Bone Densitometry for Technologists / Edition 1

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As a technology, bone densitometry is really quite extraordinary. The ability to quantify the density of the bones at a variety of skeletal sites has truly revolutionized the approach to a number of diseases, the most important of which is osteoporosis. Using the information from the machines, especially dual-energy X ray absortiometry (DXA) technology, physicians can recommend and prescribe interventions that will slow bone loss and reduce the risk of disabling fractures. The remarkable advances in skeletal imaging with densitometry devices have made possible quantitative and diagnostic assessments of skeletal structure. However it is in fact the skill and concern of the technologist that enables all of this to happen. In this updated and expanded third edition of their gold standard and highly praised Bone Densitometry for Technologists, Sydney Lou Bonnick, MD, FACP, and Lori Ann Lewis, MRT, CDT, again offer the most comprehensive review of the standards and developments in the field. Here radiologic technologists, nurse practitioners, physician assistants, and dedicated densitometry technologists can find not only the state- of-the-art guidelines for bone density testing, but also a wide range of other topics, including several new chapters. These include a new chapter on the performance of DXA lumbar spine, proximal femur and forearm studies; one on Using Absolute Risk to Predict Fracture Risk in Clinical Practice; and another providing examples of highly instructional DXA images in which artifacts or structural changes can be seen. There are 2 new appendices and the other 10 appendices from the previous edition have been updated wherever necessary to reflect the most current information available. In Appendix XII, the contents of the accompanying CD-ROM are reviewed. On this CD, readers will find the Precision Calculator Companion that was first included with the 2nd edition of Dr. Bonnick's title, Bone Densitometry in Clinical Prac

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Editorial Reviews

From The Critics
Reviewer: Janice S Bergersen, Radiologic Technologist(Froedtert Hospital)
Description: In the rapidly changing field of bone densitometry, this is a much-needed update to the 2006 edition. This is a detailed overview of what is pertinent to complement the knowledge base of both experienced bone density technologists and technologists new to this field.
Purpose: According to the author, the purpose is to provide a broad knowledge base in bone densitometry to technologists. The new edition addresses all the changes that have occurred since the previous edition was published. It is not manufacturer specific.
Audience: Radiologic technologists are the primary audience. The authors have many years of experience, which is evident throughout.
Features: "This book covers a wide spectrum of information important to bone density technologists, including the history of this modality, overview of scanners, anatomy, positioning, QC procedures, precision, and radiation safety issues. The chapters on pediatric densitometry, VFA imaging, and body composition are valuable resources that are not readily available anywhere else. New to this edition are chapter 4, which explains the importance of patient positioning, chapter 8, on fracture risk assessment, and chapter 11, which has examples of scanning artifacts on actual scans. The appendixes continue to be a concise compilation of reference data. Included with this book is a CD-ROM which includes a patient questionnaire, a precision calculator companion, and a continuing education review worth 16 continuing education credits upon successful completion. "
Assessment: As the field of bone densitometry scanning continues to evolve, this update is absolutely necessary. Most books in bone density/osteoporosis are written with clinicians in mind, but this one specifically targets technologists. This continues to be the "go to" book for technologists interested in giving their patients the best care possible.
Doody's Review Service
Reviewer: Janice S Bergersen, Radiologic Technologist(Froedtert Hospital)
Description: This is the second edition of a book that provides the technologist a detailed overview of the field of bone densitometry. The previous edition was published in 2002.
Purpose: The purpose is to provide a broad base of knowledge of bone densitometry to the technologist. It is not manufacturer specific. This second edition is even more helpful in providing additional and new information concerning osteoporosis and bone densitometry.
Audience: The targeted audience is the technologist. The authors are knowledgeable and have years of combined experience in the field of densitometry.
Features: This book covers a wide spectrum of information. Some highlights are: the history of BMD scanning, different scanning equipment, osteoporosis and therapies, QC procedures, radiation safety issues, interpretation of scans, skeletal anatomy and positioning, computer basics and the importance of precision. Chapter 11, on pediatric densitometry and chapter 12, on other uses for bone densitometers, are new. These are necessary additions as the field of bone densitometry continues to expand to include these applications. The updated appendixes are a good compilation of reference information important to the field of densitometry. Once again, the chapter on computers is not necessary, as most radiology departments are computerized.
Assessment: This book still fills a void — books written specifically for the technologist. Other bone density books are written primarily for clinicians. This book is a must for all bone density technologists who want to do the best job possible.

