Dedication Preface Acknowledgments Continuing Education An Introduction to Conventions in Densitometry p. 1 Densitometry as a Quantitative Measurement Technique p. 2 Accuracy and Precision p. 2 The Skeleton in Densitometry p. 4 Weight Bearing or Non-Weight Bearing p. 4 Axial or Appendicular p. 4 Central or Peripheral p. 6 Cortical or Trabecular p. 6 What Do the Machines Actually Measure? p. 8 The Effect of Bone Size on Areal Densities p. 9 p. v p. vii p. xi p. xxi Bone Mineral Apparent Density p. 10 Calculating ""Average"" Spine Bone Densities p. 11 Ultrasound Parameters p. 11 The Densitometry Printout p. 12 The Percentage Comparisons p. 13 The Standard Score Comparisons p. 15 The Age-Regression Graph p. 19 The Standardized BMD p. 20 The Utility of the sbmd p. 22 The National Health and Nutrition Examination Survey (NHANES) III Database for the Proximal Femur p. 23 Nomenclature Guidelines From the International Society for Clinical Densitometry p. 25 References p. 26 Densitometry Techniques p. 29 Plain Radiography in the Assessment of Bone Density p. 30 Qualitative Morphometry p. 30 Qualitative Spinal Morphometry p. 30 The Singh Index p. 31 Quantitative Morphometric Techniques p. 32 Calcar Femorale Thickness p. 32 Radiogrammetry p. 33 The Radiologic Osteoporosis Score p. 35 Radiographic Photodensitometry p. 35 Radiographic Absorptiometry p. 37 Photon Absorptiometry Techniques p. 39 Single-Photon Absorptiometry p. 40 Dual-Photon Absorptiometry p. 42 Dual-Energy X-Ray Absorptiometry p. 45
Peripheral DXA p. 51 Single-Energy X-Ray Absorptiometry p. 52 Quantitative Computed Tomography p. 53 Peripheral QCT p. 58 Quantitative Ultrasound Bone Densitometry p. 58 References p. 61 Skeletal Anatomy in Densitometry p. 67 The Spine in Densitometry p. 67 Vertebral Anatomy p. 68 Artifacts in PA or AP Spine Densitometry p. 73 Vertebral Fractures p. 73 Effect of Osteophytes on BMD p. 76 Effect of Aortic Calcification on BMD p. 77 Effect of Facet Sclerosis on BMD p. 80 Effect of Vertebral Rotation on PA Lumbar Spine Bone Density p. 81 Other Causes of Artifacts in PA and AP Lumbar Spine Studies p. 84 The Spine in the Lateral Projection p. 84 The Proximal Femur in Densitometry p. 88 Proximal Femur Anatomy p. 88 Effect of Rotation on BMD in the Proximal Femur p. 89 Effect of Leg Dominance on BMD in the Proximal Femur p. 93 Effect of Scoliosis, Osteoarthritis, Osteophytes, Surgery, and Fracture on BMD in the Proximal Femur p. 93 The Forearm in Densitometry p. 94 Nomenclature p. 94 Effect of Arm Dominance on Forearm BMD p. 97 Effect of Artifacts on BMD in the Forearm p. 98 The Metacarpals, Phalanges, and Calcaneus p. 100 References p. 102 FDA-Approved Densitometry Devices p. 105 Computer-Enhanced Radiogrammetry p. 105 Computer-Enhanced Radiographic Absorptiometry p. 107 Central X-Ray Densitometers p. 109 Peripheral X-Ray Densitometers p. 138 Ultrasound Bone Densitometers p. 148 Computer Basics p. 163 Types of Computers p. 164 Desktops, Towers, Minitowers, and Laptops p. 164 PCs and MACs p. 165 Major Components of a Computer System p. 166 Important Components Inside the Computer Housing p. 167 Motherboard, Random Access Memory, and Slots p. 167
