Quality Assurance and Dosimetry in Bone Densitometry

Radiologic Clinics of North America

Volumn 48, Issue 3, 2010, Pages 629-640

  Damilakis, John ^a,b   Guglielmi, Giuseppe ^c,d  

^a UNIVERSITY OF CRETE   (Greece)

^b UNIVERSITY HOSPITAL OF IRAKLION   (Greece)

^c UNIVERSITY OF FOGGIA   (Italy)

^d CASA SOLLIEVO DELLA SOFFERENZA HOSPITAL   (Italy)

Author keywords

Densitometry; Quality assurance; Quality control; Radiation dose; Skeletal status

Indexed keywords

BONE DENSITOMETRY; CLINICAL PRACTICE; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC ACCURACY; DOSIMETRY; DUAL ENERGY X RAY ABSORPTIOMETRY; HEALTH CARE QUALITY; HUMAN; MEDICAL EDUCATION; MULTIDETECTOR COMPUTED TOMOGRAPHY; OCCUPATIONAL EXPOSURE; OCCUPATIONAL SAFETY; OSTEOPOROSIS; PATIENT SAFETY; PRIORITY JOURNAL; QUALITY CONTROL; QUANTITATIVE DIAGNOSIS; RADIATION DOSE; RADIATION EQUIPMENT; RADIATION EXPOSURE; RADIATION PROTECTION; REPRODUCIBILITY; REVIEW; SENSITIVITY AND SPECIFICITY; STANDARDIZATION; BONE DENSITY; METHODOLOGY; PHOTON ABSORPTIOMETRY; RADIOGRAPHY; STANDARD;

ABSORPTIOMETRY, PHOTON; BONE DENSITY; HUMANS; OSTEOPOROSIS; QUALITY ASSURANCE, HEALTH CARE; QUALITY CONTROL; RADIATION DOSAGE; REPRODUCIBILITY OF RESULTS; TOMOGRAPHY, X-RAY COMPUTED;

EID: 77954157568     PISSN: 00338389     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.rcl.2010.02.011     Document Type: Review

References (61)