3 Stars from Doody
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Product Details

  • ISBN-13: 9781617373091
  • Publisher: Springer-Verlag New York, LLC
  • Publication date: 3/31/2013
  • Edition description: Softcover reprint of the original 1st ed. 2002
  • Edition number: 1
  • Pages: 323
  • Product dimensions: 5.90 (w) x 8.90 (h) x 0.90 (d)

Meet the Author

Dr. Bonnick is a native of Dallas, Texas and a graduate of Southern Methodist University and the University of Texas Southwestern Medical School. She is the medical director of the Clinical Research Center of North Texas and an adjunct professor at the University of North Texas in Denton, Texas. Dr. Bonnick is one of the founders and past Secretary of the International Society for Clinical Densitometry. Dr. Bonnick helped to create and teach the original physician and technologist bone densitometry certification courses for ISCD. She is the 1999 winner of the International Society for Clinical Densitometry President’s Award and a past recipient of the American Medical Women’s Association President’s Recognition Award and the AMWA’s Calcium Education Nutrition Award. She is a fellow in the American College of Physicians, and a member of the American Society for Bone and Mineral Research, National Osteoporosis Foundation, International Society for Clinical Densitometry and the North American Menopause Society. She is a former member of the osteoporosis advisory committee for the Texas Department of Health. Dr. Bonnick has served as a primary investigator in numerous research trials in the field of the prevention and treatment of osteoporosis and has published extensively. In addition to being the co-author of this book, she is also the author of Bone Densitometry in Clinical Practice from Humana Press. She lives in Denton, Texas. Ms. Lewis is a medical radiologic technologist and recognized by the International Society for Clinical Densitometry as a certified densitometry technologist. She is one of the original members of the technologist teaching faculty for ISCD and the 1997 winner of the ISCD technologist of the year award. She is the clinical research coordinator for Dr. Sydney Bonnick and bone density technologist at the Clinical Research Center of North Texas in Denton, Texas. She has extensive experience in bone densitometry on all types of equipment over the last 25 years. She lives in Denton, Texas.

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Table of Contents

Chapter 1. An Introduction to Conventions in Densitometry

Densitometry as a Quantitative Measurement Technique

Accuracy and Precision

The Skeleton in Densitometry

Weight Bearing or Non-Weight Bearing Sites

Axial or Appendicular Sites

Central or Peripheral Sites

Cortical or Trabecular Sites

What Do the Machines Actually Measure?

The Densitometry Printout

The Percentage Comparisons

The Standard Score Comparisons

The Age-Regression Graph

The Standardized BMD

The NHANES III Database for the Proximal Femur


Chapter 2. Densitometry Techniques

Plain Radiography in the Assessment of Bone Density

Qualitative Morphometry

Qualitative Spinal Morphometry

The Singh Index

Quantitative Morphometric Techniques

Calcar Femorale Thickness


The Radiologic Osteoporosis Score

Radiographic Photodensitometry

Radiographic Absorptiometry

Photon Absorptiometry Techniques

Single Photon Absorptiometry

Dual Photon Absorptiometry

Dual-Energy X-ray Absorptiometry

Peripheral DXA

Single-Energy X-ray Absorptiometry

Quantitative Computed Tomography

Peripheral QCT

Quantitative Ultrasound Bone Densitometry


Chapter 3. Skeletal Anatomy in Densitometry

The Spine in Densitometry

Vertebral Anatomy

Artifacts in PA or AP Spine Densitometry

Vertebral Fractures

Effects of Osteophytes on BMD

Effects of Aortic Calcification on BMD

Effects of Facet Sclerosis on BMD

Other Causes of Artifacts in PA and AP Lumbar Spine Studies

The Spine in the Lateral Projection

The Proximal Femur in Densitometry

Proximal Femur Anatomy

Effects of Rotation on BMD in the Proximal Femur

Effects of Leg Dominance on BMD in the Proximal Femur

Effects of Scoliosis, Osteoarthritis, Osteophytes, Surgery, and Fracture on BMD in the Proximal Femur
The Forearm in Densitometry


