bone densitometry radiation dose: what you need to...
TRANSCRIPT
John Damilakis, PhDAssociate Professor and Chairman
University of Crete, Iraklion, Crete, GREECE
Bone DensitometryRadiation dose: what you need to know
Estimation of bone status using X-rays
Assessment of low energy fractures
Dual-energy X-ray absorptiometry (DXA)
Quantitative Computed Tomography (QCT)
High Resolution CT imaging
Peripheral QCT (pQCT)
Spinal Radiography
Spinal radiography is used for identification of vertebral fractures
Vokes T et al (2006) J Clin Densitom 9:37-46
The dose from a lateral radiograph of the thoracic and lumbar
spine is about 600 µSv
Vertebral Fracture Assessment
VFA is a low dose technique with doses reported
to be from 1 to about 50 µSv
Ferrar L et al (2005) Osteoporos Int 16:717-28
Eff
ectiv
e D
ose
(µSv
)
1.15
2.25
PAVA LVA
Multi-Detector CT
Fracture assessment of the spine is possible
without any additional radiation burden by
routinely performing sagittal reformations
in 3D CT of the thorax and abdomen which
have been performed for other clinical
indications.
Damilakis J et al (2007) Eur Radiol 17: 1591 - 1602
Bauer JS et al (2006) Osteoporos Int 17:608-15
Estimation of bone status using X-rays
Assessment of low energy fractures
Dual-energy X-ray absorptiometry (DXA)
Quantitative Computed Tomography (QCT)
High Resolution CT imaging
Peripheral QCT (pQCT)
Dual energy X-ray absorptiometry
For the first generation pencil-beam
devices the patient effective dose
was negligible i.e. up to 1 µSv for
for a spine and femur DXA.
For fan-beam DXA devices, patient
effective doses vary between systems
of different models and manufacturers
depending on a number of variables
Damilakis J, Adams J, Guglielmi G, Link T (2010) Eur Radiol 20: 2707 - 14
Effective dose from spine DXA
Hologic DXA scanners (scan lengths adjusted to the child’s body size)
Age at time of DXA (yr)5 10 15 20
Eff
ectiv
e d
ose
(µSv
)
10
20
30
Array
Fast
Express
Blake G et al, Bone 38:935-42, 2006
9-27 µSv
4-13 µSv
Effective dose from hip DXA
Hologic DXA scanners (scan lengths adjusted to the child’s body size)
Age at time of DXA (yr)5 10 15 20
Eff
ectiv
e d
ose
(µSv
)
10
20
30
Array
Fast
Express
Blake G et al, Bone 38:935-42, 2006
5-22 µSv
3-9 µSv
Physical phantoms and TLDs
Radiation dose from DXA
Mazess et al (2011) Osteoporos Int 11:158-166
GE-Lunar makes use of a fan-beam
with a 4.50 angle orientated parallel to
the longitudinal body axis.
A filter splits the X-ray spectrum into
high- and low-energy components and
provides energies of 38 keV and
70 keV.
Radiation dose from DXA
Hologic uses a linear fan-beam
with a detector array sufficiently
wide to image an entire vertebral
column in a single sweep.
Hologic uses rapid switching
between high and low tube
potentials e.g. from 70 to 140 kVp
Effective dose from DXA: Comparison with other examinations
ED
(µ
Sv)
30
6
18
Spine + hipDXA (Hologic)
Intra-oralradiography
Dental panoramicradiography
Chest radiography
Spine + hipDXA (GE)
SourceSource : BEIR VII: BEIR VII
Risk coefficients for cancer
Age at acute exposure (yr)
Ris
k p
er U
nit
Dos
e (%
per
Sv)
10 20 30 40 50 60 70 80
3
6
9
12
15
7.4 % per Sv
Risks for cancer
50-year-old female patient
Dose per screening: 20 µSv (Hologic)
Risk = 0.074 x 20 x 10-6 = 1.48x10-6
1.5 cases of cancer / 1 million patients (Hologic)
Effective doses from DXA and potential risks are
negligible compared with the benefits
20 µSv 40-50 µSv
Exposure during flights
The worldwide average effective dose from natural Bg radiation is 2.4 mSv/y
J. Damilakis et al, Osteoporos Int (2002) 913:716-22
Conceptus dose from DXAC
once
ptus
Dos
e (µ
Gy)
1
7
6
5
Spine
Hip
Photo by L. Nilsson
Fetus at 13 weeks:
Arm and leg bones
begin to calcify.
