Common errors in dual-energy x-ray absorptiometry (DXA) examinations: insights from a cross-sectional study in Northeastern Brazil

DXA Errors Are Common and Reduced by Use of a Reporting Template

Panoramic radiograph is one of the routinely used investigations in dentistry. The value of panoramic radiograph is reduced when they are of poor diagnostic quality. Therefore, the aim of the study is to be aware of the common positional and tech­nical errors so as to minimize such errors occurring in the department. Panoramic radiographs of all the patients, who were taking radiographs for their own diagnostic purpose, were examined. All Radiographs taken for a 3 months period were 1010. All panoramic radiographs examined for various errors. Data were analyzed for the frequency of some common faults, both technical and processing errors, which directly contributed to failure of the radiographs. Total 1010 radiographs were analyzed for errors. 27.5% (n=278) were showing errors which ranged from technical errors 11.3% ( n=14) to positional errors 16.2% (n=164) and 72.5% of radiographs were error free. Most common technical error was density/dark radiographs which were 45% (n=51) and the most common positional error found was tongue not resting against the palate, 20% (n=32). Dark radiograph and tongue not resting against the palate were found common errors. Fewer errors are likely to be made when a quality assurance regimen and proper training, which includes the recognition and correction of errors, is followed DOI: http://dx.doi.org/10.3126/jcmc.v4i1.10844 Journal of Chitwan Medical College 2014; 4(1): 26-29

BackgroundHip fractures are a major cause of public health burden associated with osteoporosis in terms of mortality, disability and health care costs. The only possible way to reduce the occurrence...

Avoiding Common Technical Errors in Subclavian Central Venous Catheter Placement

Introduction: There are a multitude of factors that may lead to a reduction of the diagnostic quality of panoramic radiographs. Errors in taking radiographs increase patient's radiation exposure, and also waste time and money. Inspecting the frequency and mechanism of producing errors will result in less retakes. Therefore, the aim of the study is to identify the most common positioning and technical errors in the panoramic radiographs taken in department of oral Medicine and Radiology of our institute. Materials and Methods: 2000 panoramic radiographs were photographed and reviewed under identical conditions, on a computer screen. Radiographs were evaluated by oral and maxillofacial radiologist, and frequency of errors was recorded. Results: Out of 2000 Panoramic radiographs there were 220 radiographs (11%) which were error free and 1780 radiographs (89%) with errors. The most common error observed in this sample was failure to place the tongue on the palate (48.7%) followed by chin tipped too low or too high (21.1%). Dark room errors accounted for 2.7% radiographs due to the processing errors resulting as dark and light radiographs as well scratches on them. The least frequent errors observed were the presence of radio-opaque artifacts caused by failure to remove metallic accessories, prostheses and the use of the lead apron during exposure and processing error (2.4%). Few radiographs had more than one error. Conclusion: Frequency of errors seen on panoramic radiographs are relatively high, thus training the operators, discussing the technical errors in case of occurrence are highly essential to maximize the quality of panoramic radiographs. Also clinicians need to be able to recognize the cause of the various film faults so that appropriate corrective action can be taken.

This study aimed to investigate the presence of sarcopenia which was graded according to Magnetic Resonance (MR) imaging in paraspinal muscles and explore the degree of osteoporosis by bone mineral density. Lumber MR images of 69 female patients complaining of back pain and Dual-Energy X-ray absorptiometry (DXA) examinations were evaluated retrospectively. On MR imaging, the degree of sarcopenia in the paraspinal muscles of these patients was graded as normal, moderate and severe according to the simplified 3-Tier classification which is considered a Modified Goutallier classification by two radiologists. DXA examinations were categorized based on the t-score, with scores above -2.5 denoting osteopenia and scores below -2.5 indicating osteoporosis. Grades of atrophy in paraspinal muscles were found to be normal (n=15, 21.7%), moderate (n=43, 62.3%) and severe (n=11, 15.9%). The degree of paraspinal muscle atrophy was found to be lower in patients with osteopenia compared to patients with osteoporosis by both observers. (Radiologist 1 p: 0.284, radiologist 2 p: 0.047). As the degree of atrophy in the paraspinal muscles increases, the DXA t score decreases in some osteoporotic patients. Paraspinal muscle atrophy detected on lumbar MRI and DXA T scores are correlated in patients with low back pain. Identifying pathways affecting both bone and muscle units will facilitate developmental entities aiming to treat both conditions.

