Bone Densitometry for Technologists Book

Dedication
Preface
Chapter 1: An Introduction to Conventions in Densitometry
Densitometry as a Quantitative Measurement Technique
Accuracy and Precision
The Skeleton in Densitometry
Weight Bearing or Non-weight Bearing
Axial or Appendicular
Central or Peripheral
Cortical or Trabecular
What Do the Machines Actually Measure?
The Effect of Bone Size on Areal Densities
Bone Mineral Apparent Density
Calculating “Average” Spine Bone Densities
Ultrasound Parameters
The Densitometry Printout
The Percentage Comparisons
The Standard Score Comparisons
The Age-Regression Graph
The Standardized BMD
The Utility of the sBMD
The NHANES III Database for the Proximal Femur
Nomenclature Guidelines from the International Society for Clinical Densitometry
References

Chapter 2: Densitometry Techniques
Plain Radiography in the Assessment of Bone Density
Qualitative Morphometry:
Qualitative Spinal Morphometry
The Singh Index
Quantitative Morphometric Techniques
Calcar Femorale Thickness
Radiogrammetry
The Radiologic Osteoporosis Score
Radiographic Photodensitometry
Radiographic Absorptiometry
Photon Absorptiometry Techniques
Single Photon Absorptiometry (SPA)
Dual Photon Absorptiometry (DPA)
Dual Energy X-ray Absorptiometry (DXA)
Peripheral DXA (pDXA)
Single Energy X-ray Absorptiometry (SXA)
Quantitative Computed Tomography (QCT)
Peripheral QCT (pQCT)
Quantitative Ultrasound Bone Densitometry (QUS)
References

Chapter 3: Skeletal Anatomy in Densitometry
The Spine in Densitometry
Vertebral Anatomy
Artifacts in PA Lumbar Spine Densitometry
Vertebral Fractures Degenerative Changes and Dystrophic Calcification
The Effect of Osteophytes on Lumbar Spine BMD
The Effect of Aortic Calcification on Lumbar Spine BMD
The Effect of Facet Sclerosis on Lumbar Spine BMD
Other Causes of Artifacts in PA Lumbar Spine Studies
The Effect of Vertebral Rotation
The Spine in the Lateral Projection
The Proximal Femur in Densitometry
Proximal Femur Anatomy
The Effect of Scoliosis, Osteoarthritis, Osteophytes, Surgery and Fracture
on Proximal Femur BMD
The Forearm in Densitometry
Nomenclature
The Effect of Artifacts on Forearm BMD
The Metacarpals, Phalanges and Calcaneus
References

Chapter 4: Performing a DXA PA Lumbar Spine, Proximal Femur or Forearm Study The PA Lumbar Spine Study
The Effect of Vertebral Rotation The Proximal Femur Study
The Effect of Proximal Femur Rotation
The Effect of Leg Dominance
The Effect of Lumbar Scoliosis
The Effect of Femoral Shaft Adduction and Abduction Unilateral vs. Bilateral Proximal Femur Bone Density Measurements The Forearm Study
The Effect of Arm Dominance
The Effect of Prior Forearm Fracture
The Effect of Movement References

Chapter 5: Radiation Safety in X-ray Densitometry
Radiation Basics
Radiation Quantities
The Curie
The Roentgen
The Rad
The Rem
The Effective Dose Equivalent
Harmful Effects of Ionizing Radiation
Acute Lethal Radiation Syndromes
Local Tissue Damage from Radiation
Radiation Damage to the Skin
Radiation Damage to the Ovaries and Testes
Radiation Damage to the Bone Marrow and Blood
Late Effect of Ionizing Radiation
Radiation Doses in Densitometry
Radiation Protection Programs
Protection of the Public
Protection of the Patient
Protection of the Technologist
The Concepts of Time, Distance and Shielding
The Use of Personnel Monitoring Devices
Protection of the Pregnant Technologist
References

Chapter 6: Quality Control Procedures
Phantoms
The European Spine Phantom
The Bona Fide Spine Phantom
The Hologic Spine Phantom
The Lunar Spine Phantom The Norland Spine Phantom
Using the Phantom to Create Control Tables and Charts
Shewhart Rules and CUSUM Charts
Shewhart Rules
CUSUM Charts
Automated Quality Control Procedures
Replacing a Densitometer
References

