Bone Densitometry Cases
Back to the real world…
QA
Positioning?
Numbering?
T-scores?
Artifacts?
Positioning, centered, see iliac crests and mid T12 and almost
mid L5, so okay. Typically only include L1-L4 ROI, not L5.
Numbering? Look at iliac crests, L5 should be L4. As is currently
numbered, T-scores jump, drop L3 and L4. Artifacts, none.
L1
L4
QA
Positioning?
Artifacts?
Femoral necks centered, lesser trochanter is not seen
or small=good internal rotation, straight shafts,
symmetric left and right. No artifacts.
QA
Positioning? Numbering? T-scores? Artifacts? Comparison?
QA
Positioning? Ok. Numbering? Hard to see endplates especially L3 and L4. L1-2 too high?
Exclude T12 ROI.
T-scores? All over the place, what to drop, what to keep. L3 and L4 clearly sclerotic, so drop.
Still big jump between L1 and L2. Need to think about doing bilateral hips and adding forearm.
Comparison—huge change, double check old vs. new. No artifacts.
Same patient as prior slide.
L3 biconcave compression fracture. If no
significant trauma or secondary cause, then it is a
fragility fracture = osteoporosis. (T-scores normal!)
QA
ROI? T-scores? Artifacts?
QA
ROI? L1, L2 and L4 look
compressed/short. L1 and L2
dense.
T-scores variable but would
favor dropping L1 and L2.
Think of adding bilateral hips
and forearm.
No artifacts.
See big spur at around T10-11,
would consider smoothing
that out if it occurred in the
lumbar region. Careful when
modifying edge detection
and bone margins because
hard to reproduce
consistently.
Same patient as the previous slide
Severe wedge compression L1, moderate wedge
compression L2. L3 okay. Mild inferior concave
fracture L4? Aortic calcification circled in blue.
QA
Positioning? Numbering? T-scores? Artifacts?
QA
Positioning? Ok. Numbering? Ok. T-scores? Clearly
sclerosis at L3 and L4, maybe inferior L2. Leaves only L1 and
maybe L2 to measure but big T-score jump between the L1
and L2. Think—bilateral hips & FOREARM! Artifacts, none.
QA
Positioning? Artifacts?
QA
Shafts not straight. Good internal rotation and minimal lesser
trochanter showing. Femoral neck not as well-centered in the
right image. Artifacts, none.
QA
Positioning? Numbering? T-scores? Artifacts?
QA
Positioning ok, or move slightly to left. Numbering ok. T-scores with big jump
between L2 and L3. L3 and L4 sclerotic, so drop and use only L1 and L2. Consider
bilateral hips and forearm! No artifacts.
QA
Positioning? Numbering? T-scores? Artifacts?
QA
Positioning ok. Numbering ok but uncertain if line dividing L3 and L4 is correct. Is that L3
endplate really lower and same thing with inferior L4 endplate? See red lines. Inferior L4
difficult to define. T-scores> 1.0 change between L2 and L3, sclerosis at L3 for sure. Drop
L3 and L4. Artifacts, none. Consider bilateral hips and forearm.
QA
Positioning? Numbering? T-score? Artifacts?
QA
Positioning reasonable. Numbering, okay. T-scores, L1 -1.7 and L2 -1.3.
? sclerosis L2. Artifact—yes! Screws and underwires, neutralize!! Screws not
quite completely masked. Needs bilateral hips and forearm as well.
QA
Positioning?
Numbering?
T-scores?
Artifacts?
QA
All good, except iliac crests not well seen but contrast setting may be
the reason. Artifact--paired linear density L1, belt? If so, remove and
rescan! T-scores next slide.
T-scores > 1.0 jump between L2 and L3. 1.4 difference.
L4 sclerotic, but L3 less conspicuous. Drop L4 and
probably L3.
Same patient
No clear explanation for
jump in T-score
between L2 and L3.
QA
Positioning? Numbering? T-scores? Artifacts?
QA
All okay except artifact. L1 level, two densities adjacent to lowest
rib on left side of image. Remove or neutralize.
QA
Don’t see iliac crests or rib well but may be contrast setting.
NOT well-centered. T12-L1 & L1-2 lines slightly off, otherwise
reasonable positioning.
QA
Hologic® QA
3 corners of femoral neck box are in soft tissue but the 4th corner of neck box
should be anchored on bone, along the greater trochanter medial margin.
Otherwise reasonable positioning.
