MARCO CONCEPTUAL

From the work carried out in this study it can be said that the EDXRD technique has the potential to be used in a clinical environment. This preliminary work has been limited to simulating appendicular sites and the technique would need to be extended to some of the more commonly used clinical sites i.e. the femur and spine. It is hoped that by implementing some or all of the above modifications, the technique will become a useful and viable proposition for in-vivo clinical measurement of trabecular bone mineral density and cortical thickness. Being able to measure these two quantities in isolation from each other would be an advantage over current methods in common use such as DEXA which give an overall bone density value.

For the clinical system to operate, an accurate calibration set of data for a given clinical site would be needed from which predictions of patient measurements could be made. This calibration set could be made from a set of phantoms similar to those described in this work, in which case the measurement time for the calibration data set is not limited by dose restrictions. The measurements made on the excised femoral heads are the closest to a clinical system that was attempted in this work, and it was shown that predictions on clinical material could be made from a phantom. By incorporating some of the improvements discussed above the results may be improved on. Assuming the dose of the measurement could be reduced to an acceptable level by implementing the suggestions above, the calibration set could be made from measurements on patients. However to do this the calibration set would have to be modelled using the trabecular bone density, cortical thickness and soft tissue thickness obtained from QCT measurements. The next step in progressing with this work is to move toward a more clinical environment and to ensure that the radiation dose is reduced while maintaining the required accuracy and precision on sites that are clinically relevant.

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