A Practical Approach to Interpretation of Dual-Energy X-ray Absorptiometry (DXA) for Assessment of Bone Density

Choplin, Robert H.; Lenchik, Leon; Wuertzer, Scott

doi:10.1007/s40134-014-0048-x

Cited by 25 publications

(14 citation statements)

References 8 publications

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“…[3] Therefore, a change in BMD is important especially for followup reports. [12] In our study, we found statistically significant differences between the initial and the adjusted mean BMD and L1-L4 mean T-scores of all reports with reanalysis. This show that analysis is important not only for detection of osteoporosis but also for follow-up to benefit from treatment.…”

Section: Discussionsupporting

confidence: 42%

“…Therefore, patient positioning and scan analysis should be consistent. [12,20] Serial BMD testing can be used to determine an increase or stability in bone density, as well as treatment and response to therapy. [3] Therefore, a change in BMD is important especially for followup reports.…”

Section: Discussionmentioning

confidence: 99%

“…When only one vertebra remained, the spine region was accepted as 'non-assessable,' and the diagnosis was based on femoral neck or total proximal femur, whichever was lowest. [3,12] If scoliosis was detected in the spine images, reports were interpreted similarly. [3,5]…”

Section: Methodsmentioning

confidence: 99%

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Effects of clinical reanalysis in dual energy X-ray absorptiometry reports

Tuna

Yavuz

Kabayel

et al. 2017

Turk J Phys Med Rehab

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Objectives: This study aims to assess poor positioning rates of patients during X-ray and the accuracy of the analysis. Patients and methods: In this study, we reanalyzed 323 dual energy X-ray absorptiometry (DXA) reports, by evaluating the scan images for proper patient positioning and scan analysis. We reviewed reports, according to a checklist prepared considering the proposals of Watts and The International Society for Clinical Densitometry official positions for 2013 (which were the same as in 2015). At least two remaining vertebrae were used to derive new bone mineral density and new T-scores. Results: Positioning failures were found in 64.7% of the spine X-rays, 60.5% of the hip X-rays, and 83.9% of X-rays of both regions. A total of 112 (34.7%) spinal DXA images needed new T-score adjustments. T-scores and bone mineral density differed between the first reports and the clinician reanalysis (p<0.001). Conclusion: The error rate in DXA reports was higher than expected. Clinician analysis of DXA reports are important. To obtain a quality DXA report, all healthcare professionals should be trained and reminded about this topic.

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Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of clinical reanalysis in dual energy X-ray absorptiometry reports

Tuna

Yavuz

Kabayel

et al. 2017

Turk J Phys Med Rehab

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“…All three vertebrae of the calibration phantom and the second (L2), third (L3), and fourth (L4) lumbar vertebrae of the animal phantom were evaluated. The latter range was chosen, as pigs have an additional lumbar vertebra compared with humans, and L2-L4 more closely represent the typically used human L1-L3 vertebrae for osteoporosis screening (25).…”

Section: Vertebra Segmentationmentioning

confidence: 99%

Bone Mineral Density Quantification from Localizer Radiographs: Accuracy and Precision of Energy-integrating Detector CT and Photon-counting Detector CT

