Bone mineral densitometry with x-ray and radionuclide sources: a theoretical comparison

Bone calcium/phosphorus ratio determination using dual energy X-ray method

Non-invasive dual energy methods have been used extensively on osteoporosis diagnosis estimating parameters, such as, Bone Mineral Density (BMD) and Bone Mineral Content (BMC). In this study, an X-ray dual energy method (XRDE) was developed for the estimation of the bone Calcium-to-Phosphorous (Ca/P) mass ratio, as a bone quality index. The optimized irradiation parameters were assessed by performing analytical model simulations. X-ray tube output, filter material and thickness were used as input parameters. A single exposure technique, combined with K-edge filtering, was applied. The optimal X-ray spectra were selected according to the resulted precision and accuracy values. Experimental evaluation was performed on an XRDE system incorporating a Cadmium Telluride (CdTe) photon counting detector and three bone phantoms with different nominal mass Ca/P ratios. Additionally, the phantoms' mass Ca/P ratios were validated with energy-dispersive X-ray spectroscopy (EDX). Simulation results showed that the optimum filter atomic number (Z) ranges between 57 and 70. The optimum spectrum was obtained at 100 kVp, filtered with Cerium (Ce), with a surface density of 0.88 g/cm(2). All Ca/P ratio measurements were found to be accurate to within 1.6% of the nominal values, while the precision ranged between 0.91 and 1.37%. The accuracy and precision values of the proposed non-invasive method contributes to the assessment of the bone quality state through the mass Ca/P ratio determination.

Bone densitometry using x-ray spectra

In contrast to the two distinct energy regions that are involved in dual-energy x-ray absorptiometry for bone densitometry, the complete spectrum of a beam transmitted through two layers of different materials is utilized in this study to calculate the areal density of each material. Test objects constructed from aluminum and Plexiglas were used to simulate cortical bone and soft tissue, respectively. Solid-state HPGe (high-purity germanium) detectors provided high-resolution x-ray spectra over an energy range of approximately 20-80 keV. Areal densities were obtained from spectra using two methods: a system of equations for two spectral regions and a nonlinear fit of the entire spectrum. Good agreement with the known areal densities of aluminum was obtained over a wide range of PMMA thicknesses. The spectral method presented here can be used to decrease beam hardening at a small number of bodily points selected for examination.

Dual-energy bone densitometry using a single 100 ns x-ray pulse

A pulsed, portable hard x-ray source has been developed for medical imaging and flash x-ray absorptiometry. The source is powered by a Marx generator that drives a field emission x-ray tube which produces a 30-300 keV x-ray pulse of 100 ns duration. The x-ray fluence has dual-energy properties. The x-ray energy is relatively high early in the pulse and lower later in the pulse. The feasibility of using a single x-ray pulse for precision bone densitometry was analyzed. A computer simulation model was developed for the x-ray source, the filtration that enhances the dual-energy distribution, the absorption of the energy distribution by bone mineral and soft tissue, and the dual-energy detection system. It is feasible to determine the bone mineral density (BMD) of axial sites such as the lumbar spine and proximal femur with 2% precision over an area that is 15-20 mm in size, depending on the bone mineral and soft tissue thicknesses. An algorithm for determining the absolute BMD, to an accuracy of 2%, using a Plexiglas/TiO2 calibration phantom is discussed. At a distance of 50 cm from the source, the patient exposure is 3.7 mR. The average absorbed bone and tissue doses are 0.6 and 4.3 mrem, respectively. Factors that facilitate diagnostic measurements in clinical settings are the short patient observation time and the portability of the x-ray source.

Theoretical analysis of error propagation in triple-energy absorptiometry: application to measurement of lead in bone in vivo

We propose a three component tissue decomposition for quantifying lead in bone from a mixture of bone and muscle in vivo using a triple-energy absorptiometric method. The theoretical optimization of this method, by relating signal uncertainty to radiation dose, requires an expression of the signal variance. The error propagation was therefore theoretically modeled for a counting detector, assuming noise dominance by quantum statistics and neglecting covariance between energy levels. A final expression for the lead signal variance at each energy level was obtained via a Jacobian matrix. The Jacobian was maximized by choosing the first energy as low as permissible by dose constraints below the lead K edge. A second optimum was achieved when the upper energy was just above and the middle energy was just below the lead K edge. While the signal-to-noise ratio (SNR) had similar behavior to that of the Jacobian as a function of middle and upper energies, the SNR was almost constant as a function of lower energy in the 40-60 keV range. Hence, dose could be reduced without SNR loss. A simulated clinical measurement on an adult tibia using a 50 mCi 155Eu source and a 10 min acquisition time resulted in a standard deviation of 4 micrograms Pb/g bone mass. This approach can be applied to other systems containing three components, provided there is a K edge within the counting energy range.

Clinical reproducibility of dual energy x-ray absorptiometry

Dual energy x-ray absorptiometry is a technique advocated for the measurement of bone mass throughout the skeleton, and recently it has been used to measure changes in periprosthetic bone mass after joint replacement. The accuracy and precision of the method in clinical patient populations have not been firmly established. This study sought to establish the short-term reproducibility of measurements made with dual energy x-ray absorptiometry of multiple sites in a large sample of elderly patients with rheumatic disease. Reproducibility was assessed in the lumbar spine and in three femoral sites in 69 patients participating in a longitudinal clinical trial. In each patient, absorptiometry was performed twice in the same day at as many as five time points over a 2-year period. The mean (+/- SD) baseline bone density was 0.783 +/- 0.128 g/cm2 for the femoral neck and 1.015 +/- 0.218 g/cm2 for the lumbar spine. The correlations between the duplicate baseline measurements of the spine were excellent (r = 0.9936, p < 0.001) and were stable over the 2-year period; the mean difference between the duplicate baseline measurements was 1.82 +/- 1.54% and the mean coefficient of variation was 1.29%. Measurements in the femur were much less precise; these values were 3.61 +/- 3.14% and 2.55% in the femoral neck, 3.66 +/- 4.35% and 2.59% in the greater trochanter, and 5.28 +/- 5.61% and 3.73% in Ward's triangle. This study evaluated the short-term reproducibility of dual energy x-ray absorptiometry in a clinical population.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of the natural uranium content of fabricated, tissue substitute lung sets by dual photon absorptiometry

The assessment of tissue substitute materials by dual photon absorptiometry has been extended to detect the presence of high atomic weight materials. Commercial dual photon systems dedicated to the measurement of bone mineral mass can be used to detect other elements in fabricated tissue phantoms. The technique is sufficiently sensitive to quantitate the mass of natural uranium that had been distributed throughout the lungs of a thorax phantom.