Effects of Arm Dominance on Forearm BMD

Effects of Artifacts on BMD in the Forearm

The Metacarpals, Phalanges, and Calcaneus


Chapter 4. Densitometry Devices Approved by the Food and Drug Administration

Computer-Enhanced Radiogrammetry

Computer-Enhanced Radiographic Absorptiometry

Central X-ray Densitometers

Peripheral X-ray Densitometers

Ultrasound Bone Densitometers

Chapter 5. Computer Basics

Types of Computers

Desktops, Towers, Minitowers, and Laptops

PCs and Macs

Major Components of a Computer System

Important Components Inside the Computer Housing

Motherboard, Random Access Memory, and Slots


The Hard Drive

Internal Disk Drives

Input Devices

The Keyboard

The Mouse

The Trackball

Output Devices



Computer Ports

Keyboard and Mouse Ports

Parallel Ports

Serial Ports

Universal Serial Bus Ports

Power, Monitor, Modem, and Network Ports

Types of Storage Media

Magnetic Media

Tape Media

Optical Media

Protecting the Data

Computer Maintenance

Chapter 6. Precision in Bone Densitometry

Performing a Precision Study

Short-Term Precision Studies

Long-Term Precision Studies

Determination of Least Significant Change

When Should a Measurement Be Repeated in Clinical Practice?

Which Skeletal Site Should Be Used to Monitor Changes in Bone Density?

Is the Measured Change the Actual Change in BMD?

Case Study in Precision

Importance of Precision


Chapter 7. Radiation Safety in X-Ray Densitometry

Basics of Radiation

Quantities of Radiation

The Curie

The Roentgen

The Rad

The Rem

The Effective Dose Equivalent

Harmful Effects of Ionizing Radiation

Acute Lethal Radiation Syndromes
Local Tissue Damage from Radiation


Ovaries and Testes

Bone Marrow and Blood

Late Effects of Ionizing Radiation

Radiation Doses in Densitometry

Radiation Protection Programs

Protection of the Public

Protection of the Patient

Protection of the Technologist

Time, Distance, and Shielding

Personnel-Monitoring Devices

The Pregnant Technologist


Chapter 8. Quality Control Procedures


Using the Phantom to Create Control Tables and Charts

Methods for Tracking Machine Performance

Shewhart Rules

CUSUM Charts

Automated Quality Control Procedures


Chapter 9. An Overview of Osteoporosis

Definition of Osteoporosis

The 1991 and 1993 Consensus Development Conferences

The 1994 World Health Organization Criteria for Diagnosis of Osteoporosis

Prevalence of Osteoporosis

Consequences of Osteoporosis

Risk Factors for Osteoporosis

Attainment of Peak Bone Density

Maintenance of Bone Density

The National Osteoporosis Foundation Guidelines for Bone Mass Measurements

The 1997 Bone Mass Measurement Act

The National Osteoporosis Foundation Guidelines for Treatment Based on BMD Testing

Interventions in Osteoporosis

Nonprescription Interventions

Lifestyle Modifications


Vitamin D, and Exercise

Prescription Interventions

Estrogen Replacement

The Selective Estrogen Receptor Modulator Raloxifene

Synthetic Salmon Calcitonin


Patient Education Materials


Chapter 10. Interpretation of Bone Densitometry Data

The Results

The Skeletal Image

Measured and Calculated Bone Density Parameters

Comparisons to the Reference Database

Standardized BMD

Age-Regression Graph

Assignment of Diagnostic Category Based on WHO Criteria

Conflicting Diagnoses from Measurement of Multiple Sites

Report Review


Appendix I. Contacts for Bone Densitometry Manufacturers and Organizations of Interest

Appendix II. World Health Organization Criteria for the Diagnosis of Osteoporosis Based on Measurement of Bone Density

Appendix III. National Osteoporosis Foundation Guidelines for Bone Density Measurements

Appendix IV. Bone Mass Measurement Act of 1997

Appendix V. CPT Codes for Bone Densitometry

Appendix VI. DXA PA Spine Labeling Guidelines

Appendix VII. Conversion Formulas

Appendix VIII: Recommended Procedures for Short-Term Precision Studies

Appendix IX. Least Significant Change

Appendix X. Quality Control Shewhart Rules. Appendix XI. Glossary of Computer Terms. Appendix XII. Review Questions

Appendix XIII. Review Question Answer Sheet and Instructions for Obtaining Continuing Education Credit

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