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

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 (pinhole for pencil beam, slit for Division of Endocrinology, Gerontology, and Metabolism fan beam) Stanford University, School of Medicine X-ray Source (two energies with different attenuation profiles) Lumbar Spine Positioning Hip Positioning • Femoral shaft vertical • Small amount lesser trochanter Straight spine • • Rotation decreases lesser trochanter and apparent femoral neck BMD • Equal soft tissue on • No ischium in femoral neck ROI both sides of vertebra Hologic • Correct labeling GE • No artifacts Lunar Femoral Neck ROI different between Hologic and GE Lunar Page 1

DXA #1 Name, contact info for facility Name, contact info for facility Patient Name Demo- Patient Name Hip Positioning Med Record number graphics Med Record number DOB DOB Date Software Technologist Machine Calculated = Measured BMC (g) directly 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 DXA #3 Region BMD T- Z- T- Z- Region BMD T- Z- Region BMD Region BMD T- Z- (g/cm2) score score (g/cm2) score score (g/cm2) score Score (g/cm2) score Score L1 0.826 -0.9 0.9 Neck 0.659 -1.8 -0.1 L1 0.778 -1.3 Neck 0.541 -2.8 L2 0.860 -1.5 0.5 Total 0.871 -0.7 0.7 L2 0.858 -1.5 Total 0.622 -2.6 L3 1.003 -0.7 1.4 L3 0.711 -3.4 L4 0.869 -2.2 -0.0 L4 0.848 -2.4 -1.4 0.7 Total 0.892 Total 0.800 -2.2 Page 2

DXA #4 DXA #5 Region BMD T- Z- Region BMD T- Z- Region BMD T- Z- Region BMD T- Z- (g/cm2) score Score (g/cm2) score score (g/cm2) score Score (g/cm2) score score Neck 0.448 -3.6 -2.0 -2.6 -1.6 L1 0.638 Neck 0.574 -2.5 -1.4 -5.2 -3.5 L1 0.353 0.497 -3.6 -2.3 Total L2 0.704 -2.9 -1.8 Total 0.677 -2.2 -1.5 L2 0.440 -5.3 -3.5 L3 0.734 -3.2 -2.0 L3 0.496 -5.3 -3.4 L4 0.743 -3.4 -2.2 -4.6 -2.5 L4 0.615 Total 0.709 -3.1 -1.9 Total 0.490 -5.1 -3.2 DXA #6 DXA #7 Region BMD (g/cm2) L1 0.891 L2 1.043 L3 1.071 L4 1.140 Region BMD T- Z- Region BMD T- Z- Total 1.046 (g/cm2) score Score (g/cm2) score score Neck 0.822 -0.2 0.8 0.7 1.6 L1 1.000 Total 1.005 0.5 1.2 L2 1.164 1.2 2.2 L3 1.218 1.2 2.3 1.5 2.6 L4 1.278 Total 1.171 1.1 2.2 Page 3

DXA #8 DXA #9 April 2017 Region BMD T- Z- score score (g/cm2) L1 0.052 -8.5 -7.4 Total 0.052 -8.5 -7.4 DXA #9 DXA #10 April 2017 Region BMD T- Z- Jan 2014 DXA: (g/cm2) score Score Lumber spine (L1-L4) Neck 0.582 -2.6 Total 0.573 -2.9 BMD is 0.762 g/cm2, with a T-score of -2.6. Region BMD T- Z- (g/cm2) score score -8.5 -7.4 L1 0.052 Total 0.052 -8.5 -7.4 Page 4

DXA #12 DXA #11 GE Lunar Using pediatric reference, Z-score = -0.1 http://www.bcm.edu/bodycomplab/mainbodycomp.htm Region BMD T- Z- (g/cm2) score Score Neck 0.582 -2.6 Total 0.573 -2.9 Hologic BONE MASS 50% during adolescence 0 10 20 30 40 50 60 70 AGE DXA #14 DXA #13 GE Lunar 2017 Hologic Region BMD T- Z- (g/cm2) score Score 2016 0.595 -2.3 -0.9 Neck Total 0.745 -1.6 -0.6 Region BMD T- Z- (g/cm2) score Score Neck 0.539 -2.8 -1.5 Scan Date BMD T- Change (%) Total 0.726 -1.8 -0.8 (g/cm2) score May 2017 0.595 -2.3 10.4% 0.539 -2.8 Jan 2016 Page 5