Chapter 7: Precision in Bone Densitometry
The Concept of Precision
Performing a Precision Study
Short-term Precision Studies
Mathematical Procedures Used to Calculate Precision
Long-term Precision Studies
Applying the Precision Value to Serial Measurements
The Determination of Least Significant Change
A Case in Point
Determining the Level of Confidence for Any Change
and Precision
The Importance of Precision
Which Skeletal Sites Should Be Used for Monitoring?
How Frequently Should Measurements Be Repeated?
A Final Consideration
References

Chapter 8: Using Absolute Risk to Predict Fracture Risk in Clinical Practice Relative Fracture Risk in Clinical Trials Absolute Fracture Risk in Clinical Practice Absolute Fracture Risk Prediction Tools
FRAX®
Using the T-score with FRAX®
FRAX® Filters
FORE FRC
Canadian Association of Radiologists and Osteoporosis Canada (CAROC)
Fracture Risk Assessment System
Garvan Fracture Risk Calculator References

Chapter 9: An Overview of Osteoporosis
The Definition of Osteoporosis
The 1991 and 1993 Consensus Development Conferences
The 1994 World Health Organization Criteria for Diagnosis of Osteoporosis
The 2000 National Institutes of Health Consensus Conference
Definition of Osteoporosis
The Prevalence of Osteoporosis
Consequences of Osteoporosis
Risk Factors for Osteoporosis
The Attainment of Peak Bone Density
The Maintenance of Bone Density Guidelines for Bone Mass Measurements
The 1997 Bone Mass Measurement Act
Treatment Guidelines for Osteoporosis
The NOF Guidelines
Treatment Guidelines from AACE and NAMS Treatment Guidelines from Osteoporosis Canada and NOGG
Interventions in Osteoporosis
Non-Prescription Interventions
Life-style Modifications
Calcium, Vitamin D and Exercise
Prescription Interventions
Estrogen Therapy
The Selective Estrogen Receptor Modulator Raloxifene
Synthetic Salmon Calcitonin
The Bisphosphonates
Alendronate
Quick-Release Risedronate Delayed-Release Risedronate
Ibandronate Dosing Alendronate, Risedronate and Oral Ibandronate Zoledronic Acid Renal Function Requirements for the Bisphosphonates Other Bisphosphonate Safety Concerns
Denosumab
Parathyroid Hormone
Teriparatide
1-84 PTH
References

Chapter 10: Interpretation of Bone Densitometry Data
The Results
The Skeletal Image
The Measured and Calculated Bone Density Parameters
Comparisons to the Reference Database
The sBMD
The Age-Regression Graph
Assignment of Diagnostic Category Based on WHO Criteria
Conflicting Diagnoses from the Measurement of Multiple Sites
Report Review
References

Chapter 11: Less than Perfect Scan Images

Chapter 12: Pediatric Densitometry
Pediatric Scan Acquisition and Analysis Radiation Safety Issues in Pediatric Densitometry
Bone Age
Sexual Maturation Stage
Considerations of Bone Size and Shape
Skeletal Development and the Use of Standard Scores
in Pediatric Densitometry
Skeletal Development
The Use of Standard Scores in Pediatric Densitometry
Pediatric Reference Databases
2003, 2004 and 2007 International Society for Clinical Densitometry Guidelines
for Children
The Specialty of Pediatric Densitometry
References

Chapter 13: VFA Imaging, Femoral Morphometry and Hip Structural Analysis
VFA Imaging
The Relationship Between Prevalent Spine Fractures and Future Fracture
Risk Diagnosing Vertebral Fractures
Vertebral Fracture Assessment with Genant’s Semiquantitative
Technique Vertebral Fracture Assessment with Quantitative Techniques
Performance Comparisons of Semiquantitative and Quantitative
Techniques
Spine Imaging with DXA for the Diagnosis of Vertebral Fracture
VFA Patient Selection and Reporting
Aortic Calcification Assessment
Aortic Calcification Scoring Systems
Reporting Aortic Calcification on VFA Studies
Proximal Femur Morphometry
Hip Axis Length
The Femoral Neck-Shaft Angle
Femoral Neck Width
The Upper Femoral Neck
Hip Structural Analysis
HSA with QCT References

