• The Korean Journal of Nuclear Medicine Technology
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• v.27 no.2
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• pp.95-98
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• 2023

Purpose: The precision error of a bone density meter reflects the equipment and reproducibility of results by an examiner. Precision error values can be expressed as coefficient of variation (CV), CV%, and root mean square-SD (RMS-SD). The International Society for Clinical Densitometry (ISCD) currently recommends using RMS-SD as the precision error value. When a 95% confidence interval is applied, the least significant change (LSC) value is calculated by multiplying the precision error value by 2.77. Exceeding the LSC value reflects a significant difference in measured bone density. Therefore, the LSC value of a bone density equipment is an essential factor for accurately determining a patient's bone density. Accordingly, we aimed to calculate the LSC value of a bone density meter (Lunar iDXA, GE) and compare it with the value recommended by the ISCD. We also assessed whether the value measured by the iDXA equipment was below the LSC value recommended by ISCD. Material and Methods: The bone densities of the lumbar spine and thighs of 30 participants were measured twice, and the LSC values were calculated using the precision calculation tool provided by the ISCD (http://www.iscd.org). To check the reproducibility of the measurement, patients were asked to completely dismount from the equipment after the first measurement; the patient was then repositioned before proceeding with the second measurement. Results: The LSC values derived using the CV% values recommended by the ISCD were 5.3% for the lumbar spine and 5.0% for the thigh. The LSC values measured using our bone density equipment were 2.47% for the lumbar spine and 1.61% for the thigh. The LSC value using RMS-SD was 0.031 g/cm² for the lumbar spine and 0.017 g/cm² for the thigh. Conclusion: that the findings confirm that the CV% value measured using our bone density meter and the LSC value using RMS-SD were maintained very stably. This can be helpful for obtaining accurate measurements during bone density follow-up examinations.

• Hip & pelvis
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• v.35 no.3
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• pp.175-182
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• 2023

Purpose: This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism. Materials and Methods: This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed. Results: No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance. Conclusion: The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality.

• Clinical Nutrition Research
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• v.12 no.4
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• pp.245-256
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• 2023

A randomized, double-blind, placebo-controlled trial was conducted to confirm whether collagen peptide supplementation for 12 week has a beneficial effect on body fat control in older adults at a daily physical activity level. Participants were assigned to either the collagen group (15 g/day of collagen peptide) or the placebo group (placebo drink). Body composition was measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA). In total, 74 participants (collagen group, n = 37; placebo group, n = 37) were included in the final analysis. The collagen group showed a significant reduction in total body fat mass compared with the placebo group, as evidenced by both BIA (p = 0.021) and DEXA (p = 0.041) measurements. Body fat mass and percent body fat of the whole body and trunk reduced at 12 weeks compared with baseline only in the collagen group (whole body: body fat mass, p = 0.002; percent body fat, p = 0.002; trunk: body fat mass, p = 0.001; percent body fat, p = 0.000). Total fat mass change (%) (collagen group, -0.49 ± 3.39; placebo group, 2.23 ± 4.20) showed a significant difference between the two groups (p = 0.041). Physical activity, dietary intake, and biochemical parameters showed no significant difference between the groups. The results confirmed that collagen peptide supplementation had a beneficial effect on body fat reduction in older adults aged ≥ 50 years with daily physical activity level. Thus, collagen peptide supplementation has a positive effect on age-related changes.

• Investigative Magnetic Resonance Imaging
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• v.16 no.1
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• pp.16-24
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• 2012

