Abstract
It is widely recognized that early diagnosis of osteoporosis is of paramount importance to prevent fractures. Several X-ray based imaging techniques capable of assessing bone quantity and quality have been developed. However, exposure to ionizing radiation carries a potential risk and, for this reason, it is necessary to ensure adequate radiation protection for patients and staff. This chapter provides (a) the general terminology used in quantifying radiation, (b) a brief review of the system of radiation protection, and (c) data on the levels of radiation exposure associated with methods used for diagnosis of osteoporosis. Moreover, the importance of quality assurance in bone densitometry is discussed and quality control tests are proposed to ensure that DXA devices are operating according to specifications.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Adams JE (2008) Dual-energy X-ray absorptiometry. In: Grampp S (ed) Radiology of osteoporosis, 2nd edn. Springer, New York, pp 105–124
Adams JE (2009) Quantitative computed tomography. Eur J Radiol 71:415–424
American College of Radiology (2008) Practice guidelines for the performance of dual-energy X-ray absorptiometry (DXA). In: Practice guidelines and technical standards, pp 1–10. Available via http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx.asp. Accessed 26 March 2012
American College of Radiology (2011) ACR practice guideline for continuing medical education (CME), pp. 1–3. Available via http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/cme/cme.aspx. Accessed 23 March 2012
American Society of Radiologic Technologists (2009) Bone densitometry curriculum Albuquerque (NM). Am Soc Radiol Technol 1–70
Bacchetta J, Boutroy S, Vilayphiou N et al (2010) Early impairment of trabecular microarchitecture assessed with HR-pQCT in patients with stage II–IV chronic kidney disease. J Bone Miner Res 25:849–857
Bauer JS, Muller D, Ambekar A et al (2006) Detection of osteoporotic vertebral fractures using multidetector CT. Osteoporos Int 17:608–615
Bezakova E, Collins PJ, Beddoe AH (1997) Absorbed dose measurements in dual energy X-ray absorptiometry (DXA). Br J Radiol 70:172–179
Blake GM, Rea JA, Fogelman I (1997) Vertebral morphometry studies using dual-energy X-ray absorptiometry. Semin Nucl Med 27:276–290
Blake G, Naeem M, Boutros M (2006) Comparison of effective dose to children and adults from dual X-ray absorptiometry examinations. Bone 38:935–942
Boone JM, Velazquez O, Cherry SR (2004) Small-animal X-ray dose from micro-CT. Mol Imaging 3:149–158
Boutroy S, Bouxsein ML, Munoz F, Delmas PD (2005) In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab 90:6508–6515
Brouwers JE, van Rietbergen B, Huiskes R (2007) No effects of in vivo micro-CT radiation on structural parameters and bone marrow cells in proximal tibia of Wistar rats detected after eight weekly scans. J Orthop Res 25:1325–1332
Burrows M, Liu D, McKay H (2010) High resolution peripheral QCT imaging of bone micro-structure in adolescents. Osteoporos Int 21:515–520
Cawte SA, Pearson D, Green DJ, Maslanka WB, Miller CG, Rogers AT (1999) 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 72:354–362
Damilakis J, Guglielmi G (2010) Quality assurance and dosimetry in bone densitometry. Radiol Clin N Am 48:629–640
Damilakis J, Perisinakis K, Vrahoriti H, Kontakis G, Varveris H, Gourtsoyiannis N (2002) Embryo/fetus radiation dose and risk from dual X-ray absorptiometry examinations. Osteoporos Int 13:716–722
Damilakis J, Maris T, Karantanas A (2007) An update on the assessment of osteoporosis using radiologic techniques. Eur Radiol 17:1591–1602
Damilakis J, Adams J, Guglielmi G, Link T (2010a) Radiation exposure in X-ray-based imaging techniques in osteoporosis. Eur Radiol 20:2707–2714
