MEMS Seminar: "CT-Based Structural Rigidity Fracture Risk Prediction"
Wednesday, September 4, 2019 - 12:00pm to 1:00pm
Dr. Brian Snyder | Harvard Medical School
Preventing fractures due to skeletal neoplasms depends on objective criteria that reflect the interaction of the tumor with the host bone. Clinicians make subjective assessments regarding a patient’s fracture risk and response to treatment based on plain radiographs and clinical symptoms now recognized to be inaccurate. Metastatic cancer alters both the material and geometric properties of the bone; failure to account for changes in both of these parameters limits the accuracy of these fracture predictions. Rigidity is the structural property that integrates both the material and geometric properties of the bone; the axial (EA), bending (EI), and torsional (GJ) rigidity determine the capacity of the bone to resist axial, bending and twisting loads respectively.
We hypothesized that the structural rigidity of a bone afflicted with metabolic bone disease, benign neoplasia or metastatic cancer, provides a mechanical assay of the changes in bone tissue material properties and bone geometry induced by the disease process. Since it is the weakest segment through the bone that dictates the load capacity of the entire bone, I developed algorithms to calculate the minimal rigidity of a bone containing an osteolytic lesion from serial, trans-axial, computed tomography images through affected bones to measure both the bone tissue properties and bone cross-sectional geometry. The applicability of CT based rigidity analysis (CTRA) to predict fracture risk in the appendicular skeleton of children affected by benign skeletal neoplasms and the axial skeleton of women affected by metastatic breast cancer was established in a series of in-vivo, level II prospective studies.
A prospective, multi-center study conducted by the Musculoskeletal Tumor Society established the superiority of using reductions in structural rigidity calculated from CTRA of bones affected by metastatic cancer to prescribe surgical treatment compared to current clinical and radiographic guidelines.
Dr. Snyder is a Professor of Orthopaedic Surgery, Harvard Medical School and Research Professor of Biomedical Engineering, Boston University School of Engineering. As a Board Certified Pediatric Orthopaedic surgeon on staff at Boston Children’s Hospital, he co-directs the Cerebral Palsy Center and supervises the Spinal Muscle Atrophy Clinic. His clinical practice focuses on treating congenital and acquired deformities about the hip, spine and appendicular skeleton as a consequence of neuromuscular disease and pediatric trauma. He is a Principal Investigator at The Center for Advanced Orthopaedic Studies, a multi-disciplinary core research facility at Beth Israel Deaconess Medical Center affiliated with Harvard Medical School, the Massachussets Institute of Technology, and Boston University.
As a translational scientist, his group focuses on basic and applied research in musculoskeletal biomechanics including: characterization of bone structure-property relationships; prevention of pathologic fractures as a consequence of metabolic bone diseases and metastatic cancer; biomechanical analysis of mechanisms of spine injury, development of a novel dual ultrasound system to non-invasively measure real time cervical spine kinematics and intervertebral disc deformation during extreme activities; development of novel contrast agents for computed tomography and MRI to evaluate the in-vivo biochemical and biomechanical properties of hyaline cartilage in synovial joints affected by degenerative diseases; derivation of an animal model for early onset scoliosis to evaluate the natural history of thoracic insufficiency syndrome and the efficacy of treatments to modulate the growth and development of the spine, thorax and lungs.
He has been principal investigator of NIH/NCI RO1, NIH/NIAMS R21 and R01, NASA, DoD, private foundations (Whitaker, OREF, Susan B Komen, AO/ASIF, Coulter, POSNA, SRS) and industry sponsored grants. Additionally he is a permanent member of the NIH/NIAMS Tissue Engineering and the SBIR/STTR study panels that evaluates orthopaedic devices and biologics and represents the Pediatric Orthopaedic Society of North America and Scoliosis Research Society to the FDA and Board of Orthopaedic Specialty Societies.
Lunch will be served at 11:30 am.
Hosted by Dr. Dan Buckland