Chapter 14: Body Composition AnalysisThe Body-Mass-Index
Body Composition Methods
2-Compartment Body Composition Measurement Techniques
Underwater Weighing
Skinfold Measurements
Bioelectrical Impedance Analysis Air Displacement Plethysmography
3-Compartment Body Composition Measurement Techniques Near Infrared Interactance
Dual Energy X-ray Absorptiometry The Metabolic Syndrome
References
Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

The Body-Mass-Index
Body Composition Methods
2-Compartment Body Composition Measurement Techniques
Underwater Weighing
Skinfold Measurements
Bioelectrical Impedance Analysis Air Displacement Plethysmography
3-Compartment Body Composition Measurement Techniques Near Infrared Interactance
Dual Energy X-ray Absorptiometry The Metabolic Syndrome
References
Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

The Body-Mass-Index
Body Composition Methods
2-Compartment Body Composition Measurement Techniques
Underwater Weighing
Skinfold Measurements
Bioelectrical Impedance Analysis Air Displacement Plethysmography
3-Compartment Body Composition Measurement Techniques Near Infrared Interactance
Dual Energy X-ray Absorptiometry The Metabolic Syndrome
References
Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

The Body-Mass-Index
Body Composition Methods
2-Compartment Body Composition Measurement Techniques
Underwater Weighing
Skinfold Measurements
Bioelectrical Impedance Analysis Air Displacement Plethysmography
3-Compartment Body Composition Measurement Techniques Near Infrared Interactance
Dual Energy X-ray Absorptiometry The Metabolic Syndrome
References
Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

The Body-Mass-Index
Body Composition Methods
2-Compartment Body Composition Measurement Techniques
Underwater Weighing
Skinfold Measurements
Bioelectrical Impedance Analysis Air Displacement Plethysmography
3-Compartment Body Composition Measurement Techniques Near Infrared Interactance
Dual Energy X-ray Absorptiometry The Metabolic Syndrome
References
Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Appendices Appendix I: Contact Information for Organizations of Interest
Appendix II: World Health Organization Criteria for the Diagnosis of
Osteoporosis Based on the Measurement of Bone Density
Appendix III: 2007 ISCD Official Positions
Appendix IV: 2010 ISCD-IOF Official Positions on FRAX®
Appendix V: Guidelines for Bone Density Testing from
Major Organizations other than ISCD
Appendix VI: Bone Mass Measurement Act of 1997
Appendix VII: DXA PA Lumbar Spine Labeling Guidelines
Appendix VIII: Conversion Formulas
Appendix IX: Recommended Procedures for Short-Term Precision Studies
Appendix X: Calculation of Least Significant Change
Appendix XI: Quality Control Shewhart Rules
Appendix XII: The CD-ROM Companion

Dedication Preface
Chapter 1: An Introduction to Conventions in Densitometry
Densitometry as a Quantitative Measurement Technique
Accuracy and Precision
The Skeleton in Densitometry
Weight Bearing or Non-weight Bearing
Axial or Appendicular
Central or Peripheral
Cortical or Trabecular
What Do the Machines Actually Measure?
The Effect of Bone Size on Areal Densities
Bone Mineral Apparent Density
Calculating “Average” Spine Bone Densities
Ultrasound Parameters
The Densitometry Printout
The Percentage Comparisons
The Standard Score Comparisons
The Age-Regression Graph
The Standardized BMD
The Utility of the sBMD
The NHANES III Database for the Proximal Femur
Nomenclature Guidelines from the International Society for
Clinical Densitometry
References

Chapter 2: Densitometry Techniques
Plain Radiography in the Assessment of Bone Density
Qualitative Morphometry:
Qualitative Spinal Morphometry
The Singh Index
Quantitative Morphometric Techniques
Calcar Femorale Thickness
Radiogrammetry
The Radiologic Osteoporosis Score
Radiographic Photodensitometry
Radiographic Absorptiometry
Photon Absorptiometry Techniques
Single Photon Absorptiometry (SPA)
Dual Photon Absorptiometry (DPA)
Dual Energy X-ray Absorptiometry (DXA)
Peripheral DXA (pDXA)
Single Energy X-ray Absorptiometry (SXA)
Quantitative Computed Tomography (QCT)
Peripheral QCT (pQCT)
Quantitative Ultrasound Bone Densitometry (QUS)
References

