Implementation of the Uncertainty Calculation for the
Detection of Negative Effect of Smoking on the Bone
Density of Paranasal Sinuses
Viktor Reshetnik1, Victoriia Alekseeva2,3,4, Anastasiia Devos5, Rosana Nazaryan3, Vitaliy
Gargin3,4 and Alina Nechyporenko1,2
1
Kharkiv National University of Radioelectronics, Nauky avenue 14, Kharkiv, 61166, Ukraine
2
Technical University of Applied Sciences Wildau (TH Wildau), Hochschulring 1, Wildau, 15745, Germany
3
Kharkiv National Medical University, Nauky avenue 4, Kharkiv, 61022, Ukraine
4
Kharkiv International Medical University, Molochna street 38, Kharkiv, 61001, Ukraine
5
Borys Grinchenko Kyiv University, Faculty of Romance and Germanic Philology, 18/2 Bulvarno-Kudriavska Str, Kyiv,
Ukraine, 04053
Abstract
The aim was to implement uncertainty calculation for detecting the negative effects of smoking on the
bone density of the paranasal sinus. Materials and Methods: A total of 100 male participants aged 20 to
44 were included in the study and divided into two groups. The first group comprised individuals with
minimal harmful habits, while the second group consisted of individuals who had been smoking for at
least 10 years, consuming 1 to 2 packs of cigarettes per day. Results Bone density has a negative
impact on the bone tissue of the upper wall of the maxillary sinus. The findings suggest that
individuals with a pronounced decrease in minimum density, as well as those with a marked
difference between minimum and maximum density values, may require heightened medical attention
due to potential associations with undiagnosed diseases or specific structural characteristics in the
skull. Conclusions. The uncertainty calculation was implemented for the detection of negative effect of
smoking on the bone density of paranasal sinuses. The calculated difference between maximum and
minimum density during the research suggests significant medical implications, especially considering
the heterogeneity of the trabecular bone structure in the skull. Individuals with a marked difference
may require heightened medical attention, potentially associated with undiagnosed diseases or
specific structural characteristics in the skull.
Keywords 1
Bone density, multispiral computer tomography, uncertainty, paranasal sinuses, smoking
1. Introduction
Calculating uncertainty is an important method for determining investigated parameters,
successfully applied in various scientific and technical fields [1]. This method has found
application in medical practice, primarily in laboratory diagnostics [2]. Although uncertainty
calculation can also be successfully applied to calculate other indicators, it is particularly
interesting when standard statistical data processing is not feasible for various reasons. The
results of uncertainty calculation in physiological conditions and under pathological conditions
are particularly intriguing. One area of interest is the impact of harmful habits on the human
body [3].
Habits have become ingrained in human life, rooted in biological processes, and formed
based on close neural interactions [4]. Once formed, habits can accompany a person throughout
ProfIT AI 2023: 3rd International Workshop of IT-professionals on Artificial Intelligence (ProfIT AI 2023), November
20–22, 2023, Waterloo, Canada
viktor.reshetnik@nure.ua (V. Reshetnik); vik13052130@gmail.com (V Alekseeva); a.devos@kubg.edu.ua
(A. Devos); rs.nazaryan@knmu.edu.ua (R. Nazaryan); vitgarg@ukr.net (V. Gargin); alinanechiporenko@gmail.com
(A. Nechyporenko)
0000-0002-8021-4310 (V. Reshetnik); 0000-0001-5272-8704 (V Alekseeva); 0000-0003-3635-1091 (A. Devos);
0000-0002-0005-8777 (R. Nazaryan); 0000-0001-8194-4019 (V. Gargin); 0000-0002-4501-7426 (A. Nechyporenko)
©️ 2023 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
CEUR
ceur-ws.org
Workshop ISSN 1613-0073
Proceedings
their entire life, exerting both positive and negative effects on the human body [5]. A striking
example of the negative impact of harmful habits on the human body is smoking, which
adversely affects almost all organs and tissues, including bone tissue [6]. Men are the
undisputed leaders in tobacco consumption among the population [7].
Recently, osteoporosis was predominantly considered a female disease [8, 9]. However,
recent data from the International Osteoporosis Foundation show that men are also quite often
affected by this condition. According to the statistics of the International Osteoporosis
Foundation, for instance, one in five men will experience a spine fracture by the age of 50 due to
osteoporosis [10]. While the relationship between osteoporosis and the bones of the spine and
hip is well-researched, less explored but equally important is the topic of skull bone density and
its changes under the influence of negative factors.
