Definition
It is a speciality that uses
various methods in assessing
bone mineral density of specific
skeletal sites or the whole body
for the diagnosis of osteoporosis
and to assess the risk for future
fractures.
Bone measurement values are
used to:
Asses bone strength
Diagnosis of diseases relating to
low bone density
Monitors the effects of therapy
for such diseases
Predict risk of future fractures
It is never to soon to go for your
first bone density, especially
females
Females should go for a bone
density scan after the age of 50
years and males slightly later.
Why is bone
scans over 50 so
important ?
Because women go through
menopause at the age of ± 50
years and bone mass decreases
during menopause
Indications
Osteoporosis – main indication
Metabolic diseases affecting bone
Assessment and monitoring of
osteoporosis therapy
Assessment for hormone
replacement therapy
Hyperparathyroidism
Long- term steroid therapy
Osteoporosis
Definition: a Systemic skeletal
disease characterised by low
bone mass and micro-
architectural deterioration of
bone tissue.
Osteoporosis
It can be prevented and treated
with calcium supplements
example:
- Fosamax
- Caltrate Plus
- Procydin
- Osteovite
Osteoporosis
Risk Factors:
- Family history
- Low body weight
- Smoking
- Alcohol consumption
- Previous fractures
- Low calcium intake
- All females
- Increased age
- Estrogen deficiency
Contraindications
Too low body mass
Body part that is too thick in the area
of interest
Anatomic malformation of an anatomic
site like scoliosis or kyphosis
Pregnant patients
Contrast examinations and isotope
studies in the same week
Patient Preparation
Dress patient correct
Remove dense objects like belts
and zips from the pelvic area
Ensure correct dressing of the
patient to ensure artifact-free
acquisition
Radiographers Role
Obtain complete patient history
Explain the procedure to the patient
Answer all questions professionally
Patient care
Patient privacy and confidentiality
Record keeping for follow up scans
Radiation protection for patient and
staff
DXA
Dual energy X- ray Absorptiometry
Technique used for bone density
measurements
It makes use of both a high and low
x- ray energy range
The two ranges account for maximal
attenuation differences in bone and
soft tissue
DXA
Advantages:
- Low radiation dose
- Wide availability
- Ease of use
- Short scan time
- High resolution images
- Good precision
- Stable calibration
Dose Considerations
Extremely low dose for both
operator and patient
A scan takes about 8 min.
Dose for CXR = 50 µSv
Dose for hip and spine scan =
0.60 µSv
Important aspects for completing
a bone scan
Age and ethnicity of the patient
Current height and weight of
patient
Medical history
Current medication using
Surgeries in the area of interest
Dominant side
Projections
AP lumbar spine scan
AP proximal femur/ hip scan: non-
dominant side or other hip if the hip
is replaced or contains screws
Distal Forearm: non-dominant side if
hips are replaced or if spine contains
instrumentation
Whole body scan: not often done
Why is the non-
dominant side used for
the scans ?
It is the side less used for
everyday functions and therefore
will show detoriation of the bone
first.
Centering Points
Depends on the type of machine
used
It must allow for the inclusion of all
necessary anatomy
AP lumbar spine: Middle of T12 to
middle of L5. L1 to L4 are analysed
AP proximal femur/ hip: Shaft of
femur must be straight, with greater
trochanter centered to the scan
window. Entire femoral head should
be visualized
The information obtained from the
scan is computer analysed and
measurements is obtained. The
results are printed out by the
operator and taken to the
Radiologist for reporting.
Record keeping is very
important.
Why ?
Because comparisons must be
made with previous scans to
determine the progress or
detoriation of the patient’s
condition
DXA scan results
Provide accurate and precise
measurements of small changes in bone
mineral density (BMD)
Provide record of rate of bone loss or gain
and estimates for risk for fractures
T- scores represents the difference
between the patient’s BMD and young
normals
Z- scores represents the difference
between the patient's BMD and those of
aged matched peers
Other Modalities
Quantitative computed
tomography
(QCT)
Quantitative ultrasound (QUS)
Reference
Bontrager page 745 to 748
Merrill Vol 3 Chapter 39