ACDSee-10 Gamma Correction ^99mTc-HDP Pinhole Bone Scan of Normal Adult Bone Skeleton Viewed from the Stand Point of Wolff’s Law

Abstract

Julius Wolff stated in 1892 that “Every change in the form and function of bone or of their function alone is followed by certain definite changes in their internal architecture, and equally definite alteration in their external conformation in accordance with mathematical laws.” (Wolff 1892; Alexander and Elma 2016). His statement was highlighted in his monograph, “Das Gesetz der Transformation von Knochen,” not an article in a journal. According to a medical dictionary his statement is currently paraphrased as “a bone, normal or abnormal, develops the structure most suited to resist the forces acting upon it” (Dorland’s Illustrated Medical Dictionary, 32nd edition by Elsevier Saunders 2012, p. 1011). We first tentatively checked if there is any significant difference exists among the ACDsee-10 gamma correction values in the cervical, thoracic, and lumbar spines finding that the gamma values were 85 in the normal cervical and thoracic spines and 95 in the normal lumbar spine. We interpreted this difference to reflect that the lumbar spine is under a higher body mechanical stress than the cervical and thoracic spines. Encouraged by this fragmentary finding we prospectively extended the gamma correction value study to the entire normal bone skeleton in 18 adults of both sexes from the cranium through the axial skeleton to the appendicular bones. This chapter reports the results we attained from the ACDSee-10 gamma correction ^99mTc-HDP pinhole bone scan study performed in the whole normal adult human bone skeletons to in vivo imaging-wise verify Wolff’s law. Clinically, the results were unique and highly informative. Thus, we propose a graded quantitation scale of CTMF (callused trabecular microfractures): nil (n = 0), mild (n = 1–9), moderate (n = 10–29), marked (30–49), and numerous (n ≥ 50) (Fig. 10.1).