DXA #15 DXA #15 2007 2009 Region BMD T- Z- Region BMD T- Z- (g/cm2) score score score score (g/cm2) L1 0.675 -2.9 -1.8 L1 0.679 -2.2 -1.3 L2 0.686 -3.1 -1.9 L2 0.755 -2.5 -1.4 L3 0.714 -3.4 -2.1 L3 0.820 -2.4 -1.3 L4 0.681 -3.5 -2.1 L4 0.778 -3.1 -1.9 -3.2 -2.0 BMD T- Change (%) Total 0.690 Scan Date Total 0.764 -2.6 -1.5 Scan Date BMD T- Change (%) (g/cm2) score (g/cm2) score Oct 2009 0.690 -3.2 -9.7% 0.829 -0.9 13.7% Oct 2009 Oct 2007 0.764 -2.6 Oct 2007 0.729 -1.7 DXA #15 DXA #16 2007 2009 2014 2015 Region BMD T- Z- Region BMD T- Z- Region BMD T- Z- Region BMD T- Z- (g/cm2) score Score (g/cm2) score Score (g/cm2) score Score (g/cm2) score Score Neck 0.675 -1.6 -0.5 Neck 0.587 -2.4 -1.2 97 x 115 0.508 -3.1 -2.4 Neck 0.517 -3.0 -2.3 Neck Total 0.729 -1.7 -1.0 Total 0.829 -0.9 -0.1 97 x 96 NECK 48 x 15 Total 0.625 -2.6 -2.2 Total 0.713 -1.9 -1.4 NECK 49 x 15 Page 6

DXA #17 DXA #17 Aug 2018 Aug 2018 Aug 2013 Aug 2018 Region BMD T- Z- Region BMD T- Z- Region BMD T- Z- Region BMD T- Z- (g/cm2) score score (g/cm2) score score (g/cm2) score Score (g/cm2) score score L1 0.835 -1.4 0.7 L1 0.835 -1.4 0.7 Neck 0.565 -2.6 -0.5 L1 0.695 -2.7 -0.9 L3 0.890 -1.8 0.7 L3 0.890 -1.8 0.7 Total 0.710 -1.9 -0.2 L2 0.725 -2.8 -0.7 L4 0.794 -2.4 0.1 L4 0.794 -2.4 0.1 L3 0.782 -2.7 -0.6 Total 0.834 -2.0 0.4 Total 0.834 -2.0 0.4 L4 0.811 -2.3 -0.1 Total 0.757 -2.6 -0.6 Scan Date BMD T- Change (%) Scan Date BMD T- Change (%) Scan Date BMD T- Change (%) (g/cm2) score (g/cm2) score (g/cm2) score Aug 2018 0.710 -1.9 -10.6% Aug 2018 0.834 -2.0 9.1% Aug 2018 0.834 -2.0 9.1% Aug 2013 0.795 -1.2 Aug 2013 0.764 -2.6 Aug 2013 0.764 -2.6 DXA #17 DXA #17 Aug 2018 Aug 2013 Aug 2018 Aug 2013 Region BMD T- Z- Region BMD T- Z- (g/cm2) score Score (g/cm2) score Score Neck 0.565 -2.6 -0.5 Neck 0.661 -1.7 0.1 Total 0.710 -1.9 -0.2 Total 0.795 -1.2 0.3 Scan Date BMD T- Change (%) (g/cm2) score Aug 2018 0.710 -1.9 -10.6% Aug 2013 0.795 -1.2 Page 7

DXA #18 DXA #18 April 2018 Lumbar spine June 2019 June 2019 April 2018 Lumbar spine DXA #18 DXA #19 April 2018 June 2019 18 3.2 Page 8

DXA #19 DXA #19 11 1.1 18 3.2 DXA #20 Radius styloid process excluded ROI box too high Ultradistal line where radius and ulna meet 2014 Correct 1/3 forearm site determine by radius length positioning Size of ROI box ROI should extend beyond soft tissue Page 9

DXA #21 DXA #22 Did not measure forearm. ROI too short 2017 2015 Correct Radius BMD T- Z- (g/cm2) score Score positioning 1/3 0.503 -3.2 -2.1 185x77 228x91 BMD T- Change (%) Scan Date (g/cm2) score March 2017 0.503 -3.2 -21.1% July 2015 0.638 -0.9 DXA #22 DXA #23 2015 Radius BMD T- Z- (g/cm2) score Score 0.638 -0.9 -0.0 1/3 228x84 2017 Radius BMD T- Z- (g/cm2) score Score BMD T- Z- Radius 1/3 0.289 -6.8 -3.5 (g/cm2) score Score 228x84 1/3 0.503 -3.2 -2.1 Page 10

Questions? Page 11