Steven Ligthert, M.A.
The Orthopaedic Resarch Lab (ORL) is implementing a computer model that predicts fracture risk in the femur (thighbone) in patients with metastatic lesions (cancer and bone metastases).
Bone metastases are the most common form of malignant tumors in the skeleton and often give cancer patients a lot of pain and an increased risk of a pathological fracture. Treatment of bone metastases is based on the fracture risk: patients with a low fracture risk get pain relief (for example with radiotherapy), while patients with a high risk of fracture are eligible for a preventive stabilizing operation to prevent a pathological fracture.
In current clinical practice, the fracture risk is estimated on the basis of X-rays or CT scans, with particular attention to the location and size of the lesion(s); no biomechanical information is included in the risk assessment. However, these fracture predictors are insufficiently accurate, which means that many patients are over- and under-treated. That is why we have developed a patient-specific finite-element computer model within the ORL, with which we can better estimate the risk of fracture. A biomechanical calculation of bone strength is done based on a CT scan.
The added value of this computer model has now been scientifically substantiated. The next step is to implement the computer model in clinical practice, starting at the radiotherapy centers where most patients with bone metastases are treated, in order to improve care for this group of patients in their final phase of life and to prevent under- and over-treatment.
I’m managing the implementation of this tool. Some of my tasks are:
- Make contact with clinical centers, PR (attend conferences, hold presentations in (radiotherapy) departments), recruit new institutes;
- Coordinate logistics: for example, exchange of (anonymous) patient data;
- Start procedure to obtain CE certification;
- Evaluation after implementation: with doctors through interviews and with patients through questionnaires;
- Follow-up of patients via Electronic Patient Dossier;