• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.3
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• pp.137-142
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• 2009

Purpose: World Health Organization (WHO) have suggested that an individual's 10-year absolute fracture risk is more reliable than Bone Mineral Density (BMD) measurement as the predictor of osteoporotic fracture. In 2008, Fracture Risk Assessment Tool ($FRAX^{TM}$) was developed by WHO to evaluate fracture risk of patients based on individual's clinical risk factors. The purpose of this study is to offer the comparative analysis of the existing GE prodigy and $FRAX^{TM}$ Tool in Absolute Fracture Risk Assessment Tool. Materials and Methods: 201 women ($55{\pm}3.5$ years) underwent femoral neck BMD measurement using GE Prodigy. The 10-year probability (%) of hip fracture (or a major osteoporosis-related fracture) was estimated using T-scores of GE prodigy and $FRAX^{TM}$. We made a comparative analysis of these data using SPSS (Ver.12). Results: There was a significant difference statistically between T-score ($-0.52{\pm}0.97$) of GE prodigy and T-score ($-1.45{\pm}0.81$) of $FRAX^{TM}$ (r=0.977, p=0.000). Also, there was a significant difference statistically between a major osteoporosis- related fracture ($9.15{\pm}3.71$) of GE prodigy and a major osteoporosis-related fracture ($4.87{\pm}1.51$) of $FRAX^{TM}$ (r=0.909, p=0.000). Moreover, a statistically significant difference was found in the 10-year probability of hip fracture of GE prodigy ($1.56{\pm}1.48$) and of hip fracture ($0.53{\pm}0.61$) of $FRAX^{TM}$ (r=0.905, p=0.000). Conclusions: There was a significant difference statistically between GE prodigy and $FRAX^{TM}$ Tool in Absolute Fracture Risk Assessment Tool. Especially, T-score, a major osteoporosis-related fracture and the 10-year probability of hip fracture that were estimated using GE prodigy tended to show the higher results than one evaluated by $FRAX^{TM}$ Tool. In conclusion, $FRAX^{TM}$ Tool may provide a better tool. The application of $FRAX^{TM}$ Tool as a fracture predictor remains to be clarified.

• Journal of Radiation Industry
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• v.11 no.1
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• pp.27-31
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• 2017

Reliable follow-up of bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) is essential in clinical practice. When there is a difference in the BMD values from DXA systems in the same patient, cross calibration equation is required for the reliable follow-up. Unfortunately, no equation is existed in BMD measure between GE Lunar Prodigy Advance (US, GE Healthcare; LPA) and Osteosys Dexxum T (Korea, Osteosys; ODT) DXA systems. In this study, we evaluate the agreement of BMD values between LPA and ODT and suggest the cross calibration equation using European spine phantom (ESP) with two systems. We performed BMD measurements using ten scans with ESP in each DXA systems. We compared BMD values and calculated cross calibration equation by linear regression analysis. The comparison between the LPA and ODT bone densitometers used the ESP. Compared to the ESP BMD values, ODT underestimated 14.36% and LPA overestimated 12.96%. The average of total BMD measurement values acquired with ODT were 21.44% lower than those from LPA. Cross-calibration equation for LPA and ODT was derived from ESP. We calculated simple cross calibration equation for LPA and ODT DXA systems. Cross-calibration equation is necessary for the reliable follow-up of BMD values in two different systems.

• Journal of the Korean Society of Physical Medicine
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• v.7 no.1
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• pp.119-124
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• 2012