Purpose : The purpose of this study was to determine whether there is a significant correlation between vertebral marrow fat fraction measured using Dixon quantitative chemical shift MRI (QCSI) and BMD on dual-energy X-ray absorptiometry (DXA). Materials and Methods: This retrospective study included 68 healthy individuals [mean age, 50.7 years; range, 25-76; male/female (M/F) = 36/32] who underwent DXA of the L-spine and whole body MRI including QCSI of the L-spine and chemical shift MRI of the liver. The enrolled individuals were divided into subgroups according to sex and T-score [i.e., normal bone density (M/F=27/23) and osteopenia (M/F=9/9)]. Vertebral marrow (Dixon QCSI, TR/TE 10.2/4.8 ms) and hepatic fat fractions (chemical shift technique, TR/TE 110/4.9 and 2.2 ms) were calculated on MRI. We evaluated whether there were significant differences in age, body mass index (BMI), vertebral marrow fat fraction, or hepatic fat fraction among the subgroups. Whether or not the participant had reached menopause was also evaluated in females. The correlations among variables (i.e., age, BMI, vertebral marrow and hepatic fat fractions, BMD) were evaluated using Spearman's correlation method. Results: There were no significant differences in age, BMI, or vertebral marrow and hepatic fat fractions between the two male subgroups (normal bone density vs. osteopenia). In female subjects, mean age in the osteopenic subgroup was greater than that in the normal subgroup (p=0.01). Presence of menopause was more common in the osteopenic subgroup [77.8% (7/9)] than the normal subgroup [26.1% (6/23), p<0.05]. The other variables showed no significant difference between female subgroups. The only significant correlation with marrow fat fraction after partial correlation analysis was that with age in the female subjects (r=0.43, p<0.05). Conclusion: The vertebral marrow fat fraction calculated using the Dixon QCSI does not precisely reflect the mild decrease in BMD for either sex.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.1
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• pp.72-78
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• 2009

Purpose: Bone mineral density (BMD) measurements need to be precise enough to be capable of detecting small changes in bone mass of rats. Using a regular dual-energy X-ray absorptiometry (DXA), we measured many BMD of various skeletal sites in rats to examine precision of DXA in relation to the repositioning on the bones of rats. Materials and Methods: Using DXA and small animal software, scans were performed 4 times in all 12 male rats without repositioning (Group 1a). Another four scans for 6 of 12 rats were done with repositioning between scans (Group 2). Customized regions of interest (ROIs), encapsulate the right hind limb, L1-4, skull and pelvic bones were drawn at each measurement. The precision of the measurements was evaluated by measuring the coefficient of variation (CV) of four measurements of BMD at each skeletal site of all rats with or without repositioning. Significance of differences between group 1b (six rats out of group 1a, which were come under group 2) and group2 were evaluated with Wilcoxon Signed Rank Sum Test. Results: CVs obtained at different skeletal sites of all measurements in Group 1b and 2. It was $3.51{\pm}1.20$, $ 2.62{\pm}1.20$ for the hindlimb (p=0.173), $3.83{\pm}2.02$, $4.59{\pm}2.02$ for L1-4 (p=0.600), $3.73{\pm}1.87$, $1.53{\pm}0.89$ for skull (p=0.046), and $2.92{\pm}0.60$, $1.45{\pm}0.60$ for pelvic bones (p=0.075). Conclusion: Our study demonstrates that the DXA technique has the precision necessary when used to assess BMD for various skeletal sites in rats regardless of repositioning.

• Journal of radiological science and technology
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• v.32 no.4
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• pp.361-370
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• 2009

The image quality management of bone mineral density is the responsibility and duty of radiologists who carry out examinations. However, inaccurate conclusions due to lack of understanding and ignorance regarding the methodology of image quality management can be a fatal error to the patient. Therefore, objective of this paper is to understand proper image quality management and enumerate methods for examiners and patients, thereby ensuring the reliability of bone mineral density exams. The accuracy and precision of bone mineral density measurements must be at the highest level so that actual biological changes can be detected with even slight changes in bone mineral density. Accuracy and precision should be continuously preserved for image quality of machines. Those factors will contribute to ensure the reliability in bone mineral density exams. Proper equipment management or control methods are set with correcting equipment each morning and after image quality management, a phantom, recommended from the manufacturer, is used for ten to twenty-five measurements in search of a mean value with a permissible range of ${\pm}1.5%$ set as standard. There needs to be daily measurement inspections on the phantom or at least inspections three times a week in order to confirm the existence or nonexistence of changes in values in actual bone mineral density. in addition, bone mineral density measurements were evaluated and recorded following the rules of Shewhart control chart. This type of management has to be conducted for the installation and movement of equipment. For the management methods of inspectors, evaluation of the measurement precision was conducted by testing the reproducibility of the exact same figures without any real biological changes occurring during reinspection. Bone mineral density inspection was applied as the measurement method for patients either taking two measurements thirty times or three measurements fifteen times. An important point when taking measurements was after a measurement whether it was the second or third examination, it was required to descend from the table and then reascend. With a 95% confidence level, the precision error produced from the measurement bone mineral figures came to 2.77 times the minimum of the biological bone mineral density change. The value produced can be stated as the least significant change (LSC) and in the case the value is greater, it can be stated as a section of genuine biological change. From the initial inspection to equipment moving and shifter, management must be carried out and continued in order to achieve the effects. The enforcement of proper quality control of radiologists performing bone mineral density inspections which brings about the durability extensions of equipment and accurate results of calculations will help the assurance of reliable inspections.