Changes in skull bone density, intensified by smoking, can act as a trigger for the
development of pathological inflammatory processes [11]. Moreover, it can become a factor
contributing to the spread of inflammatory processes in the cranial cavity and/or eye sockets,
thus leading to complications.
Considering all the aforementioned, the aim of our study was to implement uncertainty
calculation for detecting the negative effects of smoking on the bone density of the paranasal
sinus.
2. Material and Methods
A total of 100 male participants aged 20 to 44 were included in the study and divided into two
groups. The first group comprised individuals with minimal harmful habits, while the second
group consisted of individuals who had been smoking for at least 10 years, consuming 1 to 2
packs of cigarettes per day. To eliminate the influence of other harmful habits (e.g., alcohol or
drug addiction), all participants were advised to fill out a questionnaire anonymously. The
questionnaire included inquiries about demographic data (age), the presence of concomitant
diseases, particularly endocrine disorders that could disturb electrolyte balance, such as
diabetes, thyroid diseases, and parathyroid diseases. Questions about other harmful habits
(alcohol and drug addiction) were also included.
All participants provided informed consent to participate in the experiment, and the study
was approved by the bioethics committee of Kharkiv National Medical University (protocol 1
dated 08.11.2018).
Computed tomography (CT) scans were conducted on all patients at the Kharkiv Clinical
Institute of Emergency Surgery using a Toshiba Aquilion CT scanner (Japan) [12]. During the
research, preference was given to the results obtained specifically through multi-slice spiral
computed tomography (MSCT), considering its undeniable advantages compared to cone-beam
computed tomography (CBCT), primarily due to the presence of a densitometric scale. The CT
results were analyzed using RadiAnt DICOM Viewer [13]. Attention was focused on the upper
wall of the maxillary sinus, considering its higher susceptibility to pathological processes
compared to other areas. The more frequent inflammation of this sinus could be explained by its
structural features, such as its higher position compared to the natural ostium. The proximity to
tooth locations was also considered, which might create conditions for odontogenic spread of
the pathological process [14]. Additionally, this sinus is the largest in size, potentially leading to
the development of extensive purulent inflammatory processes capable of spreading to adjacent
organs and tissues, resulting in complications.
Given the challenges in anatomical point selection for obtaining representative bone density
data, uncertainty calculation was employed to determine the range of minimum and maximum
values that would be reliable for the calculated parameter. The uncertainty calculation followed
a widely accepted algorithm described in our previous works [15, 16].
3. Results
As a result of our conducted research, it can be hypothesized that density has a negative impact
on the bone tissue of the skull, particularly on the upper wall of the maxillary sinus. Table 1
presents the results of a study on bone density in the maxillary sinus measured in Hounsfield
Units (HU) for two groups: the 1st Group (smokers) and the 2nd Group (control).
Table 1
The results of the study of bone density (HU - Hounsfield Units) in the maxillary sinus
(1st(smokers) and 2nd (control) Groups)
Indicator 1st Group Max 1st Group min 2nd Group Max 2nd Group Min
UA(HHi) 79.74 24.9 28.18 19.94
UB(HHi) 0,00044 -0,000009 0.0007 -0.0000017
Uc 79.74 24.9 28.18 19.94
U 159.48 49.80 56.38 39.87
The calculated parameters UB(HHi) and U show some variations and might represent specific
characteristics or derived measures related to bone density.
In the figure 1 the results of determining the density count in each of the groups
(experimental and control) are presented.
1600 500
Smokers Max
Smokers Min
400
1400
300
1200
200
1000
100
800
0
-500 -400 -300 -200 -100 0 100 200 300
600 -100
400 -200
-300
200
-400
0
0 200 400 600 800 1 000 1 200 1 400 1 600 1 800 2 000 -500
Control GroupMin
Control Group Max
Figure 1: Maximum (a) and minimum (b) bone tissue density values in the study and control
groups
In analyzing the obtained results, we believe particular attention should be given to the
differences in density values between the experimental and control groups to determine the
negative impact of nicotine on the human body. Fig. 2 illustrates the variations in minimum and
maximum density within the two groups of individuals included in the study.