목적 : 본 연구는 척수손상환자들 중 신체활동 정도가 급격하게 차이 나는 운동 선수군과 비선수군의 일상생활동작과 골밀도를 비교 분석하는데 그 목적이 있다. 방법 : 본 연구를 위해 20명(선수 10명, 비선수 10명)의 SCI 환자가 실험에 참가하였다. 골밀도 측정을 위해 이중에너지 방사선골밀도 측정기(Lunar Prodigy, GE Healthcare. England)를 이용하여 종골부위(calcaneus)의 골밀도를 측정하였다. 척수손상환자의 일상 생활 기능을 측정하기 위해 자조관리(self care), 호흡과 괄약근 조절 (respiration and sphincter management task), 이동(transfer)의 세 영역으로 나누어진 SCIM II(Spinal Cord Injury Measurement II)을 이용하였다. 척수손상환자들 중 운동 선수군과 비운동 선수군의 일상생활 동작과 골밀도를 비교 하기 위해 SPSS 14.0 통계 프로그램의 independent t-test를 이용하여 통계분석을 실시하였고 일상생활 동작과 골밀도의 상관관계는 Pearson correlation을 실시하였다. 유의수준은 ${\alpha}$=.05로 통계처리 하였다. 결과 : 검사 결과 선수군이 비선수군보다 통계적으로 유의하게 큰 SCIM 점수와 T-score를 보여주었다. 결론 : 일상생활동작을 측정하기 위하여 SCIM II(SpinalCordIndependenceMeasureII) 척도를 사용하였는데 선수군이 비선수군에 비해 유의하게 높은 SCIM II 총점을 나타내어 운동을 통한 훈련이 척수손상환자의 기능적 활동을 향상시킬 수 있다고 사료된다. 그리고 골밀도 측정 결과 선수군이 비선수군에 비해 통계적으로 유의하게 높은 골밀도를 나타내었다. 이 역시 강도 높은 훈련이 척수손상환자에게 나타날 수 있는 신체구성을 강화시켜줄 수 있을 것으로 사료된다. 운동을 통한 재활 중에서 그 강도가 높을수록 신체의 구성적, 기능적 측면 뿐 아니라 신경의 가소성 측면에서도 증가를 기대해 볼 수 있을 것으로 판단된다.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.3
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• pp.132-136
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• 2009

Purpose: WHO(world health organization) announced the FRAX Tool(fracture risk assessment) of new software in the beginning of 2008. FRAX Tool was considered various risk factor, being different from existing fracture risk. In this study, we wanted to know the fracture risk of following the changing of the risk factor of fracture. Materials and Methods: A total of 50 women aged 50~60 were studied. We measured BMD at the part of femur neck which was based on the age, weight, height of individual with GE, Lunar-prodigy. The control group is fracture risk without considering fracture risk factor. The experimental group is previous fracture, parent fracture, current smoking, glucocorticoid, rheumatoid arthritis, secondary osteoporosis, alcohol. if each items makes one 'existence', others are all 'nothing'. and the results produced major osteoporotic region and hip fracture risk in 10-years. Statistics used t-test of SPSS 12.0. Results: The average rate of increment of major osteoporotic region between control group and experimental group, previous fracture-74% increase, parent fracture-96% increase, current smoking-2% increase, glucocorticoid-61% increase, rheumatoid arthritis-29% increase, alcohol-20% increase, secondary osteoporosis-0.18% decrease. The average rate of increment of hip region between control group and experimental group, previous fracture-84% increase, parent fracture-5% increase, current smoking-72% increase, glucocorticoid-84% increase, rheumatoid arthritis-40% increase, alcohol-52% increase, secondary osteoporosis-1.69% decrease. Conclusions: Each fracture risk factor has different rate of increment between major osteoporotic and hip region while in occasion of the second osteoporosis it has little relation because of low P-value. We could know that a contribution of the risk factor is different between major osteoporotic and hip region.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.1
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• pp.73-76
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• 2009

