According to WHO, for the diagnosis of osteoporosis, based on the measurement of bone density is:
2.5 SDs or more below the young adult peak bone density and a fracture
2.5 SDs or more below the young adult peak bone density
More than 1 SD but less than 2.5 SDs below the young adult peak bone density
Not more than 1 SD below the young adult peak bone density
What is the most common technique that is used to measure BMD?
QUS
QCT
SXA
DXA
What is the most common osteoporotic fracture?
Hip
Shoulder
Spine
Wrist
In bone densitometry, what is the primary responsibility of the technologist?
beam collimation
distance
shielding
time
Which of the following is considered an uncontrollable risk factor for osteoporosis?
exercise
lifestyle choices
smoking
race
Which of the following measures more trabecular bone?
PA spine
Lateral spine
QCT spine
VFA
Primary osteoporosis Type 1, is related to
aging
disease
medication
menopause
Identify the incorrect statement from the following:
Caucasian and Asians are at an increase risk of developing osteoporosis compared to other ethnic groups
most obese patients are at an increase risk of developing osteoporosis
women are at an increase risk of developing osteoporosis compared to men because they achieve a lower peak bone mass and go through menopause
smoking is a recognized risk factor for the development of osteoporosis
Cancellous bone is also known as :
compact bone
cortical bone
trabecular bone
osteophyte
New bone matrix is formed by:
osteoblasts
osteoclasts
cancellous bone
What percentage of trabecular bone is found in the PA spine?
1%
33%
50%
66%
Currently, the most accurate method to determine a patient’s response to therapy form osteoporosis is:
serial DXA measurements of the forearm
serial DXA measurements of the hip and spine
serial QUS measurements of the calcareous
Serial QCT measurements of the spine
Which of the following does not help in achieving peak bone mass?
normal puberty
corticosteroid therapy
adequate calcium and vitamin D intake
Which of the following statement is false concerning QUS advantages over x-ray base methodologies for BMD measurements?
QUS units are comparatively inexpensive
the patients heel must be immersed in liquid during the procedure
patients are not subjected to ionizing radiation
ultrasound examinations are quick to perform
which of following site is mostly composed of cortical bone
distal forearm
femoral neck
proximal forearm
vertebral bodies
What is the anatomical landmark on the proximal femur that indicates the best visual indication of the degree of rotation of the proximal femur?
femoral head
femoral shaft
greater trochanter
lesser trochanter
Which lumbar vertebra is described as having a characteristic shape of an X or H on a DXA PA spine scan?
L1
L2
L3
L4
What is the name of the radionuclitide used in DPA?
Americium- 241
Gadolinium-153
Iodine‘-125
Technetium-99
The forearm is not used to monitor the effects of therapy for osteoporosis because
accuracy is poor
precision is poor
there is no effect
the rate of change in BMD is to slow
Which of the following is not a bisphosphonate?
alendronate
etodronate
foiteo
zoledronic acid
The primary mechanism of action of anti-resorptive therapies is the result of direct interaction with:
the bone lining cells
the osteoblasts
the osteoclasts
the osteocytes
The WHO criteria for diagnosing osteoporosis was initially defined to apply to
all women
all Caucasian women
only postmenopausal women
only Caucasian postmenopausal women
The measurement of peripheral BMD is advocated for
all individuals regardless of age
pediatrics
screening
males
The PA spine mostly measures the:
posterior elements
transverse processes
pedicle
Which of the following statement about QCT measurements of bone density of the spine is not True?
the measurements are volumetric rather than areal measurements of bone density
accuracy may be affected by marrow fat
results are usually reported in g/cm squared
trabecular bone can be isolated from cortical bone
ln order to do a compare analysis:
the patient must have a previous scan done on the same mode/speed
you must retrieve the baseline scan(s)
patient positioning must be consistent
all of the above
How many degrees should you rotate the femur when positioning for a proximal femur scan?
10 -15 degrees
15-25 degrees
20-25 degrees
25-30 degrees
When should Z-scores be used to make a diagnosis, instead of T-scores?
females 65 and older
males 65 and older
postmenopausal females
males or females under age 20
Which of the following bone parameters is measured in grams?
area
bone mineral content
bone mineral density
total
Which lumbar vertebra has the widest transverse process?