• Journal of radiological science and technology
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• v.29 no.4
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• pp.229-236
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• 2006

Purpose: This study was conducted to search for the type of technical error in DEXA(dual-energy X-ray absorptiometry) and the effect of error to measurement of BMD. Materials and Methods: The changes of BMD($g/cm^2$, T-score) by patients information(Age, Weight, Height, Manopause age) input error and Confirming ROI error were investigated. Using spine phantom, we canned 10 times by age(5, 10), weight(10, 20 kg), height(5, 10 cm), manopause age(5, 10) increase & decrease respectively. Scanning region(L-spine, femur, Forearm) of 10 patients was calculated by changing ROI respectively. Analysis of difference for mean(precision 1%) were carried out. Results: The error of patient information(Age, Weight, Height, Manopause age) was not changed differently. In confirming ROI, the BMD and T-score of L-spine involving T-12 was decreased to $0.063\;g/cm^2$, 0.3 and involving L-5 increased to $0.077\;g/cm^2$, 0.5. In narrowing 1 cm of vertical line of ROI, the BMD and T-score decreased to $0.006\;g/cm^2$, 0.1 and in 2 cm, $0.021\;g/cm^2$, 0.15, each. In hip ROI, Upper and left shift(0.5 cm) of line was not influenced BMD and T-score. In 0.5 cm lower shift(lesser trochanter below), the BMD and T-score increased $0.031\;g/cm^2$, 0.3 and in 1 cm $0.094\;g/cm^2$, 0.65, each. In forearm ROI, the BMD and T-score decreased $0.042\;g/cm^2$, 0.9 involving 1 cm lower wrist. And expanding 1 cm of vertical line, the BMD and T-score decreased $0.008\;g/cm^2$, 0.1 and in 2 cm, $0.021\;g/cm^2$, 0.3, each. The L-spine, hip, forearm ROI error was changed differently. Conclusion: There are so many kinds of technical error in BMD processing. Errors according to age, weight, height, manopause age did not influent to $BMD(g/cm^2)$ and T-score. There are mean differences BMD and T-score in confirming ROI. For the precision exam, in L-spine processing, L1-4 have to confirmed without shift of ROI vertical line. In hip processing, the ROI have to included greater trochanter, femur head and lesser trochanter. In forearm processing, the ROI have to included wrist, radius and ulnar.

• Journal of radiological science and technology
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• v.32 no.3
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• pp.271-276
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• 2009

The aim of this study was to evaluate the effect of Bone Mineral Density(BMD) at mandible. So, we studied how to measure the BMD at mandible using DEXA(Dual energy X-ray absorptiometry, DEXA) by Horner er al (1996) and knew reproducibility of the measurements. Thirty-five patients (13 men, 22 women, mean age : 25.4 years) were examined using the GE Lunar Prodigy Advance(LUNAR Corporation, madison, USA). They were examined in Semiprone position of their body and true lateral position of their mandible selected the Lumbar lateral mode. We used the custom mode in analysis when ROI (area $30{\times}2.5\;mm^2$). Three ROIs ($30{\times}2.5\;mm^2$, $50{\times}2.5\;mm^2$, $20{\times}2.5\;mm^2$) were located each at the two different sites of the mandible (angle of mandible and mental symphysis) and BMD was measured. Differences in BMD measurement was statistically compared according to the size and location of ROI. BMD was $1.320{\pm}0.358g/cm^3$ in men and was $1.152{\pm}0.340g/cm^3$ in women. BMD at the angle of mandible was $1.201{\pm}0.361g/cm^3$ in men and was $1.025{\pm}0.377g/cm^3$ in women. BMD of men at the mental symphysis was $1.434{\pm}0.341g/cm^3$ and that of women was $1.19{\pm}0.358g/cm^3$. With the ROI of $20{\times}2.5\;mm^2$, BMD was $1.262{\pm}0.384g/cm^3$ in men and was $1.113{\pm}0.357g/cm^3$ in women. With the ROI of $50{\times}2.5\;mm^2$, BMD of men was $1.320{\pm}0.358g/cm^3$ and that of women was $1.129{\pm}0.340g/cm^3$. There was a statistically significant difference of BMD according to the size and location of ROI. When measuring mandible BMD, there are good for increasing ROI and locate between ramus and mental symphysis. Especially following exam, refer to same size and location with fore exam. According to study which measure mandible BMD, It's correct to measure better a portion of mandible then whole of BMD. Using DEXA protocol is studied good for the additional study to compare the BMD at mandible. Later date, It will be good for measurement value in implant and bone graft quantitatively. Using DEXA method gain BMD threshold value in korean.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.3-9
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• 2011