Purpose: Bone mineral densitometry test region advised by ISCD (International Society for Clinical Densitometry) is both site in case of femur, whereas our medical center measures left femur except for few extraordinary cases. It is said that right-handers had higher mean femur BMD in the left side than in the right side, but the factor influence the femur BMD is unknown. Thus, we investigate whether testing left femur only is a adequate clinical diagnosis. Materials and Methods: Subjects were 209 right-handers and 20 left-handers patient in Asan Medical Center from July to August, 30 to 70 years of age ($51{\pm}6.7$). Subjects fill out the questionnaire on hand preference and taking regular exercise. Total BMDs of bilateral femur were measured with GE Lunar Prodigy advance densitometer, and the statistical soft ware SPSS 12.0 for windows was used for statistical analysis. Results: In the total sample of the exercise group (n=127), the difference of both femur mean BMDs are $0.001{\pm}0.127\;g/cm^2$ and the non-exercise group's (n=102) both femur difference is $0.002{\pm}0.126\;g/cm^2$, there is no significant difference. And in exercise group, classified according to hand preference, each t-value is shown at right handers (n=114) are 0.65, left handers (n=13) are -0.39. Also, In non-exercise group, right handers (n=95) are -0.78, left handers (n=7) are -0.64. In the 95% confidence limit, there was no statistically significant difference (p>0.05). Conclusions: In recently researchs, there have been differences between both femurs according to hand preference. However, Our study have no significant difference both femurs BMDs. Therefore we suggest that BMD measurement of femur has no problem only one side, except for particular case like femur operation.

• 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.13 no.1
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• pp.67-72
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• 2009

Purpose: ISCD (International Society for Clinical Densitometry) requests that users perform mandatory Precision test to raise their quality even though there is no recommendation about patient selection for the test. Thus, we investigated the effect on precision test by measuring reproducibility of 3 bone density groups (normal, osteopenia, osteoporosis). Materials and Methods: 4 users performed precision test with 420 patients (age: $57.8{\pm}9.02$) for BMD in Asan Medical Center (JAN-2008 ~ JUN-2008). In first group (A), 4 users selected 30 patient respectively regardless of bone density condition and measured 2 part (L-spine, femur) in twice. In second group (B), 4 users measured bone density of 10 patients respectively in the same manner of first group (A) users but dividing patient into 3 stages (normal, osteopenia, osteoporosis). In third group (C), 2 users measured 30 patients respectively in the same manner of first group (A) users considering bone density condition. We used GE Lunar Prodigy Advance (Encore. V11.4) and analyzed the result by comparing %CV to LSC using precision tool from ISCD. Check back was done using SPSS. Results: In group A, the %CV calculated by 4 users (a, b, c, d) were 1.16, 1.01, 1.19, 0.65 g/$cm^2$ in L-spine and 0.69, 0.58, 0.97, 0.47 g/$cm^2$ in femur. In group B, the %CV calculated by 4 users (a, b, c, d) were 1.01, 1.19, 0.83, 1.37 g/$cm^2$ in L-spine and 1.03, 0.54, 0.69, 0.58 g/$cm^2$ in femur. When comparing results (group A, B), we found no considerable differences. In group C, the user_1's %CV of normal, osteopenia and osteoporosis were 1.26, 0.94, 0.94 g/$cm^2$ in L-spine and 0.94, 0.79, 1.01 g/$cm^2$ in femur. And the user_2's %CV were 0.97, 0.83, 0.72 g/$cm^2$ L-spine and 0.65, 0.65, 1.05 g/$cm^2$ in femur. When analyzing the result, we figured out that the difference of reproducibility was almost not found but the differences of two users' several result values have effect on total reproducibility. Conclusions: Precision test is a important factor of bone density follow up. When Machine and user's reproducibility is getting better, it’s useful in clinics because of low range of deviation. Users have to check machine's reproducibility before the test and keep the same mind doing BMD test for patient. In precision test, the difference of measured value is usually found for ROI change caused by patient position. In case of osteoporosis patient, there is difficult to make initial ROI accurately more than normal and osteopenia patient due to lack of bone recognition even though ROI is made automatically by computer software. However, initial ROI is very important and users have to make coherent ROI because we use ROI Copy function in a follow up. In this study, we performed precision test considering bone density condition and found LSC value was stayed within 3%. There was no considerable difference. Thus, patient selection could be done regardless of bone density condition.

