Background: Accurate measurement of bone mineral density (BMD) in dual-energy X-ray absorptiometry (DXA) is essential for proper diagnosis of osteoporosis. Calculation of BMD requires precise bone segmentation and subtraction of soft tissue absorption. Femur segmentation remains a challenge as many existing methods fail to correctly distinguish femur from soft tissue. Reasons for this failure include low contrast and noise in DXA images, bone shape variability, and inconsistent X-ray beam penetration and attenuation, which cause shadowing effects and person-to-person variation.
Objective: To present a new method namely, a Pixel Label Decision Tree (PLDT), and test whether it can achieve higher accurate performance in femur segmentation in DXA imaging.
Methods: PLDT involves mainly feature extraction and selection. Unlike photographic images, X-ray images include features on the surface and inside an object. In order to reveal hidden patterns in DXA images, PLDT generates seven new feature maps from existing high energy (HE) and low energy (LE) X-ray features and determines the best feature set for the model. The performance of PLDT in femur segmentation is compared with that of three widely used medical image segmentation algorithms, the Global Threshold (GT), Region Growing Threshold (RGT), and artificial neural networks (ANN).
Results: PLDT achieved a higher accuracy of femur segmentation in DXA imaging (91.4%) than either GT (68.4%), RGT (76%) or ANN (84.4%).
Conclusions: The study demonstrated that PLDT outperformed other conventional segmentation techniques in segmenting DXA images. Improved segmentation should help accurate computation of BMD which later improves clinical diagnosis of osteoporosis.
Keywords: Dual-energy X-ray absorptiometry (DXA); decision tree; feature extraction; feature selection; mathematical morphology; non-local means filter; osteoporosis; segmentation.