Chapter 3: Skeletal Anatomy in Densitometry
The Spine in Densitometry
Vertebral Anatomy
Artifacts in PA Lumbar Spine Densitometry
Vertebral Fractures Degenerative Changes and Dystrophic Calcification
The Effect of Osteophytes on Lumbar Spine BMD
The Effect of Aortic Calcification on Lumbar Spine BMD
The Effect of Facet Sclerosis on Lumbar Spine BMD
Other Causes of Artifacts in PA Lumbar Spine Studies
The Effect of Vertebral Rotation
The Spine in the Lateral Projection
The Proximal Femur in Densitometry
Proximal Femur Anatomy
The Effect of Scoliosis, Osteoarthritis, Osteophytes, Surgery and Fracture
on Proximal Femur BMD
The Forearm in Densitometry
Nomenclature
The Effect of Artifacts on Forearm BMD
The Metacarpals, Phalanges and Calcaneus
References

Chapter 4: Performing a DXA PA Lumbar Spine, Proximal Femur or Forearm Study The PA Lumbar Spine Study
The Effect of Vertebral Rotation The Proximal Femur Study
The Effect of Proximal Femur Rotation
The Effect of Leg Dominance
The Effect of Lumbar Scoliosis
The Effect of Femoral Shaft Adduction and Abduction Unilateral vs. Bilateral Proximal Femur Bone Density Measurements The Forearm Study
The Effect of Arm Dominance
The Effect of Prior Forearm Fracture
The Effect of Movement References

Chapter 5: Radiation Safety in X-ray Densitometry
Radiation Basics
Radiation Quantities
The Curie
The Roentgen
The Rad
The Rem
The Effective Dose Equivalent
Harmful Effects of Ionizing Radiation
Acute Lethal Radiation Syndromes
Local Tissue Damage from Radiation
Radiation Damage to the Skin
Radiation Damage to the Ovaries and Testes
Radiation Damage to the Bone Marrow and Blood
Late Effect of Ionizing Radiation
Radiation Doses in Densitometry
Radiation Protection Programs
Protection of the Public
Protection of the Patient
Protection of the Technologist
The Concepts of Time, Distance and Shielding
The Use of Personnel Monitoring Devices
Protection of the Pregnant Technologist
References

Chapter 6: Quality Control Procedures
Phantoms
The European Spine Phantom
The Bona Fide Spine Phantom
The Hologic Spine Phantom
The Lunar Spine Phantom The Norland Spine Phantom
Using the Phantom to Create Control Tables and Charts
Shewhart Rules and CUSUM Charts
Shewhart Rules
CUSUM Charts
Automated Quality Control Procedures
Replacing a Densitometer
References

Chapter 7: Precision in Bone Densitometry
The Concept of Precision
Performing a Precision Study
Short-term Precision Studies
Mathematical Procedures Used to Calculate Precision
Long-term Precision Studies
Applying the Precision Value to Serial Measurements
The Determination of Least Significant Change
A Case in Point
Determining the Level of Confidence for Any Change
and Precision
The Importance of Precision
Which Skeletal Sites Should Be Used for Monitoring?
How Frequently Should Measurements Be Repeated?
A Final Consideration
References

Chapter 8: Using Absolute Risk to Predict Fracture Risk in Clinical Practice Relative Fracture Risk in Clinical Trials Absolute Fracture Risk in Clinical Practice Absolute Fracture Risk Prediction Tools
FRAX®
Using the T-score with FRAX®
FRAX® Filters
FORE FRC
Canadian Association of Radiologists and Osteoporosis Canada (CAROC)
Fracture Risk Assessment System
Garvan Fracture Risk Calculator References

Chapter 9: An Overview of Osteoporosis
The Definition of Osteoporosis
The 1991 and 1993 Consensus Development Conferences
The 1994 World Health Organization Criteria for Diagnosis of
Osteoporosis
The 2000 National Institutes of Health Consensus Conference
Definition of Osteoporosis
The Prevalence of Osteoporosis
Consequences of Osteoporosis
Risk Factors for Osteoporosis
The Attainment of Peak Bone Density
The Maintenance of Bone Density Guidelines for Bone Mass Measurements
The 1997