The region of the proximal femur lying on the border of the femoral neck is termed:
hip axis length
ward's area
What is important for serial monitoring?
accuracy
precision
If the daily QC fails, (in the United States) what should be your first step of action?
repeat the scan
call the manufacturer
get yourself another cup of coffee
go home!
With changes in rotation of the femoral neck what happens?
decrease in the BMC
decrease in the BMD
increase in the BMD
increase ROI
Which of the following would best describe low bone mass due to menopause?
primary osteoporosis/Type 1
primary osteoporosis/Type 11
secondary osteoporosis
According to WHO, if a healthy female age 36 (female with no known medical condition present, all body parts working perfecting) has a T-score of 1 6 SD how would she be diagnosed?
normal
osteopenia
osteoporosis
none of the above
Which of the following term best describes the sum of data values divided by the number of values?
the mean
the standard deviation
the variance
the coefficient
How many decimal places to the right of the decimal point is used in reporting the T-scores?
0
1
2
3
At low energies the majority of x-ray interactions are:
Compton scattering
photoelectric
photodisintegration
pair production
What concept should always guide radiation protection effects?
ALARA
If a patient has a history of hyper-parathyroidism, which of the following would be the preferred site to evaluate ?
proximal femur
spine
ultradistal
33% or 1/3 forearm
Which of the following classes of cells are involved in bone remodeling?
osteocytes
a and b
Which of the following has the highest percentage of cortical bone?
fingers
whole body
33% radius
Which of the following bone parameters is measured in grams per centimeter squared?
BMC
BMD
BMMA
What is the percentage of trabecular bone in the skeleton?
20%
30%
70%
80%
How would start labeling the vertebral bodies on a PA lumbar scan?
Let the software do it all!
start at L1, and count/label down
start at L4, and count/label up
What is the major source of precision error in clinical practice?
equipment
physician
technologist
receptionist
Which of the following is correct?
BMD=BMC/Area
BMD=BMCxArea
During analyzes of the lumbar spine, what would help you identify the vertebral bodies?
read the manual
look for L3 ( longest transverse process)
their characteristic shapes
A great forearm scan should include all of the following except:
forearm centered
forearm straight
free of artifacts
motion
Sunlight is the main source of vitamin:
A
C
D
K
Bisphosphonates prevent bone loss by:
reducing the activity of the osteoclasts
increasing the activity of the osteoblasts
increasing the activity of the osteoclasts
DXA results may be influenced by:
body thickness
degenerative changes
fractures
scan mode
Which of the following would best describe the effective dose for a central DXA scan?
one-tenth of a chest x-ray
less than a day of background radiation
less than a round trip from Boston to LA
When measuring the proximal femur, which of the following statements is true?
the neck ROI includes any portion of the greater trochanter
the neck ROI is perpendicular to the femoral neck
the neck ROI includes both ends in bone
I need to read the manual!!
Which of the following statements is true regarding DXA?
DXA has been widely studied and requires a radioactive source
DXA is faster than DPA but is not as precise
DXA can only predict fracture risk of the hip and spine
DXA can be used to predict fracture risk and to evaluate the effectiveness of treatment
How often should you perform the QA on the DXA unit?
once a week
once a year
every day you scan
only when you get a message on your monitor
Why is the non-dominant arm used in bone densitometry?
easier for the patient
easier for the technologist
its density values will be greater than that of the dominant arm
reference values reflect non-dominant arm measurements
If a patients BMC is 60.58 and the area is 61.60 what is her BMD?
0.983
1.01
All of the following are true, except:
accuracy is the ability to measure true value
accuracy is most important for diagnosis, less important for serial monitoring
accuracy is affected by the technologist
accuracy is affected by the technology
What is the distance a technologist should be away from the edge of the DXA table with a pencil beam scanner?
2 feet
3 feet
4 feet
10 feet
heel
hip
wrist
Two bones with the same volumetric densities may have different densities when measured with DXA because:
poor precision
poor accuracy
differ in size
Regarding the Shewart Rules, the control limits are based on what percentage of the average values?
0.5%
1.5%
2%
All follow-up DXA scans should be compared to:
any prior scan
the most recent scan
the baseline scan
Operator’s choice!
With DXA, regarding the PA spine, which vertebra is expected to have the lowest bone mineral density?