QA
Numbering?
QA
L4-5 disk space as labeled is well above iliac crests, but next
level down is well below iliac crests. L3 usually has longest
transverse processes. Transitional vertebrae? Someone
made a decision and let’s stick with it to be consistent.
Reminder, check the prior images!
QA Numbering?
Numbering?
L4-5 disk space as labeled is well above iliac crests, but next level down is well
below iliac crests. L3 usually has longest transverse processes. Transitional
vertebrae?
Reminder, check the prior images!
Probably would have chosen next level down as L4-5. Scan is supposed to
include mid T12, does not as currently numbered.
QA
Positioning? Numbering? T-scores? Artifacts?
QA
Positioning ok. Exclude T12 ROI. Agree with numbering but not sure if L3-4
and L4-5 lines are correct, looks like both should be moved inferior—see red
lines. Note T12 compression fx and probably L2 as well. Agree with
dropping at least L1 due to degenerative sclerosis and high T-score. All these
challenges, think bilateral hips & forearm.
QA
Positioning? Numbering? T-scores? Artifacts?
QA
Positioning ok, maybe could shift more to the left side of image. Agree with
numbering. Big jump in T-score between L2 and L3. Drop L3 and L4.
What is the artifact that was neutralized? Could it have been a navel ring or
snap? Maybe underwire artifact at top of the image especially left side of
image. Remove, remove, remove and rescan!
QA
Positioning? Numbering? T-scores? Artifacts
QA
Positioning ok. Agree with numbering. T-scores not provided.
Artifacts!!!! Bra hooks at T12 level. What is next to L2-3 on the left side
of the image?! Remove or neutralize. Consider smoothing out the spur at
the superior L3 level. Remove, remove, remove artifacts and rescan!
QA
Positioning ok,
maybe could shift
more to the right side
of the image.
Agree with
numbering.
Big jump in T-score
between L2 and L3.
Drop L1 and L2 due
to degenerative
sclerosis.
Continued…
QA
Positioning ok, maybe could
shift more to right side of
image.
Agree with numbering. Big
jump in T-score between
L2 and L3. Drop L1 and L2
due to degenerative
sclerosis.
Superior aspect of box should
be angled.
Smooth out defect in ROI
inferior L4.
Expanded results summary
allows radiologist to select
appropriate levels—L3-L4.
GE: Femoral neck box is moved up the slope to avoid ischium. But need to
keep 4 corners in soft tissue. May have to neutralize a portion of ischium.
This as far as you should move the box superiorly.
QA
Positioning? Artifacts?
QA
Positioning: Neck not centered in the image, should include more
medial structures right and left.
Shaft not straight, especially on right-sided image. Hard to reproduce
positioning year to year if not correctly positioned. Positioning not
symmetric left and right, inconsistent and poor precision.
QA
Positioning? Artifacts?
QA
GE: Necks relatively well-centered in image, shafts fairly straight.
Neck box touching bone? Should move it down and neutralize
ischium. Not much room in this patient.
Artifact?? Remove, remove, remove and rescan.
QA
Positioning?
Artifacts?
GE: Neck relatively well-centered on left image but not so much
on the right image. On right image, need to include more medial
structures. Shafts pretty straight, slightly abducted on the left.
Artifact bilaterally!! Remove, remove, remove and rescan.
If see significant change from one exam to the next and unusual
in that one site goes up and the other goes down, review old and
new exams. Any changes such as interval fracture, differences in
numbering, ROIs, positioning, artifact, etc.?
Scoliosis and significant degenerative sclerosis,
especially L1, L2 and L3, although T-scores still < 1.0
difference between levels.
Think bilateral hips and forearm!
QA
Positioning? Artifacts?
Positioning, neck not centered in image. Need to include more
medial structures.
Shaft not quite straight. Internal rotation okay.
No artifacts.
QA
Positioning? Numbering? T-scores? Artifacts?
QA
Positioning ok. Agree with numbering but not sure if L4-5 line is
correct, looks like it should be moved inferior.
Jump in T-score between L2 and L3. Drop L3 and L4, subtle
degenerative sclerosis.
QA
Positioning? Numbering? T-scores? Artifacts?
Positioning ok, maybe could shift more to right side of image. Agree
with numbering.
What is the artifact that was neutralized? Underwire. Still underwire
artifact on the other side!!
Remove, remove, remove and rescan!
Hope this was helpful.
Questions??