Background: Osteoporosis is a metabolic skeletal disease characterized by bone mineral density reduction, leading to increased susceptibility to fractures. Although several studies have investigated the association between body mass index (BMI) and bone mineral density (BMD), the results are inconsistent. The aim of this study was to further investigate the relation between BMI and BMD. Patients and Methods: The retrospective study included 113 patients without any apparent illness referred to have a dual-energy x-ray absorptiometry (DEXA) examination in INMAS, Suhrawardy, in the period from October 2023 to November 2024. The following anthropometric data were collected: body mass index, body weight, height, dual-energy x-ray absorptiometry T-score, and bone mineral density (BMD), as well as some other data. Results: The mean age was 56.17 years, the mean weight was 59.97 kg, and the mean height was 158.1 cm. There were 70 participants in the group of normal body mass index < 25.0 kg/m2, 34 participants were overweight (BMI 25.0-30.0 kg/m2), and 09 were obese (BMI > 30 kg/m2). In the obese group, 55.56% of participants had osteoporosis, 33.33% had osteopenia, and 11.11% had the normal T-score. In the overweight group, 14.71% of the participants had osteoporosis, 26.47% had osteopenia, and 58.82% had the normal T-score. In the normal body mass index group, 32.86% of the participants had osteoporosis, 34.29% had osteopenia, and 32.86% had the normal T-score. Conclusion: This study reveals that the prevalence of osteoporosis and osteopenia is higher in obese patients. It is obvious that there was a stronger correlation between body mass index and bone mineral density of the lumbar spine than between body mass index and bone mineral density of the total hip. Bangladesh J. Nuclear Med. 27(2): 253-259, 2024

Category: Ankle Introduction/Purpose: Although previous studies have demonstrated the potential of conventional computed tomography (CT) as a screening tool for osteoporosis, the assessment correlation of BMD in those studies was limited to the spine. This study aimed to evaluate the reliability and validity of CT as a screening tool for osteoporosis and to estimate the correlation between central BMD and peripheral bone attenuation using lower extremity CT. Methods: In total, 292 patients who underwent a lower extremity, lumbar spine, or abdomen and pelvic CT scan within a 3- month interval of a dual-energy X-ray absorptiometry (DEXA) examination were included (Fig 1). Following reliability testing, bone attenuation of the L1, L2, L3, L4, femoral head, femoral neck, greater trochanter, distal femur, proximal tibia, distal tibia, and talus was measured by placing a circular region of interest on the central part of each bony region on a coronal CT image (Fig 2 and 3). Partial correlation was used to assess the correlation between CT and DEXA, after adjusting for age and body mass index. Results: In terms of reliability, all bone attenuation measurements, except the femoral neck, showed good to excellent interobserver reliability (intraclass correlation coefficients, 0.691–0.941). In terms of validity, bone attenuation of the L1 to L4, femoral neck, and greater trochanter on CT showed significant correlations with BMD of each area on DEXA (correlation coefficients, 0.399–0.613). Bone attenuation of the distal tibia and talus on CT showed significant correlations with BMD of all parts on DEXA (correlation coefficients, 0.493–0.581 for distal tibia, 0.396–0.579 for talus). Conclusion: Lower extremity CT is a useful screening tool for osteoporosis, and peripheral bone attenuation on lower extremity CT adequately reflects central BMD on DEXA.

