Does BMDNow require dual-energy CT (DECT)?

BMDNow supports DECT for physics-first material decomposition. If only single-kV CT is available, it provides calibrated estimates via HU→BMD mapping anchored to a DECT ground-truth database.

Is intravenous contrast a problem?

The pipeline excludes vascular/contrast voxels from mineral estimates and leverages energy information to remain robust in contrast-enhanced exams.

Which skeletal sites are supported?

Initial focus on trabecular vertebrae (L1–L4) and proximal femur, with roadmap for forearm and mandible.

How are results delivered?

Structured DICOM SR and PDF with site-specific BMD (mg/cm³), guideline categories, QC flags, and optional FHIR/HL7 for EHR integration.

AI + DECT · Opportunistic QCT

Opportunistic CT Bone Mineral Density (mg/cm³)

Turning routine CT into comprehensive bone health assessment through dual-energy physics and machine learning.

Request demo See the science ↓

Opportunistic screening

Use existing CT exams to detect osteopenia/osteoporosis with volumetric BMD.

DECT material

Voxel-wise separation of bone, water, and fat for calibrated mg/cm³.

Clinic-ready outputs

Site-specific results, guideline categories, longitudinal comparisons.

Executive Summary

Opportunistic CT screening is a paradigm shift in osteoporosis detection, enabling bone mineral density (BMD) assessment during scans acquired for other clinical indications—no extra radiation, no extra cost, no extra appointments. Recent studies show 76–113% higher detection rates and >$2.5B potential annual savings in the U.S.

46.4%

Osteoporosis detection with QCT vs 17.1% with DXA

56%

Vertebral fractures missed by DXA

0.997

AUC for osteoporosis detection

$16,430

ICER per QALY (cost-effective)

Scientific Foundations of Opportunistic Screening

The underdiagnosis problem

Osteoporosis affects 200+ million people globally, leading to 1.66 million hip fractures annually. Despite DXA availability, about two-thirds of eligible patients are never assessed. Undiagnosed vertebral fractures cut 4-year survival from 60% to 30% in adults ≥75.

Why QCT

True volumetric measurement

vBMD in mg/cm³; 3D trabecular focus; independent of bone size.

Trabecular vs cortical

Compartment distinction; trabecular bone is more metabolically sensitive and predicts fractures better.

Fewer degenerative artefacts

Avoids DXA overestimation from osteophytes, endplate sclerosis, aortic calcification.

DECT physics

Two energy spectra enable material decomposition (bone/water/fat) with vendor-specific coefficients, phantom-anchored linearity, and contrast robustness.

Clinical Evidence & Validation

Fracture prediction

Opportunistic QCT predicts incident vertebral fractures better than DXA (AUC 0.84 vs 0.67); >56% of incident fracture patients were classified non-osteoporotic by DXA.

BMDNow quantitative CT bone mineral density analysis showing AI-powered spine and hip segmentation with color-coded trabecular BMD mapping in mg/cm³ for opportunistic osteoporosis detection with superior AUC 0.84 vs DXA 0.67 — BMDNow's AI-powered QCT analysis demonstrates superior fracture prediction (AUC 0.84) compared to standard DXA (0.67), with automated vertebral and hip segmentation providing calibrated volumetric BMD measurements for opportunistic osteoporosis screening.

Parameter	Opportunistic QCT	Standard DXA	QCT Advantage
Osteoporosis detection rate	46.4%	17.1%	+171%
AUC for fracture prediction	0.84	0.67	+25%
Sensitivity for vertebral fractures	89%	44%	+102%
Specificity	92%	88%	+5%

AI integration

Automatic vertebral segmentation (>98% accuracy)
AI-BMD vs dedicated QCT correlation (R² = 0.991–0.998)
Retrospective processing without human intervention
Automated DICOM SR + PDF reports

Diagnostic thresholds

L1 trabecular attenuation norms (n=20,374):

Normal: >120 mg/cm³ (>160 HU)
Osteopenia: 80–120 mg/cm³ (110–160 HU)
Osteoporosis: <80 mg/cm³ (<110 HU)

Cost-Effectiveness

Multiple studies demonstrate economic superiority of opportunistic CT screening:

Cost savings

Especially in women ≥65

$70,249/QALY

WTP threshold achieved

129

Fractures prevented per 10,000 screenings

$2.5B

Potential annual savings (U.S.)

No added operational cost

No extra scan time
No additional radiation
No separate appointments
No extra acquisition staff
No specialized hardware beyond existing CT

Return

Markov analyses: ICER $16,430/QALY—well below WTP thresholds; dominant in high-risk groups.

Clinical Implementation & Workflow

PACS integration

Auto-detect eligible studies
Vertebral segmentation and BMD analysis
Structured reporting (DICOM SR + PDF)

Recommended protocol

Women ≥65 / Men ≥70: all thoracic/abdominal CT
Age 50–64 with risks: prior fractures, corticosteroids, RA
Oncology: baseline and follow-up
Pre-surgical: spine or arthroplasty planning

Clinical action

<80 mg/cm³: immediate osteoporosis work-up
80–120 mg/cm³: assess additional risk factors
Vertebral fracture: start anti-osteoporotic therapy
Follow-up: 12–24 months

Regulatory & privacy

SaMD lifecycle aligned to MDR/FDA
GDPR compliance, audit trails, RBAC
On-prem or cloud deployment

Technology Roadmap

Asynchronous calibration

Internal tissue references
Vendor/protocol-specific corrections
DECT cross-validation
Contrast-phase adjustment

Low-dose CT

Feasible at 80 kV (lung cancer screening); correlation R²=0.991–0.998 vs 120 kV QCT.

Multi-domain

Bone: BMD, microarchitecture, finite-element strength
Body composition: sarcopenia, fat infiltration
CV risk: aortic calcification, epicardial fat

Barriers & Solutions

Barrier	Proposed solution	Status
Scanner variability	Multi-vendor asynchronous calibration	Implemented in BMDNow
Specific reimbursement	CPT codes for advanced image analysis	In progress
Workflow integration	Full automation via PACS	Available
Medical education	Training & certification	Expanding
Incidental findings	Standardized referral protocols	Guidelines published