Interpretation of DXA Scans Very low radiation to patient. Very - - PowerPoint PPT Presentation

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Interpretation of DXA Scans Very low radiation to patient. Very - - PowerPoint PPT Presentation

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DXA Technology Detector (detects 2 tissue types - bone and soft tissue) Interpretation of DXA Scans Very low radiation to patient. Very little scatter radiation to technologist Patient Deborah Sellmeyer, MD Professor of Medicine Collimator

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Interpretation of DXA Scans

Deborah Sellmeyer, MD Professor of Medicine Division of Endocrinology, Gerontology, and Metabolism Stanford University, School of Medicine

DXA Technology

X-ray Source (two energies with different attenuation profiles) Collimator (pinhole for pencil beam, slit for

fan beam)

Patient Detector (detects 2 tissue types - bone and soft tissue)

Very low radiation to patient. Very little scatter radiation to technologist

Lumbar Spine Positioning

  • Straight spine
  • Equal soft tissue on

both sides of vertebra

  • Correct labeling
  • No artifacts

Hip Positioning

  • Femoral shaft vertical
  • Small amount lesser trochanter
  • Rotation decreases lesser trochanter and

apparent femoral neck BMD

  • No ischium in femoral neck ROI

Femoral Neck ROI different between Hologic and GE Lunar GE Lunar Hologic

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SLIDE 2

Page 2 Hip Positioning

DXA #1

Name, contact info for facility Name, contact info for facility

Patient Name Med Record number DOB Patient Name Med Record number DOB Demo- graphics

Date Software Technologist Machine Measured directly Calculated = BMC (g) area (cm2)

T-score = SD’s above (+) or below (-) young reference population Z-score = SD’s above or below age matched reference population

Reference population

DXA #2

T- score

  • 0.9
  • 1.5
  • 0.7
  • 2.2
  • 1.4

Z- score 0.9 0.5 1.4

  • 0.0

0.7 BMD (g/cm2) 0.826 0.860 1.003 0.869 0.892 Region L1 L2 L3 L4 Total T- score

  • 1.8
  • 0.7

Z- score

  • 0.1

0.7 Region Neck Total BMD (g/cm2) 0.659 0.871

DXA #3

T- score

  • 1.3
  • 1.5
  • 3.4
  • 2.4
  • 2.2

Z- Score Region L1 L2 L3 L4 Total BMD (g/cm2) 0.778 0.858 0.711 0.848 0.800 T- score

  • 2.8
  • 2.6

Z- Score Region Neck Total BMD (g/cm2) 0.541 0.622

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DXA #4

T- score

  • 5.2
  • 5.3
  • 5.3
  • 4.6
  • 5.1

Z- score

  • 3.5
  • 3.5
  • 3.4
  • 2.5
  • 3.2

BMD (g/cm2) 0.353 0.440 0.496 0.615 0.490 Region L1 L2 L3 L4 Total T- score

  • 3.6
  • 3.6

Z- Score

  • 2.0
  • 2.3

Region Neck Total BMD (g/cm2) 0.448 0.497

DXA #5

T- score

  • 2.6
  • 2.9
  • 3.2
  • 3.4
  • 3.1

Z- score

  • 1.6
  • 1.8
  • 2.0
  • 2.2
  • 1.9

BMD (g/cm2) 0.638 0.704 0.734 0.743 0.709 Region L1 L2 L3 L4 Total T- score

  • 2.5
  • 2.2

Z- Score

  • 1.4
  • 1.5

Region Neck Total BMD (g/cm2) 0.574 0.677

DXA #6

T- score 0.7 1.2 1.2 1.5 1.1 Z- score 1.6 2.2 2.3 2.6 2.2 BMD (g/cm2) 1.000 1.164 1.218 1.278 1.171 Region L1 L2 L3 L4 Total T- score

  • 0.2

0.5 Z- Score 0.8 1.2 Region Neck Total BMD (g/cm2) 0.822 1.005

DXA #7

BMD (g/cm2) 0.891 1.043 1.071 1.140 1.046 Region L1 L2 L3 L4 Total

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DXA #8 April 2017

DXA #9

T- score

  • 8.5
  • 8.5

Z- score

  • 7.4
  • 7.4

BMD (g/cm2) 0.052 0.052 Region L1 Total

Jan 2014 DXA: Lumber spine (L1-L4) BMD is 0.762 g/cm2, with a T-score of -2.6. April 2017

DXA #9

T- score

  • 8.5
  • 8.5

Z- score

  • 7.4
  • 7.4

BMD (g/cm2) 0.052 0.052 Region L1 Total

DXA #10

T- score

  • 2.6
  • 2.9

Z- Score Region Neck Total BMD (g/cm2) 0.582 0.573

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DXA #11

10 20 30 40 50 60 70 BONE MASS AGE 50% during adolescence

Using pediatric reference, Z-score = -0.1 http://www.bcm.edu/bodycomplab/mainbodycomp.htm

T- score

  • 2.6
  • 2.9

Z- Score Region Neck Total BMD (g/cm2) 0.582 0.573

DXA #12

GE Lunar Hologic

DXA #13

Hologic GE Lunar

DXA #14

2017 2016

T- score

  • 2.8
  • 1.8

Z- Score

  • 1.5
  • 0.8

Region Neck Total BMD (g/cm2) 0.539 0.726 T- score

  • 2.3
  • 1.6

Z- Score

  • 0.9
  • 0.6

Region Neck Total BMD (g/cm2) 0.595 0.745 Change (%) 10.4% T- score

  • 2.3
  • 2.8

Scan Date May 2017 Jan 2016 BMD (g/cm2) 0.595 0.539

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DXA #15

Change (%)

