Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2020; 30(03): 362-371
DOI: 10.4103/ijri.IJRI_495_19
Miscellaneous

Technical and patient-related sources of error and artifacts in bone mineral densitometry using dual-energy X-ray absorptiometry: A pictorial review

Mohsen Qutbi
Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran
,
Mehdi Soltanshahi
Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran
,
Yaser Shiravand
Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran
,
Saba Karami Gorzi
Science and Research Branch, Islamic Azad University, Tehran, Iran
,
Babak Shafiei
Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran
,
Isa Neshandar Asli
Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
   Permissions and Reprints

Abstract

Dual-energy X-ray absorptiometry is currently the standard and validated tool for measurement of bone mineral density and for the evaluation of osteoporosis. Current densitometry scanners based on dual-energy X-ray absorptiometry method produce two X-ray beams with different energies to differentiate the overlapped soft tissue and bony structures, by creating two different attenuation profiles. Procedural guidelines are available to technicians and physicians to guarantee the best practice, including consistent positioning during scanning and standard reporting. However, similar to other imaging modalities, dual-energy X-ray absorptiometry may be influenced by technical errors, and thus, imaging artifacts may arise and accuracy and precision of the results may be influenced. This issue may, in turn, affect the final result and interpretation. Hence, the article is arranged with the intention of presenting some less common and rare technical and patient-related sources of error and resultant artifacts, from poor patient preparation to acquisition and data processing. Where appropriate, the corresponding tables of densitometric results (bone mineral density) and statistical parameters (T- and Z-scores) are provided.

Keywords

Artifact - atlas - bone mineral densitometry - dual-energy X-ray absorptiometry


Publication History

Received: 05 January 2020

Accepted: 28 May 2020

Article published online:
19 July 2021

© 2020. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Dual Energy X Ray Absorptiometry for Bone Mineral Density and Body Composition Assessment. Vienna: International Atomic Energy Agency; 2011
    Google Scholar
  • 2 Martineau P, Bazarjani S, Zuckier LS. Artifacts and incidental findings encountered on Dual-energy X-Ray absorptiometry: Atlas and analysis. Semin Nucl Med 2015; 45: 458-69
    CrossrefPubMedGoogle Scholar
  • 3 Spencer RP, Malcolm DM, Barton PA. Totem pole sign. Bone densitometry study with retained barium. Clin Nucl Med 1991; 16: 596
    CrossrefPubMedGoogle Scholar
  • 4 Proft F, Poddubnyy D. Ankylosing spondylitis and axial spondyloarthritis: Recent insights and impact of new classification criteria. Ther Adv Musculoskelet Dis 2018; 10: 129-39
    CrossrefPubMedGoogle Scholar
  • 5 Vasdev V, Bhakuni D, Garg MK, Narayanan K, Jain R, Chadha D. Bone mineral density in young males with ankylosing spondylitis. Int J Rheum Dis 2011; 14: 68-73
    CrossrefPubMedGoogle Scholar
  • 6 Magrey MN, Lewis S, Asim Khan M. Utility of DXA scanning and risk factors for osteoporosis in ankylosing spondylitis-A prospective study. Semin Arthritis Rheum 2016; 46: 88-94
    CrossrefPubMedGoogle Scholar
  • 7 Paccou J, Michou L, Kolta S, Debiais F, Cortet B, Guggenbuhl P. High bone mass in adults. Joint Bone Spine 2018; 85: 693-9
    CrossrefPubMedGoogle Scholar
  • 8 Aparisi F. Vertebroplasty and kyphoplasty in vertebral osteoporotic fractures. Semin Musculoskelet Radiol 2016; 20: 382-91
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Watts NB. Fundamentals and pitfalls of bone densitometry using Dual-energy X-ray absorptiometry (DXA). Osteoporos Int 2004; 15: 847-54
    CrossrefPubMedGoogle Scholar
  • 10 QDR reference manual. Document No. MAN-01016 Revision 003. Hologic, Inc.; 2009
    Google Scholar
  • 11 Dual Energy X-ray Absorptiometry (DXA) Procedures Manual. National health and nutrition examination survey (NHANES); 2007. Available from: https://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/manual_dexa.pdf. [Last accessed on 2019 Nov 05]
    Google Scholar
  • 12 Morgan SL, Prater GL. Quality in Dual-energy X-ray absorptiometry scans. Bone 2017; 104: 13-28
    CrossrefPubMedGoogle Scholar
  • 13 Theodorou DJ, Theodorou SJ. Dual-energy X-ray absorptiometry in clinical practice: Application and interpretation of scans beyond the numbers. Clin Imaging 2002; 26: 43-9
    CrossrefPubMedGoogle Scholar
  • 14 Qutbi M, Salek A, Soltanshahi M, Ajdari SE, Asli IN. The impact of nonstandard hip rotation on densitometric results of hip regions and potential misclassification of diagnosis. Arch Osteoporos 2019; 14: 86
    CrossrefPubMedGoogle Scholar