Osteoporosis Imaging

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Bone Densitometry: 2.75
Patient Care: 1.00
Patient Bone Health, Care, and Radiation Principles: 1.00
Image Production: 0.75
Equipment Operation and Quality Control: 0.75
Procedures: 1.00
DXA Scanning: 1.00

Computed Tomography: 1.50
Image Production: 0.75
Image Formation: 0.75
Procedures: 0.75
Head, Spine, and Musculoskeletal: 0.75

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Musculoskeletal and Endocrine Sections: 2.75

Outline

1. Introduction
2. Epidemiology and Pathophysiology of Osteoporosis
3. Importance of Osteoporosis Imaging
4. Diagnostic Techniques to Measure BMD
5. Diagnostic Techniques to Measure Bone Quality
   1. High-Resolution Peripheral Quantitative CT
   2. Multidetector CT
   3. MR Imaging
   4. MR Spectroscopy and Perfusion
   5. Quantitative US
6. Detection of Fragility Fractures by Using Radiologic Techniques
7. Conclusion

Objectives

Upon completion of this course, students will:

1. know the meaning of osteoporosis and how prevalent it is in our aging population
2. be familiar with the medical imaging modalities that are used to diagnose osteoporosis
3. understand which of the medical imaging modalities provide qualitative, semi-quantitative or quantitative evaluation of osteoporosis
4. understand which imaging modalities provide information on trabecular bone and cortical bone architecture
5. understand the importance for radiologists to report coincidental fragility fracture findings
6. understand the role of DXA scans in diagnosing osteoporosis
7. be familiar with T- and Z-scores as outlined by the WHO
8. be able to differentiate osteopenia from osteoporosis by WHO guidelines
9. understand the classifications of T- and Z-scores and the patient populations they are outlined for by the ISCD
10. understand how the FRAX tool is applied to T- and Z-scores
11. be familiar with current research looking for biomarkers to identify osteoporosis
12. be familiar with the FDA’s current stance on the review of the use of oral bisphosphonates and presence of atypical subtrochanteric femoral fractures
13. understand bone composition and the various types of bone
14. be familiar with the role of genetics in developing osteoporosis
15. understand how osteoporosis is classified
16. be familiar with lifestyle and risk factors that may put an individual at risk for osteoporosis
17. identify when peak bone mass is obtained and when bone loss begins
18. define what coupling means when referring to bone formation
19. identify conventional radiography’s role in diagnosing osteoporosis
20. be familiar with disease processes other than osteoporosis that may lead to bone loss
21. be familiar with the advantages and disadvantages of DXA scans
22. understand potential artifacts that may make a DXA scan inaccurate
23. be familiar with the role that central QCT plays in diagnosing osteoporosis
24. understand the process of conversion in QCT of Hounsfield units into milligrams hydroxyapatite per cubic centimeter (BMD)
25. be familiar with ACR guidelines for QCT in calculating BMD
26. be familiar with the effective radiation dose of each imaging modality used to diagnose osteoporosis
27. understand the role and technology behind HR-pQ in diagnosing osteoporosis
28. understand which disease processes may lead to higher BMD’s
29. define quantitative bone morphometry
30. understand the benefits of MDCT and its role in diagnosing osteoporosis
31. explain the role of high resolution MRI in the diagnosis of osteoporotic disease
32. understand the role of proton MR spectroscopy in assessing bone marrow
33. describe the applications of UTE in MR imaging
34. understand the benefits and disadvantages of high resolution quantitative ultrasound QUS in diagnosing osteoporosis
35. understand the Genant classification of vertebral spine fractures along with the various grades