[Show abstract][Hide abstract] ABSTRACT: Serotonin plays a potential role in bone metabolism, but the nature and extent of this relationship is unclear and human studies directly addressing the skeletal effect of circulating serotonin are rare.
PLoS ONE 10/2014; 9(10):e109028. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this cross-sectional study, 95 postmenopausal women, with and without fracture history, were measured by low-frequency axial transmission ultrasound. The measured ultrasound velocity discriminated the fractured subjects from the nonfractured ones equally or better than peripheral quantitative computed tomography (pQCT) and dual energy x-ray absorptiometry (DXA). These results suggest that low-frequency ultrasound is suitable for bone fragility assessment. INTRODUCTION: Quantitative low-frequency axial transmission ultrasound is a promising modality for assessing mineral density and geometrical properties of long bones such as radius and tibia. The aim of the current study was to evaluate the ability of low-frequency axial transmission ultrasound to discriminate fractures retrospectively in postmenopausal women. METHODS: A cross-sectional study involved 95 female subjects aged 45-88 years, whose fracture information was gathered retrospectively. The fracture group was defined as subjects with one or more low-/moderate-energy fractures. The radius and tibial shaft were measured with a custom-made ultrasonometer to assess the velocity of the low-frequency first-arriving signal (V (LF)). Site-matched pQCT was used to measure volumetric cortical and subcortical bone mineral density (sBMD), and cortical thickness (CTh). Areal BMD (aBMD) was measured using DXA for the whole body (WB), lumbar spine, and hip. RESULTS: The majority (19/32; 59 %) of the fractures were in the upper limb. V (LF) in the radius, but not in the tibia, discriminated fractures with an age- and BMI-adjusted odds ratio (OR) of 2.06 (95 % CI 1.21-3.50, p < 0.01). In the radius, CTh and cortical BMD (CBMD) significantly discriminated fractures, as did the total, cortical, and sBMD in the tibia (adjusted OR 1.35-2.15, p < 0.05). Sensitivity and specificity were similar among all the measurements (area under the receiver operating characteristic curve 0.74-0.81, p < 0.001). CONCLUSIONS: Low-frequency axial transmission ultrasound in the radius was able to discriminate fractured subjects from the nonfractured ones. This suggests that low-frequency axial transmission ultrasound has the potential to assess bone fragility in postmenopausal women.
Osteoporosis International 05/2012; · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bone adapts to mechanical loads applied on it. During aging, loads decrease to a greater extent at those skeletal sites where loads increase most in earlier life. Thus, the loss of bone may occur preferentially at sites where most bone has been deposited previously; ie, bone loss could be the directional reversal of accrual. To test this hypothesis, we compared the bone mass distribution at weight-bearing (tibia) and non-weight-bearing (radius) bones among 18-year-old girls, their premenopausal mothers, and their postmenopausal maternal grandmothers. Bone and muscle properties were measured by pQCT, and polar distribution of bone mass was obtained in 55 girl-mother-maternal grandmother trios. Site-matched differences in bone mass were compared among three generations. The differences between girls and mothers and between mothers and grandmothers were used to represent the patterns of bone mass accrual from early adulthood to middle age and bone loss from middle to old age, respectively. Compared to the mothers, 18-year old girls had less bone mass in the anterior and medial-posterior regions of the tibial shaft, while the grandmothers had less bone in the anterior and posterior regions. In contrast, the bone mass differences in the radial shaft between girls and mothers and mothers and grandmothers were relatively uniform. We conclude that both bone accrual and loss are direction-specific in weight-bearing bones but relatively uniform in non-weight-bearing bones. Bone loss in old age is largely, but not completely, a reversal of the preferential deposition of bone in the most highly loaded regions during early life.
Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2011; 26(5):934-40. · 6.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Axial transmission velocity of a low-frequency first arriving signal (V (LF)) was assessed in the radius and tibia of 254 females, and compared to site-matched pQCT measurements. V (LF) best correlated with cortical BMD, but significantly also with subcortical BMD and cortical thickness. Correlations were strongest for the radius in postmenopausal females.
