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What are the positioning landmarks for the AP spine DXA and proximal femur?
- Umbilicus (navel)
- Iliac Crest
- Xypoid Process
Why is the leg positioning block placed under a patient’s legs for the AP spine DXA?
reduces the lordotic curce of a person's spine and opens up the intervertebral spaces
Do you label/count the vertebrae from the top to bottom or vice versa?
always count vertebrae from the bottom up
What shapes do the lumbar vertebrae resemble?
- L1-3: U transcerse process sometimes seen on L3
- L4:X or H
- L5: I on its die or bow tie
What is the most common osteoporotic fracture?
- Vertebral Fracture
- most common compression fracture at T11 or L1
Do fractures decrease or increase the BMD?
What is lordosis and kyphosis?
- Lordosis- inward curvature of the lower spine
- Kyphosis- outward curvature of the upper spine (dowangers hump)
What are some spine internal and external artifacts that can sometimes be seen on DXA scans? (Same for proximal femur and forearm)
- Kidney stones, Pancreatic calsifications, Gall stones, aortic calcifications, surgical implants and orthopedic hardware, degenerative sclerosis, vertebral fractures, osteophytes.
- Femur- Artritis, Schlerosis, Paget's Disease, Fractures, Polio, Paralysis, Avascular Necrosis, Congenital Defects- items left in pockets, hip replacements, surgical hardware, body habitus
- Forearm- jewelry
What degree of rotation is optimum for the proximal femur and what is a sure sign if you have rotated too much or not enough?
- internally rotate 15-25 degress
- too much rotation and the lesser trochanter will not be seen and too little rotation will make the lesser trochanter appear pointed and large
Do you rotate the leg internally or externally for the proximal femur DXA scan?
How do you decide which forearm to scan?
always scan the non-dominant arm- if person writes with right scan left
Artifacts in spine or hip, Severe degenerative disase or arthritis, severe scoli, large discordance between spine and hip results, hyperparathyroidism, wheel chair confined, over weight limit, research
What is the T-score?
Young adult- compares the patients BMD with the peak BMD value expected for healthy young adults of the same sex
What is the Z-score?
Age matched- compares the patients BMD with the BMD that is expected for an individual of the same age and sex
Up to what age would be considered a pediatric patient?
Which score( T or Z) is used in pediatric patients and what is the number to look for that might alert you that something is abnormal in the pediatric patient?
- -2 indicator that something is not right with their bone development
Is bone age and chronological age the same thing?
What are the two compartment ways to measure body composition?
- Underwater Weighing
- Skin fold measurement
- Bioelectric impedance analysis
- air displacement plethsmography
What are the three compartment ways to measure body composition?
- Near Infrared Interactance
- Dual-Enerfy X-ray Absorptiometry (DXA)
For every standard deviation decline in bone density the risk of fracture does
what? (Do not need to know the site specific fracture risk numbers
just the overall global fracture risk for every decline in bone density)
for every standard deviation the risk is 2 fold or doubles