Effect of Field Size on the Clinical Exposure Index for Lumbar Spine X-ray Examination

Abstract The International Electrotechnical Commission introduced the concepts of exposure index (EI), target exposure index (EIT) and deviation index (DI) to manage and optimize patient dose in real time. In this study, we have proposed an appropriate method for setting the EIT based on the Korean national diagnostic reference levels (DRLs). Furthermore, we evaluated the use of clinical EI, EIT and DI as tools for patient dose optimization in clinical environments by observing the changes in DI with those in EIT. According to the Korean national exposure conditions, we conducted experiments on three representative radiographic examinations (chest posterior–anterior, lateral and abdomen anterior–posterior) of clinical environments. As the exposure conditions and DRLs varied, the clinical EI, EIT and DI also varied. These results reveal that the clinical EI, EIT and DI can be used as tools for optimizing the patient dose if EIT is periodically and properly updated.

Download Full-text

Bone density and bone health alteration in boys with Duchenne Muscular Dystrophy: a prospective observational study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0680 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Renu Suthar ◽

B. V. Chaithanya Reddy ◽

Manisha Malviya ◽

Titiksha Sirari ◽

Savita Verma Attri ◽

...

Keyword(s):

Lumbar Spine ◽

Bone Health ◽

Prospective Observational Study ◽

Bone Fractures ◽

Long Bone ◽

Vertebral Compression Fractures ◽

Serum Osteocalcin ◽

Z Score ◽

X Ray ◽

Compression Fractures

Abstract Objectives Boys with Duchenne Muscular Dystrophy (DMD) are at increased risk for compromised bone health, manifesting as low-impact trauma long bone fractures and vertebral compression fractures. Methods In a prospective observational study, we studied bone health parameters in North Indian boys with DMD. We consecutively enrolled ambulatory boys with DMD on glucocorticoid therapy. Bone health was evaluated with X-ray spine, Dual-energy X-ray absorptiometry (DXA), serum calcium, vitamin D3 (25[OH]D), 1,25-dihyroxyvitamin D3 (1,25[OH]2D3), serum osteocalcin, osteopontin, and N terminal telopeptide of type 1 collagen (Ntx) levels. Results A total of 76 boys with DMD were enrolled. The median age was 8.5 (interquartile range [IQR] 7.04–10.77) years. Among these, seven (9.2%) boys had long bone fractures, and four (5.3%) had vertebral compression fractures. Fifty-four (71%) boys underwent DXA scan, and among these 31 (57%) had low bone mineral density (BMD, ≤−2 z-score) at the lumbar spine. The mean BMD z-score at the lumbar spine was −2.3 (95% confidence interval [CI] = −1.8, −2.8), and at the femoral neck was −2.5 (95% CI = −2, −2.9). 25(OH)D levels were deficient in 68 (89.5%, n=76) boys, and 1,25(OH)2D3 levels were deficient in all. Mean serum osteocalcin levels were 0.68 ± 0.38 ng/mL (n=54), serum osteopontin levels were 8.6 ± 4.6 pg/mL (n=54) and serum Ntx levels were 891 ± 476 nmol/L (n=54). Boys with low BMD received glucocorticoids for longer duration, in comparison to those with normal BMD (median, IQR [16.9 (6–34) months vs. 7.8 (4.8–13.4) months]; p=0.04). Conclusions Bone health is compromised in North Indian boys with DMD. BMD at the lumbar spine is reduced in more than half of boys with DMD and nearly all had vitamin D deficiency on regular vitamin D supplements. Longer duration of glucocorticoid therapy is a risk factor for low BMD in our cohort.

Download Full-text

POS0045 LEAST SIGNIFICANT CHANGE IN BONE DENSITOMETRY IN PATIENTS WITH OBESITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3819 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 227.2-228

Author(s):

D. Claire ◽

M. Geoffroy ◽

L. Kanagaratnam ◽

C. Isabelle ◽

A. Hittinger ◽

...

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

General Population ◽

Bone Mineral ◽

Bone Densitometry ◽

Dual Energy ◽

Mineral Density ◽

Least Significant Change ◽

X Ray ◽

Significant Change

Background:Dual energy X-ray absoprtiometry is the reference method to mesure bone mineral density (1). Loss of bone mineral density is significant if it exceeds the least significant change. The threshold value used in general population is 0,03 g/cm2 (2). Patients with obesity are known for having a higher bone mineral density due to metabolism and physiopathology characteristics (3,4).Objectives:The aim of our study was to determine the least significant change in bone densitometry in patients with obesity.Methods:We conducted an interventionnal study in 120 patients with obesity who performed a bone densitometry. We measured twice the bone mineral density at the lumbar spine, the femoral neck and the total hip in the same time (5,6). We determined the least significant change in bone densitometry from each pair of measurements, using the Bland and Altman method. We also determined the least significant change in bone densitometry according to each stage of obesity.Results:The least significant change in bone densitometry in patients with obesity is 0,046g/cm2 at the lumbar spine, 0.069 g/cm2 at the femoral neck and 0.06 g/cm2 at the total hip.Conclusion:The least significant change in bone densitometry in patients with obesity is higher than in general population. These results may improve DXA interpretation in this specific population, and may personnalize their medical care.References:[1]Lees B, Stevenson JC. An evaluation of dual-energy X-ray absorptiometry and comparison with dual-photon absorptiometry. Osteoporos Int. mai 1992;2(3):146-52.[2]Briot K, Roux C, Thomas T, Blain H, Buchon D, Chapurlat R, et al. Actualisation 2018 des recommandations françaises du traitement de l’ostéoporose post-ménopausique. Rev Rhum. oct 2018;85(5):428-40.[3]Shapses SA, Pop LC, Wang Y. Obesity is a concern for bone health with aging. Nutr Res N Y N. mars 2017;39:1-13.[4]Savvidis C, Tournis S, Dede AD. Obesity and bone metabolism. Hormones. juin 2018;17(2):205-17.[5]Roux C, Garnero P, Thomas T, Sabatier J-P, Orcel P, Audran M, et al. Recommendations for monitoring antiresorptive therapies in postmenopausal osteoporosis. Jt Bone Spine Rev Rhum. janv 2005;72(1):26-31.[6]Ravaud P, Reny JL, Giraudeau B, Porcher R, Dougados M, Roux C. Individual smallest detectable difference in bone mineral density measurements. J Bone Miner Res. août 1999;14(8):1449-56.Disclosure of Interests:None declared.

