title: Reliability of Phase Velocity Measurements of Flexural Acoustic Waves in the Human Tibia In-Vivo.
abstract: OBJECTIVE
  Axial-transmission acoustics have shown to be a promising technique to measure individual bone properties and detect bone pathologies. With the ultimate goal being the in-vivo application of such systems, quantification of the key aspects governing the reliability is crucial to bring this method towards clinical use.
  
  
  METHODS
  This work presents a systematic reliability study quantifying the sources of variability and their magnitudes of in-vivo measurements using axial-transmission acoustics. 42 healthy subjects were measured by an experienced operator twice per week, over a four-month period, resulting in over 150000 wave measurements. In a complementary study to assess the influence of different operators performing the measurements, 10 novice operators were trained, and each measured 5 subjects on a single occasion, using the same measurement protocol as in the first part of the study.
  
  
  RESULTS
  The estimated standard error for the measurement protocol used to collect the study data was ∼ 17 m/s (∼ 4% of the grand mean) and the index of dependability, as a measure of reliability, was Φ = 0.81. It was shown that the method is suitable for multi-operator use and that the reliability can be improved efficiently by additional measurements with device repositioning, while additional measurements without repositioning cannot improve the reliability substantially. Phase velocity values were found to be significantly higher in males than in females (p < 10-5) and an intra-class correlation coefficient of r = 0.70 was found between the legs of each subject.
  
  
  CONCLUSIONS
  The high reliability of this non-invasive approach and its intrinsic sensitivity to mechanical properties opens perspectives for the rapid and inexpensive clinical assessment of bone pathologies, as well as for monitoring programmes without any radiation exposure for the patient.
authors.affiliation: Institute for Biomechanics, Department of Health Sciences and Technology, Swiss Federal Institute for Technology in Zurich, Zurich, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Vogl
authors.affiliation: Institute for Biomechanics, Department of Health Sciences and Technology, Swiss Federal Institute for Technology in Zurich, Zurich, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Schnüriger
authors.affiliation: Institute for Biomechanics, Department of Health Sciences and Technology, Swiss Federal Institute for Technology in Zurich, Zurich, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Gerber
authors.affiliation: Institute for Biomechanics, Department of Health Sciences and Technology, Swiss Federal Institute for Technology in Zurich, Zurich, Switzerland.
authors.forename: William R
authors.initials: WR
authors.lastname: Taylor
mesh_terms: D000162:Acoustics; D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007866:Leg / Q000473:pathology; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D013016:Sound; D013314:Stress, Mechanical; D013977:Tibia / Q000033:anatomy & histology / Q000502:physiology*