Ultrasonic low-frequency (LF; 0.2-0.4 MHz) axial transmission, based on the first arriving signal (FAS), provides enhanced sensitivity to thickness and endosteal properties of cortical wall of the radius and tibia compared to using higher frequencies (e.g., 1 MHz). This improved sensitivity of the LF approach has not yet been clearly confirmed by an in vivo study on adult subjects. The aims of the present study were to evaluate the extent to which LF measurements reflect cortical thickness and bone mineral density, and to assess whether an individual LF measurement can provide a useful estimate for these bone properties.
Velocity of the LF FAS (V (LF)) was assessed in the radius and tibia shaft by a new ultrasonometer (CV(RMS) = 0.5%) in a cross-sectional study involving 159 premenopausal (20-58 years) and 95 postmenopausal females (45-88 years). Site-matched volumetric total bone mineral density (BMD), cortical bone mineral density (CBMD), subcortical bone mineral density (ScBMD) and cortical thickness (CTh) were assessed using pQCT.
For the postmenopausal females, V (LF) correlated best with CBMD in the radius (R = 0.850, p < 0.001), but significantly also with ScBMD and CTh (R = 0.759 and R = 0.761, respectively; p < 0.001). Similar trends but weaker correlations were observed for the tibia and for the premenopausal women.
The LF assessment, with an optimal excitation frequency, thus provided good prediction of both cortical thickness and subcortical bone material properties. These results suggest that the LF approach does indeed have enhanced sensitivity for detecting osteoporotic changes that occur deep in the endosteal bone.
Osteoporosis International 04/2011; 22(4):1103-13. · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Body weight and lean mass correlate with bone mass, but the relationship between fat mass and bone remains elusive. The study population consisted of 396 girls and 138 premenopausal mothers and 114 postmenopausal grandmothers of these girls. Body composition and tibial length were assessed using dual-energy X-ray absorptiometry (DXA), and bone traits were determined at the tibia using peripheral quantitative computed tomography (pQCT) in the girls at the ages of 11.2 ± 0.8, 13.2 ± 0.9, and 18.3 ± 1.0 years and in the mothers (44.7 ± 4.1 years) and grandmothers (70.7 ± 6.3 years). The values of relative bone strength index (RBSI), an index reflecting the ratio of bone strength to the load applied on the tibia, were correlated among family members (all p < .05). The mean values of RBSI were similar among 11- and 18-year-old girls and premenopausal women but significantly lower in 13-year-old girls and postmenopausal women. However, in each age group, subjects in the highest BMI tertiles had the lowest RBSI values (all p < .01). RBSI was inversely associated with body weight (all p < .01), indicating a deficit in bone strength relative to the applied load from greater body weight. RBSI was inversely associated with fat mass (all p < .001) across age groups and generations but remained relatively constant with increasing lean mass in girls and premenopausal women (all p > .05), indicating that the bone-strength deficit was attributable to increased fat mass, not lean mass. Moreover, the adverse effect of fat mass was age-dependent, with every unit increase in fat mass associated with a greater decrease in RBSI in pre- and postmenopausal women than in girls (all p < .001). This is largely due to the different capacity of young and adult bones to increase diaphyseal width by periosteal apposition in response to increased load. In summary, increasing body weight with fat accumulation is accompanied by an age-dependent relative bone-strength deficit in women because the beneficial effects of increased fat mass on bone, if any, do not compensate for the mechanical burden that it imposes.
Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2010; 25(11):2341-9. · 6.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this 7-year prospective longitudinal study was to examine whether the level and consistency of leisure-time physical activity (LTPA) during adolescence affected the bone mineral content (BMC) and bone mineral density (BMD) attained at early adulthood. The study subjects were 202 Finnish girls who were 10 to 13 years of age at baseline. Bone area (BA), BMC, and BMD of the total body (TB), total femur (TF), and lumbar spine (L(2)-L(4)) were assessed by dual-energy X-ray absorptiometry (DXA). Scores of LTPA were obtained by questionnaire. Girls were divided into four groups: consistently low physical activity (G(LL)), consistently high (G(HH)), and changed from low to high (G(LH)) and from high to low (G(HL)) during 7 years of follow-up. At baseline, no differences were found in BA, BMC, and BMD among the groups in any of the bone sites. Compared with the G(LL) group, the G(HH) group had higher BMC (11.7% in the TF, p < .05) and BMD at the TB (4.5%) and the TF (12.2%, all p < .05) at age 18. Those in the G(LH) group also had higher a BMC at each site (8.5% to 9.4%, p < .05) and a higher BMD in the TB (5.4%) and the TF (8.9%) than that of G(LL) (all p < 0.05) at the age 18. Our results suggest that long-term leisure-time physical activity has a positive effect on bone mass gain of multiple bone sites in girls during the transition from prepuberty to early adulthood. In addition, girls whose physical activity increases during adolescence also benefit from bone mass gain.
Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 11/2009; 25(5):1034-41. · 6.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aetiology of increased incidence of fracture during puberty is unclear. This study aimed to determine whether low volumetric bone mineral density (vBMD) in the distal radius is associated with upper-limb fractures in growing girls, and whether any such vBMD deficit persists into adulthood. Fracture history from birth to 20 years was obtained and verified by medical records in 1034 Finnish girls aged 10-13 years. Bone density and geometry at distal radius, biomarkers and lifestyle/behavioural factors were assessed in a subset of 396 girls with a 7.5-year follow-up. We found that fracture incidence peaked during puberty (relative risk 3.1 at age of 8-14 years compared to outside this age window), and 38% of fractures were in the upper-limb. Compared to the non-fracture cohort, girls who sustained upper-limb fracture at ages 8-14 years had lower distal radial vBMD at baseline (258.9+/-37.5 vs. 287.5+/-34.1 mg/cm(3), p=0.001), 1-year (252.0+/-29.3 vs. 282.6+/-33.5 mg/cm(3), p=0.001), 2-year (258.9+/-32.2 vs. 289.9+/-40.1 mg/cm(3), p=0.003), and 7-year follow-ups (early adulthood, 307.6+/-35.9 vs. 343.6+/-40.9 mg/cm(3), p=0.002). There was a consistent trend towards larger bone cross-sectional area in the fracture cohort compared to non-fracture. In a logistic regression model, lower vBMD (p=0.001) was the only significant predictor of upper-limb fracture during the period of 8-14 years. Our results indicate that low BMD is an important factor underlying elevated upper-limb fracture risk during puberty, and that low BMD in pubertal girls with fracture persists into adulthood. Hence low vBMD during childhood is not a transient deficit. Methods to monitor vBMD and to maximise bone mineral accrual and reduce risks of falling in childhood should be developed.
[Show abstract][Hide abstract] ABSTRACT: The growth of lean mass precedes that of bone mass, suggesting that muscle plays an important role in the growth of bone. However, to date, no study has directly followed the growth of bone and muscle size through puberty and into adulthood. This study aimed to test the hypothesis that the growth of muscle size precedes that of bone size (width and length) and mass during puberty. Bone and muscle properties were measured using pQCT and DXA in 258 healthy girls at baseline (mean age, 11.2 yr) and 1-, 2-, 3-4- and 7-yr follow-up. Growth trends as a function of time relative to menarche were determined from prepuberty to early adulthood for tibial length (TL), total cross-sectional area (tCSA), cortical CSA (cCSA), total BMC (tBMC), cortical volumetric BMD (cBMD), and muscle CSA (mCSA) in hierarchical models. The timings of the peak growth velocities for these variables were calculated. Seventy premenopausal adults, comprising a subset of the girl's mothers (mean age, 41.5 yr), were included for comparative purposes. In contrast to our hypothesis, the growth velocity of mCSA peaked 1 yr later than that of tibial outer dimensions (TL and tCSA) and slightly earlier than tBMC. Whereas TL ceased to increase 2 yr after menarche, tCSA, cCSA, tBMC, and mCSA continued to increase and were still significantly lower than adult values at the age of 18 yr (all p < 0.01). The results do not support the view that muscle force drives the growth of bone size during puberty.
Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2009; 24(10):1693-8. · 6.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The ultrasonic axial transmission technique has been proposed as a method for cortical bone characterization. Using a low enough center frequency, Lamb modes can be excited in long bones. Lamb waves propagate throughout the cortical bone layer, which makes them appealing for characterizing bone material and geometrical properties. In the present study, a prototype low-frequency quantitative ultrasonic axial transmission device was used on elderly women (n = 132) to investigate the relationships between upper femur geometry and bone mineral density (BMD) and tibial speed of sound. Ultrasonic velocities (V) were recorded using a two-directional measurement set-up on the midtibia and compared with dual-energy X-ray absorptiometry measurements and plain radiographs of the hip. Statistically significant, but weak, correlations were found between V and femoral shaft cortex thickness measured from radiographs (r = 0.20-0.26). V also correlated significantly with various BMD and bone mineral content parameters (r = 0.20-0.35). Femoral BMD and geometry were found to be significant independent predictors of V (R(2) = 0.07-0.16, p < 0.01). This study showed that femoral geometry and BMD affect significantly the axial ultrasound velocity measured at the tibia. In addition, the results confirmed, for the first time, a relationship between tibial ultrasound velocity and cortical bone thickness at the proximal femur.
Ultrasound in medicine & biology 02/2009; 35(6):903-11. · 2.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent in vitro and simulation studies have shown that guided waves measured at low ultrasound frequencies (f=200 kHz) can characterize both material properties and geometry of the cortical bone wall. In particular, a method for an accurate cortical thickness estimation from ultrasound velocity data has been presented. The clinical application remains, however, a challenge as the impact of a layer of soft tissue on top of the bone is not yet well established, and this layer is expected to affect the dispersion and relative intensities of guided modes. The present study is focused on the theoretical modeling of the impact of an overlying soft tissue. A semianalytical method and finite-difference time domain simulations were used. The models developed were shown to predict consistently real in vivo data on human radii. As a conclusion, clinical guided wave data are not consistent with in vitro data or related in vitro models, but use of an adequate in vivo model, such as the one introduced here, is necessary. A theoretical model that accounts for the impact of an overlying soft tissue could thus be used in clinical applications.
The Journal of the Acoustical Society of America 11/2008; 124(4):2364-73. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Quantitative ultrasound (QUS) is a safe, inexpensive, and nonradiation method for bone density assessment. QUS correlates with, and predicts fragility fractures comparable to, dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) in postmenopausal women. However, its validity in monitoring bone growth in children is not well understood. Two hundred and fifty-eight 10-13 yr pubertal girls and 9 37-43 yr adults without diseases or history of medications known to affect bone metabolism were included in the 2-yr prospective study. Calcaneal broadband ultrasound attenuation (cBUA) was assessed using QUS-2 (Quidel, Santa Clara, CA), speed of sound of tibial shaft (tSOS) using Omnisense (Sunlight Technologies, Israel), apparent volumetric BMD (vBMD) of tibial shaft using peripheral quantitative computed tomography (pQCT; XCT2000, Stratec), and femoral neck (FN) and lumbar spine 2-4 (LS) areal BMD (aBMD) using DXA (Prodigy, GE). Over the 2 yr in girls, FN and LS aBMD showed the largest increases (17+/-8% and 20+/-8%, respectively), followed by tibial vBMD and cBUA (10+/-5% and 9+/-9%, respectively). There was no apparent change in tSOS (2+/-3%). The increase in FN and LS aBMD attenuated 48% and 40%, respectively, after adjustment of the change in body size. The change of cBUA correlated significantly with change in tibial vBMD and FN and LS aBMD (r=0.24-0.40). At the matched location, tSOS correlated only with cortical vBMD, not with cortical thickness, apparent vBMD, or bone size. The long-term reproducibility, assessed using the concordance correlation coefficient of young adults' pre-post measurements, was substantially lower in tSOS than cBUA, tibial vBMD, FN, and LS aBMD (0.65 vs 0.97, 0.95, 0.98, and 0.96; p<0.05). The transverse transmission method-derived calcaneal BUA, but not the axial transmission method-derived SOS, is comparable to DXA and pQCT for monitoring bone densitometric change in pubertal girls. The role of QUS in fracture-risk prediction in children and adolescents needs further investigation.