1. Kanis J.A., Melton L.J., Christiansen C., et al. The diagnosis of osteoporosis. J Bone Miner Res 1994, 9:1137-1141.
2. Gundry C.R., Miller C.W., Ramos E., et al. Dual-energy radiographic absorptiometry of the lumbar spine: clinical experience with two different systems. Radiology 1990, 174:539-541.
3. Pocock N.A., Sambrook P.N., Nguyen T., et al. Assessment of spinal and femoral bone density by dual X-ray absorptiometry: comparison of Lunar and Hologic instruments. J Bone Miner Res 1992, 7:1081-1084.
4. Steiger P. Standardization of measurements for assessing BMD by DXA. Calcif Tissue Int 1995, 57:469. [letter to the editor].
5. Hanson J. Standardization of femur BMD. J Bone Miner Res 1997, 12:1316-1317. [letter to the editor].
6. Kalender W.A., Felsenberg D., Genant H.K., et al. The European Spine Phantom-a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT. Eur J Radiol 1995, 20:83-92.
7. Adams J.E. Quantitative computed tomography. Eur J Radiol 2009, 71:415-424.
8. Adams J.E. Dual-energy X-ray absorptiometry. Radiology of osteoporosis 2008, 105-124. Berlin, Heidelberg, Springer, New York. 2nd revised edition. S. Grampp (Ed.).
9. Blake G., Fogelman I. The clinical role of dual energy X-ray absorptiometry. Eur J Radiol 2009, 71:406-414.
10. Blake G.M., Wahner H., Fogelman I. The evaluation of osteoporosis: dual energy X-ray absorptiometry and ultrasound in clinical practice 1999, Dunitz, London, 45-71, 147-72.
11. Engelke K., Mastmeyer A., Bousson V., et al. Reanalysis precision of 3D quantitative computed tomography (QCT) of the spine. Bone 2009, 44:566-572.
12. Gallagher J.C., Goldgar D., Moy A. Total bone calcium in normal women: effect of age and menopause status. J Bone Miner Res 1987, 2:491-495.
13. Lewiecki E., Gordon C., Baim S., et al. International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone 2008, 43:1115-1121.
14. Damilakis J., Maris T., Karantanas A. An update on the assessment of osteoporosis using radiologic techniques. Eur Radiol 2007, 17:1591-1602.
15. Damilakis J., Papadokostakis G., Perisinakis K., et al. Hip fracture discrimination by the Achilles insight QUS imaging device. Eur J Radiol 2007, 63:59-62.
16. Guglielmi G., de Terlizzi F. Quantitative ultrasound in the assessment of osteoporosis. Eur J Radiol 2009, 71:425-431.
17. Barkmann R., Laugier P., Moser U., et al. In vivo measurements of ultrasound transmission through the human proximal femur. Ultrasound Med Biol 2008, 34:1186-1190.
18. Damilakis J., Papadokostakis G., Vrahoriti H., et al. Ultrasound velocity through the cortex of phalanges, radius, and tibia in normal and osteoporotic postmenopausal women using a new multisite quantitative ultrasound device. Invest Radiol 2003, 38:207-211.
19. Guglielmi G., Adams J., Link T.M. Quantitative ultrasound in the assessment of skeletal status. Eur Radiol 2009, 19:1837-1848.
20. Machado A., Hannon R., Henry Y., et al. Standardized coefficient of variation for dual X-ray absorptiometry (DXA), quantitative ultrasound (QUS) and markers of boné turnover. J Bone Miner Res 1997, 12(Suppl 1):S258. [abstract].
21. Lu Y., Gluer C.C. Statistical tools in quantitative ultrasound applications. Quantitative ultrasound. Assessment of osteoporosis and bone status 1999, 77-100. Dunitz, London. C. Njeh, D. Hans, T. Fuerst (Eds.).
22. Koo W.W., Walters J., Bush A.J., et al. Technical considerations of dual-energy X-ray absorptiometry-based bone mineral measurements for pediatric studies. J Bone Miner Res 1995, 10:1998-2004.
23. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007, 37:1-332.
24. Shrimpton P.C., Hillier M.C., Lewis M.A., et al. National survey of doses in the UK: 2003. Br J Radiol 2006, 79:968-980.
25. Valentin J., International Commission on Radiation Protection Managing patient dose in multi-detector computed tomography (MDCT). ICRP publication 102. Ann ICRP 2007, 37:1-79.
26. Bezakova E., Collins P.J., Beddoe A.H. Absorbed dose measurements in dual energy X-ray absorptiometry (DXA). Br J Radiol 1997, 70:172-179.
27. Lewis M.K., Blake G.M., Fogelman I. Patient dose in dual X-ray absorptiometry. Osteoporos Int 1994, 4:11-15.
28. Faulkner R.A., Bailey D.A., Drinkwater D.T., et al. Regional and total body bone mineral content, bone mineral density and total body tissue composition in children 8-16 years of age. Calcif Tissue Int 1993, 53:7-12.
29. Huda W., Morin R.L. Patient doses in bone mineral densitometry. Br J Radiol 1996, 69:422-425.
30. Cawte S.A., Pearson D., Green D.J., et al. Cross-calibration, precision and patient dose measurements in preparation for clinical trials using dual energy X-ray absorptiometry of the lumbar spine. Br J Radiol 1999, 72:354-362.
31. Njeh C.F., Samat S.B., Nightingale A., et al. Radiation dose and in vitro precision in bone mineral density measurement using dual X-ray absorptiometry. Br J Radiol 1997, 70:719-727.
32. Kalender W.A. Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int 1992, 2:82-87.
33. Pye D.W., Hannan W.J., Hesp R. Effect dose equivalent in dual X-ray absorptiometry. Br J Radiol 1990, 63:746. [letter].
