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ARRT Bone Density Exam Study Guide-
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According to the WHO criteria, what is the diagnosis of osteoporosis based on the measurement of bone density? 2.5 SD or more below the young adult peak bone density What is the gold standard technique for measuring bone density? DXA Cancellous bone is also know as? Trabecular Bone What is the anatomical landmark on the proximal femur that gives the best visual indication of the degree of rotation of the proximal femur? Lesser Trochanter Which lumbar vertebra is described as having a characteristic shape of an X or and H on a DXA PA spine scan? L Is Forteo a bisphosphonate? NO Quantitative Computated Tomography (QCT)
- measurements are volumetric
- trabecular bone can be isolated from cortical bone
- accuracy may be affected by marrow fat Peripheral BMD measurements are advocated for _____________? Screening What is the most important clinical consequence of osteoporosis? Fracture What is the name of the tool that integrates clinical information in a quantitative manner to predict a 10-year probability of major osteoporotic fracture for both men and women? FRAX What is the major source of precision error in clinical practice? Technologist What is the percentage of trabecular bone in the skeleton? 20 % The forearm is not used to monitor the effects of therapy for osteoporosis because....... rate of change in BMD is too slow
Cancellous bone is also known as _______________? Trabecular bone How would you start labeling the vertebral bodies on a PA lumbar scan? Start at L4 and count/label up With changes in rotation of the femoral neck, what happens? Increases the BMD If daily QC fails, what should be your first step of action?
- repeat the scan
- if scan fails again, then call for help Although the technology is similar with all of the DXA units, the BMD results are different because..........
- different calibration standards
- algorithms to calculate BMD
- differences in the ROI
- different databases
The primary mechanism of action of antiresorptive therapies is the direct interaction with the __________________ osteoclasts Which site is preferred for determination of fracture prediction? proximal femur What is one disease not associated with low BMD? osteopetrosis DXA results may be influenced by.........
- body thickness
- degenerative changes
- fractures
- scan mode A great forearm scan should include.......
- forearm centered
- forearm straight
- less than a day of background radiation
- less than a round trip from Boston to LA
- one-tenth of a chest xray Why is the non-dominant arm used in bone densitometry? reference values reflect non-dominant arm measurements When measuring the proximal femur, how should the neck ROI be placed? the neck ROI should be perpendicular to the femoral neck What is the bone edge detection methodology? it tests the machines ability to distinguish bone from soft tissue What are the two most common methods for shifting the energies in DXA units?
- energy shifting
- k-edge filters Why do you use the hip positioner during scanning of the proximal femur? to place the femoral neck parallel to the tabletop Bisphosphonates prevent bone loss by.... reducing the activity of the osteoclasts
If a patient has a history of hyperparathyroidism, what would the preferred site be for evaluation? 33% or 1/3 of the forearm What is important for serial monitoring? precision What pharmaceutical may be suggested for a woman with a high risk of breast cancer and elevated lipids? Evista (Raloxifene) What year was the Bone Mass Measurement Act proposed? 1997 What type of osteoporosis is a result of menopause? Primary Osteoporosis Type 1 What classes of cells are involved in bone remodeling?
- osteoclasts
- osteoblasts
- osteocytes What therapy mimics the effects of estrogen on bone and has antiestrogenic effects in other tissue?
Bone mineral density is expressed as......... g/cm squared How many times should you scan a patient with in-vivo precision study?
- 30 patients scanned twice
- 15 patients scanned 3 times When analyzing the PA spine, what should you not mess with? Width of ROI box How many places to the right of the decimal point is used in reporting BMD? 3 The name of the forearm sites are based on what? the location of the site on the bone in relationship to the overall length A postmenopausal woman with a femoral neck T-score of - 2.0 SD below a young adult is to be classified as....... osteopenia What happens when there is an imbalance or uncoupling of the remodeling cycle? the usual result is a net loss in the bone mass A technologist should perform a precision study in order to calculate _______________.
LSC (Least Significant Change) A DXA scanner that uses a single detector and a pinhole collimator is a........ pencil beam scanner Regarding Shewart Rules, the control limits are based on what percentage of the average values? 1.5% (3 SD) What is the sum of the data values divided by the number of values? mean A DXA system that employs a rare earth filtered x-ray source uses what type of detector? pulse counting The characteristic shapes of the vertebrae seen on the DXA image are primarily based on the appearance of the ____________ elements. posterior Accuracy
- ability to measure true value
- most important for diagnosis
- less important for serial monitoring
males or females under age 20 What is the name of the isotope used in DPA? Gadolinium- 153 What bone parameter is measured in grams? BMC The region of the proximal femur lying on the border of the femoral neck and the greater trochanter is termed the.............. Ward's Area What are the diagnosis guidelines for children?
- z-scores are used
- "low for age" is used instead of "osteopenia"
- pediatric software is highly recommended What is the age range used with FRAX? 40 - 90 years What is the number which the precision error is multiplied to determine the LSC at 95% confidence level?
What skeletal site may be preferred for assessing early menopause following an oophorectomy? spine An increase in the overall bone mass of a patient is closely related to an accelerated rate of bone ___________ and a reduced amount of _______________. formation; resorption What scan measures the most trabecular bone? QCT of the spine What are 2 types of exercise that are great for your bones?
- weight bearing
- weight resistence What are the 4 classifications that apply to the heel?
- appendicular
- peripheral
- predominantly trabecular
- weight bearing
54 million The _____ is the only validated skeletal site for the clinical use of QUS in osteoporosis. heel Standard Deviation (SD) measure of the variability or the spread of data around the mean As _______ increases, the risk for a hip fracture increases independent of the BMD HAL (hip axis length) What is the scanning pattern used with the pencil beam? rectilinear What does Sievert refer to? effective dose What is accuracy most important for? diagnosis *less important for serial monitoring Standard Scores (SS) indicate how many standard deviations above or below the average value in question actually lies Precision
ability to reproduce a measurement when performed under identical conditions T-score number of SD an individual's BMD is from the average BMD for sex-matched young normal peak bone mass Quantitative Ultrasound (QUS) measures the broadband attenuation properties of bone Bone loss occurs when __________ exceeds ____________ resorption; formation Osteoporosis skeletal disorder characterized by compromised bone strength WHO definition of osteoporosis T-score of - 2.5 SD or below Primary Osteoporosis
- result of the cumulative impact of bone loss and deterioration of bone loss that occurs as people age
- also called age-related osteoporosis Type 1 Primary Osteoporosis associated with no ovaries Type 2 Primary Osteoporosis
What is the major inorganic compound of bone? calcium phosphate crystals Bone consists of ______% of organic substances 25% Bone consists of ____% of inorganic substances 75% Appendicular skeleton pelvic girdle, limbs, hands and feet Weight bearing sites
- lower extremities
- spine
- calcaneus
- portions of the pelvis Central sites of the skeleton
- thoracic spine
- lumbar spine
- proximal femur Peripheral sites of the skeleton
- forearm
- fingers
- metacarpals
- tibia
- calcaneus Cortical Bone (Compact Bone)
- dense, hard bone
- found in locations where bone compresses in a limited number of directions
- found in the shaft of long bones
- organized into Haversian Systems
