Table of Contents

Chapter 1: An Introduction to Conventions in Densitometry

Densitometry as a Quantitative Measurement Technique

Accuracy and Precision

The Skeleton in Densitometry

Weight Bearing or Non-Weight Bearing

Axial or Appendicular

Central or Peripheral

Cortical or Trabecular

What Do the Machines Actually Measure?

The Effect of Bone Size on Areal Densities

Bone Mineral Apparent Density

Calculating “Average” Spine Bone Densities

Ultrasound Parameters

The Densitometry Printout

The Percentage Comparisons

The Standard Score Comparisons

The Age-Regression Graph

The Standardized BMD

The Utility of the sBMD

The National Health and Nutrition Examination Survey (NHANES) III Database for the Proximal Femur

Nomenclature Guidelines From the International Society for Clinical Densitometry

References

Chapter 2: Densitometry Techniques

Plain Radiography in the Assessment of Bone Density

Qualitative Morphometry

Qualitative Spinal Morphometry

The Singh Index

Quantitative Morphometric Techniques

Calcar Femorale Thickness

Radiogrammetry

The Radiologic Osteoporosis Score

Radiographic Photodensitometry

Radiographic Absorptiometry

Photon Absorptiometry Techniques

Single-Photon Absorptiometry

Dual-Photon Absorptiometry

Dual-Energy X-Ray Absorptiometry

Peripheral DXA

Single-Energy X-Ray Absorptiometry

Quantitative Computed Tomography

Peripheral QCT

Quantitative Ultrasound Bone Densitometry

References

Chapter 3: Skeletal Anatomy in Densitometry

The Spine in Densitometry

Vertebral Anatomy

Artifacts in PA or AP Spine Densitometry

Vertebral Fractures

Effect of Osteophytes on BMD

Effect of Aortic Calcification on BMD

Effect of Facet Sclerosis on BMD

Effect of Vertebral Rotation on PA Lumbar Spine Bone Density

Other Causes of Artifacts in PA and AP Lumbar Spine Studies

The Spine in the Lateral Projection

The Proximal Femur in Densitometry

Proximal Femur Anatomy

Effect of Rotation on BMD in the Proximal Femur

Effect of Leg Dominance on BMD in the Proximal Femur

Effect of Scoliosis, Osteoarthritis, Osteophytes, Surgery, and Fracture on BMD in the Proximal Femur

The Forearm in Densitometry

Nomenclature

Effect of Arm Dominance on Forearm BMD

Effect of Artifacts on BMD in the Forearm

The Metacarpals, Phalanges, and Calcaneus

References

Chapter 4: FDA-Approved Densitometry Devices

Computer-Enhanced Radiogrammetry

Computer-Enhanced Radiographic Absorptiometry

Central X-Ray Densitometers

Peripheral X-Ray Densitometers

Ultrasound Bone Densitometers

Chapter 5: Computer Basics

Types of Computers

Desktops, Towers, Minitowers, and Laptops

PCs and MACs

Major Components of a Computer System

Important Components Inside the Computer Housing

Motherboard, Random Access Memory, and Slots

Central Processing Units

Hard Drives

Internal Disk Drives

Input Devices

The Keyboard

The Mouse

The Trackball

Output Devices

Monitors

Printers

Computer Ports

Keyboard and Mouse Ports

Parallel Ports

Serial Ports

Universal Serial Bus Ports

Power, Monitor, Modem, and Network Ports

Types of Storage Media

Magnetic Media

Optical Storage Media

Flash Memory

Protecting the Data

Computer Maintenance

Chapter 6: The Importance of Precision

The Concept of Precision

Performing a Precision Study

Short-Term Precision Studies

Mathematical Procedures Used to Calculate Precision

Long-Term Precision Studies

Applying the Precision Value to Serial Measurements

Determination of Least Significant Change

Using the Least Significant Change to Determine the Timing of Repeat Measurements

A Case in Point

More Sophisticated Issues of Statistical Confidence for the Measured Change

Determining the Level of Confidence for Any Change and Precision

The Confidence Interval for the Change in BMD Between Two Measurements

The Importance of Precision

Which Skeletal Sites Should Be Used for Monitoring

How Frequently Should Measurements Be Repeated?

