| Dual X-ray absorptiometry and laser | |
|---|---|
| Purpose | bone density studies for osteoporosis assessment |
Dual X-ray absorptiometry and laser technique (DXL) in the area of bone density studies for osteoporosis assessment is an improvement to the DXA Technique, adding an exact laser measurement of the thickness of the region scanned. The addition of object thickness adds a third input to the two x-ray energies used by DXA, better solving the equation for bone and excluding more efficiently these soft tissues components.
The body consists of three main components: bone mineral, lean soft tissue (skin, blood, water and skeletal muscle) and adipose tissue (fat and yellow bone marrow). These different components have different x-ray attenuating properties. The standard in bone mineral density scanning developed in the 1980s is called Dual X-ray Absorptiometry, known as DXA. The DXA technique uses two different x-ray energy levels to estimate bone density. DXA scans assume a constant relationship between the amounts of lean soft tissue and adipose tissue. This assumption leads to measurement errors, with an impact on accuracy as well as precision.
To reduce soft-tissue errors in DXA, DXL technology was developed in the late 1990s by a team of Swedish researchers led by Prof. Ragnar Kullenberg. With DXL technology, the region of interest is scanned using low and high energy x-rays as with a DXA scan. The improvement to DXA with DXL is that, for each pixel scanned by DXA, the exact thickness of the measured object is also measured using lasers. The DXL results allow for a more accurate estimation of bone density by using three separate inputs (low and high x-ray energies plus thickness) rather than two for each pixel in the measuring region.
Using the DXL technique, for each measuring point (or pixel) the following equations apply:
N1 = N01⋅exp(-(νb1⋅tb⋅σb + νs1⋅ts⋅σs + νf1⋅tf⋅σf))
N2 = N02⋅exp(-(νb2⋅tb⋅σb + νs2⋅ts⋅σs + νf2⋅tf⋅σf))
T = tb + ts + tf
Where:
tb * σb is the unknown bone density that one wants to calculate, e.g. areal mass (g/cm2).
The DXL technique is used in the bone densitometry system DXL Calscan, manufactured and marketed by the company Demetech AB, Täby, Sweden. Many published studies have evaluated the DXL technique using the DXL Calscan system, which scans the subject's heel. Several published fracture studies have shown that heel scans using DXL Calscan have an ability to predict fractures as well or better than the DXA technique scanning the hip. [1] [2] [3] [4]
A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, and enable mobility. Bones come in a variety of shapes and sizes and have complex internal and external structures. They are lightweight yet strong and hard and serve multiple functions.
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone among the elderly. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. After the broken bone heals, the person may have chronic pain and a decreased ability to carry out normal activities.
Dual-energy X-ray absorptiometry is a means of measuring bone mineral density (BMD) using spectral imaging. Two X-ray beams, with different energy levels, are aimed at the patient's bones. When soft tissue absorption is subtracted out, the bone mineral density (BMD) can be determined from the absorption of each beam by bone. Dual-energy X-ray absorptiometry is the most widely used and most thoroughly studied bone density measurement technology.
Osteopenia, known as "low bone mass" or "low bone density", is a condition in which bone mineral density is low. Because their bones are weaker, people with osteopenia may have a higher risk of fractures, and some people may go on to develop osteoporosis. In 2010, 43 million older adults in the US had osteopenia. Unlike osteoporosis, osteopenia does not usually cause symptoms, and losing bone density in itself does not cause pain.
The body fat percentage (BFP) of a human or other living being is the total mass of fat divided by total body mass, multiplied by 100; body fat includes essential body fat and storage body fat. Essential body fat is necessary to maintain life and reproductive functions. The percentage of essential body fat for women is greater than that for men, due to the demands of childbearing and other hormonal functions. Storage body fat consists of fat accumulation in adipose tissue, part of which protects internal organs in the chest and abdomen. A number of methods are available for determining body fat percentage, such as measurement with calipers or through the use of bioelectrical impedance analysis.