et al. 2021

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Background Bone mineral density (BMD) could be derived from CT localizer radiographs and could potentially enable opportunistic osteoporosis screening. Purpose To assess the accuracy and precision of BMD measurement using two localizer radiographs obtained with energy-integrating detector CT and a single localizer radiograph obtained with photon-counting detector CT. Materials and Methods A calibration phantom and a porcine phantom with lumbar vertebrae were imaged with a dual-energy x-ray absorptiometry (DXA) scanner, a clinical energy-integrating detector CT scanner, and a prototype photon-counting detector CT scanner. Two localizer radiographs at different combinations of tube voltages were obtained with energy-integrating detector CT, and one localizer radiograph was obtained with photon-counting detector CT using different energy thresholds. BMD was calculated for all three approaches and compared with the known specifications in the calibration phantom. In the animal phantom, BMDs from both CT systems were compared with those from the DXA scanner (the reference standard). Accuracy was defined as the measurement error of BMD (ΔBMD), and precision was defined as the coefficient of variation (in percentage). Radiation doses were estimated. Nonparametric tests were applied. Results In the calibration phantom, ΔBMD was smaller with both CT systems compared with the DXA scanner (both P < .05). ΔBMD ranged from -5% to -1.8% for DXA, from -2.3% to -1.7% for energy-integrating detector CT, and from -1.6% to 1.6% for photon-counting detector CT. Precision (range, 0.3%-2.8%) was high for both CT systems. In the animal phantom, ΔBMD ranged from -0.6% to 0.1% for energy-integrating detector CT and from -0.1% to 0.6% for photon-counting detector CT, with no significant differences between CT systems (P = .65). The dose-area product in the animal phantom was 4.6 cGy cm 2 for DXA, 3.5-11.5 cGy cm 2 for energy-integrating detector CT, and 7.2-11.2 cGy cm 2 for photon-counting detector CT, depending on tube voltage and energy threshold combination. Conclusion Experimental evidence suggests that bone mineral density measurements are accurate and precise using two localizer radiographs at different tube voltages from energy-integrating detector CT and a single localizer radiograph with different energy thresholds from photon-counting detector CT.

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“…When a VFF is present, a baseline DXA BMD is not compulsory to establish the diagnosis of osteoporosis [3]. Nevertheless, baseline DXA BMD measurements may be required and are often preferred to help assess response to treatment and direct future patient management [42]. In some jurisdictions, vertebral fracture assessment (VFA) can also be used as an alternative to DXA BMD due to its lowcost nature.…”

Section: Data Aggregationmentioning

confidence: 99%

Understanding current UK practice for the incidental identification of vertebral fragility fractures from CT scans: an expert elicitation study

et al. 2022

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Background There is an emerging interest in using automated approaches to enable the incidental identification of vertebral fragility fractures (VFFs) on existing medical images visualising the spine. Aim To quantify values, and the degree of uncertainty associated with them, for the incidental identification of VFFs from computed tomography (CT) scans in current practice. Methods An expert elicitation exercise was conducted to generate point estimates and measures of uncertainty for four values representing the probability of: VFF being correctly reported by the radiologist; the absence of VFF being correctly assessed by the radiologist; being referred for management when a VFF is identified; having a dual-energy X-ray absorptiometry (DXA) scan after general practitioner (GP) referral. Data from a sample of seven experts in the diagnosis and management of people with VFFs were pooled using mathematical aggregation. Results The estimated mean values for each probability parameter were: VFF being correctly reported by the radiologist = 0.25 (standard deviation (SD): 0.21); absence of VFF being correctly assessed by the radiologist = 0.89 (0.10); being referred for management when a VFF is identified by the radiologist = 0.15 (0.12); having a DXA scan after GP referral = 0.66 (0.28). Discussion These estimates could be used to facilitate the subsequent early economic evaluation of potential new approaches to improve the health outcomes of people with VFFs. Conclusion In the absence of epidemiological studies, this study produced point estimates and measures of uncertainty for key parameters needed to describe current pathways for the incidental diagnosis of VFFs.

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A Practical Approach to Interpretation of Dual-Energy X-ray Absorptiometry (DXA) for Assessment of Bone Density

Cited by 25 publications

References 8 publications

Effects of clinical reanalysis in dual energy X-ray absorptiometry reports

Effects of clinical reanalysis in dual energy X-ray absorptiometry reports

Bone Mineral Density Quantification from Localizer Radiographs: Accuracy and Precision of Energy-integrating Detector CT and Photon-counting Detector CT

Understanding current UK practice for the incidental identification of vertebral fragility fractures from CT scans: an expert elicitation study

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