• Journal of Radiation Industry
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• v.12 no.4
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• pp.311-316
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• 2018

Average life expectancy is getting longer due to medical developments and improvements in living standards. So much so that the elderly have an increased risk of developing osteoporosis. Therefore, it is important to prevent, diagnose, and treat the senile disease at an early stage through a bone density test. Bone density is measured by dual energy X-ray absorption (DXA). In this study, while using DXA, in cases when the measurements for both the lumbar and the femur could not be taken simultaneously, the correlation between both measurements were known, and the measurement of one area was used to make a clinical inference for the value of the other. Measurements were taken using Lunar Prodigy Advance (GE) for 43 participant with clinically significant fractures. Statistical calculations were produced and analysed regarding bone density. In case of T-score, lumbar spine produced a statistical result of $-2.112{\pm}1.836$ and femur neck was $-1.716{\pm}1.565$. In case of Z-score lumbar spine produced a statistical result of $-0.151{\pm}1.513$, and femur neck $-0.026{\pm}1.283$. It is indicated that the pearson correlation coefficient of T-score between lumbar spine and femur neck is high at 0.699, and the pearson correlation coefficient of Z-score is considered relatively high at 0.503. The correlation of bone density between lumbar spine and femur neck is shown to be statistically meaningful in T-score's p-value at 0.000 and Z-score's p-value at 0.001. In conclusion, it seems to have clinical usefulness that we can infer the result of one measurement through that of the other part tested, based on the knowledge of the correlation coefficients between lumbar spine and femur neck.

• Journal of radiological science and technology
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• v.31 no.1
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• pp.17-23
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• 2008

Purpose : Because there is a difference depending on the environment as for an inspection equipment the important part of bone density scan and the precision/accuracy of a tester, the management of quality must be made systematically. The equipment failure caused by overload effect due to the aged equipment and the increase of a patient was made frequently. Thus, the replacement of equipment and additional purchases of new bonedensity equipment caused a compatibility problem in tracking patients. This study wants to know whether the clinical changes of patient's bonedensity can be accurately and precisely reflected when used it compatiblly like the existing equipment after equipment replacement and expansion. Materials and methods : Two equipments of GE Lunar Prodigy Advance(P1 and P2) and the Phantom HOLOGIC Spine Road(HSP) were used to measure equipment precision. Each device scans 20 times so that precision data was acquired from the phantom(Group 1). The precision of a tester was measured by shooting twice the same patient, every 15 members from each of the target equipment in 120 women(average age 48.78, 20-60 years old)(Group 2). In addition, the measurement of the precision of a tester and the cross-calibration data were made by scanning 20 times in each of the equipment using HSP, based on the data obtained from the management of quality using phantom(ASP) every morning (Group 3). The same patient was shot only once in one equipment alternately to make the measurement of the precision of a tester and the cross-calibration data in 120 women(average age 48.78, 20-60 years old)(Group 4). Results : It is steady equipment according to daily Q.C Data with $0.996\;g/cm^2$, change value(%CV) 0.08. The mean${\pm}$SD and a %CV price are ALP in Group 1(P1 : $1.064{\pm}0.002\;g/cm^2$, $%CV=0.190\;g/cm^2$, P2 : $1.061{\pm}0.003\;g/cm^2$, %CV=0.192). The mean${\pm}$SD and a %CV price are P1 : $1.187{\pm}0.002\;g/cm^2$, $%CV=0.164\;g/cm^2$, P2 : $1.198{\pm}0.002\;g/cm^2$, %CV=0.163 in Group 2. The average error${\pm}$2SD and %CV are P1 - (spine: $0.001{\pm}0.03\;g/cm^2$, %CV=0.94, Femur: $0.001{\pm}0.019\;g/cm^2$, %CV=0.96), P2 - (spine: $0.002{\pm}0.018\;g/cm^2$, %CV=0.55, Femur: $0.001{\pm}0.013\;g/cm^2$, %CV=0.48) in Group 3. The average error${\pm}2SD$, %CV, and r value was spine : $0.006{\pm}0.024\;g/cm^2$, %CV=0.86, r=0.995, Femur: $0{\pm}0.014\;g/cm^2$, %CV=0.54, r=0.998 in Group 4. Conclusion: Both LUNAR ASP CV% and HOLOGIC Spine Phantom are included in the normal range of error of ${\pm}2%$ defined in ISCD. BMD measurement keeps a relatively constant value, so showing excellent repeatability. The Phantom has homogeneous characteristics, but it has limitations to reflect the clinical part including variations in patient's body weight or body fat. As a result, it is believed that quality control using Phantom will be useful to check mis-calibration of the equipment used. A value measured a patient two times with one equipment, and that of double-crossed two equipment are all included within 2SD Value in the Bland - Altman Graph compared results of Group 3 with Group 4. The r value of 0.99 or higher in Linear regression analysis(Regression Analysis) indicated high precision and correlation. Therefore, it revealed that two compatible equipment did not affect in tracking the patients. Regular testing equipment and capabilities of a tester, then appropriate calibration will have to be achieved in order to calculate confidential BMD.

