NMTCB 1997. Task analysis report. Nuclear Medicine Technology Certification Board.
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Biomedical subjects
Publications and source records attributed to D Leahey.
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Recent studies have demonstrated the ability of ultrasound techniques to differentiate normal and osteoporotic women. To define the ability of broadband ultrasound attenuation (BUA) of the calcaneus to predict axial bone mass, the ultrasound value was correlated with lumbar vertebral and femoral neck density in 22 Caucasian women. The three measures of bone mass inversely correlated with age: lumbar density (r = 0.54), femoral neck density (r = 0.65), and BUA (r = 0.73). BUA correlated with lumbar (r = 0.83) and femoral neck (r = 0.87) density. Lumbar vertebral density predicted femoral neck density with a standard error of estimate (SEE) of 0.07 g/cm2, and femoral neck density predicted lumbar density with a SEE of 0.09 g/cm2. BUA of the calcaneus was as effective as either axial bone mass measure in predicting the other value: the SEE for lumbar density was 0.09 g/cm2 while that for femoral neck density was only 0.06 g/cm2. The results of this preliminary study indicate that this rapid, radiation-free technique can accurately predict axial bone mass, and may be of value as an initial procedure to discriminate those women warranting more extensive radiologic evaluations.
Recent studies have evaluated techniques for estimating bone mass without radiation. The present study compares broadband ultrasound attenuation of the calcaneus and bone densities of the femoral neck and the lumbar spine in 17 normal women and 41 women with osteoporosis. Twenty of the osteoporotic women had spine (n = 16) or femoral neck (n = 4) fractures. There was a significant decrease in the broadband ultrasound attenuation (P less than 0.001) in women with osteoporosis compared with normal women. The osteoporotic women also showed a decrease in vertebral (P less than 0.0001) and femoral neck (P less than 0.0001) densities compared with normal women. At 63 dB/MHz, the sensitivity and specificity of broadband ultrasound attenuation for decreased bone mineral density with or without fractures were 76%. All women with fractures had a broadband ultrasound attenuation less than 72 dB/MHz. This corresponded to a specificity of 41%. To determine whether broadband ultrasound attenuation correlated with trabecular bone volume, samples of cadaver calcaneus were analyzed. The histologic determination showed a significant correlation between broadband ultrasound attenuation and trabecular bone volume (r = 0.992, P = 0.008). These results suggest broadband ultrasound attenuation of the calcaneus reflects bone mass and can be used as a safe and sensitive indicator for decreased axial bone density.
To define the natural history of bone loss around a femoral prosthesis, the bone mineral content and bone mineral density were measured for each femur in 28 patients with unilateral total hip arthroplasty, 18 age-matched controls, and seven patients with unilateral osteoarthritis. The areas measured were inside the lesser trochanter and 4.8 cm distal to it. The contralateral hip served as the control. Three years after arthroplasty there was 40% loss in average bone mineral content inside the lesser trochanter, and 28% loss in average bone mineral content 4.8 cm distally in the medial cortex. At seven to 14 years after operation, patients had lost 40% of bone proximally and 49% distally. The data suggest that this may progress in a proximal-to-distal fashion, and could account for a 50% decrease in bone mass seven to 14 years after surgery.
The effect of exercise on bone mass is unclear. To determine the skeletal effect of weight-bearing exercise in premenopausal women, we prospectively evaluated the effects of a weight-training program on lumbar spine bone mass in 10 women (mean +/- SEM, 36.2 +/- 1.3 yr) and compared the results with those in 7 sedentary women (40.4 +/- 1.6 yr). None of the women had previously participated in a weight-training program, and all ingested a 500-mg calcium supplement each day throughout the study. Axial loading and balance of large muscle groups were emphasized. Individual strength increased by 57 +/- 8% over 9 months. Despite the increase in muscle strength, lumbar spine bone density in the exercising women decreased by 2.90% at 4.5 months and 3.96% at 9 months (P = 0.01). In contrast, there was no change in lumbar density in the controls over the 9-month period. We conclude that short term weight training at this frequency and intensity decreases vertebral bone mass in premenopausal women.
Bone ultrasound attenuation of the calcaneus, and vertebral and femoral bone density measured by dual photon absorption were determined in 22 women with osteoporosis, 10 women with hip fractures, and 29 normal, age-matched controls to determine the utility of the ultrasound technique as an indicator of axial osteopenia. Vertebral and femoral neck density and bone ultrasound attenuation were significantly decreased (P less than 0.01) in the women with osteoporosis and those with hip fractures. The sensitivity and specificity of bone ultrasound attenuation was 80% at a value of 50 dB/MHz. At 90% specificity the sensitivity of bone ultrasound attenuation was 65%. The results of this pilot study suggest that ultrasound attenuation, a safe, simple, and radiation-free procedure, may be utilized as an indicator of decreased axial bone mass.
We investigated the independent variables correlating with the multigated radionuclide peak filling rate (PFR) at rest and during supine bicycle exercise in 20 normal individuals. Independent variables were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), ejection fraction (LVEF), time to PFR (TPFR), peak ejection rate (PER) and time to PER (TPER). Fifteen subjects completed at least five stages of exercise at 25 watts each. Correlating independent variables were selected by a forward-backward stepwise multiple linear regression (BMDP2R). A partial correlation statistical program was also used to allow control of critical independent variables. The final regression equations were: a) resting state, PFR = -2.5 + 0.03HR + 0.05LVEF + 0.02SBP-0.02DBP, and b) exercise state, PFR = -3.8 + 0.04HR + 0.08LVEF. All independent variables mentioned above correlated with PFR (simple correlations designated as zero partials). However, when LVEF and HR were held constant (second order partials), the correlation of PFR with any of the other independent variables disappeared. In summary, the radionuclide global LV PFR is predominantly correlated to LVEF and HR at rest and during exercise. These correlations should be considered when assessing exercise effects of disease states on PFR.