Abstract:
Disuse osteopenia following leg fracture in postmenopausal women: Implications for HIP fracture risk and fracture liaison services

© 2017 the College of Radiographers Introduction: Disuse osteopenia is a known consequence of reduced weight-bearing and has been demonstrated at the hip following leg injury but has not been specifically studied in postmenopausal women. Method: Bilateral DXA (GE Lunar Prodigy) bone mineral density (BMD) measurements were taken at the neck of femur (NOF), total hip region (TH) and lumbar spine in postmenopausal female groups comprising controls (N = 43), new leg fractures (#1yr) (N = 24). #>1yr were assessed at a single visit and the remaining groups at intervals over twelve months. Weight-bearing, function, 3-day pedometer readings, and pain levels were also recorded. Results: the #1yr scored significantly below controls in almost all key physical and functional outcomes demonstrating a long-term deficit in hip bone density on the ipsilateral side. Conclusion: the clinical significance of post-fracture reduction in hip BMD is a potential increased risk of hip fracture for a variable period that may be mitigated after return to normal function and weight-bearing. Improvement at 12 months in #1yr results indicating that long-term impairment in function and bone health may persist for some leg fracture patients. Unilateral bone loss could have implications for Fracture Liaison Services when assessing the requirement for medication post fracture.

Abstract:
“It's what's behind the mask”: Psychological diversity in compassionate patient care

© 2018 Introduction: the Francis Report recommended an increased focus on compassion in healthcare, and recognition and non-judgmental acceptance of diversity is fundamental in compassionate patient care. The aim of this study was to achieve a wider understanding of diversity that includes individual patient needs, expectations, perceptions and feelings during diagnostic imaging. Methods: Using thirty-four semi-structured interviews with individual patients, this qualitative study explored their experiences of undergoing diagnostic radiography examinations and asked what compassionate care meant to them and how it is perceived and manifested in the brief, task-focussed and highly technical diagnostic projection imaging encounter. Data were analysed using Thematic Analysis. Results: Four key themes were identified from the analysis; these were: feelings and vulnerability; hidden emotions; professionalism and valued qualities and communication. Conclusion: Diversity is defined not only in terms of socio-cultural differences but also psychological ones, i.e. individual emotional and attitudinal characteristics, some of which may be consciously or unconsciously concealed. In order that patients are treated equitably and all of their care needs met, recommendations include a broader focus in education and training to include adapting communication skills and techniques in perception and expression of non-verbal cues. Further research into the pressures specific to the time-pressured, task-focussed, highly technical and rapid turnover environment of projection imaging radiography and how this impacts upon compassionate patient care would make a useful contribution to the field.

Abstract:
A study investigating short- and medium-term effects on function, bone mineral density and lean tissue mass post-total knee replacement in a Caucasian female post-menopausal population: implications for hip fracture risk.

UNLABELLED: Significant increased hip fracture incidence has been reported in the year following total knee replacement. This study demonstrates that bone and muscle loss is a post-surgical consequence of total knee replacement, alongside poor outcomes in function and activity potentially contributing to reduced quality of life and increased hip fracture risk. INTRODUCTION: a significant increase in hip fracture incidence in the year following total knee replacement (TKR) surgery has been reported. This study investigated function and activity following TKR and the effects of limited mobility on bone and muscle loss and their potential contribution to hip fracture risk. METHODS: Changes in dual-energy X-ray absorptiometry (DXA) (GE Lunar Prodigy, Bedford MA), bone mineral density (BMD) at the neck of femur (NOF), total hip region (TH) and lumbar spine were measured alongside leg lean tissue mass (LLTM) in post-menopausal Caucasian females following TKR (N = 19) compared to controls (N = 43). Lumbar spine trabecular bone scores (TBSs) were calculated. Ipsilateral/contralateral weight bearing, lower limb function, 3-day pedometer readings, pain levels and falls were also recorded. Measurements were obtained at pre-surgery baseline and at 6 weeks, 6 months and 12 months post-surgery. RESULTS: No statistically significant differences were demonstrated between groups at baseline bilaterally in LLTM or BMD at the NOF and TH. Losses in ipsilateral NOF and TH BMD and contralateral LLTM were significantly higher in the TKR group at 6 months. Impairment in function and weight bearing persisted in the TKR group 12 months post-operatively alongside deficits in bilateral muscle mass and ipsilateral NOF and TH BMD. Falls incidence was not significantly higher in the TKR group. CONCLUSIONS: Bone loss at the hip with associated muscle loss is a consequence of TKR that, in addition to poor patient outcomes in function and activity, potentially contributes to increased hip fracture risk in the year following surgery.