• The Korean Journal of Nuclear Medicine Technology
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• v.27 no.2
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• pp.99-109
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• 2023

Purpose: CT scan makes up for the weak point of the nuclear medicine image having a low resolution and also were used for attenuation correction on image reconstruction. Recently, many studies try to make use of CT images additionally, one of them is to measure the bone mineral density(BMD) using Quantitative CT(QCT) software. BMD exams are performed to scan lumbar and femur with DXA(Dual-Energy X-Ray Absorptiometry) in order to diagnose bone disease such as osteopenia, osteoporosis. The purpose of this study is to identify the usefulness of QCT_BMD analyzed with low dose CT images on L-spine Bone SPECT/CT comparing with DXA_BMD. Materials and Methods: Fifty five women over 50 years old (mean 66.4 ± 9.1) who took the both examinations(L-spine Bone SPECT/CT with SIEMENS Intevo 16 and DXA scan with GE Lunar prodigy advance) within 90 days from April 2017 to July 2022, BMD, T-score and disease classification were analyzed. Three-dimensional BMD was analyzed with low dose CT images acquired on L-spine Bone SPECT/CT scan on Mindways QCT PRO^TM software and two-dimensional BMD was analyzed on DXA scan. Basically, Lumbar 1-4 were analyzed and the patients who has lesion or spine implants on L-spine were excluded for this study. Pearson's correlation analysis was performed in BMD and T-score, chi-square test was performed in disease classification between QCT and DXA. Results: On 55 patients, the minimum of QCT_BMD was 18.10, maximum was 166.50, average was 82.71 ± 31.5 mg/cm³. And the minimum of DXA-BMD was 0.540, maximum was 1.302, average was 0.902 ± 0.201 g/cm², respectively. The result shows a strong statistical correlation between QCT_BMD and DXA_BMD(p<0.001, r=0.76). The minimum of QCT_T-score was -5.7, maximum was -0.1, average was -3.2 ± 1.3 and the minimum of DXA_T-score was -5.0, maximum was 1.7, average was -2.0 ± 1.3, respectively. The result shows a statistical correlation between QCT T-score and DXA T-score (p<0.001, r=0.66). On the disease classification, normal was 5, osteopenia was 25, osteoporosis was 25 in QCT and normal was 10, osteopenia was 25, osteoporosis was 20 in DXA. There was under-estimation of bone decrease relatively on DXA than QCT, but there was no significant differences statistically by chi-square test between QCT and DXA. Conclusion: Through this study, we could identify that the QCT measurement with low dose CT images QCT from L-Spine Bone SPECT/CT was reliable because of a strong statistical correlation between QCT_BMD and DXA_BMD. Bone SPECT/CT scan can provide three-dimensional information also BMD measurement with CT images. In the future, rather than various exams such as CT, BMD, Bone scan are performed, it will be possible to provide multipurpose information via only SPECT/CT scan. In addition, it will be very helpful clinically in the sense that we can provide a diagnosis of potential osteoporosis, especially in middle-aged patients.