Damilakis J, Perisinakis K, Tzedakis A, Papadakis A, Karantanas A (2010b) Radiation dose to the conceptus from multidetector CT during early gestation: a method that allows for variations in maternal body size and conceptus position. Radiology 257:483–489
Das M, Mahnken AH, Muhlenbruch G et al (2005) Individually adapted examination protocols for reduction of radiation exposure for 16-MDCT chest examinations. Am J Roentgenol 184:1437–1443
Deak PD, Langner O, Lell M, Kalender WA (2009) Effects of adaptive section collimation on patient radiation dose in multisection spiral CT. Radiology 252:140–147
Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257:158–166
Engelke K, Adams JE, Armbrecht G et al (2008) 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 11:123–162
Engelke K, Libanati C, Liu Y et al (2009a) 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 45:110–118
Engelke K, Mastmeyer A, Bousson V, Fuerst T, Laredo J, Kalender W (2009b) Reanalysis precision of 3D quantitative computed tomography (QCT) of the spine. Bone 44:566–572
European Commission, Radiation Protection 99 (1998) Guidance on medical exposures in medical and biomedical research, Directorate-General Environment. Nuclear Safety and Civil Protection
Fan B, Lu Y, Genant H, Fuerst T, Shepherd J (2010) Does standardized BMD still remove differences between Hologic and GE-Lunar state-of-the-art DXA systems? Osteoporos Int 21:1227–1236
Ferrar L, Jiang G, Adams J, Eastell R (2005) Identification of vertebral fractures: an update. Osteoporos Int 16:717–728
Fuerst T, Njeh C, Hans D (1999) Quality assurance and quality control in quantitative ultrasound. In: Njeh CF, Hans D, Fuerst T, Gluer CC, Genant H (eds) Quantitative ultrasound. Assessment of osteoporosis and bone status, 1st edn. Martin Dunitz, London, pp 163–175
Genant HK, Engelke K, Prevrhal S (2008) Advanced CT bone imaging in osteoporosis. Rheumatology 47:iv9–iv16
Gies M, Kalender WA, Wolf H et al (1999) Dose reduction in CT by anatomically adapted tube current modulation. I. Simulation studies. Med Phys 26:2235–2247
Graeff C, Timm W, Nickelsen TN, Farrerons J et al (2007) Monitoring teriparatide-associated changes in vertebral microstructure by high-resolution CT in vivo: results from the EUROFORS study. J Bone Miner Res 22:1426–1433
Greess H, Wolf H, Baum U et al (1999) Dosage reduction in computed tomography by anatomy-oriented attenuation-based tube-current modulation: the first clinical results. Rofo 170:246–250
Greess H, Wolf H, Baum U et al (2000) Dose reduction in computed tomography by attenuation-based on-line modulation of tube current: evaluation of six anatomical regions. Eur Radiol 10:391–394
Greess H, Lutze J, Nomayr A et al (2004) Dose reduction in subsecond multislice spiral CT examination of children by on-line tube current modulation. Eur Radiol 14:995–999
Griffith J, Genant H (2008) Bone mass and architecture determination: state of the art. Best Pract Res Clin Endocrinol Metab 22:737–764
Gundry CR, Miller CW, Ramos E et al (1990) Dual-energy radiographic absorptiometry of the lumbar spine: clinical experience with two different systems. Radiology 174:539–541
Hanson J (1997) Standardization of femur BMD (letter to the editor). J Bone Miner Res 12:1316–1317
Huda W, Morin RL (1996) Patient doses in bone mineral densitometry. Br J Radiol 69:422–425
Hui SL, Gao S, Zhou XH et al (1997) Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments. J Bone Miner Res 12:1463–1470
Hundt W, Rust F, Stabler A et al (2005) Dose reduction in multislice computed tomography. J Comput Assist Tomogr 29:140–147
International Commission on Radiological Protection [ICRP publication 103] (2007) Recommendations of the international commission on radiological protection. Ann ICRP 37:1–332