A Final Consideration

References

Chapter 7: Radiation Safety in X-Ray Densitometry

Radiation Basics

Radiation Quantities

The Curie

The Roentgen

The Rad

The Rem

The Effective Dose Equivalent

Harmful Effects of Ionizing Radiation

Acute Lethal Radiation Syndromes

Local Tissue Damage From Radiation

Skin

Ovaries and Testes

Bone Marrow and Blood

Late Effects of Ionizing Radiation

Radiation Doses in Densitometry

Radiation Protection Programs

Protection of the Public

Protection of the Patient

Protection of the Technologist

Time, Distance, and Shielding

Personnel Monitoring Devices

The Pregnant Technologist

References

Chapter 8: Quality Control

Phantoms

European Spine Phantom

Bona Fide Spine Phantom

Hologic Spine and Hip Phantoms

Lunar Spine Phantom

Using the Phantom to Create Control Tables and Charts

Shewhart Rules and CUSUM Charts

Shewhart Rules

CUSUM Charts

Automated Quality Control Procedures

Replacing a Densitometer

References

Chapter 9: An Overview of Osteoporosis

The Definition of Osteoporosis

The 1991 and 1993 Consensus Development Conferences

The 1994 World Health Organization Criteria for Diagnosis of Osteoporosis

The 2000 National Institutes of Health Consensus Conference Definition of Osteoporosis

Prevalence of Osteoporosis

Consequences of Osteoporosis

Risk Factors for Osteoporosis

Attainment of Peak Bone Density

Maintenance of Bone Density

Guidelines for Bone Mass Measurements

The National Osteoporosis Foundation Guidelines for Bone Mass Measurements

Guidelines From Specialty Societies

The 1997 Bone Mass Measurement Act

Treatment Guidelines for Postmenopausal Osteoporosis

NOF Guidelines

Treatment Guidelines From AACE and NAMS

Interventions in Osteoporosis

Nonprescription Interventions

Lifestyle Modifications

Calcium, Vitamin D, and Exercise

Prescription Interventions

Estrogen Replacement

The Selective Estrogen Receptor Modulator Raloxifene

Synthetic Salmon Calcitonin

Bisphosphonates

Alendronate

Risedronate

Ibandronate

Dosing, Contraindications, and Safety

Teriparatide

Patient Education Materials

References

Chapter 10: Interpretation of Bone Densitometry Data

The Results

The Skeletal Image

Measured and Calculated Bone Density Parameters

Comparisons to the Reference Database

Standardized BMD

Age-Regression Graph

Assignment of Diagnostic Category Based on WHO Criteria

Conflicting Diagnoses From the Measurement of Multiple Sites

Report Review

References

Chapter 11: Considerations in Pediatric Densitometry

Scan Acquisition and Analysis Considerations

Bone Age

Sexual Maturation Stage

Considerations of Bone Size and Shape

Skeletal Development and the Use of Standard Scores

in Pediatric Densitometry

Skeletal Development

Use of Standard Scores in Pediatric Densitometry

Pediatric Reference Databases

International Society for Clinical Densitometry Guidelines for Children

The Specialty of Pediatric Densitometry

References

Chapter 12: Moving Beyond Bone Density With Bone Densitometers: Skeletal Morphometry and Body Composition Assessments

Skeletal Morphometry for Structural Diagnoses and Prediction of Fracture Risk

Vertebral Morphometry and Fractures

Relationship Between Prevalent Spine Fractures and Future Fracture Risk

Diagnosing Vertebral Fractures

Vertebral Fracture Assessment With Genant’s Semiquantitative Technique

Vertebral Fracture Assessment With Quantitative Techniques

Performance Comparisons of Semiquantitative and Quantitative Techniques

Fan-Array Spine Imaging With DXA

Proximal Femur Morphometry

Hip Axis Length

The Femoral Neck-Shaft Angle

Femoral Neck Width

The Upper Femoral Neck

Hip Strength Analysis

Body Composition Analysis

The Body Mass Index

Body Composition Methods

Two-Compartment Body Composition Measurement Techniques

Underwater Weighing

Skinfold Measurements

Bioelectrical Impedance Analysis

Air Displacement Plethysmography

Three-Compartment Body Composition Measurement Techniques

Near Infrared Interactance

Dual Energy X-Ray Absorptiometry

References

Appendix I. Contacts for Bone Densitometry Manufacturers and Organizations of Interest

Appendix II. World Health Organization Criteria for the Diagnosis of Osteoporosis Based on the Measurement of Bone Density

Appendix III: Guidelines for Bone Density Testing

Appendix IV: Bone Mass Measurement Act of 1997

Appendix V: CPT Codes for Bone Densitometry

Appendix VI: Dual-Energy X-Ray Apsorptiometry Posteroanterior Lumbar Spine Labeling Guidelines

Appendix VII. Conversion Formulas

Appendix VIII. Recommended Procedures for Short-Term Precision Studies

Appendix IX. Least Significant Change

Appendix X. Quality Control Shewhart Rules

Appendix XI. Glossary of Computer Terms

Appendix XII. The CD-ROM Companion

Index

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