an external imaging provider to have the study performed. Patients attending a radiology clinic for a chest x-ray study will be provided with a short pamphlet or brochure by the attending health professional or clerical staff that outlines the nature of the study and contact details of the research team. Patients would contact the research team to express their interest and would be assessed if they are eligible to participate in the study. Patients flagged for a follow-up DEXA study will be contacted by designated research staff and referred to an external imaging provider to have the study performed. Recruitment will continue until approximately 1307 DEXA BMD studies have been performed.