  • 9.7%

T- score

  • 3.2
  • 2.6

Scan Date Oct 2009 Oct 2007 BMD (g/cm2) 0.690 0.764 Change (%) 13.7% T- score

  • 0.9
  • 1.7

Scan Date Oct 2009 Oct 2007 BMD (g/cm2) 0.829 0.729

DXA #15

T- score

  • 2.2
  • 2.5
  • 2.4
  • 3.1
  • 2.6

Z- score

  • 1.3
  • 1.4
  • 1.3
  • 1.9
  • 1.5

BMD (g/cm2) 0.679 0.755 0.820 0.778 0.764 Region L1 L2 L3 L4 Total T- score

  • 2.9
  • 3.1
  • 3.4
  • 3.5
  • 3.2

Z- score

  • 1.8
  • 1.9
  • 2.1
  • 2.1
  • 2.0

BMD (g/cm2) 0.675 0.686 0.714 0.681 0.690 Region L1 L2 L3 L4 Total

2007 2009

DXA #15

T- score

  • 2.4
  • 0.9

Z- Score

  • 1.2
  • 0.1

Region Neck Total BMD (g/cm2) 0.587 0.829 T- score

  • 1.6
  • 1.7

Z- Score

  • 0.5
  • 1.0

Region Neck Total BMD (g/cm2) 0.675 0.729

2007 2009

DXA #16

T- score

  • 3.0
  • 1.9

Z- Score

  • 2.3
  • 1.4

Region Neck Total BMD (g/cm2) 0.517 0.713 T- score

  • 3.1
  • 2.6

Z- Score

  • 2.4
  • 2.2

Region Neck Total BMD (g/cm2) 0.508 0.625

97 x 96 NECK 49 x 15 97 x 115 NECK 48 x 15

2014 2015

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Page 7

Aug 2018 Aug 2018 DXA #17

T- score

  • 1.4
  • 1.8
  • 2.4
  • 2.0

Z- score 0.7 0.7 0.1 0.4 BMD (g/cm2) 0.835 0.890 0.794 0.834 Region L1 L3 L4 Total T- score

  • 2.6
  • 1.9

Z- Score

  • 0.5
  • 0.2

Region Neck Total BMD (g/cm2) 0.565 0.710 Change (%) 9.1% T- score

  • 2.0
  • 2.6

Scan Date Aug 2018 Aug 2013 BMD (g/cm2) 0.834 0.764 Change (%)

  • 10.6%

T- score

  • 1.9
  • 1.2

Scan Date Aug 2018 Aug 2013 BMD (g/cm2) 0.710 0.795

Aug 2018 DXA #17

T- score

  • 1.4
  • 1.8
  • 2.4
  • 2.0

Z- score 0.7 0.7 0.1 0.4 BMD (g/cm2) 0.835 0.890 0.794 0.834 Region L1 L3 L4 Total Change (%) 9.1% T- score

  • 2.0
  • 2.6

Scan Date Aug 2018 Aug 2013 BMD (g/cm2) 0.834 0.764

Aug 2013

T- score

  • 2.7
  • 2.8
  • 2.7
  • 2.3
  • 2.6

Z- score

  • 0.9
  • 0.7
  • 0.6
  • 0.1
  • 0.6

BMD (g/cm2) 0.695 0.725 0.782 0.811 0.757 Region L1 L2 L3 L4 Total

Aug 2018

DXA #17

T- score

  • 2.6
  • 1.9

Z- Score

  • 0.5
  • 0.2

Region Neck Total BMD (g/cm2) 0.565 0.710 Change (%)

  • 10.6%

T- score

  • 1.9
  • 1.2

Scan Date Aug 2018 Aug 2013 BMD (g/cm2) 0.710 0.795

Aug 2013

T- score

  • 1.7
  • 1.2

Z- Score 0.1 0.3 Region Neck Total BMD (g/cm2) 0.661 0.795

Aug 2018 Aug 2013

DXA #17

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Page 8

DXA #18

June 2019 April 2018

Lumbar spine

April 2018

Lumbar spine

June 2019

DXA #18

April 2018 June 2019

DXA #18

DXA #19 18 3.2

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Page 9

DXA #19 18 3.2 11 1.1 DXA #19

Radius styloid process excluded Ultradistal line where radius and ulna meet 1/3 forearm site determine by radius length Size of ROI box ROI should extend beyond soft tissue

DXA #20 2014 Correct positioning ROI box too high

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SLIDE 10

Page 10 2015 DXA #21 Correct positioning Did not measure forearm. ROI too short

185x77 228x91

DXA #22

2017

T- score

  • 3.2

Z- Score

  • 2.1

Radius 1/3 BMD (g/cm2) 0.503 Change (%)

  • 21.1%

T- score

  • 3.2
  • 0.9

Scan Date March 2017 July 2015 BMD (g/cm2) 0.503 0.638

DXA #22

2015 2017

T- score

  • 3.2

Z- Score

  • 2.1

Radius 1/3 BMD (g/cm2) 0.503 T- score

  • 0.9

Z- Score

  • 0.0

Radius 1/3 BMD (g/cm2) 0.638

228x84 228x84

DXA #23

T- score

  • 6.8

Z- Score

  • 3.5

Radius 1/3 BMD (g/cm2) 0.289

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SLIDE 11

Page 11 Questions?