Journal of Clinical Densitometry 01/2008; 11(2):295-301. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It was reported in a previous study that simulated guided wave axial transmission velocities on two-dimensional (2D) numerically reproduced geometry of long bones predicted moderately real in vitro ultrasound data on the same bone samples. It was also shown that fitting of ultrasound velocity with simple analytical model yielded a precise estimate (UTh) for true cortical bone thickness. This current study expands the 2D bone model into three dimensions (3D). To this end, wave velocities and UTh were determined from experiments and from time-domain finite-difference simulations of wave propagation, both performed on a collection of 10 human radii (29 measurement sites). A 3D numerical bone model was developed with tuneable fixed material properties and individualized geometry based on X-ray computed tomography reconstructions of real bones. Simulated UTh data were in good accordance (root-mean-square error was 0.40 mm; r(2)=0.79, p<0.001) with true cortical thickness, and hence the measured phase velocity can be well estimated by using a simple analytical inversion model also in 3D. Prediction of in vitro data was improved significantly (by 10% units) and the upgraded bone model thus explained most of the variability (up to 95% when sites were carefully matched) observed in in vitro ultrasound data.
The Journal of the Acoustical Society of America 11/2007; 122(4):2439-45. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previously it has been demonstrated that cortical bone thickness can be estimated from ultrasonic guided-wave measurements, in an axial transmission configuration, together with an appropriate analytical model. This study considers the impact of bone thickness variation within the measurement region on the ultrasonically determined thickness (UTh). To this end, wave velocities and UTh were determined from experiments and from time-domain finite-difference simulations of wave propagation, both performed on a set of ten human radius specimens (29 measurement sites). A two-dimensional numerical bone model was developed with tunable material properties and individualized geometry based on x-ray computed-tomography reconstructions of human radius. Cortical thickness (CTh) was determined from the latter. UTh data for simulations were indeed in a excellent accordance (root-mean-square error was 0.26 mm; r2=0.94, p<0.001) with average CTh within the measurement region. These results indicate that despite variations in cortical thickness along the propagation path, the measured phase velocity can be satisfactorily modeled by a simple analytical model (the A(0) plate mode in this case). Most of the variability (up to 85% when sites were carefully matched) observed in the in vitro ultrasound data was explained through simulations by variability in the cortical thickness alone.
The Journal of the Acoustical Society of America 09/2007; 122(3):1818. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Quantitative ultrasound is in widespread clinical use for assessment of bone quality at peripheral skeletal sites, but has not yet been applied to those sites in the axial skeleton, such as the spine and hip, where osteoporotic fractures are common.
Ultrasound measurements were made in 11 cadaveric vertebrae and relationships with bone mineral density and failure load were investigated. An ultrasonic imaging system was used to measure speed of sound, broadband ultrasonic attenuation, and attenuation at a single frequency, through the vertebral body in the sagittal plane. Ultrasonic measurements were averaged over a region of interest centrally within the vertebral body, and were calculated with and without normalization for bone size. Vertebral bone mineral density was measured in antero-posterior and lateral projections using dual energy X-ray absorptiometry. Compressive mechanical testing was performed to determine vertebral failure load.
Bone mineral density correlated with failure load (r=0.74-0.78, all P<0.01), and with quantitative ultrasound (r=0.63-0.82, P=0.038-0.004), in line with previous studies. Of the ultrasonic measurements, those parameters not normalized for bone size gave the highest correlations with failure load, ranging from r=0.71 (P=0.021) for speed of sound to r=0.93 (P<0.001) for attenuation. When ultrasonic measurements were normalized for bone size, the correlations with both failure load and bone mineral density were lower.