We evaluated the correlation between central bone mineral density (BMD) and peripheral bone attenuation using lower extremity computed tomography (CT). A good correlation was found between lower extremity CT and central BMD suggesting that CT is useful for screening osteoporosis, and that peripheral bone attenuation adequately reflects central BMD. This study aimed to evaluate the reliability and validity of CT as a screening tool for osteoporosis and to estimate the correlation between central BMD and peripheral bone attenuation using lower extremity CT. In total, 292 patients who underwent a lower extremity, lumbar spine, or abdomen and pelvic CT scan within a 3-month interval of a dual-energy X-ray absorptiometry (DEXA) examination were included. Following reliability testing, bone attenuation of the L1, L2, L3, L4, femoral head, femoral neck, greater trochanter, distal femur, proximal tibia, distal tibia, and talus was measured by placing a circular region of interest on the central part of each bony region on a coronal CT image. Partial correlation was used to assess the correlation between CT and DEXA after adjusting for age and body mass index. In terms of reliability, all bone attenuation measurements, except the femoral neck, showed good to excellent interobserver reliability (intraclass correlation coefficients, 0.691-0.941). In terms of validity, bone attenuation of the L1 to L4, femoral neck, and greater trochanter on CT showed significant correlations with BMD of each area on DEXA (correlation coefficients, 0.399-0.613). Bone attenuation of the distal tibia and talus on CT showed significant correlations with BMD of all parts on DEXA (correlation coefficients, 0.493-0.581 for distal tibia, 0.396-0.579 for talus). Lower extremity CT is a useful screening tool for osteoporosis, and peripheral bone attenuation on lower extremity CT adequately reflects central BMD on DEXA.

A Qualitative Examination of the Ward Region of Interest as Imaged on Dual-Energy X-ray Absorptiometry Examinations: The “Wandering Ward Sign”

In-Accuracy Of Bone Density Measurements By DXA In Patients With Hemoglobinopathies and Iron Overload

To examine self-reported physical activity levels from the International Physical Activity Questionnaire (IPAQ) as an independent predictor of dual-energy x-ray absorptiometry (DXA)-measured percent body fat (%BF) from body mass index (BMI), gender, and race. Two hundred and seventy-eight students, aged 18-24 yr, volunteered to participate. There were 133 males (85 white and 48 black) and 145 females (77 white and 68 black). Total activity levels were quantified in MET hours per week (MET h wk(-1)) using the IPAQ short form. Height and weight were measured, and BMI values were calculated (kg m(-2)). %BF was assessed using DXA. Linear regression analysis was used to develop and compare a body fat prediction equation with (full) and without (reduced) the variable MET-h.wk. Both models included BMI, gender, and race as predictor variables. The prediction sum of squares (PRESS) statistic was used to cross-validate both models, and the individual predictive accuracy was compared using modified Bland-Altman plots. Mean +/- SD values were as follows: BMI = 24.4 +/- 4.1 kg m(-2), %BF = 24.5 +/- 9.3%, and MET h wk(-1) = 37.4 +/- 21.9. Gender, BMI, and race explained 81% of the variance in %BF, with a root mean square error (RMSE) of 4.07. The full model with MET-h.wk improved the prediction of %BF by 2% (R2 = 0.83, RMSE = 3.87). When cross-validated, the corresponding PRESS statistics for the reduced and full model were 4.10 and 3.90, respectively. Bland-Altman limits of agreement were greater for the reduced model compared with the full model (-8.09, 8.10 vs -7.67, 7.68). These results suggest that %BF can be predicted with greater precision and accuracy in a young adult population when MET-h.wk are included in addition to BMI, gender, and race.

Identification of osteoporosis risk in postmenopausal women by the combined use of ultrasounds and clinical factors

BMI: Does it really reflect body fat mass?

Endodontic technical errors are the foremost cause of treatment failure. A thorough understanding of root canal configuration (RCC) is essential to prevent these iatrogenic errors. This study used CBCT images to determine the association between root canal configuration, endodontic technical errors, and periapical status. CBCT images of 101 patients, including total of 212 obturated premolars (256 canals) were assessed. RCCs were classified according to the Vertucci system. The presence of endodontic errors and periapical lesions associated with each RCC was noted. Presence or absence of coronal restoration and its association with periapical radiolucency was recorded. The most frequent RCC was Type I (199 cases; 77.73%), followed by Type II (26 cases; 10.15%), Type IV (22 cases; 8.59%), Type V (4 cases; 1.56%), Type III (4 cases; 1.56%), and Type VI (1 case; 0.39%). Under-filling and non-homogeneous filling were the most common technical errors. Prevalence of periapical radiolucency was 81% in the presence of technical errors. The absence of coronal restoration caused apical lesions in 93% of cases. The frequency of endodontic technical errors increased as the root canal configurations became more complex. Periapical lesions occurred more often in teeth with endodontic errors and/or absent coronal restoration.