Documenti di Didattica
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Seminar Report
2004
Presented by
ACKNOWLEDGMENT
CONTENTS
Abstract 4
1. Introduction 5
2. Principles of Dual Energy X-ray Absorptiometry 6
2.1 Principal components of a DEXA system 6
2.2 Interaction of X-ray photon with physical matter 7
2.3 Mass attenuation coefficient (U) and
mass per unit area (M) of the absorber 9
2.4 Determination of Mass per unit area
of a homogeneous absorber 11
3. DEXA analysis of human body composition 13
3.1 Components of a human body 13
3.2 A model DEXA analysis 15
4. Actual DEXA calculation 17
4.1 The R value 17
4.2 Use of R value 18
5. Advantages of DEXA scanning 23
6. Conclusions 24
7. References 25
ABSTRACT
1. INTRODUCTION
DEXA (the whole body scanner) uses low dose x-rays to give us
information on bone content and density. It is currently the most widely
used machine in the clinical setting to diagnose the disease osteoporosis,
the thinning of bones.
1. Source of X-rays
2. The sample space
3. The detector
a. The photon knocks the weakly bound outer orbit electron giving up some of
its energy to the electron and gets deflected (scattered) from its path. The scattered
photon has a lower energy and hence a longer wavelength than the incident photon.
This is Compton scattering (Figure 3a).
b. The photon collides with more tightly bound orbit electron giving up all its
energy to the electron and the photon ceases to exist. This is photoelectric collision
(Figure 3b).
2.3 Mass attenuation coefficient (U) and mass per unit area
(M) of the absorber
The extent to which the photon energy is attenuated is a function of the initial
energy of the X-ray photon, the mass per unit area (M) of the absorber material and
the mass attenuation coefficient (U) of the absorber. For a given absorber material,
U (which is a measure of the degree of attenuation) is a constant at any given photon
energy. For instance, at an incident photon energy of 40 keV, A for hydrogen is
0.3458 cm2/g; at an incident photon energy of 70 keV, it is 0.3175 cm2/g. The mass
attenuation coefficients of some absorber elements are given below for two photon
energies for examination:
(a) U increases with atomic number of the element. In other words, higher atomic
number elements attenuate the X-ray beam to a greater degree than lower atomic
number elements.
(b) The lower energy beam is always attenuated to a greater degree than the
higher energy beam.
U can be used to calculate the Mass per unit area (M) of a homogenous
absorber irradiated at a specific incident X-ray energy.
Figure 5. X-ray image of a human leg. The square mark on the image represents an
area of 1 cm2
area 1cm2 on the image. The mass of bone and soft tissue ‘below’ this square would
represent the mass per unit area of the absorber, viz., leg. For instance, if there are
100 grams of bone and soft tissue below this square, the mass per unit area (M) would
be 100 g/cm2.
Knowledge of M of the human body components, especially of bone, is
important in determining the possibility of osteoporosis.
Calculation of M:
For instance, let us consider that we allow a 40 keV X-ray beam to pass
through the absorber bone mineral, whose U value is 0.9039 cm2/g (see Table 2).
Some of the energy will be lost due to Compton scattering and photoelectric effect.
Let the emerging X-ray beam be attenuated to 10 keV. Then, the mass per unit area
of this homogeneous absorber, bone mineral, is given by
M = ln (40/10) / 0.9039
= ( ln 4 ) / 0.9039
= 1.534 g /cm2
Thus using a single X-ray beam we are able to determine the mass of bone
mineral in our sample.
Unfortunately, a human body is not a homogeneous absorber since there
are several different components in the body, such as fat, lean tissue, and bone.
A single X-ray beam cannot differentiate among these different components. For this
we must utilize a “dual energy X-ray” beam.
While a mono energetic X-ray source is capable of measuring the areal density
of a homogeneous absorber, a dual energy X-ray source is required to determine the
areal densities of up to two components of an absorber. Before we discuss the DEXA
body composition analysis, let us have a look at the various components of human
body.
Bone mineral
Non-bone mineral
Glycogen
Proteins
Water
Fat
The sum of all these make up the body weight. These 6 components can be
conveniently grouped into a 2-component system: Soft tissue mass and Bone
mineral mass. Here soft tissue mass includes all the non-bone mass (items 2 to 6)
made up of lean tissue mass (items 2 to 5) and fat tissue mass (item 6).
In areas that contain no bone, the soft tissue component can be divided into its
own 2-component model consisting of Fat soft tissue and Lean soft tissue. By
considering the body to be made up of a series of 2-component systems, DEXA can
analyze each 2-component system separately and then combine the results for a
complete body composition analysis.
Thus, when the dual energy X-ray beams are over a position of the body that
contains no bone, DEXA can analyze the area for the 2 components, fat tissue mass
and lean tissue mass. When the dual energy X-ray beams are over a position of the
body that does contain bone, DEXA can analyse the area for the 2 components, soft
tissue mass (fat and lean combined) and bone mineral mass. The fat and lean
components of the bone-containing areas can then be deducted by a method that we
shall discuss. This way, the human body can be regarded as consisting of 3
principal components viz., fat mass, lean mass and bone mass (see Figure 6) and
these 3 components can be estimated by a 2-component technique using dual
energy X-rays.