A DXA scanner that uses a single detector and a pinhole collimator is:
a fan beam scanner
a pencil beam scanner
an aerial beam scanner
The characteristic shapes of the vertebrae seen on the spine DXA image are primarily based on the appearance of the:
posterior elements of the vertebra
intervertebral discs
When scanning the proximal femur, what is the anatomical landmark to look at if you have correct rotation?
the femoral head
the greater trochanter
the lesser trochanter
the ischium
To determine the least significant change at 95% confidence level (for baseline and one follow-up scan), what is the "number" which the precision error is multiplied to determine the least significant change?
2.77
1.96
1.81
1.28
A technologist should perform a precision study in order to:
quantify the shifts and drifts(QA)
calculate the LSC
To see how great you are!
To see how great your doc is doing!
How many places to the right of the decimal point is used in reporting BMD?
The name of the forearm sites is based on what?
the location of the site on the bone in relationship to the overall length of the radius
the location of the site on the bone in relationship to the overall length of the ulna
% of cortical bone found at that site
% of trabecular bone found at that site
What skeletal site may be preferred for assessing early menopause or following oophorectomy?
Calcaneus
Forearm
When analyzing the PA spine, which of the following is a "no can do?
Spine straight and centered within the ROI
The top line of the ROI positioned between T12 and L1
The bottom of the line of the ROI positioned between L4 and L5
Width is operator’s choice
If you are very fortunate, and you get a new DXA unit, what must be performed in order to do compare studies?
establish QC program
cross-calibration
All of the following are examples of weight-bearing exercise except:
running
dancing
racket sports
lap swimming
What type of bone with long term use of steroids affect?
trabecular
cancellous
Cortical
Compact
b and c
c and d
If a patient has had an Iaminectomy, how would that affect the results?
increase BMD
decrease BMD
nothing at all
What are the two most common methods for shifting the energies in DXA units?
energy switching
K-edge filtration
Compton effect
photoelectric effect
Why do you use a leg block, when performing a PA spine DXA scan? Select all that appy.
reduce Iordotic curve
separate the verebrae
may feel good to the patient
Operator’s manual said so!
What is the term often used to express the precision of the DXA unit?
mean
standard deviation
linear regression
Why do you use a “hip positioner", during scanning of the proximal femur?
to place the femoral neck parallel to the tabletop
to place the ward's area in the correct location
to obtain the total hip results
because you have it!
lf a patients is found to have coins in their pocket while obtaining the proximal femur what should you do.
scan the other hip
scan the forearm
remove the coins and rescan the hip
remove the coins and keep them!
A patient with an elevated alkaline phosphatase may be an indicator of
osteomalacia
osteopetrosis
Pagets
What is the percentage of cortical bone (compact bone) in the skeleton?
What angle should the patient's leg be positioned on the leg block for the PA spine?
30-60 degrees
40-60 degrees
60-80 degrees
60-90 degrees
What year was the Bone Mass Measurement Act proposed?
1991
1993
1997
1998
What pharmaceutical may be suggested for a woman with high risk of breast cancer and elevated lipids?
Actonel
Evista
Fosamax
Prolia
In bone densitometry, what describes the ability to reproduce the measurement when it is performed under identical conditions?
absolute risk
relative risk
Decide which of the following is the most important factor to consider when performing a DXA scan?
make sure pt is comfortable
make sure patient removes items that may attenuate the beam
make sure patient is NPO
make sure that you have the correct patient!
How can a patient be deprived of vitamin D?
reduction in dietary intake
malabsorption of fats
not exposed to sunlight
Which of the following calcium supplements should be the choice for women who are at risk of kidney stone formation?
calcium carbonate
calcium citrate
calcium gluconate
calcium lactate
The correct way to measure radiation dose is as effective dose, expressed as:
uGy
uSv
uCi
rad
All of the following are risk factors for 733 except:
drinking 48 ounces of coffee a day
alcohol use
obesity
QUS what is the gold standard to measure bone density?
DPA
Cortical bone makes up what?
the inner core of the bones
the outer core of the bones
All of the following are correct except:
osteoporosis is usually asymptomatic
back pain and height loss may be the first signs of osteoporosis
kyphosis is common in patients with osteoporosis
African Americans are at higher risk to develop osteoporotic in comparison to Asians
What are the four classifications that apply to the heel?
appendicular, predominately trabecular and weight-bearing
axial, peripheral, predominantly cortical and non weight-bearing
Secondary osteoporosis is defined as:
bone loss caused by factors other than estrogen deficiency
bone loss caused by factors other than aging
bone loss caused by factors other than estrogen deficiency and aging
The forearm, pelvis, and scapula all belong to which skeletal classification?
appendicular
axial
central
weight-bearing
When there is an imbalance/uncoupling of the remodeling cycle, the result is
an increase in the calcium
a decrease in the resorption
a net gain in the bone mass
a net loss in the bone mass
During a DXA of the hip of a thin patient, a mottled or moth eaten appearance at the edge is seen, what may be helpful to correct this?
use a higher speed setting
use a slower speed setting
can another site
get the next patient!