Central Processing Units p. 167 Hard Drives p. 168 Internal Disk Drives p. 169 Input Devices p. 170 The Keyboard p. 170 The Mouse p. 172 The Trackball p. 172 Output Devices p. 173 Monitors p. 173 Printers p. 174 Computer Ports p. 175 Keyboard and Mouse Ports p. 175 Parallel Ports p. 175 Serial Ports176 Universal Serial Bus Ports p. 177 Power, Monitor, Modem, and Network Ports p. 177 Types of Storage Media p. 179 Magnetic Media p. 180 Optical Storage Media p. 182 Flash Memory p. 183 Protecting the Data p. 184 Computer Maintenance p. 186 The Importance of Precision p. 189 The Concept of Precision p. 189 Performing a Precision Study p. 190 Short-Term Precision Studies p. 192 Mathematical Procedures Used to Calculate Precision p. 195 Long-Term Precision Studies p. 197 Applying the Precision Value to Serial Measurements p. 197 Determination of Least Significant Change p. 197 Using the Least Significant Change to Determine the Timing of Repeat Measurements p. 200 A Case in Point p. 201 More Sophisticated Issues of Statistical Confidence for the Measured Change p. 203 Determining the Level of Confidence for Any Change and Precision p. 203 The Confidence Interval for the Change in BMD Between Two Measurements p. 204 The Importance of Precision p. 206 Which Skeletal Sites Should Be Used for Monitoring p. 207 How Frequently Should Measurements Be Repeated? p. 210 A Final Consideration p. 211 References p. 212 Radiation Safety in X-Ray Densitometry p. 213
Radiation Basics p. 213 Radiation Quantities p. 214 The Curie p. 214 The Roentgen p. 214 The Rad p. 215 The Rem p. 215 The Effective Dose Equivalent p. 216 Harmful Effects of Ionizing Radiation p. 217 Acute Lethal Radiation Syndromes p. 217 Local Tissue Damage From Radiation p. 218 Skin p. 218 Ovaries and Testes p. 218 Bone Marrow and Blood p. 219 Late Effects of Ionizing Radiation p. 219 Radiation Doses in Densitometry p. 220 Radiation Protection Programs p. 222 Protection of the Public p. 223 Protection of the Patient p. 224 Protection of the Technologist p. 227 Time, Distance, and Shielding p. 227 Personnel Monitoring Devices p. 228 The Pregnant Technologist p. 229 References p. 229 Quality Control p. 231 Phantoms p. 232 European Spine Phantom p. 233 Bona Fide Spine Phantom p. 234 Hologic Spine and Hip Phantoms p. 235 Lunar Spine Phantom p. 235 Using the Phantom to Create Control Tables and Charts p. 237 Shewhart Rules and CUSUM Charts p. 241 Shewhart Rules p. 242 CUSUM Charts p. 245 Automated Quality Control Procedures p. 249 Replacing a Densitometer p. 254 References p. 255 An Overview of Osteoporosis p. 257 The Definition of Osteoporosis p. 258 The 1991 and 1993 Consensus Development Conferences p. 258 The 1994 World Health Organization Criteria for Diagnosis of Osteoporosis p. 259 The 2000 National Institutes of Health Consensus Conference Definition of Osteoporosis p. 261
Prevalence of Osteoporosis p. 262 Consequences of Osteoporosis p. 263 Risk Factors for Osteoporosis p. 264 Attainment of Peak Bone Density p. 264 Maintenance of Bone Density p. 265 Guidelines for Bone Mass Measurements p. 266 The National Osteoporosis Foundation Guidelines for Bone Mass Measurements p. 266 Guidelines From Specialty Societies p. 267 The 1997 Bone Mass Measurement Act p. 268 Treatment Guidelines for Postmenopausal Osteoporosis p. 271 NOF Guidelines p. 271 Treatment Guidelines From AACE and NAMS p. 271 Interventions in Osteoporosis p. 272 Nonprescription Interventions p. 272 Lifestyle Modifications p. 272 Calcium, Vitamin