Download Full-text

Ability of radiofrequency echographic multispectrometry to identify osteoporosis status in elderly women with type 2 diabetes

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01889-w ◽

2021 ◽

Author(s):

Carla Caffarelli ◽

Maria Dea Tomai Pitinca ◽

Antonella Al Refaie ◽

Elena Ceccarelli ◽

Stefano Gonnelli

Keyword(s):

Type 2 Diabetes ◽

Lumbar Spine ◽

Elderly Women ◽

Fragility Fractures ◽

Dual Energy ◽

Healthy Controls ◽

Diagnosis Of Osteoporosis ◽

X Ray ◽

The Difference

Abstract Background Patients with type 2 diabetes (T2DM) have an increased or normal BMD; however fragility fractures represent one of the most important complications of T2DM. Aims This study aimed to evaluate whether the use of the Radiofrequency Echographic multi spectrometry (REMS) technique may improve the identification of osteoporosis in T2DM patients. Methods In a cohort of 90 consecutive postmenopausal elderly (70.5 ± 7.6 years) women with T2DM and in 90 healthy controls we measured BMD at the lumbar spine (LS-BMD), at femoral neck (FN-BMD) and total hip (TH-BMD) using a dual-energy X-ray absorptiometry device; moreover, REMS scans were also carried out at the same axial sites. Results DXA measurements were all higher in T2DM than in non-T2DM women; instead, all REMS measurements were lower in T2DM than in non T2DM women. Moreover, the percentage of T2DM women classified as “osteoporotic”, on the basis of BMD by REMS was markedly higher with respect to those classified by DXA (47.0% vs 28.0%, respectively). On the contrary, the percentage of T2DM women classified as osteopenic or normal by DXA was higher with respect to that by REMS (48.8% and 23.2% vs 38.6% and 14.5%, respectively). T2DM women with fragility fractures presented lower values of both BMD-LS by DXA and BMD-LS by REMS with respect to those without fractures; however, the difference was significant only for BMD-LS by REMS (p < 0.05). Conclusions Our data suggest that REMS technology may represent a useful approach to enhance the diagnosis of osteoporosis in patients with T2DM.

Download Full-text

Estimation of dose and cancer risk to newborn from chest X-ray in South-South Nigeria: a call for protocol optimization

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00445-w ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Akintayo Daniel Omojola ◽

Michael Onoriode Akpochafor ◽

Samuel Olaolu Adeneye ◽

Isiaka Olusola Akala ◽

Azuka Anthonio Agboje

Keyword(s):

Cancer Risk ◽

Age Groups ◽

Field Size ◽

Radiological Protection ◽

International Studies ◽

X Ray ◽

Thermoluminescent Dosimeters ◽

Chest X Ray ◽

Neonatal Patient ◽

The Mean

Abstract Background The use of X-ray as a diagnostic tool for complication and anomaly in the neonatal patient has been helpful, but the effect of radiation on newborn stands to increase their cancer risk. This study aims to determine the mean, 50th percentile (quartile 2 (Q2)), and 75th percentile (quartile 3 (Q3)) entrance surface dose (ESD) from anteroposterior (AP) chest X-ray and to compare our findings with other relevant studies. The study used calibrated thermoluminescent dosimeters (TLDs), which was positioned on the central axis of the patient. The encapsulated TLD chips were held to the patients’ body using paper tape. The mean kilovoltage peak (kVp) and milliampere seconds (mAs) used was 56.63(52–60) and 5.7 (5–6.3). The mean background TLD counts were subtracted from the exposed TLD counts and a calibration factor was applied to determine ESD. Results The mean ESDs of the newborn between 1 and 7, 8 and 14, 15 and 21, and 22 and 28 days were 1.09 ± 0.43, 1.15 ± 0.50, 1.19 ± 0.45, and 1.32 ± 0.47 mGy respectively. A one-way ANOVA test shows that there were no differences in the mean doses for the 4 age groups (P = 0.597). The 50th percentile for the 4 age groups was 1.07, 1.26, 1.09, and 1.29 mGy respectively, and 75th percentile were 1.41, 1.55, 1.55, and 1.69 mGy respectively. The mean effective dose (ED) in this study was 0.74 mSv, and the estimated cancer risk was 20.7 × 10−6. Conclusion ESD was primarily affected by the film-focus distance (FFD) and the patient field size. The ESD at 75th percentile and ED in this study was higher compared to other national and international studies. The estimated cancer risk to a newborn was below the International Commission on Radiological Protection (ICRP) limit for fatal childhood cancer (2.8 × 10−2Sv−1).

Download Full-text