Abstract:
Compassionate care in radiography recruitment, education and training: a post-Francis Report review of the current literature and patient perspectives

© 2016 the College of Radiographers Compassion is elemental in the care of a patient during their medical imaging (MI) procedure and is highly topical in the light of the Francis Report. The patient–practitioner interaction is an amalgam of context, communication and individual differences, and whilst compassion is a term in common parlance in the media, policy and radiographers' professional documents, its meaning and manifestation in radiography recruitment, education and practice are less clearly articulated. A review of the existing literature was undertaken, including a small scale study exploring patients' experiences in diagnostic medical imaging. Themes from the study included communication; competence; emotions; attitudes and relationships, but notably absent was any mention of compassion per se. Radiography research would benefit from further exploratory work into the nature of compassionate patient care in the unique context of the medical imaging encounter; offering an evidence-based contribution to radiography in the light of the Francis Report.

Abstract:
Obesity increases precision errors in total body dual-energy x-ray absorptiometry measurements

© 2015 the International Society for Clinical Densitometry. Total body (TB) dual-energy X-ray absorptiometry (DXA) is increasingly being used to measure body composition in research and clinical settings. This study investigated the effect of body mass index (BMI) and body fat on precision errors for total and regional TB DXA measurements of bone mineral density, fat tissue, and lean tissue using the GE Lunar Prodigy (GE Healthcare, Bedford, UK). One hundred forty-four women with BMI's ranging from 18.5 to 45.9kg/m2 were recruited. Participants had duplicate DXA scans of the TB with repositioning between examinations. Participants were divided into 3 groups based on their BMI, and the root mean square standard deviation and the percentage coefficient of variation were calculated for each group. The root mean square standard deviation (percentage coefficient of variation) for the normal (30kg/m2; n=32) BMI groups, respectively, were total BMD (g/cm2): 0.009 (0.77%), 0.009 (0.69%), 0.011 (0.91%); total fat (g): 545 (2.98%), 486 (1.72%), 677 (1.55%); total lean (g): 551 (1.42%), 540 (1.34%), and 781 (1.68%). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated.

Abstract:
SpineAnalyzer™ is an accurate and precise method of vertebral fracture detection and classification on dual-energy lateral vertebral assessment scans

© 2015. Osteoporotic fractures of the spine are associated with significant morbidity, are highly predictive of hip fractures, but frequently do not present clinically. When there is a low to moderate clinical suspicion of vertebral fracture, which would not justify acquisition of a radiograph, vertebral fracture assessment (VFA) using Dual-energy X-ray Absorptiometry (DXA) offers a low-dose opportunity for diagnosis. Different approaches to the classification of vertebral fractures have been documented. The aim of this study was to measure the precision and accuracy of SpineAnalyzer™, a quantitative morphometry software program. Lateral vertebral assessment images of 64 men were analysed using SpineAnalyzer™ and standard GE Lunar software. The images were also analysed by two expert readers using a semi-quantitative approach. Agreement between groups ranged from 95.99% to 98.60%. The intra-rater precision for the application of SpineAnalyzer™ to vertebrae was poor in the upper thoracic regions, but good elsewhere. SpineAnalyzer™ is a reproducible and accurate method for measuring vertebral height and quantifying vertebral fractures from VFA scans.

Abstract:
SpineAnalyzer™ is an accurate and precise method of vertebral fracture detection and classification on dual-energy lateral vertebral assessment scans

Osteoporotic fractures of the spine are associated with significant morbidity, are highly predictive of hip fractures, but frequently do not present clinically. When there is a low to moderate clinical suspicion of vertebral fracture, which would not justify acquisition of a radiograph, vertebral fracture assessment (VFA) using Dual-energy X-ray Absorptiometry (DXA) offers a low-dose opportunity for diagnosis. Different approaches to the classification of vertebral fractures have been documented. The aim of this study was to measure the precision and accuracy of SpineAnalyzer™, a quantitative morphometry software program. Lateral vertebral assessment images of 64 men were analysed using SpineAnalyzer™ and standard GE Lunar software. The images were also analysed by two expert readers using a semi-quantitative approach. Agreement between groups ranged from 95.99% to 98.60%. The intra-rater precision for the application of SpineAnalyzer™ to vertebrae was poor in the upper thoracic regions, but good elsewhere. SpineAnalyzer™ is a reproducible and accurate method for measuring vertebral height and quantifying vertebral fractures from VFA scans.