Purpose: Generally dual energy X-ray absorptiometry has been used for the purpose of evaluation of osteoporosis and treatment. Recently the interest of obesity came to be high and body percent fat test is increasing. Existing measure of body fat have to scan the whole body can be evaluated, but only lumbar spine and hip measurements was assumed to be whole body fat as well as improving the software. It tries to check whether the part measured value not being whole body measurement has the validity or not compared with the value calculated with the method that it is different, it forgives through a correlation with a (BIA) and (BMI). Materials and Methods: In 2010, the body percent fat was measured among the examinee coming to the Asan Medical Center public health care center from March till August against 90 females more than 40 years old through (DXA) and BIA. BMI utilized the value which wrote an hight and weight measured through the body measuring instrument in the examinee information and is automatically calculated. In addition, it classified as the low weight ($13-18.5kg/m^2$), normal ($18.5-25kg/m^2$), and corpulence ($25-30kg/m^2$) based on BMI and so that it could check whether there was the difference according to the weight or not BMI and BIA and correlation between DXA were analyzed in each group. The statistical program for the analysis used SPSS 12.0. Results: The comparison of DXA at 3 which it divides into the low weight and normal and corpulence groups and BIA did not show the difference noted statistically in all groups and the between group comparison was exposed to do not have a meaning. The body percent fat measured by the correlation analysis result DXA at the state that it doesn't divide into the group showed the high correlation (r=0.908, p0.01) noted statistically compared with BMI and showed the high correlation noted statistically in a comparison with BIA (r=0.927, p0.01). Conclusion: It confirmed that the whole body percent fat presumed from the part bone density measurement showed the excel correlation compared with BIA and BMI and information is high. There is still no clear standard about the presumed whole body percent fat and it is difficult to evaluate the fat evaluation by the bone mineral density measurement. However, it is determined that the information offering which is more objective through the comparative study with the body percent fat which is very efficient and in that it can obtain till the information about a fat as well as diagnosis of the osteoporosis through the bone density checkup is measured by the afterward telegraph bone density checkup and is clinically useful is possible.

• Journal of the Korean Society of Radiology
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• v.18 no.3
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• pp.187-201
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• 2024

Osteoporosis is a major health issue globally, often remaining undetected until a fracture occurs. To facilitate early detection, deep learning (DL) models were developed to classify osteoporosis using abdominal computed tomography (CT) scans. This study was conducted using retrospectively collected data from 3,012 contrast-enhanced abdominal CT scans. The DL models developed in this study were constructed for using image data, demographic/clinical information, and multi-modality data, respectively. Patients were categorized into the normal, osteopenia, and osteoporosis groups based on their T-scores, obtained from dual-energy X-ray absorptiometry, into normal, osteopenia, and osteoporosis groups. The models showed high accuracy and effectiveness, with the combined data model performing the best, achieving an area under the receiver operating characteristic curve of 0.94 and an accuracy of 0.80. The image-based model also performed well, while the demographic data model had lower accuracy and effectiveness. In addition, the DL model was interpreted by gradient-weighted class activation mapping (Grad-CAM) to highlight clinically relevant features in the images, revealing the femoral neck as a common site for fractures. The study shows that DL can accurately identify osteoporosis stages from clinical data, indicating the potential of abdominal CT scans in early osteoporosis detection and reducing fracture risks with prompt treatment.