For convenience, we shall reduce the human example into a block of tissue
containg the 3 components we are interested in. The left half of the block represents
an area of tissue containg only soft tissue (fat + lean). The right half represents an
area of tissue that contains both soft tissue and bone (see Figure 7).
As the dual energy X-ray beams pass through the “soft-tissue only” region, the
mass of the 2 components, fat tissue and lean tissue, can be determined. Similarly, as
the dual energy X-ray beams scan through the “bone + soft-tissue” region, the mass of
its 2 components, bone mineral and soft tissue, can be determined.
The composition of the soft tissue over the bone is nearly the same as the
composition of the soft tissue in the no-bone area. For instance, if the total soft
tissue mass of the “soft tissue only” area is 10g and it contains 2g fat (known from
scan), then we have the following results:
No-Bone area
% Fat = 2 x 100 /10 = 20
∴ % Lean = 100 – 20 = 80
This composition of the soft tissue in the “no-bone” area is assumed to be the
composition of the soft tissue in the “bone” area also. Thus,
Bone area
Fat mass = 2g
∴ % Fat = 2 x 100 /10 = 20
∴ % Lean = 100 – 20 = 80
If the total mass of the soft tissue in the bone area is 5g (known from the scan),
then the fat mass of this area can now be calculated as
Bone area
% fat = 20
soft tissue mass (from scan) = 5g
∴ fat mass = 5 x 20/100 = 1g
∴ lean mass = 5 – 1 = 4g
(Bone mass is also known from the scan)
Let us first scan through the “soft tissue (ST) only” area. The energy of the 40
keV beam has been attenuated to 0.358 keV and that of 70 keV to 2.291 keV. Now
scan the bone (B) area. The energy of the 40 keV beam has been attenuated to 0.080
keV and that of 70 keV to 1.960 keV. The data collected may be represented as
shown below:
40 70
E0 = 40 keV E0 = 70 keV
40 70
EST = 0.358 keV EST = 2.291 keV
40 70
EB = 0.080 keV EB = 1.960 keV
We have now collected all the necessary DEXA data to determine the
composition of our tissue block. We need to know the mass attenuation coefficients
and R-values for fat tissue (F), lean tissue (L) and bone (B). These are known from
experiments and are given below.
40
UF = 0.23 cm2/g 70
UF = 0.19 cm2/g RF = 1.211
40
UL = 0.27 cm2/g 70
UL = 0.19 cm2/g RL = 1.421
40
UB = 1.00 cm2/g 70
UB = 0.32 cm2/g RB = 3.125
We also need to know the mass attenuation coefficients and R-value for soft
tissue (ST). These values will vary from subject to subject. (Recall the variation of
soft tissue R value with the amount of fat in the subject.) So we have to determine
them from our experimental results by the following procedure.
Calculation of RST:
We know,
ln ( E0 / E ) = U x M
Note that M, the mass per unit area of the tissue will not change with the
energy of the radiation. Applying these equations for calculating the R value of the
soft tissue, we obtain
ln ( 40E0 / 40EST ) 40
UST x MST 40
UST
----------------- = ----------------- = ------ = RST
ln ( 70E0 / 70EST ) 70
UST x MST 70
UST
Thus, substituting the known values on the LHS, we can cal culate the value of
RST.
We can now calculate the % Lean content of the soft tissue from the equation
40 70
Calculation of UST and UST :
40
UST = (Lean fraction) x 40UL + (Fat fraction) x 40UF
70
UST = (Lean fraction) x 70UL + (Fat fraction) x 70UF
DEXA scanning has become the most widely used method for measuring bone
mineral density for several reasons. When compared with radiographic absortiometry
or single energy x-ray absortiometry, DEXA scanning more precisely documents
small changes in bone mass and is also more flexible since it can be used to examine
both the spine and the extremities. A scan of the spine, hip or the total body requires
only one, two or four minutes respectively. Qualitative computed tomography (QCT)
is the only technique that can directly measure bone density and volume but can
distinguish trabecular from cortical bone. DEXA scanning is less expensive, exposes
the patient to less radiation and is more sensitive and accurate at measuring subtle
changes in bone density over time or in response to drug therapy than is QCT.
6. CONCLUSIONS
DEXA is the most commonly used modern technique to determine the bone
density and hence the bone strength. The DEXA results help to predict the patient’s
risk factors for osteoporosis. It is a fast, accurate, and less expensive technique. It
exposes the patient to fewer amounts of radiations. So the risk is reduced to a great
extend.
Studies using DEXA scanning have shown that women with osteoporosis have
substantially lower bone density measurements than normal, age-matched women.
Bone mineral density is widely accepted as a good indicator of bone strength. Thus
low values can be compared against standard bone density measurements and help
predict a patient’s risk for fracture based upon the DEXA scan measurements.
7. REFERENCES