What is the bone edge detection methodology?
it tests the machine's ability to measure BMD
it tests the machine's ability to distinguish bone from soft tissue
it verifies the machine is calibrated correctly
What sites are preferred for children?
Iumbar spine and hip(s)
lumbar spine, hip, and forearm
lumbar spine and TBLH
lumbar spine only
In making a diagnosis for children, what are some guidelines? Select all that apply.
Z--scores are used
low for age is preferred over the term osteopenia
pediatric software is highly recommended
osteoporosis can be made with a Z-score of -2.5 SD
What is the only anabolic pharmaceutical on the market for treatment of osteoporosis?
calcitonin
aloxifene
teriparatide
Although the technology is similar with all the DXA units, the BMD results are different because...select all that apply.
due to different calibration standards
algorithms to calculate BMD
differences in the region of interest
databases
All of the above
For low energies, the most common process of absorption is the:
How many patients and how many times do you scan them in order to perform a precision study? Select all that apply.
10 patients 3 times
15 patients 3 times
20 patients 2 times
30 patients 2 times
Phantoms that mimic the shape and size of a skeletal region are called:
block phantom
brass phantom
anthromomorphic phantom
hydroxyaptite
If the QC graph shows a gradual decline in BMD overtime, what should you do?
repeat the QC
Re-establish a baseline value
call the manufacturer for service
upgrade your unit
Regarding bone densitometry, which of the following best describes accuracy?
the degree to which the measurement of BD reflects true value
the degree to which the QC reflects true value
the degree to which the %CV reflects true value
Which of the following are clinical signs and consequences of vertebral fractures? Select all that apply.
kyphosis
weight loss
reduced lung function
increase in height
All of the following are markers of bone formation, except?
24-hour excretion rate of calcium
serum alkaline phosphatase
serum osteocalcin
Pencil beam DXA units usually have shorter scanning times and better resolution compared to fan beam units.
Quantitative ultrasonometry measures the broad band attenuation properties of bone.
The correct term for the scanning pattern of a pencil beam unit is rectilinear.
Archiving patient’s scans and running the system back-up are one in the same.
The weight Iimit for the DXA table is manufacturer specific?
When analyzing the proximal femur the box measuring the neck should include the greater trochanter.
In regards to the International society for Clinical Densitometry 2013 Official Positions, Osteoporosis cannot be diagnosed in men under the age 50 on the basis of BMD alone.
Cortical bone is also known as cancellous bone.
With fan beam scanners, scanning occurs point by point.
Discordance is a term that is rarely used in DXA.
The smaller the %CV, the better the accuracy and precision.
Rheumatoid arthritis can contribute to the development of osteoporosis.
Bone loss occurs when resorption exceeds formation.
T-scores are useful for the expression of relative risk.
T-scores should be used in serial monitoring.
Sievert refers to effective dose.
The measure of the variability or the spread of data around the mean is termed standard deviation.
Accuracy is most important for diagnosis, less important for serial monitoring.
The ultra distal part of the forearm is mostly trabecular bone.
With VFA, you are measuring the BMD L4 through T4.
Cortical bone is primarily affected with an estrogen deficient woman.
Precision is the ability to reproduce a measurement when performed under identical conditions.
When a patient comes back for a follow-up scan, it's no problem if you don't use the compare/copy function.
The Tanner and Whitehouse (TW2) method is often used to indicate bone age in children.
The T-score is the number of SDs an individual’s BMD is from the average BMD for sex-matched young normal peak bone mass.
Caucasians and Asians are at increased risk to developing osteoporosis compared to otherethnic groups.
Smoking is not recognized as a risk factor for the development of osteoporosis.
With fan beam scanners a solid state/multi element array detector system is used.
DXA BMD measures the amount of mineralized tissue in the area scanned. (g/cm3)
Accuracy indicates how close a measured value is to the actual value.