International Commission on Radiological Protection [ICRP publication 84] (2000) Pregnancy and medical radiation. Ann ICRP 30:1–43
International Committee for Standards in Bone Measurement (1997) Standardization of proximal femur bone mineral density (BMD) measurements by DXA. Bone 21:369–370
International Osteoporosis Foundation (2012) Training and education courses. Available via http://www.iofbonehealth.org/bonehealth/training-and-education-courses. Accessed 29 March 2012
International Society for Clinical Densitometry (2012) Education. Available via http://www.iscd.org/Visitors/education/. Accessed 29 March 2012
Issever A, Link T, Kentenich M et al (2009) Assessment of trabecular bone structure using MDCT: comparison of 64- and 320-slice CT using HR-pQCT as the reference standard. Eur Radiol 20:458–468
Ito M, Ikeda K, Nishiguchi M et al (2005) Multidetector row CT imaging of vertebral microstructure for evaluation of fracture risk. J Bone Miner Res 20:1828–1836
Kalender WA (1992) Effective dose values in bone mineral measurements by photon absorptiometry and computed tomography. Osteoporos Int 2:82–87
Kalender W (2005) Computed tomography, fundamentals, system technology, image quality, applications. Publicis Corporate Publishing, Erlangen, pp 209–230
Kalender WA, Felsenberg D, Genant HK et al (1995) The European Spine Phantom—a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT. Eur J Radiol 20:83–92
Kanis JA, Melton LJ III, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141
Khoo BC, Brown K, Cann C et al (2009) Comparison of QCT-derived and DXA-derived areal bone mineral density and T scores. Osteoporos Int 20:1539–1545
Klinck R, Campbell G, Boyd S (2008) Radiation effects on bone architecture in mice and rats resulting from in vivo micro-computed tomography scanning. Med Eng Phys 30:888–895
Krebs A, Graeff C, Frieling I et al (2009) High resolution computed tomography of the vertebrae yields accurate information on trabecular distances if processed by 3D fuzzy segmentation approaches. Bone 44:145–152
Larkin A, Sheahan N, O’Connor U et al (2008) QA/Acceptance testing of DEXA X-ray systems used in bone mineral densitometry. Radiat Prot Dosim 129:279–283
Lespessailles E, Gadois C, Kousiqnian I et al (2008) Clinical interest of bone texture analysis in osteoporosis: a case control multicenter study. Osteoporos Int 19:1019–1028
Lewis MK, Blake GM, Fogelman I (1994) Patient dose in dual X-ray absorptiometry. Osteoporosis Int 4:11–15
Link TM, Koppers BB, Licht T et al (2004) In vitro and in vivo spiral CT to determine bone mineral density: initial experience in patients at risk for osteoporosis. Radiology 231:805–811
Majumdar S, Lin J, Link T et al (1999) Fractal analysis of radiographs: assessment of trabecular bone structure and prediction of elastic modulus and strength. Med Phys 26:1330–1340
Majumdar S, Link TM, Millard J et al (2000) In vivo assessment of trabecular bone structure using fractal analysis of distal radius radiographs. Med Phys 27:2594–2599
Mettler F, Huda W, Yoshizumi T, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: A catalog. Radiology 248:254–263
National Research Council Committee on the Biological Effects of Ionizing Radiation, Committee to Assess Health Risks from Exposure to Low levels of Ionizing Radiation; Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research Council of the National Academies (2006) Health Risks from Exposure to low Levels of Ionizing Radiation: BEIR VII Phase 2. The National Academy Press, Washington
Njeh CF, Samat SB, Nightingale A, McNeil EA, Boivin CM (1997) Radiation dose and in vitro precision in bone mineral density measurement using dual X-ray absorptiometry. Br J Radiol 70:719–727
