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Densitometry Techniques

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Bone Densitometry in Clinical Practice

Part of the book series: Current Clinical Practice ((CCP))

Abstract

Clinical densitometry is relatively new but densitometry itself is actually quite old. It was first described over 100 years ago in the field of dental radiology as dentists attempted to quantify the bone density in the mandible(1,2). With today’s techniques bone density can be quantified in almost every region of the skeleton. The extraordinary technical advances in recent years have expanded the realm of densitometry from that of a quantitative technique to that of an imaging technique as well. But even the oldest techniques remain both viable and valuable with computer modernization. Densitometry technologies have evolved as our understanding of relevant disease processes has increased. In a complimentary fashion, our understanding of the disease processes has increased as the technologies have evolved.

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Notes

  1. 1.

    Correlation indicates the strength of the association between two values or variables. The correlation value is denoted with the letter “r.” A perfect correlation would be indicated by an r-value of +1.00 or −1.00.

  2. 2.

    Techniques are compared on the basis of accuracy and precision, which can be described using the percent coefficient of variation (%CV). The %CV is the standard deviation divided by the average of replicate measurements expressed as a percentage. The lower the %CV, the better the accuracy or precision. See Chapters 3 and 11 for a detailed discussion of precision and accuracy.

  3. 3.

    This technique is discussed later in this chapter.

  4. 4.

    Picture Archiving and Communications System.

  5. 5.

    See Chapter 3 for a discussion of the AUROC.

  6. 6.

    Ward’s triangle was first described by F.O. Ward in Outlines of Human Osteology, London; Henry Renshaw, 1838. It is a triangular region created by the intersection of three groups of trabeculae in the femoral neck.

  7. 7.

    See Chapter 2 for a discussion of the composition of the radius and ulna.

  8. 8.

    Global fracture risk refers to the risk of having any and all types of fractures combined. This is in contrast to a site-specific fracture risk prediction in which the risk for a fracture at a specific skeletal site is given, such as spine fracture risk or hip fracture risk.

  9. 9.

    A central device is a bone densitometer that can be used to quantify bone density in the spine and proximal femur. The distinction between central and peripheral devices is discussed in Chapter 2.

  10. 10.

    Although spine bone density studies with dual-energy X-ray absorptiometry are often referred to as AP spine studies, the beam actually passes in a posterior to anterior direction. Such studies are correctly characterized as PA spine studies, but an accepted convention is to refer to them as AP spine bone density studies. The Lunar Expert, a fan-array DXA scanner, does acquire spine bone density studies in the AP projection.

  11. 11.

    See Chapter 6 for a detailed discussion of the difference in values obtained using central devices from different manufacturers, conversions equations, and the development of the sBMD.

  12. 12.

    See Chapter 15for a listing of radiation dose according to device and scan type.

  13. 13.

    Specific descriptions and photographs of these scanners can be found in Chapter 15.

  14. 14.

    This application is discussed in detail in Chapter 13.

  15. 15.

    This application on newer GE Healthcare devices is now called DVA (Dual-energy vertebral assessment). An image of the spine in the PA projection can be obtained in addition to the lateral view with DVA.

  16. 16.

    A new version of this application is called high-definition instant vertebral assessment or IVA-HD and is available as a standard or optional application, depending on the model of Hologic DXA device.

  17. 17.

    See Chapter 11 for a detailed discussion on the interaction between precision and rate of change in determining the time interval required between measurements to demonstrate significant change.

  18. 18.

    See Chapter 11 for a discussion of short-term precision.

  19. 19.

    OFELY is a prospective study of the determinants of bone loss, involving over 1000 women aged 31–89 years from France.

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    Sydney Lou Bonnick MD, FACP

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Bonnick, S.L. (2010). Densitometry Techniques. In: Bone Densitometry in Clinical Practice. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-499-9_1

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