Opportunistic Bone Density Screening

Dual-energy x-ray absorptiometry (DEXA) is the standard imaging modality used to screen patients for osteoporosis. Despite this, DEXA scanners are not commonplace nor accessible to those at high risk for osteoporosis. What can be done to alleviate this drawback? We believe computed tomography (CT) can be used to measure bone density and diagnose osteoporosis with a specificity and sensitivity comparable to that of DEXA. If true, CT would present an effective and ubiquitous means of screening for osteoporosis across all patient populations. This has been well shown in noncontrast CTs, and we are working on making this possible in contrast-enhanced CTs, which are far more common.

DEXA Utilization in Asians and Asian Americans

Asians and Asian Americans are patient populations at high risk for developing osteoporosis. However, the proportion of these patient populations screened for osteoporosis using standard dual-energy x-ray absorptiometry (DEXA) is significantly lower than those of other patient populations. Why is this the case? Are Asians and Asian Americans restricted in their access to DEXA screening? Do Asians and Asian Americans forgo receiving DEXA screening? We are collaborating with researchers at NYU Langone Health to uncover the answers to these questions

This project is supported by a grant from the Radiological Society of North America (RSNA).

Bone Marrow Pressures – Seeking Answers!

What is the normal pressure within bone marrow? Is there a waveform? Is the pressure related to systemic blood pressure? Does disease (such as leukemia) affect bone marrow pressure? Does treatment (such as chemotherapy) affect bone marrow pressure? We are currently recruiting our CT-guided bone marrow patients for this study.

This project is supported by the MGH Schlaeger Fellowship.

Cross-Sectional Imaging for Myeloma – Cost Effective?

What is the most cost-effective imaging modality (XR, CT, MRI, PET) in the screening of monoclonal gammopathy of uncertain significance (MGUS) patients and multiple myeloma (MM) recurrence patients? We intend to find out! Using a large decision tree, along with data inputs from creditable sources, we are assembling a sophisticated Markov model to assess 3 cost-effectiveness questions: (1) Which modality is best for screening MGUS patients for MM? (2) Which modality is best for detecting MM recurrence? (3) If only one modality is available for both screening and recurrence detection, which modality should you choose? We hope that this cost-effectiveness study can help physicians make more informed decisions to minimize the medical expenses and maximizing the quality-adjusted life years of their patients.

Opportunistic Body Composition – Low Dose Whole Body CTs

Patients on the myeloma spectrum are imaged using low dose whole body CTs to look for lytic lesions and therefore progression of disease. Could this be an opportunity to also perform body composition measurements, which may predict their clinical outcomes? Are traditional 2D body composition techniques sufficient? What about newer 3D body composition techniques – do they have similar or better predictive value? Let’s find out!