O’Connor U, Dowling A, Larkin A et al (2008) Development of training syllabi for radiation protection and quality assurance of dual-energy X-ray absorptiometry (DXA) systems. Radiat Prot Dosim 129:211–213
Obenaus A, Smith A (2004) Radiation dose in rodent tissues during micro-CT imaging. J X-ray Sci Tech 12:241–249
Papadakis AE, Perisinakis K, Damilakis J (2008) Automatic exposure control in pediatric and adult multidetector CT examinations: a phantom study on dose reduction and image quality. Med Phys 35:4567–4576
Papadakis AE, Karantanas AH, Papadokostakis G, Petinellis E, Damilakis J (2009) Can abdominal multi-detector CT diagnose spinal osteoporosis? Eur Radiol 19:172–176
Papadakis A, Perisinakis K, Oikonomou I, Damilakis J (2011) Automatic exposure control in pediatric and adult computed tomography examinations. Invest Radiol 46:654–662
Pocock NA, Sambrook PN, Nguyen T et al (1992) Assessment of spinal and femoral bone density by dual X-ray absorptiometry: comparison of Lunar and Hologic instruments. J Bone Miner Res 7:1081–1084
Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K (2003) Studies of mortality of atomic bomb survivors: report 13—solid cancer and noncancer disease mortality, 1950–1997. Radiat Res 160:381–407
Rizzoli R, Chapurlat R, Laroche J et al (2012) Effects of strontium ranelate and alendronate on bone microstructure in women with osteoporosis. Results of a 2 year study. Osteoporos Int 23:305–315
Seeram E (2001) Computed tomography. physical principles, clinical applications and quality control, 2nd edn. W.B.Saunders, Philadelphia
Sheahan NF, Dowling A, O’Reilly G et al (2005) Commissioning and quality assurance protocol for dual energy X-ray absorptiometry (DEXA) systems. Radiat Prot Dosimetry 117:288–290
Sont WN, Zielinski, Ashmore JM, Jiang H, Krewski D, Fair ME, Band PR, Letourneau EG (2001) First analysis of cancer incidence and occupational radiation exposure based on the national dose registry of Canada. Am J Epidemiol 153:309–318
Steel SA, Baker AJ, Saunderson JR (1998) An assessment of the radiation dose to patients and staff from a lunar expert-xl fan beam densitometer. Physiol Meas 19:17–26
Steiger P (1995) Standardization of measurements for assessing BMD by DXA (letter to the editor). Calcif Tissue Int 57:469
Tack D, De Maertelaer V, Gevenois PA (2003) Dose reduction in multidetector CT using attenuation-based online tube current modulation. Am J Roentgenol 181:331–334
Tothill P, Hannan W (2007) Precision and accuracy of measuring changes in bone mineral density by dual-energy X-ray absorptiometry. Osteoporos Int 18:1515–1523
Tzedakis A, Damilakis J, Perisinakis K, Stratakis J, Gourtsoyiannis N (2005) The effect of z overscanning on patient effective dose from multidetector helical computed tomography examinations. Med Phys 32:1621–1629
Tzedakis A, Perisinakis K, Raissaki M, Damilakis J (2007) The effect of z overscanning on radiation burden of pediatric patients undergoing head CT with multidetector scanners: a Monte Carlo study. Med Phys 33:2472–2478
Vokes T, Bachman D, Baim S et al (2006) Vertebral fracture assessment: the 2005 ISCD official positions. J Clin Densitom 9:37–46
World Nuclear Association. Nuclear Radiation and Health Effects (updated November 2011). Available via http://www.world-nuclear.org/info/inf05.html. Accessed 27 March 2012
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Damilakis, J., Solomou, G. (2013). Radiation Protection and Quality Assurance in Bone Densitometry. In: Guglielmi, G. (eds) Osteoporosis and Bone Densitometry Measurements. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_612
Download citation
DOI: https://doi.org/10.1007/174_2012_612
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-27883-9
Online ISBN: 978-3-642-27884-6
eBook Packages: MedicineMedicine (R0)