These results confirm the feasibility of vertebral quantitative ultrasound in vitro, and indicate that ultrasound does provide information on both bone mineral density and failure load. The predictive performance of ultrasonic measurements for failure load was comparable to or greater than that of bone mineral density, suggesting that ultrasound has the potential to be at least as useful as mineral density in the assessment of vertebral bone. Normalizing ultrasonic measurements for bone size reduced the strength of correlations because both bone mineral density and bone strength reflect bone size to a certain extent.
[Show abstract][Hide abstract] ABSTRACT: The mechanical environment is considered to be the most important determinant of bone strength. Local muscle force, in turn, is regarded as the largest source of loading applied to bones. However, the effect of weight-bearing on bone mineral accrual is unclear. Comparing the relationship between muscle force and bone mineral content (BMC) in the upper and lower limbs provides a means of investigating this issue.
The study group comprised 258 healthy girls aged 10-13 years old at baseline. BMC, lean body mass (LM) and fat body mass (FM) of total body were assessed by dual-energy X-ray absorptiometry at baseline and 2 years after. The maximal isometric voluntary contraction (MVC) of left elbow flexors and knee extensors was evaluated by a dynamometer. A hierarchical linear statistical model with random effects was used to analyze the relationship between BMC and limb-matched MVC. Fisher's z-transformation was used to compare the correlation coefficients between arms and legs. The ratio of BMC to MVC (BMC/MVC) in upper and lower limbs was compared using Student's t-test.
BMC was highly correlated with MVC in arms and legs (r(2)=0.54 and 0.50, respectively), and the correlation coefficients did not differ between upper and lower limbs. On the other hand, BMC/MVC was significantly (30%) higher in leg than in arm.
The results indicate that local muscle contraction and weight-bearing exert an additive effect on bone mass accretion in the lower limbs. Exercise regimes combining resistance and impact training should provide larger bone response than either one of them alone in growing children.
Bone 06/2007; 40(5):1196-202. · 4.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Determination of cortical bone thickness is warranted, e.g., for assessing the level of endosteal resorption in osteoporosis or other bone pathologies. We have shown previously that the velocity of the fundamental antisymmetric (or flexural) guided wave, measured for bone phantoms and bones in vitro, correlates with the cortical thickness significantly better than those by other axial ultrasound methods. In addition, we have introduced an inversion scheme based on guided wave theory, group velocity filtering and 2-D fast Fourier transform, for determination of cortical thickness from the measured velocity of guided waves. In this study, the method was validated for tubular structures by using numerical simulations and experimental measurements on tube samples. In addition, 40 fresh human radius specimens were measured. For tubes with a thin wall, plate theory could be used to determine the wall thickness with a precision of 4%. For tubes with a wall thicker than 1/5 of the outer radius, tube theory provided the wall thickness with similar accuracy. For the radius bone specimens, tube theory was used and the ultrasonically-determined cortical thickness was found to be U-Th = 2.47 mm +/- 0.66 mm. It correlated strongly (r(2) = 0.73, p < 0.001) with the average cortical thickness, C-Th = 2.68 +/- 0.53 mm, and the local cortical thickness (r(2) = 0.81, p < 0.001), measured using peripheral quantitative computed tomography. We can conclude that the guided-wave inversion scheme introduced here is a feasible method for assessing cortical bone thickness.
Ultrasound in Medicine & Biology 02/2007; 33(2):254-62. · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Guided waves, consistent with the A0 Lamb mode, have previously been observed in bone phantoms and human long bones. Reported velocity measurements relied on line fitting of the observed wave fronts. Such an approach has limited ability to assess dispersion and is affected by interference by other wave modes. For a more robust identification of modes and determination of phase velocities, signal processing techniques using the fast Fourier transform (FFT) were investigated. The limitations of FFT because of spatial resolution were addressed to improve the precision of the measured modes. An inversion scheme was developed for determining the plate thickness from the measured velocity. Experiments were performed on free and immersed plates, mimicking bone without and with an overlying tissue. With group velocity filtering, modes could be identified reliably with precise phase velocities and thicknesses. These methods were essential for the immersed plates and they should lead to more reliable in vivo measurements.
Ultrasound in Medicine & Biology 06/2006; 32(5):709-19. · 2.10 Impact Factor