2000 500 Control Group
Bone Density Smokers Max
Bone Density , Smokers Min
Control Group Min
1800 Max SmokersMin
400
SmokersMax
1600 300
1400 200
1200 100
1000 0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49
800 -100
600 -200
400 -300
200 -400
0 -500
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 Measurements
Measurements
(а) (в)
Figure 2: Differences in maximum (a) and minimum (b) density between the experimental and
control groups
During our research, we obtained intriguing data regarding the heterogeneous decrease in
density in each case. In light of this, it can be hypothesized that nicotine may exert varying
degrees of negative influence on each individual. To assess the extent of this impact, we also
calculated the difference in maximum and minimum density in each group. This approach
allows us to identify a subgroup of individuals who are more susceptible to the adverse effects
of smoking on bone tissue than others. Such individuals may subsequently represent a potential
risk group for complications in inflammatory processes, especially if they occur in the paranasal
sinuses.
Furthermore, these individuals also present scientific interest, as there is an opportunity to
identify factors that could contribute to an increased sensitivity of organs and tissues to
nicotine. This exploration could shed light on the underlying mechanisms that make certain
individuals more vulnerable to the effects of smoking on bone density.
|Pmax control -Psmok max|
|Pmin control -Psmok min|
25 20
18
20 16
14
15 12
10
10 8
6
5 4
2
0 0
00 00 00 00 00 00 00 00 00 00 00 00 00
=1 =2 =3 =4 =5 =6 =1 =2 =3 =4 =5 =6 =7
d< =d< =d< =d< =d< =d< d< =d< =d< =d< =d< =d< =d<
1< 1< 1< 1< 1< 1< 1< 1< 1< 1< 1<
10 20 30 40 50 10 20 30 40 50 60
The value of the difference The value of the difference
(а) (в)
Figure 3: The value of the difference of Maximum and Minimum bone density in 2 groups
12
|Psmok max - Psmok min|
16
14 10
12
|Pmax-Pmin|
8
10
8 6
6 4
4
2
2
0 0
00 0 0 0 0 0 0 0 0 0 d
0
0
0
0
0
0
00
0
00
d
00
20 30 40 50 60 70 80 90 00 <=
20
30
40
50
60
70
90
<=
=1
8
10
=1
<= <= <= <= <= <= <= <= =1 00
00
<=
<=
<=
<=
<=
<=
<=
<=
d<
d<
<=
=d =d =d =d =d =d =d =d d< 10
=d
=d
=d
=d
=d
=d
=d
=d
10
=d
< < < < < < < < =
1<
1<
1<
1<
1<
1<
1<
1<
1 1 1 1 1 1 1 1 1<
1<
10 20 30 40 50 60 70 80
10
20
30
40
50
60
70
80
90
90
The value of the difference The value of the difference
(а) (в)
Figure 4: The value of the difference of Maximum and Minimum bone density in 2 groups
As seen in Fig. 3, in most cases, the difference between maximum and minimum values
ranges from 0 to 100 Hounsfield Units (Hu). Groups of individuals with a difference of around
600 Hu deserve particular attention, suggesting that the bone tissue of such individuals may
have a specific sensitivity to the detrimental effects of smoking, potentially leading to
complications more frequently.
Individuals with a pronounced decrease in minimum density are even more concerning.
Upon analyzing Fig. 3 (в), it is evident that in most cases, the difference between the minimum
densities in the two groups ranges from 100 to 300 Hu. Although cases with a difference of 400
to 700 Hu are rare, these individuals may also cause concern among medical personnel
regarding the potential development of complications in pathological processes.
During the research, the difference between maximum and minimum density was also
calculated. In our opinion, this parameter can have significant medical implications, especially
considering the heterogeneity of the trabecular bone structure in the skull. Therefore,
individuals with a markedly pronounced difference between minimum and maximum density
values may require heightened medical attention. This significant difference in their case may
be associated with undiagnosed diseases or specific characteristics in the structure of the skull,
such as the presence of diastemata.
4. Discussion
In recent years, the number of scientific studies indicating that smoking plays a significant role
in reducing bone density, typical of osteoporosis, has increased [17]. At the same time,
osteoporosis can significantly impact patients with chronic obstructive pulmonary disease
(COPD), leading to reduced activity levels and diminished quality of life [18]. The combination
of impaired lung function, decreased physical activity, and the presence of osteoporosis
substantially increases susceptibility to falls and fractures. Therefore, it is essential to monitor
bone mineral density in patients with a history of smoking and COPD to prevent complications
associated with osteoporosis.
Bone mineral density can be measured using various modern diagnostic methods, with dual-
energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT) being
commonly used in clinical practice [19]. DXA is recommended by the World Health Organization
as the gold standard for osteoporosis diagnosis. However, both DXA and QCT have limited
availability, primarily in large tertiary hospitals or physical examination centers. Therefore,
there is a need for a simple and accurate method to determine bone mineral density, allowing
for timely prevention and treatment of osteoporosis and related complications.
