Bone Densitometry for Technologists

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 Sites Axial or Appendicular Sites Central or Peripheral Sites Cortical or Trabecular Sites What Do the Machines Actually Measure? The Densitometry Printout The Percentage Comparisons The Standard Score Comparisons The Age-Regression Graph The Standardized BMD The NHANES III Database for the Proximal Femur 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 Effects of Osteophytes on BMD Effects of Aortic Calcification on BMD Effects of Facet Sclerosis on BMD 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 Effects of Rotation on BMD in the Proximal Femur Effects of Leg Dominance on BMD in the Proximal Femur Effects of Scoliosis, Osteoarthritis, Osteophytes, Surgery, and Fracture on BMD in the Proximal Femur The Forearm in Densitometry Nomenclature Effects of Arm Dominance on Forearm BMD Effects of Artifacts on BMD in the Forearm The Metacarpals, Phalanges, and Calcaneus References Chapter 4. Densitometry Devices Approved by the Food and Drug Administration 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 The CPU The Hard Drive 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 Tape Media Optical Media Protecting the Data Computer Maintenance Chapter 6. Precision in Bone Densitometry Performing a Precision Study Short-Term Precision Studies Long-Term Precision Studies Determination of Least Significant Change When Should a Measurement Be Repeated in Clinical Practice? Which Skeletal Site Should Be Used to Monitor Changes in Bone Density? Is the Measured Change the Actual Change in BMD? Case Study in Precision Importance of Precision References Chapter 7. Radiation Safety in X-Ray Densitometry Basics of Radiation Quantities of Radiation 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 Procedures Phantoms Using the Phantom to Create Control Tables and Charts Methods for Tracking Machine Performance Shewhart Rules CUSUM Charts Automated Quality Control Procedures References Chapter 9. An Overview of Osteoporosis Definition of Osteoporosis The 1991 and 1993 Consensus Development Conferences The 1994 World Health Organization Criteria for Diagnosis of Osteoporosis Prevalence of Osteoporosis Consequences of Osteoporosis Risk Factors for Osteoporosis Attainment of Peak Bone Density Maintenance of Bone Density The National Osteoporosis Foundation Guidelines for Bone Mass Measurements The 1997 Bone Mass Measurement Act The National Osteoporosis Foundation Guidelines for Treatment Based on BMD Testing 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 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 Measurement of Multiple Sites Report Review 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 Measurement of Bone Density Appendix III. National Osteoporosis Foundation Guidelines for Bone Density Measurements Appendix IV. Bone Mass Measurement Act of 1997 Appendix V. CPT Codes for Bone Densitometry Appendix VI. DXA PA 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. Review Questions Appendix XIII. Review Question Answer Sheet and Instructions for Obtaining Continuing Education Credit