Osteoporosis is a health condition that weakens bones, making them fragile and more likely to fracture. It develops slowly over several years, or even decades, without symptoms and is often only diagnosed when a fall or sudden impact causes a bone fracture. According to the International Osteoporosis Foundation, 1 in 3 women and 1 in 5 men over the age of 50 years will experience osteoporotic fractures. In the UK alone, more than 500,000 people per year receive hospital treatment for osteoporosis fractures, with 75% of sufferers unaware that they have the condition. Most osteoporosis related fractures are preventable. Early detection would provide opportunities for simple, effective measures (e.g. hormone treatment, medicines, moderate weight-bearing exercise) to greatly lower the risk of fractures occurring. However, due to the lack of screening, most individuals are simply diagnosed too late. Dentists use x-rays routinely to diagnose conditions such as tooth decay and jaw-bone loss, but these radiographs contain a wealth of additional information on a patient's general health which cannot be easily detected by a human clinician specialist maxillofacial radiologists. This project, led by Manchester Imaging Limited, will demonstrate use of an Artificial Intelligence (AI) digital healthcare solution to analyse these x-ray images for the diagnosis of osteoporosis. This ground-breaking AI dental technology will move osteoporosis identification from post-fracture to pre-fracture, and allow much more effective treatment of this condition. This will significantly improve patient outcomes and quality-of-life, and save the NHS hundreds of millions each year.

The project focus is global education of dental studentsat university dental schools. This sector is badly impactedby the current pandemic, struggling to maintain many aspects of dental student education and anticipating difficulties recovering functionally and economically in the aftermath and future years. There are 17 university dental schools in the UK and a further 200 dental schools across Europe and a larger number in the US. In these schools are over 100,000 dental students that would benefitfrom an AI-based self-directed distance learning tool focussed on dental radiograph analysis skills improvement. Dental radiograph analysisis central to dental diagnosis and treatment planning. Used correctly analysis of the dental radiograph is an important tool in preventative dentistryto detect a range of dental diseases and treat dental patients at an early stage. Expert AI-based prompting systemsare of value in many medical fields in which inspection of radiographs is necessary e.g. screening mammography, spinal, and ophthalmic images. Dentistry is a further example where an AI-based prompting system, trained using expert data provided by dento-maxillofacial radiologists, has been shown to improve overall standards of diagnostic accuracy by dental students(data from University of Manchester and Manchester Imaging on file). Additionally in a world where distance learningis increasingly valued many current university dental school teaching methods do not readily lend themselves to the_\*_teaching of clinical analysis of medical images\*. Using current technologies, dental students cannot easily record their clinical assessment of a dental radiographs and work on this with their tutors who have no means of assessing the student's performance improvement. AssistDent(r) from Manchester Imaging Limited is an aid in the diagnosis of early dental disease, currently sold in the UK and Europe to dentists. They use it as a prompting system specifically to help when analysing bitewing radiographs looking for a particular early type of tooth decay. AssistDent is AI software available in a web application that isapproved as a CE marked medical device produced to ISO-13485 accredited standard. This project will adapt and repurpose the AssistDent(r)to prompt for a much wider range of dental diseases so that it can be used by all university dental schools to enable dental students to improve their dental radiograph analysis abilitywithout having to attend the dental school facilities. It is envisioned that within the six months interim releases will provide access to new functions as they become available. EFFECTS OF 'EXTENSION FOR IMPACT' FUNDING Uptake by university dental schools of the new online dental student training tool, AssistDent, has been slow. With the ability to utilise Extension for Impact funding Manchester Imaging will address the key learning from the project so far. The two key reasons for slow uptake are firstly that customers need to see case studies from satisfied users before committing to buy, and secondly customers require more features which facilitate the integration of the product into their current online teaching workflow i.e. improved reporting, collating and export of results for assessment. The Extension for Impact funding will allow Manchester Imaging to invest time and money in partnering with customers to develop case studies of our product in use. By showcasing the benefits, and using these case studies in a refreshed marketing campaign, we believe we can accelerate the uptake. We will set a target of partnering with 8 university dental schools across UK, Scandinavia, Germany, Middle East and the US. At completion of the 3 months the 8 case studies should result in sales in the 8 universities that partnered and serve as marketing material to drive adoption by the wider global base of university dental schools, as per the original project.

We wish to investigate the commercial viability of the idea for a new product, ‘OSTEODENT’, enabling the early detection of osteoporosis from dental radiographs and clinical risk factors. The impact of OSTEODENT in reducing the health burden of osteoporosis could be significant if it is used to detect early signs of osteoporosis and allow preventative treatment to be implemented. Currently if an elderly woman has a hip fracture there is an increased risk of mortality; it is fatal in 20% of cases and permanently disables 50%. The National Osteoporosis Society estimates that around 1,150 people die every month in the UK as a result of hip fractures. In addition, hip fracture almost always involves surgery and post-operative physiotherapy. Some people do not achieve the previous level of mobility and are unable to live at home. Manchester imaging’s approach meets a diagnostic gap; using X-ray images acquired during dental examination, it identifies individuals with low bone mineral density that have not presented or been identified in primary care. The company believes that this will lead to fewer patients receiving an after-fracture diagnosis, and will pick up sufferers at an earlier stage where intervention is more effective and economical.