In physical fitness, body composition is used to describe the percentages of fat, bone, water, and muscle in human bodies. Because muscular tissue takes up less space in the body than fat tissue, body composition, as well as weight, determines leanness. Two people of the same gender, height, and body weight may have completely different body types as a consequence of having different body compositions.
Bone density, or bone mineral density, is the amount of bone mineral in bone tissue. The concept is of mass of mineral per volume of bone, although clinically it is measured by proxy according to optical density per square centimetre of bone surface upon imaging. Bone density measurement is used in clinical medicine as an indirect indicator of osteoporosis and fracture risk. It is measured by a procedure called densitometry, often performed in the radiology or nuclear medicine departments of hospitals or clinics. The measurement is painless and non-invasive and involves low radiation exposure. Measurements are most commonly made over the lumbar spine and over the upper part of the hip. The forearm may be scanned if the hip and lumbar spine are not accessible.
Quantitative computed tomography (QCT) is a medical technique that measures bone mineral density (BMD) using a standard X-ray Computed Tomography (CT) scanner with a calibration standard to convert Hounsfield Units (HU) of the CT image to bone mineral density values. Quantitative CT scans are primarily used to evaluate bone mineral density at the lumbar spine and hip.
A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.
Orthopedic pathology, also known as bone pathology is a subspecialty of surgical pathology which deals with the diagnosis and feature of many bone diseases, specifically studying the cause and effects of disorders of the musculoskeletal system. It uses gross and microscopic findings along with the findings of in vivo radiological studies, and occasionally, specimen radiographs to diagnose diseases of the bones.
Digital X-ray radiogrammetry is a method for measuring bone mineral density (BMD). Digital X-ray radiogrammetry is based on the old technique of radiogrammetry. In DXR, the cortical thickness of the three middle metacarpal bones of the hand is measured in a digital X-ray image. Through a geometrical operation the thickness is converted to bone mineral density. The BMD is corrected for porosity of the bone, estimated by a texture analysis performed on the cortical part of the bone.
March fracture, is the fracture of the distal third of one of the metatarsals occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and people whose duties entail much standing. March fractures most commonly occur in the second and third metatarsal bones of the foot. It is a common cause of foot pain, especially when people suddenly increase their activities.
DEXA or Dexa may refer to either:
DXL may refer to:
The trabecular bone score is a measure of bone texture correlated with bone microarchitecture and a marker for the risk of osteoporosis. Introduced in 2008, its main projected use is alongside measures of bone density in better predicting fracture risk in people with metabolic bone problems.
Rachael Taylor is a New Zealand childhood nutrition academic. She is currently a full professor at the University of Otago.
Single photon absorptiometry is a measuring method for bone density invented by John R. Cameron and James A. Sorenson in 1963.
Ignac Fogelman was a professor of Nuclear Medicine at King’s College London, Honorary Consultant Physician at Guy’s and St Thomas’ NHS Trust, and Director of the Osteoporosis Screening & Research Unit at Guy’s Hospital. He was born in 1948 in Germany and died on 5 July 2016 in the United Kingdom. He is known as the father of bone imaging by some researchers and academics.
Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology for osteoporosis diagnosis and for fracture risk assessment. REMS processes the raw, unfiltered ultrasound signals acquired during an echographic scan of the axial sites, femur and spine. The analysis is performed in the frequency domain. Bone mineral density (BMD) is estimated by comparing the results against reference models.
John A. Shepherd is an American physicist, professor of epidemiology and population sciences and director of the Shepherd Research Laboratory at the University of Hawaii Cancer Center in Honolulu, Hawaii. He is an expert in the use of dual-energy X-ray absorptiometry (DXA) for quantitative bone and soft tissue imaging, and pioneered the use of 3D optical imaging of the whole body for quantifying body composition and associated diseases including cancer risk, obesity, diabetes, and frailty. In 2016, he was the President of the Board of the International Society for Clinical Densitometry.