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Assessment of bone fragility in projection images using radiomic features

A radiomics-based model was developed to predict bone fragility based on x-ray projection images. The model was trained using ROIs of MicroCT images, in which mean von Mises stress was computed using finite element modeling. The average normalized RMSE of the estimated von Mises stress of all folds was 14.7%. The model identifies GLSZM and GLDM features as important texture features for estimating stress. This work demonstrates radiomic features from projection images can be combined with nonlinear regression techniques to predict bone fragility and may result in a more accurate projection-domain estimate than areal bone mineral density.