The evaluation of Hounsfield units [20] (HU) is proposed as an important tool for screening
changes in bone density. Determining HU in vertebral bodies is suggested as a quick and cost-
effective method that provides additional information about bone health without additional
radiation exposure. The optimal threshold for defining average bone mineral density associated
with osteoporosis is proposed as 136.2 HU for men with a sensitivity of 95.0 and specificity of
77.6, and 137.9 HU for women with a sensitivity of 96.0 and specificity of 64.4.
Factors related to smoking that can influence bone density include the direct effects of
nicotine and certain cigarette elements on osteoblast activity [21], inhibition by nicotine acid,
increased estrogen metabolism with decreased estrogen levels, inhibition of ovarian function,
and the long-term use of glucocorticoids leading to osteoblast proliferation inhibition.
Smoking is considered a significant risk factor for life-threatening diseases [22]. Prolonged
smoking has been linked to a decrease in average life expectancy by 22 years and a threefold
increase in mortality rates. Despite these risks, the number of smokers is expected to rise,
leading to approximately 10 million deaths annually by 2030.
Smoking in childhood [23] and adolescence contributes to worsened general health,
increased risk, and severity of respiratory diseases, impacting the development and functioning
of the respiratory system. The statistics on smoking among children and adolescents are
alarming, with a substantial number becoming regular smokers, leading to premature death.
The exploration of smoking's impact on subgingival bacteria should consider eliminating other
factors that may interfere and are related to gingivitis and periodontitis.
It is essential to recognize the adverse effects of smoking, particularly among the youth, as
early smoking initiation often leads to nicotine addiction and complicates smoking cessation.
The early development of generalized osteoporosis is an important consequence of smoking in
those who start smoking at a young age, impacting the bones of the facial skeleton. The
implications of these changes in the dental and periodontal tissues, affecting the early loss of
teeth, should be given more attention by ear, nose, and throat specialists.
The impact of nicotine requires careful consideration, especially among the youth. An
important adverse consequence of smoking in those who start at a young age is the early
development of generalized osteoporosis. Despite this, the changes in the bones of the facial
skeleton receive insufficient attention from ear, nose, and throat specialists compared to the
attention given by dentists to changes in the dental and periodontal tissues. To assess the
impact of smoking on subgingival bacteria, other factors that may interfere or are related to
gingivitis and periodontitis should be eliminated.
In the context of examining the impact of smoking on bone density, our findings align with
the broader scope of research in healthcare-related intelligent systems. Studies on an
intelligent expert system for knowledge examination of medical staff regarding infections
associated with the provision of medical care [23], as well as works in the areas of smart
systems, data-driven services in healthcare, and the application of smart technologies for
medical services, may contribute to the growing body of knowledge in the field of the detection
of bone density [24].
The integration of smart systems and data-driven services in healthcare, as explored by
some authors [25-27] emphasizes the importance of leveraging technology for improved
medical outcomes. Our study, focusing on the influence of smoking on bone density, adds to this
discourse by shedding light on a specific aspect of health that may be impacted by lifestyle
choices such as smoking
In conclusion, smoking can be considered a fully-fledged risk factor for life-threatening
diseases, affecting the respiratory system and bone density. Recognizing the impact of smoking
on various aspects of health, including oral health, is crucial for providing comprehensive care
and preventive measures. Continuous efforts are needed to raise awareness about the
consequences of smoking, particularly among young individuals, and to promote strategies for
smoking cessation.
5. Conclusion
The uncertainty calculation was implemented for the detection of negative effect of smoking on
the bone density of paranasal sinuses. Our study suggests a potential negative impact of
smoking on the skull bone tissue, specifically on the upper wall of the maxillary sinus.
Individuals with a pronounced decrease in minimum density, as well as those with a marked
difference between minimum and maximum density values present scientific interest.
Significant Medical Implications:
The calculated difference between maximum and minimum density during the research
suggests significant medical implications, especially considering the heterogeneity of the
trabecular bone structure in the skull. Individuals with a marked difference may require
heightened medical attention, potentially associated with undiagnosed diseases or specific
structural characteristics in the skull.
Our research contributes valuable insights into the complex relationship between bone
density, smoking, and potential health complications, emphasizing the need for further research
and clinical consideration of individuals with specific density patterns.
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