34. Steel S.A., Baker A.J., Saunderson J.R. An assessment of the radiation dose to patients and staff from a Lunar Expert-XL fan beam densitometer. Physiol Meas 1998, 19:17-26.
35. Blake G., Naeem M., Boutros M. Comparison of effective dose to children and adults from dual X-ray absorptiometry examinations. Bone 2006, 38:935-942.
36. Larkin A., Sheahan N., O'Connor U., et al. QA/Acceptance testing of DEXA X-ray systems used in bone mineral densitometry. Radiat Prot Dosimetry 2008, 129:279-283.
37. Thomas S.R., Kalkwarf H.J., Buckley D.D., et al. Effective dose of dual-energy X-ray absorptiometry scans in children as a function of age. J Clin Densitom 2005, 8:415-422.
38. Damilakis J., Perisinakis K., Vrahoriti H., et al. Embryo/fetus radiation dose and risk from dual X-ray absorptiometry examinations. Osteoporos Int 2002, 13:716-722.
39. Engelke K., Adams J.E., Armbrecht G., et al. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom 2008, 11:123-162.
40. Khoo B.C., Brown K., Cann C., et al. Comparison of QCT-derived and DXA-derived areal bone mineral density and T scores. Osteoporos Int 2009, 20:1539-1545.
41. Engelke C., Libanati C., Liu Y., et al. Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone 2009, 45:110-118.
42. Link T.M., Vieth V., Matheis J., et al. Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures. Eur Radiol 2002, 12:401-408.
43. Stauber M., Rapillard L., van Lenthe G.H., et al. Importance of individual rods and plates in the assessment of bone quality and their contribution to bone stiffness. J Bone Miner Res 2006, 21:586-595.
44. Issever A., Link T., Kentenich M., et al. Assessment of trabecular bone structure using MDCT: comparison of 64- and 320-slice CT using HR-pQCT as the reference standard. Eur Radiol 2010, 20:458-468.
45. Krebs A., Graeff C., Frieling I., et al. High resolution computed tomography of the vertebrae yields accurate information on trabecular distances if processed by 3D fuzzy segmentation approaches. Bone 2009, 44:145-152.
46. Ito M., Ikeda K., Nishiguchi M., et al. Multidetector row CT imaging of vertebral microstructure for evaluation of fracture risk. J Bone Miner Res 2005, 20:1828-1836.
47. Graeff C., Timm W., Nickelsen T.N., et al. Monitoring teriparatide-associated changes in vertebral microstructure by high-resolution CT in vivo: results from the EUROFORS study. J Bone Miner Res 2007, 22:1426-1433.
48. Tzedakis A., Damilakis J., Perisinakis K., et al. The effect of z overscanning on patient effective dose from multidetector helical computed tomography examinations. Med Phys 2005, 32:1621-1629.
49. Deak P.D., Langner O., Lell M., et al. Effects of adaptive section collimation on patient radiation dose in multisection spiral CT. Radiology 2009, 252:140-147.
50. Perisinakis K., Papadakis A., Damilakis J. The effect of X-ray beam quality and geometry on radiation utilization efficiency in multidetector CT imaging. Med Phys 2009, 36:1258-1266.
51. Papadakis A.E., Perisinakis K., Damilakis J. Automatic exposure control in pediatric and adult multidetector CT examinations: a phantom study on dose reduction and image quality. Med Phys 2008, 35:4567-4576.
52. Perisinakis K., Tzedakis A., Damilakis J. On the use of Monte Carlo-derived dosimetric data in the estimation of patient dose from CT examinations. Med Phys 2008, 35:2018-2028.
53. Gregory K., Bibbo G., Pattison J. On the uncertainties in effective dose estimates of adult CT head scans. Med Phys 2008, 35:3501-3510.
54. Theocharopoulos N., Damilakis J., Perisinakis K., et al. Energy imparted-based estimates of the effect of z overscanning on adult and pediatric patient effective doses from multi-slice computed tomography. Med Phys 2007, 34:1139-1152.
55. Myronakis M., Perisinakis K., Tzedakis A., et al. Evaluation of a patient-specific Monte Carlo software for CT dosimetry. Radiat Prot Dosimetry 2009, 133:248-255.
56. Bauer J.S., Link T.M. Advances in osteoporosis imaging. Eur J Radiol 2009, 71:440-449.
57. Sheahan N.F., Dowling A., O'Reilly G., et al. Commissioning and quality assurance protocol for dual energy X-ray absorptiometry (DEXA) systems. Radiat Prot Dosimetry 2005, 117:288-290.
58. Slavchev A., Avramova-Cholakova S., Vassileva J. National protocol for quality assurance in DXA-bone densitometry. Pol J Med Phys Eng 2008, 14:207-215.
59. Australian and New Zealand Bone and Mineral Society, Australian and New Zealand Association of Physicians in Nuclear Medicine, Royal Australian and New Zealand College of Radiologists, Australasian College of Physical Scientists and Engineers. Accreditation guidelines for bone densitometry. 2004:21-3. Available at: Accessed February 20, 2010. http://www.anzbms.org.au/resources/DXA/guide/index.htm.
60. American Society of Radiologic Technologists Bone densitometry curriculum 2009, American Society of Radiologic Technologists, Albuquerque (NM), p. 1-68.
61. American College of Radiology Practice guidelines for the performance of dual-energy X-ray absorptiometry (DXA). Practice guidelines and technical standards 2008, 1-10. American College of Radiology, Reston (VA), Available at:, Accessed February 20, 2010. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx.aspx.