Abstract:
Evaluation of a dual-scales method to measure weight-bearing through the legs, and effects of weight-bearing inequalities on hip bone mineral density and leg lean tissue mass.

OBJECTIVE: to investigate: the accuracy of measuring relative left/right weight-bearing using two identically calibrated weighing scales; the short-term weight-bearing tendencies in a general population of 9 participants and long-term in 42 females; the effect weight-bearing inequalities on hip bone mineral density and leg lean tissue mass. METHOD: Participants were measured standing astride two scales. Short-term volunteers were measured 10 times on one visit, with repositioning between measurements and the long-term group were measured on three visits at 6 month intervals. Baseline bilateral hip and total body Dual X-ray Absorptiometry scans were performed on the long-term group. RESULTS: the short-term Coefficient of Variation is 5.41% and long-term 7.01%. No significant correlations were found between hip bone density differences and weight-bearing inequalities, although a weak correlation of r = 0.31 (p = 0.047) was found for differences in leg lean tissue mass. CONCLUSION: Left/right weight-bearing measured using two scales is a consistent method for evaluating weight distribution through the legs. The short- and long-term weight-bearing tendencies showed a similar degree of variation. Weight-bearing inequalities were not associated with any significant left/right differences in bone mineral density at the hip, but were weakly associated with left-right differences in leg muscle mass.

Abstract:
Obesity Increases Precision Errors in Dual-Energy X-Ray Absorptiometry Measurements

The precision errors of dual-energy X-ray absorptiometry (DXA) measurements are important for monitoring osteoporosis. This study investigated the effect of body mass index (BMI) on precision errors for lumbar spine (LS), femoral neck (NOF), total hip (TH), and total body (TB) bone mineral density using the GE Lunar Prodigy. One hundred two women with BMIs ranging from 18.5 to 45.9kg/m 2 were recruited. Participants had duplicate DXA scans of the LS, left hip, and TB with repositioning between scans. Participants were divided into 3 groups based on their BMI and the percentage coefficient of variation (%CV) calculated for each group. The %CVs for the normal (30kg/m 2) (n=28) BMI groups, respectively, were LS BMD: 0.99%, 1.30%, and 1.68%; NOF BMD: 1.32%, 1.37%, and 2.00%; TH BMD: 0.85%, 0.88%, and 1.06%; TB BMD: 0.66%, 0.73%, and 0.91%. Statistically significant differences in precision error between the normal and obese groups were found for LS (p=0.0006), NOF (p=0.005), and TB BMD (p=0.025). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated. © 2012 the International Society for Clinical Densitometry.

Abstract:
Obesity increases precision errors in dual-energy X-ray absorptiometry measurements.

The precision errors of dual-energy X-ray absorptiometry (DXA) measurements are important for monitoring osteoporosis. This study investigated the effect of body mass index (BMI) on precision errors for lumbar spine (LS), femoral neck (NOF), total hip (TH), and total body (TB) bone mineral density using the GE Lunar Prodigy. One hundred two women with BMIs ranging from 18.5 to 45.9 kg/m(2) were recruited. Participants had duplicate DXA scans of the LS, left hip, and TB with repositioning between scans. Participants were divided into 3 groups based on their BMI and the percentage coefficient of variation (%CV) calculated for each group. The %CVs for the normal (30 kg/m(2)) (n=28) BMI groups, respectively, were LS BMD: 0.99%, 1.30%, and 1.68%; NOF BMD: 1.32%, 1.37%, and 2.00%; TH BMD: 0.85%, 0.88%, and 1.06%; TB BMD: 0.66%, 0.73%, and 0.91%. Statistically significant differences in precision error between the normal and obese groups were found for LS (p=0.0006), NOF (p=0.005), and TB BMD (p=0.025). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated.