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Sun W, Gao X, Lei H, Wang W, Cao Y. Biophysical Approaches for Applying and Measuring Biological Forces. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105254. [PMID: 34923777 PMCID: PMC8844594 DOI: 10.1002/advs.202105254] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 05/13/2023]
Abstract
Over the past decades, increasing evidence has indicated that mechanical loads can regulate the morphogenesis, proliferation, migration, and apoptosis of living cells. Investigations of how cells sense mechanical stimuli or the mechanotransduction mechanism is an active field of biomaterials and biophysics. Gaining a further understanding of mechanical regulation and depicting the mechanotransduction network inside cells require advanced experimental techniques and new theories. In this review, the fundamental principles of various experimental approaches that have been developed to characterize various types and magnitudes of forces experienced at the cellular and subcellular levels are summarized. The broad applications of these techniques are introduced with an emphasis on the difficulties in implementing these techniques in special biological systems. The advantages and disadvantages of each technique are discussed, which can guide readers to choose the most suitable technique for their questions. A perspective on future directions in this field is also provided. It is anticipated that technical advancement can be a driving force for the development of mechanobiology.
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Affiliation(s)
- Wenxu Sun
- School of SciencesNantong UniversityNantong226019P. R. China
| | - Xiang Gao
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
| | - Hai Lei
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
- Chemistry and Biomedicine Innovation CenterNanjing UniversityNanjing210023P. R. China
| | - Wei Wang
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
| | - Yi Cao
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
- MOE Key Laboratory of High Performance Polymer Materials and TechnologyDepartment of Polymer Science & EngineeringCollege of Chemistry & Chemical EngineeringNanjing UniversityNanjing210023P. R. China
- Chemistry and Biomedicine Innovation CenterNanjing UniversityNanjing210023P. R. China
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Sun SZ, Jiang WB, Song TW, Chi YY, Xu Q, Liu C, Tang W, Xu F, Zhou JX, Yu SB, Sui HJ. Architecture of the cancellous bone in human proximal tibia based on P45 sectional plastinated specimens. Surg Radiol Anat 2021; 43:2055-2069. [PMID: 34642771 DOI: 10.1007/s00276-021-02826-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To reveal differences in the pattern of trabecular architecture in the epiphysis and metaphysis of the proximal tibia. METHODS The trabecular architecture of the proximal tibia was observed in 27 P45 plastinated knee specimens. RESULTS In the medial and lateral condyles, under the articular cartilage surrounded by the medial or lateral meniscus, the cancellous bone is formed by thick and dense trabecular bands, which run longitudinally in the epiphysis and then pass through the epiphyseal line to terminate on the slanted cortex of the metaphysis. In the intercondylar eminence, the trabeculae are arranged basically in a network. In the central portion of the tibial metaphysis, cancellous bone consists of fine arcuate trabeculae, which extend to the anterior and posterior cortices, respectively. These trabeculae are intersected sparsely and form trusses over the medullary cavity. Near the areas of attachment of the iliotibial tract, tibial collateral ligament, anterior and posterior cruciate ligaments, and patellar ligament, the cancellous bone is locally reinforced with patchy trabeculae, dense radiating trabeculae, or two orthotropic trabecular bands. CONCLUSION This study provides further accurate anatomical information on the trabeculae of the proximal tibia. The soft structures of knee joint, including the articular cartilage, menisci, and ligaments, and the slanted cortices of the metaphysis are important landmarks for the location of different arrangements of the cancellous architecture. The present results are beneficial for clinical diagnosis and treatment of pathologies of the knee joint, or the establishment of a finite element analysis model of the knee joint.
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Affiliation(s)
- Shi-Zhu Sun
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Wen-Bin Jiang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ting-Wei Song
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Qiang Xu
- Department of Radiology, The No. 967 Hospital of PLA Joint Logistics Support Force, Dalian, 116021, China
| | - Cong Liu
- Department of Radiology, The No. 967 Hospital of PLA Joint Logistics Support Force, Dalian, 116021, China
| | - Wei Tang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Fei Xu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Jia-Xin Zhou
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China. .,Expert Workstation, Dalian Hoffen Bio-Technique Co. Ltd., Dalian, 116052, China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China. .,Dalian Hoffen Bio-Technique Co. Ltd., Dalian, 116052, China.
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QCT-FE modeling of the proximal tibia: Effect of mapping strategy on convergence time and model accuracy. Med Eng Phys 2021; 88:41-46. [PMID: 33485512 DOI: 10.1016/j.medengphy.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/04/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022]
Abstract
Quantitative computed tomography (QCT) based finite element (FE) modeling, referred to as QCT-FE, has seen rapid growth and application for modeling bone mechanics. With this approach, varying bone material properties are set via experimentally-derived density-modulus equations. One challenge though associated with QCT-FE is to identify the appropriate mapping strategy for assigning elastic moduli to elements. The goal of this study was to evaluate different QCT-FE mapping strategies to identify the optimum approach with fastest convergence rate and highest accuracy. Four proximal tibial medial compartments were imaged using QCT and experimentally tested to characterize proximal tibial subchondral bone stiffness at four surface points, resulting in a total of 16 indentation measures. Three material mapping methods were analyzed: (1) constant-E where an average elastic modulus was assigned to each element; (2) node-based where the material properties were first mapped on nodes then interpolated to Gaussian integration points; and (3) element-based in which the material properties were directly assigned to Gaussian integration points. Different element sizes were assessed with edge-lengths ranging from 0.9 to 3 mm. Results indicated that all converged models showed similar coefficient-of-determination (R2) and normalized root-mean-square errors (RMSE%). Though, the constant-E and node-based methods converged with the element edge-length of 1.5 mm (prediction error of 4.8% and 2.5%, respectively) whereas the element-based method converged with a larger element having an edge-length 2.5 mm (error = 4.9%). In conclusion, the element-based method, with a larger element size, resulted in similar predictive accuracy, faster convergence and shorter run-times relative to the constant-E and node-based approaches. As such, we recommend the element-based method for future subject-specific QCT-FE modeling.
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Zdravkovic V, Kaufmann R, Neels A, Dommann A, Hofmann J, Jost B. Bone mineral density, mechanical properties, and trabecular orientation of cancellous bone within humeral heads affected by advanced shoulder arthropathy. J Orthop Res 2020; 38:1914-1919. [PMID: 32073163 PMCID: PMC7496343 DOI: 10.1002/jor.24633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/16/2019] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
The mechanical properties of cancellous bone in the humeral head are increasingly interesting due to the increased popularity of stemless prosthetic fixation in the cancellous bone of the metaphysis. Age or pathology-related systemic osteoporosis, inactivity, or pathology of the shoulder joint may influence the primary bonding of implants that rely on good cancellous bone quality. We assessed the bone mineral density (BMD) and anisotropy using micro-computed tomography (micro-CT) (0.04 mm voxel size) and correlated the results with indentation load/displacement response. Resected parts of humeral heads (from patients undergoing total shoulder replacement, n = 18) were used as probes. The region of interest was defined as 2 mm medial from the resection plane, presuming that it mirrored the bone quality lateral to the resection plane. The indentation tests were performed with a large probe (diameter 10 mm) in a single destructive loading procedure. The BMD and trabecular orientation were determined by micro-CT. Our results showed a correlation between the BMD and the slope of the load/displacement curve. Furthermore, the trabeculae were predominantly oriented orthogonal to the joint surface. In conclusion, the predominant factor determining the bone quality and mechanical resistance to pressure appears to be the BMD, while trabecular orientation could not be related to load/displacement response. Statement of clinical significance: Bone quality predominately determines the mechanical properties of cancellous bone. This might be crucial when prosthetic implants need to be anchored in metaphyseal bone. Therefore, clinical decision-making processes should also include local BMD measurements.
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Affiliation(s)
- Vilijam Zdravkovic
- Department of Orthopaedics and TraumatologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Rolf Kaufmann
- Center for X‐ray Analytics, Empa, Swiss Federal Laboratories for Materials Science and TechnologySt. GallenSwitzerland
| | - Antonia Neels
- Center for X‐ray Analytics, Empa, Swiss Federal Laboratories for Materials Science and TechnologySt. GallenSwitzerland
| | - Alex Dommann
- Center for X‐ray Analytics, Empa, Swiss Federal Laboratories for Materials Science and TechnologySt. GallenSwitzerland
| | - Jürgen Hofmann
- Center for X‐ray Analytics, Empa, Swiss Federal Laboratories for Materials Science and TechnologySt. GallenSwitzerland
| | - Bernhard Jost
- Department of Orthopaedics and TraumatologyKantonsspital St. GallenSt. GallenSwitzerland
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Benca E, Amini M, Pahr DH. Effect of CT imaging on the accuracy of the finite element modelling in bone. Eur Radiol Exp 2020; 4:51. [PMID: 32869123 PMCID: PMC7458968 DOI: 10.1186/s41747-020-00180-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022] Open
Abstract
The finite element (FE) analysis is a highly promising tool to simulate the behaviour of bone. Skeletal FE models in clinical routine rely on the information about the geometry and bone mineral density distribution from quantitative computed tomography (CT) imaging systems. Several parameters in CT imaging have been reported to affect the accuracy of FE models. FE models of bone are exclusively developed in vitro under scanning conditions deviating from the clinical setting, resulting in variability of FE results (< 10%). Slice thickness and field of view had little effect on FE predicted bone behaviour (≤ 4%), while the reconstruction kernels showed to have a larger effect (≤ 20%). Due to large interscanner variations (≤ 20%), the translation from an experimental model into clinical reality is a critical step. Those variations are assumed to be mostly caused by different “black box” reconstruction kernels and the varying frequency of higher density voxels, representing cortical bone. Considering the low number of studies together with the significant effect of CT imaging on the finite element model outcome leading to high variability in the predicted behaviour, we propose further systematic research and validation studies, ideally preceding multicentre and longitudinal studies.
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Affiliation(s)
- Emir Benca
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Morteza Amini
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.,Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.,Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500, Krems an der Donau, Austria
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Mukherjee S, Nazemi M, Jonkers I, Geris L. Use of Computational Modeling to Study Joint Degeneration: A Review. Front Bioeng Biotechnol 2020; 8:93. [PMID: 32185167 PMCID: PMC7058554 DOI: 10.3389/fbioe.2020.00093] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/31/2020] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA), a degenerative joint disease, is the most common chronic condition of the joints, which cannot be prevented effectively. Computational modeling of joint degradation allows to estimate the patient-specific progression of OA, which can aid clinicians to estimate the most suitable time window for surgical intervention in osteoarthritic patients. This paper gives an overview of the different approaches used to model different aspects of joint degeneration, thereby focusing mostly on the knee joint. The paper starts by discussing how OA affects the different components of the joint and how these are accounted for in the models. Subsequently, it discusses the different modeling approaches that can be used to answer questions related to OA etiology, progression and treatment. These models are ordered based on their underlying assumptions and technologies: musculoskeletal models, Finite Element models, (gene) regulatory models, multiscale models and data-driven models (artificial intelligence/machine learning). Finally, it is concluded that in the future, efforts should be made to integrate the different modeling techniques into a more robust computational framework that should not only be efficient to predict OA progression but also easily allow a patient’s individualized risk assessment as screening tool for use in clinical practice.
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Affiliation(s)
- Satanik Mukherjee
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium.,Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Majid Nazemi
- GIGA in silico Medicine, University of Liège, Liège, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Liesbet Geris
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium.,Biomechanics Section, KU Leuven, Leuven, Belgium.,GIGA in silico Medicine, University of Liège, Liège, Belgium
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Kalajahi SMH, Nazemi SM, Johnston JD. An exclusion approach for addressing partial volume artifacts with quantititive computed tomography-based finite element modeling of the proximal tibia. Med Eng Phys 2019; 76:95-100. [PMID: 31870545 DOI: 10.1016/j.medengphy.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Quantitative computed tomography based finite element modeling (QCT-FE) has potential to clarify the role of subchondral bone stiffness in osteoarthritis. The limited spatial resolution of clinical QCT systems, however, results in partial volume (PV) artifacts and low contrast between cortical and trabecular bone, which adversely affects the accuracy of QCT-FE models. The objective of this research was to evaluate the agreement between stiffness predictions offered by QCT-FE models of proximal tibial subchondral bone (constructed with and without a new voxel-exclusion algorithm) with experimentally-derived local subchondral bone structural stiffness. METHODS Thirteen proximal tibial compartments were obtained and imaged using QCT. Two types of QCT-FE models were developed: (1) standard model, which employed the standard procedure for QCT-FE modeling; and (2) "voxel exclusion (VE)" model, which addressed PV artifacts by excluding low density voxels during the material mapping stage of construction. We assessed agreement between QCT-FE stiffness estimates (using standard and VE approaches) with experimental stiffness by reporting predicted variance from linear regression and mean bias with 95% Limits of Agreement (LOA). RESULTS The standard and VE models explained 81% and 84% of the variance in experimentally measured stiffness, respectively. The standard model showed a mean bias of -268 N/mm (LOA -1210 to 679 N/mm); the VE model showed a mean bias of +59 N/mm (LOA -762 to 910 N/mm). INTERPRETATION The VE model explained more variance in subchondral bone stiffness with less bias. Our findings indicate that the VE method has potential to improve QCT-FE models of bone affected by PV artifacts.
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Affiliation(s)
| | - S Majid Nazemi
- Biomechanics Research Unit, GIGA In Silico Medicine, University of Liège, Liège, Belgium
| | - James D Johnston
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada.
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Hosseini Kalajahi SM, Nazemi SM, Johnston JD. Separate modeling of cortical and trabecular bone offers little improvement in FE predictions of local structural stiffness at the proximal tibia. Comput Methods Biomech Biomed Engin 2019; 22:1258-1268. [DOI: 10.1080/10255842.2019.1661386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - S. Majid Nazemi
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - James D. Johnston
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
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Knowles NK, Langohr GDG, Faieghi M, Nelson AJ, Ferreira LM. A comparison of density-modulus relationships used in finite element modeling of the shoulder. Med Eng Phys 2019; 66:40-46. [PMID: 30833224 DOI: 10.1016/j.medengphy.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 11/29/2018] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
Subject- and site-specific modeling techniques greatly improve the accuracy of computational models derived from clinical-resolution quantitative computed tomography (QCT) data. The majority of shoulder finite element (FE) studies use density-modulus relationships developed for alternative anatomical locations. As such, the objectives of this study were to compare the six most commonly used density-modulus relationships in shoulder finite element (FE) studies. To achieve this, ninety-eight (98) virtual trabecular bone cores were extracted from uCT scans of scapulae from 14 cadaveric specimens (7 male; 7 female). Homogeneous tissue moduli of 20 GPa, and heterogeneous tissue moduli scaled by CT-intensity were considered. Micro finite element models (µ-FEMs) of each virtual core were compressively loaded to 0.5% apparent strain and apparent strain energy density (SEDapp) was collected. Each uCT virtual core was then co-registered to clinical QCT images, QCT-FEMs created, and each of the 6 density-modulus relationships applied (6 × 98 = 588 QCT-FEMs). The loading and boundary conditions were replicated and SEDapp was collected and compared to µ-FEM SEDapp. When a homogeneous tissue modulus was considered in the µ-FEMs, SEDapp was best predicted in QCT-FEMs with the density-modulus relationship developed from pooled anatomical locations (QCT-FEM SEDapp = 0.979µ-FEM SEDapp + 0.0066, r2 = 0.933). A different density-modulus relationship best predicted SEDapp (QCT-FEM SEDapp = 1.014µ-FEM SEDapp + 0.0034, r2 = 0.935) when a heterogeneous tissue modulus was considered. This study compared density-modulus relationships used in shoulder FE studies using an independent computational methodology for comparing these relationships.
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Affiliation(s)
- Nikolas K Knowles
- School of Biomedical Engineering, The University of Western Ontario, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, Surgical Mechatronics Laboratory, St. Josephs Health Care, 268 Grosvenor St., London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
| | - G Daniel G Langohr
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, Surgical Mechatronics Laboratory, St. Josephs Health Care, 268 Grosvenor St., London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada
| | - Mohammadreza Faieghi
- School of Biomedical Engineering, The University of Western Ontario, London, ON, Canada
| | - Andrew J Nelson
- Department of Anthropology, The University of Western Ontario, London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada; Department of Chemistry, The University of Western Ontario, London, ON, Canada
| | - Louis M Ferreira
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, Bioengineering Laboratory, Surgical Mechatronics Laboratory, St. Josephs Health Care, 268 Grosvenor St., London, ON, Canada; Collaborative Training Program in MSK Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada.
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Guglielmi G, Balzano RF, Cheng X. What is changed in the diagnosis of osteoporosis: the role of radiologists. Quant Imaging Med Surg 2018. [PMID: 29541617 DOI: 10.21037/qims.2018.02.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Guglielmi
- Department of Radiology, Università degli Studi di Foggia, Viale Luigi Pinto, Foggia, Puglia, Italy.,Department of Radiology, Ospedale Casa Sollievo della Sofferenza, Viale cappuccini, San Giovanni Rotondo, Italy
| | - Rosario Francesco Balzano
- Department of Radiology, Università degli Studi di Foggia, Scuole di Specializzazione di Area Medica, Viale Luigi Pinto, Foggia, Puglia, Italy
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
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