First Trimester Second Trimester Third Trimester
DXA: How to reduce patient dose
Patient preparation is important for reducing the radiation dose
Avoid patient movement during imaging
Select the most appropriate acquisition protocol
Use dose reduction tools such as SmartScan©
The length of the DXA should take into account patient’s body size
Estimation of bone status using X-rays
Assessment of low energy fractures
Dual-energy X-ray absorptiometry (DXA)
Quantitative Computed Tomography (QCT)
High Resolution CT imaging
Peripheral QCT (pQCT)
QCT using body CT
Adams J, EJR (2009) 71:415-24
Radiation dose from QCTE
ffec
tive
Dos
e (m
Sv)
0.5
3.5
3.0
2.5
2D QCT Spine
3D MDQCT Spine
3D MDQCT Hip
3D MDQCT Radius
Huda W et al, BJR (1996) 69:422-25
0.06 <0.01
Estimation of bone status using X-rays
Assessment of low energy fractures
Dual-energy X-ray absorptiometry (DXA)
Quantitative Computed Tomography (QCT)
High Resolution CT imaging
Peripheral QCT (pQCT)
High-Resolution CT imaging
Ito M et al, (2005) J Bone Miner Res 20:1828-36
Important information can be
obtained from structure analysis
of high-resolution image data.
Effective dose of about 3 mSv
Parameters that affect CT dose
kV, mAs
Filtration
Beam shaping filter Collimation
Detection system efficiency
Scanning length, scanner geometry, beam collimation, rsw, pitch, algorithms, dose reduction tools
-10 0 10 20 30 40 500.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14
0.16
0.18
0.20
Distance (cm)
Nor
mal
ized
Con
cept
us D
ose
The body is not irradiated uniformly
Patient-specific MC SimulationAllows machine-specific and patient-specific
calculations of the dose distributions
J. J. DamilakisDamilakis et al, Radiology 257:483et al, Radiology 257:483--9, 20109, 2010
J. J. DamilakisDamilakis et al, Medical Physics 37:6411 et al, Medical Physics 37:6411 –– 6420, 20106420, 2010
Estimation of bone status using X-rays
Assessment of low energy fractures
Dual-energy X-ray absorptiometry (DXA)
Quantitative Computed Tomography (QCT)
High Resolution CT imaging
Peripheral QCT (pQCT)
Peripheral QCT
Isotropic voxel size in the order of 80 µm
which allows direct or indirect evaluation
of cortical and trabecular bone architecture
Effective dose lower than 3 µSv
Link T et al, (2010) Skeletal Radiol 39:943-55
Burrows M et al, (2010) Osteoporos Int 21:515-20
Occupational doses and shielding
Dose rates at 1m from the central axis of the imaging table range
from about 0.01 µSv/h to about 5 µSv/h, depending on the model.
Examine isodose curves provided by the manufacturer!
Radiation doses associated with DXA are very lowPencil beam : less than 1 µSv/scan Fan beam : up to 25 µSv/scan
VFA is associated with considerably l ower exposurethan lateral spine radiography (1-50 µSv vs. 600 µSv)
Messages to take home
Emphasis must be on dose optimization, especially forpaediatric examinations
Protocols used to examine vertebral microstructure using HR MDCT provide an effective dose of 3 mSv
2D QCT of the lumbar spine is a low-dose techniquewith doses reported to be from 60 to about 90 µSv
Messages to take home
The effective dose from pQCT is negligible i.e. from 3 to 10 µSv
Examine isodose curves provided by the manufacturer
Thank you !
Ευχαριστώ !