D, and Exercise p. 273 Prescription Interventions p. 276 Estrogen Replacement p. 276 The Selective Estrogen Receptor Modulator Raloxifene p. 277 Synthetic Salmon Calcitonin p. 278 Bisphosphonates p. 278 Alendronate p. 279 Risedronate p. 280 Ibandronate p. 281 Dosing, Contraindications, and Safety p. 282 Teriparatide p. 283 Patient Education Materials p. 284 References p. 285 Interpretation of Bone Densitometry Data p. 289 The Results p. 290 The Skeletal Image p. 290 Measured and Calculated Bone Density Parameters p. 292 Comparisons to the Reference Database p. 296 Standardized BMD p. 300 Age-Regression Graph p. 300 Assignment of Diagnostic Category Based on WHO Criteria p. 303 Conflicting Diagnoses From the Measurement of Multiple Sites p. 305 Report Review p. 308 References p. 312 Considerations in Pediatric Densitometry p. 313 Scan Acquisition and Analysis Considerations p. 314
Bone Age p. 315 Sexual Maturation Stage p. 317 Considerations of Bone Size and Shape p. 317 Skeletal Development and the Use of Standard Scores in Pediatric Densitometry p. 319 Skeletal Development p. 320 Use of Standard Scores in Pediatric Densitometry p. 322 Pediatric Reference Databases p. 324 International Society for Clinical Densitometry Guidelines for Children p. 325 The Specialty of Pediatric Densitometry p. 325 References p. 326 Moving Beyond Bone Density With Bone Densitometers: Skeletal Morphometryand Body Composition Assessments p. 329 Skeletal Morphometry for Structural Diagnoses and Prediction of Fracture Risk p. 329 Vertebral Morphometry and Fractures p. 330 Relationship Between Prevalent Spine Fractures and Future Fracture Risk p. 330 Diagnosing Vertebral Fractures p. 330 Vertebral Fracture Assessment With Genant's Semiquantitative Technique p. 332 Vertebral Fracture Assessment With Quantitative Techniques p. 332 Performance Comparisons of Semiquantitative and Quantitative Techniques p. 334 Fan-Array Spine Imaging With DXA p. 335 Proximal Femur Morphometry p. 339 Hip Axis Length p. 339 The Femoral Neck-Shaft Angle p. 342 Femoral Neck Width p. 342 The Upper Femoral Neck p. 342 Hip Strength Analysis p. 344 Body Composition Analysis p. 345 The Body Mass Index p. 346 Body Composition Methods p. 347 Two-Compartment Body Composition Measurement Techniques p. 349 Underwater Weighing p. 349 Skinfold Measurements p. 350 Bioelectrical Impedance Analysis p. 351 Air Displacement Plethysmography p. 352 Three-Compartment Body Composition Measurement Techniques p. 352 Near Infrared Interactance p. 352 Dual Energy X-Ray Absorptiometry p. 353 References p. 361 Contacts for Bone Densitometry Manufacturers and Organizations of Interest p. 367 World Health Organization Criteria for the Diagnosis of Osteoporosis Based on the Measurement of Bone Density p. 373 Guidelines for Bone Density Testing p. 375
Bone Mass Measurement Act of 1997 p. 379 CPT Codes for Bone Densitometry p. 381 Dual-Energy X-Ray Apsorptiometry Posteroanterior Lumbar Spine Labeling Guidelines p. 383 Conversion Formulas p. 385 Recommended Procedures for Short-Term Precision Studies p. 389 Least Significant Change p. 393 Quality Control Shewhart Rules p. 395 Glossary of Computer Terms p. 397 The CD-ROM Companion p. 407 Index p. 409 About the Authors p. 417 Table of Contents provided by Blackwell's Book Services and R.R. Bowker. Used with permission.